Happy Anniversary

This year marks the fiftieth anniversary of the creation of the Psoriasis Association, one of the very first support groups for patients with skin disorders, and it is a good time to remember the remarkable Dr Richard ‘Dickie’ Coles OBE (1919–1999), former Consultant Dermatologist in Northampton, whose idea it all was.

Fifty years ago, having psoriasis as a patient, or managing it as a doctor, was a formidable proposition. There were no topical vitamin D3 analogues, no photochemotherapy (and the ultraviolet machines that were available had no mechanism for calibrating the dose given), no methotrexate, oral retinoids or ciclosporin, let alone biologic agents. Potent topical steroids were new, and often misused, leading to steroid atrophy of the skin and, through percutaneous absorption, Cushing’s syndrome. The mainstay of therapy was topical crude coal tar (which made the poor patients smell dreadful), and dithranol (which stained their clothing, bedding and bathroom fittings). In desperate cases, systemic arsenic was used. It is small wonder that patients with psoriasis felt isolated and stigmatised.