title: Diagnosis and management of psoriasis.
abstract: OBJECTIVE
  To provide primary care clinicians with an up-to-date and practical overview of the diagnosis and management of psoriasis.
  
  
  METHODS
  PubMed, MEDLINE, EMBASE, and Cochrane databases were searched for relevant meta-analyses, randomized controlled trials, systematic reviews, and observational studies about the diagnosis and management of psoriasis.
  
  
  RESULTS
  Psoriasis is a chronic, multisystem inflammatory disease with predominantly skin and joint involvement. Beyond the physical dimensions of disease, psoriasis has an extensive emotional and psychosocial effect on patients, affecting social functioning and interpersonal relationships. As a disease of systemic inflammation, psoriasis is associated with multiple comorbidities, including cardiovascular disease and malignancy. The diagnosis is primarily clinical and a skin biopsy is seldom required. Depending on the severity of disease, appropriate treatment can be initiated. For mild to moderate disease, first-line treatment involves topical therapies including corticosteroids, vitamin D3 analogues, and combination products. These topical treatments are efficacious and can be safely initiated and prescribed by primary care physicians. Patients with more severe and refractory symptoms might require further evaluation by a dermatologist for systemic therapy.
  
  
  CONCLUSIONS
  Many patients with psoriasis seek initial evaluation and treatment from their primary care providers. Recognition of psoriasis, as well as its associated medical and psychiatric comorbidities, would facilitate timely diagnosis and appropriate management with effective and safe topical therapies and other medical and psychological interventions, as needed. More severe and refractory cases might warrant referral to a dermatologist for further evaluation and possible systemic therapy.
authors.affiliation: Dermatology resident at the University of Ottawa in Ontario.
authors.forename: Whan B
authors.initials: WB
authors.lastname: Kim
authors.affiliation: Head of the Division of Rheumatology at the University of Toronto in Ontario.
authors.forename: Dana
authors.initials: D
authors.lastname: Jerome
authors.affiliation: Lecturer in the Division of Dermatology at the University of Toronto. jensen.yeung@utoronto.ca.
authors.forename: Jensen
authors.initials: J
authors.lastname: Yeung
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001685:Biological Factors / Q000627:therapeutic use; D002762:Cholecalciferol / Q000627:therapeutic use; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D010789:Phototherapy; D011565:Psoriasis / Q000145:classification / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D001685:Biological Factors; D003879:Dermatologic Agents; D002762:Cholecalciferol; D016572:Cyclosporine; D008727:Methotrexate