Psoriasis patients across the UK are experiencing differing and sometimes sub-standard levels of care, a survey by the British Association of Dermatologists and Royal College of Physicians of London has found.

The survey of 100 dematology units found that 39% of units are restricted in prescribing new biologic therapies, targeted at the cause of psoriasis, on financial grounds. It also found that 20% of units have no dermatology specialist nurses and that in 41% of units, topical treatments were applied by nurses who had no dermatology training, or by the patients themselves.

As a result, 38% of units would consider using the traditional treatment coal tar and 46% dithranol, but lack trained nurses to apply them. Scalp treatments were not provided in a quarter of units and over a third of pharmacies could not readily provide coal tar or dithranol preparations.

Dr Colin Holden, president of the British Association of Dermatologists said that the NHS was “failing to provide patients with the level of care they deserve”. He added: “Basic elements such as bathing facilities, appropriately trained staff and access to treatments are lacking to a worrying degree. Old fashioned treatments such as dithranol or tar are safe, effective and relatively cheap, albeit messy. Coal tar and dithranol still have a place in the management of some patients with psoriasis - both outpatients and in-patients - but units should invest in trained nurses and pharmacies to apply and supply the treatments respectively. Scalp psoriasis is particularly problematic for some patients, but a quarter of units denied patients the opportunity of outpatient scalp treatment.”

Study co-author Dr David Eedy, a consultant dermatologist at the Craigavon Area Hospital in County Armagh, said: “Until recently most skin disease has been managed either by GPs, or for more severe or persistent cases, in hospital by specialist dermatologists with access to day-care and in-patient services. However, the government’s initiative to provide ‘Care Closer to Home’ is changing the way such services are delivered.The care for patients with psoriasis is also changing with the advent of more effective treatments such as the biologics."

“The results exposed major discrepancies and a ‘postcode lottery’ in the care of patients," he finished. "We will be making the government aware of our findings.” By Rob Finch