Psoriasis is a common skin condition, which affects 3 per cent of the population. Men and women are equally affected, and there is often a family history of the disease. A chronic condition, it waxes and wanes, often improving in summer because of the benefits of sunshine.
The commonest form of the disease is plaque psoriasis which has the appearance of raised red scaly patches with dry silvery scales. It usually affects the knees, elbows, scalp and nails. Arthritis, similar to rheumatoid arthritis, occurs in 6 per cent of these patients, and about half will have a "thimble-like" pitting of the nail.
Mild to moderate psoriasis can usually be managed effectively using topical treatment, such as ointments and creams. These range in strength from aqueous creams to potent steroids, which must not be used long-term without medical supervision.
The more severe cases are treated by a skin specialist with phototherapy, a medically refined ultraviolet light. A tablet, psoralen, is given to some patients to increase effectiveness of the ultraviolet rays. PUVA treatment, the medical name for phototherapy, is usually given for four to six weeks.
Northern Ireland: Paul is a 61year-old retired industrial worker from Co Antrim with a long history of psoriasis. He is married with four children and had to take early retirement because of psoriatic arthritis.
Paul's GP manages his psoriasis mostly with coal-tar creams and other lotions. However, every five years or so the condition flares up, and he needs referral to a consultant dermatologist for ultraviolet therapy.
He was last referred to the local dermatology department on October 27th, 2000. He was seen in outpatients on January 25th last and received PUVA the same day. He is responding well to ongoing phototherapy.
The Republic: Rosemary is a 43-year-old single office worker living in Dublin. She has had psoriasis since her teens. Rosemary is self-conscious about the disease. She feels it looks "dirty" and would never go swimming, being ashamed to show her arms and legs covered in plaques. Every couple of years, the psoriasis "breaks through" the usual treatment. She was referred to the dermatology department in the local public hospital on February 28th, 2000, but the next available appointment was in early September 2000. There would also have been a subsequent wait of up to a month for PUVA therapy.
Rosemary opted for private treatment as she was not prepared to wait over six months. She was seen on April 26th and had her first PUVA treatment the next day. She completed this by the end of May and was relieved to be able to wear a summer dress without being self-conscious.
Comparison: Although not life-threatening, psoriasis affects quality of life. Patients perceive themselves as unclean and even "infectious". A disturbed body image is reported by some long-term sufferers. Therefore a wait of over six months for treatment in the Republic is unacceptable. The NHS in the North can process a similar patient in three months, with PUVA available on the same day as the outpatient appointment.
Private healthcare in the Republic was able to offer consultation and treatment in two months, a time-scale the public system must aspire to.