1. The pharmacist’s role: The rational use of topical steroids
Zinc Code: UK/RET/0102/16b
Date of Prep: November 2016
The pharmacist’s role: The rational use of topical steroids

2. Zinc Code: UK/RET/0120/16b
Date of Prep: November 2016
Christine Eksteen
Global Scientific Director for Dermatology at Stiefel, a GSK company
Pharmacist by training, working in the pharmaceutical industry for the last 15 years and in Global Medical Affairs for dermatology over the last 3 years
In Stiefel, she has been leading the Global Medical Affairs activities for acne, superficial skin infections, psoriasis, atopic dermatitis and androgenic alopecia

3. Webinar overview Introduction to atopic dermatitis (AD) and psoriasis
Zinc Code: UK/RET/0120/16b
Date of Prep: November 2016
Webinar overview
Introduction to atopic dermatitis (AD) and psoriasis
Role of topical corticosteroids (TCS) in the treatment of AD and psoriasis
Appropriate use and potential side effects of TCS
Role of pharmacists in patient education
Live Q&A

4. Introduction to atopic dermatitis (AD) and psoriasis
Zinc Code: UK/RET/0120/16b
Date of Prep: November 2016
 Introduction to atopic dermatitis (AD) and psoriasis
There is a range of skin disorders that are responsive to topical corticosteroid therapy; for the purposes of this presentation, we will focus specifically on atopic dermatitis and psoriasis

5. About atopic dermatitis (AD)
Zinc Code: UK/RET/0120/16b
Date of Prep: November 2016
About atopic dermatitis (AD)
Causes1
Common symptoms1
Impacts2
No known single cause
Dry skin
Itching
Redness
Reduced quality of life
Genetic link
Prevalence3
Emotional distress
Affects at least 15%
of children
Affects
2–10%
of adults
Environmental factors
Disturbed sleep
AD can be mild, moderate or severe1
AD is a common condition, seen in up to 10% of adults,1 and can have a broad impact on patients’ quality of life beyond the symptoms themselves.2 The itching associated with AD can disturb patients’ sleep, and emotional impact can include embarrassment and loss of social confidence, as well as frustration and anger.2
References
Kabashima K. J Dermatol Sci 2013; 70:3–11.
Basra MK, et al. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3):
1. NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; Accessed September 2016;
2. Basra MK, et al. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3):271–283; 3. Kabashima K. J Dermatol Sci 2013; 70:3–11.

6. Assessing severity of AD
Zinc Code: UK/RET/0120/16b
Date of Prep: November 2016
Assessing severity of AD
Clear
Mild
Moderate*
Severe**
Dry skin
None
Some
Widespread
Itching
Infrequent
Frequent
Incessant
Redness
Possibly small areas
Some areas
For moderate-to-severe cases, advise the patient to consult their doctor
For mild cases, patients may be able to be treated with over-the-counter treatment options
The severity of AD is assessed based on the patient’s symptoms.1 Within the pharmacy, you should only expect to deal with mild cases of AD, which can be treated with options that are available without prescription. If patients appear to have moderate or severe AD, they should consult their primary care physician for advice and treatment options.
Reference
NICE. Eczema – atopic. Clinical Knowledge Summaries Available at Accessed September 2016.
*May include excoriation and localised skin thickening
**May include picked skin, extensive thickening, bleeding, oozing, cracking, or colour alterations
NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; Accessed September 2016.

7. Patches, papules or plaques Reduced quality of life
Zinc Code: UK/RET/0120/16b
Date of Prep: November 2016
About psoriasis
Causes
Common symptoms2
Impacts2,3
Scaly skin lesions
Itching
Patches, papules or plaques
Reduced quality of life
Inappropriate immune response1
Flare triggers include:
Psychological effects
Prevalence
Affects approximately 2% of the world’s population:4 nearly 150 million people worldwide5
Stress, trauma2
There are several forms of psoriasis, including plaque, pustular, nail, guttate, and erythrodermic2
Physical effects
Environmental factors2
Psoriasis should normally be managed by a primary or secondary care physician, following appropriate referral2
Psoriasis is an autoimmune condition affecting tens of millions of people worldwide.1,2
Psychological and social effects of psoriasis may include:3
Anxiety and depression
Negative body image and self image
Shame, guilt, embarrassment, and fear of being considered dirty or infectious
Limitation of activities, including those requiring skin exposure (such as swimming) and work
Negative effect on social, professional, and personal relationships
References
Lowes MA, et al. Nature 2007; 445(7130):
Bhosle MJ, et al. Health Qual Life Out 2006.
NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016;
1. Lowes MA, et al. Nature 2007; 445(7130):866–873; 2. NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016; 3. Basra MK, et al. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3):271–283; 4. Bhosle MJ, et al. Health Qual Life Out 2006; 4:35; 5. World population estimate: 7,450,000,000 ( accessed 23 September 2016).

8. Assessing severity of plaque psoriasis
Zinc Code: UK/RET/0120/16b
Date of Prep: November 2016
Assessing severity of plaque psoriasis
Plaque psoriasis accounts for 80–90% of all psoriasis cases and the Physician’s Global Assessment (PGA) is used for assessing severity of disease on a 7-point scale1 1 2 3 4 5 6
Clear
Nearly clear
Mild
Moderate
Severe
Very severe
The Psoriasis Area and Severity Index (PASI) is another commonly used tool to quantify disease severity. Scores range from 0–72 with higher scores indicating more severe disease2
Those patients with severe or very severe PGA scores should be referred to a specialist dermatologist1
By far the most common type of psoriasis is plaque psoriasis, which can present with varying levels of severity – this assessment is performed by the primary care physician, generally using either the PGA or the PASI scale.1 All patients with psoriasis should consult their primary care physician and manage the condition with therapies that are prescribed to them.
Reference:
NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016.
1. NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016; 2. Fredriksson T, Pettersson U. Dermatologica 1978; 157:238–44.

9. Zinc Code: UK/RET/0120/16b
Date of Prep: November 2016
Psoriasis and AD are common disorders that impact patients’ quality of life
AD is a common condition featuring dry, itchy and red skin1
Only mild AD can be treated over the counter – patients with more severe forms of the condition should be referred to their primary care physician1
Psoriasis is a debilitating disease with psychological and physical consequences;2,3 plaque psoriasis is by far the most common form2
Patients with psoriasis should be managed collaboratively by both their primary care physician and dermatologist with regard to assessing the impact of psoriasis and disease severity2
In addition to advice on using emollients, pharmacists can provide key practical support and guidance on TCS use, including how and where to apply the formulations. It is common for patients to be prescribed a selection of TCS with different potencies; therefore, it is important that they understand which therapy should be used where, and for how long.
In case of any doubt, the patient should return to their HCP for further assessment and guidance.
Doctor by ProSymbols, Noun Project
1. NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; Accessed September 2016; 2 NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016; 3. Basra MK, et al. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3):