Counselling · Intermediate · Dermatology

Managing Psoriasis and Lifestyle Factors

Practise this PLAB 2 counselling station on Psoriasis. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in a GP surgery conducting a follow-up appointment. Mr Jabari Ikenna, a 52-year-old man with known psoriasis, has come to discuss his skin condition. He wants to understand what triggers his flares and how to better manage them. His psoriasis has been worse over the past few months and he is struggling with the psychological impact. Please counsel the patient on lifestyle modifications, trigger identification, and treatment options.

Background notes: PMH: Psoriasis 15 years, Hypertension 5 years

What this station tests

  • Identifying modifiable triggers: stress, alcohol, smoking, recent infection, medications (beta-blockers, lithium)
  • Psychological impact assessment: depression screening, body image, social avoidance, work confidence
  • Treatment adherence review: patients often stop topical treatment during remission and present in flare
  • Escalation pathway: from topical to phototherapy to systemic (methotrexate, biologics) for moderate-severe disease
  • Beta-blocker check: a commonly missed medication trigger for psoriasis flares

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, establish what patient already knows and understands.
  • 1-3 min — Explain Condition: Explain diagnosis or condition using chunk-and-check technique. Use simple language, avoid jargon.
  • 3-5 min — Management Options: Discuss treatment options. Shared decision-making. Risks, benefits, alternatives.
  • 5-7 min — Address Concerns: Explore and address specific concerns. Check understanding. Discuss lifestyle implications.
  • 7-8 min — Closing: Summarise agreed plan. Safety netting. Arrange follow-up. Written information offer.

Consultation approach

The opening

Follow-up psoriasis counselling tests the candidate's ability to identify modifiable triggers, address psychological impact, and adjust the treatment plan. Mr Ikenna is 52, known psoriasis for 15 years, now flaring significantly over 3 to 4 months. He wants to understand triggers and management. Open with: 'Mr Ikenna, tell me what has changed over the past few months and how the psoriasis is affecting you.'

Core approach

Identify triggers for the current flare. Stress: he is a senior manager under significant work pressure (stress is the commonest trigger). Recent respiratory infection (streptococcal infection is a well-known trigger, particularly for guttate flares). Alcohol: ask about intake (alcohol worsens psoriasis and reduces treatment adherence). Smoking: ask (associated with more severe disease and reduced treatment response). Medications: beta-blockers, lithium, antimalarials, and rapid steroid withdrawal can all trigger flares. Check his antihypertensive (is he on a beta-blocker?).

Assess psychological impact. He has visible plaques on his neck, arms, and scalp affecting his confidence at work and socially. Screen for depression and anxiety: 'How has this been affecting your mood?' Psoriasis has significant psychiatric comorbidity. Offer support: psychology referral, psoriasis support groups.

Review current treatment. Is he using his topical treatments correctly? Adherence often drops during remission and patients present in flare having stopped treatment. If topical therapy is no longer controlling the disease, escalation (phototherapy, systemic treatment) should be discussed.

Closing and safety netting

Lifestyle advice with specific, actionable recommendations. Stress management: specific strategies, not just 'reduce stress.' Consider referral to occupational health, CBT, or mindfulness. Alcohol: quantify intake and advise reduction (even moderate alcohol worsens psoriasis). Smoking cessation if applicable. Weight management if overweight (psoriasis improves with weight loss). Emollient use: daily, even during remission, to reduce flare frequency.

Treatment escalation if topical therapy is inadequate. Refer to dermatology for consideration of phototherapy (UVB), or systemic treatment (methotrexate, ciclosporin, or biologics for moderate to severe disease). Explain: 'There are very effective treatments available beyond creams if your psoriasis needs more.'

Safety net: 'If you develop joint pain or stiffness, come back as psoriasis can affect joints. If your mood drops significantly, come in sooner.' Follow-up in 6 weeks.

How examiners mark this station

Examiners will assess your ability to explain psoriasis and its management in a patient-centred way. Domain 2 (Clinical Management) and Domain 3 (Interpersonal Skills) are equally weighted and primary. Expect marks for accurate information delivery, shared decision-making, chunk-and-check technique, and addressing the patient's specific concerns. Domain 1 (Data Gathering) is assessed through how well you establish the patient's baseline understanding and elicit their concerns.

Domain 1: Data Gathering, Technical and Assessment Skills (Primary focus)

Scores well: Triggers identified (stress, infection, alcohol, medications). Psychological impact assessed. Current treatment adherence reviewed. Severity compared to previous baseline. Medication list checked for triggers.

Costs marks: Not identifying triggers. Not assessing mood. Not reviewing medications.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Specific lifestyle advice (not generic). Treatment adherence addressed. Escalation pathway discussed (phototherapy, systemic). Dermatology referral if needed. Joint screening safety netting.

Costs marks: Generic advice. No escalation pathway. No dermatology referral option. No joint screening.

Domain 3: Interpersonal Skills (Throughout)

Scores well: Acknowledging psychological burden. Validating impact on work and confidence. Providing hope about advanced treatments. Not trivialising a visible chronic condition.

Costs marks: Trivialising the impact. Not acknowledging psychological dimension. Being purely clinical.

Common examiner feedback (and how to fix it)

Did not provide adequate explanation or plan to the patient

Fix: Use chunk-and-check: deliver one concept, check understanding, then move to the next. Offer all relevant treatment options with risks and benefits before helping the patient decide.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Before and during counselling, explicitly ask what concerns the patient most. Respond to emotional cues with empathic statements before continuing with information.

Common mistakes in this station

  1. Not checking medications. Beta-blockers are a well-known psoriasis trigger. If he is on one for hypertension, switching to an alternative may improve his skin. Candidates who do not review his medication list miss a modifiable cause.
  2. Giving generic lifestyle advice. 'Reduce stress and drink less' is not actionable. Specific recommendations (occupational health referral, CBT, quantified alcohol reduction targets) score higher.
  3. Not screening for depression. Psoriasis has significant psychiatric comorbidity. Visible skin disease affecting a professional man's confidence requires mood assessment. Candidates who treat only the skin miss the whole patient.

Resitting PLAB 2?

If counselling stations have been a challenge, the most common issue is information overload: delivering too much clinical detail without checking understanding. Practise the chunk-and-check technique until it becomes automatic. Remember that shared decision-making, not lecturing, is what scores highly in Domain 3.

Example opening

Hello, my name is Dr [Name]. I understand you've come in today to discuss [topic]. Before I explain things, could you tell me what you've been told so far, so I know where to start?

Frequently asked questions

How do I open and run a psoriasis counselling station in PLAB 2?

Follow-up psoriasis counselling tests the candidate's ability to identify modifiable triggers, address psychological impact, and adjust the treatment plan. Mr Ikenna is 52, known psoriasis for 15 years, now flaring significantly over 3 to 4 months. He wants to understand triggers and management.

What does a strong performance look like to the examiner in this station?

Strong performances show: Triggers identified (stress, infection, alcohol, medications). Psychological impact assessed. Current treatment adherence reviewed. Severity compared to previous baseline. Weak performances: Not identifying triggers. Not assessing mood. Not reviewing medications.

What is the biggest pitfall in this psoriasis station?

Not checking medications. Beta-blockers are a well-known psoriasis trigger. If he is on one for hypertension, switching to an alternative may improve his skin.

How should I prepare for psoriasis if I have never seen it in practice?

This station rewards process over personal experience. The skill being assessed: Psychological impact assessment: depression screening, body image, social avoidance, work confidence. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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