About Psoriasis:

Psoriasis is a common, chronic inflammatory disease affecting about 3% of the population. Its cause is unknown. It is not contagious from one person to another and reports state that it usually does not form scars on the skin. Symptoms of psoriasis appear as localised clearly defined skin lesions, mostly symmetrical, red papules and plaques, usually covered with white or silver scales. This thickened, inflamed skin is also characterised by itching, stinging and pain; and usually occurs on the knees, elbows, trunk or scalp, but it may occur anywhere.

Currently, there is current cure for psoriasis. Psoriasis is a complex illness with multi-systemic involvement.

Treating the only skin symptoms is not sufficient to control this complex disease. Your doctor’s advice is required.

Tell your doctor that you are using this cream.

While psoriasis visibly involves the skin and nails, it is important to recognise that this disease is associated with a number of significant comorbidities (that is, additional diseases, symptoms or disorders).  For example; Individuals with psoriasis have an increased risk of developing chronic, inflammatory arthritis, cardiovascular and other non-communicable diseases. The need for treatment is usually life-long and is aimed at remission.

 Treatment of the visible signs of psoriasis is based on controlling the symptoms.  A range of topical and systemic therapies are available, as well as phototherapy (exposure of effected areas to specific wavelengths of light). Your doctor may recommend a combination of methods. Other treatments for cardiovascular, metabolic and other comorbid (concurrent) conditions may also be required.

Usually, the first line in treatment is use of emollient moisturisers such as Graham’s Natural Psoriasis Cream.  These emollient moisturisers ease itching and dryness, reduce scaling, soften scale and help promote the penetration of other topical treatments. Very mild psoriasis may respond to treatment with emollients alone.

A Clinical Guideline for assessing and managing psoriasis in adults, young people and children, that aims to improve long-term disease control and quality of life for people with psoriasis can be found at

https://www.nice.org.uk/guidance/cg153

Important Instructions for Use:

This complex oil-in-water cream contains a range of naturally derived ingredients considered suitable for the topical use in the wider population; however some may trigger to personal sensitivity reactions in susceptible  individuals.

• CHECK the ingredients list before use; do not use if you suspect allergy or sensitivity to any of the ingredients (unless advised to do so by a doctor)
• PATCH test the product by placing a small amount on normal, healthy skin; if after several hours there is no irritation or redness, proceed to application to psoriasis affected skin.
• IF at any time during the use of this product you experience atypical redness, sensitivity or other adverse reaction seek medical advice. 

For Routine Use:

Skin should be routinely cleansed using a pH neutral cleanser (not alkaline soap). Apply Graham’s Natural Psoriasis Cream to clean, dry skin as frequently as required (nominally 2-3 times daily) to keep plaques and psoriasis effected skin moist and comfortable. It is best to use emollients thinly and frequently throughout the day (not thickly and occasionally), because the emollient action helps the skin to maintain its natural hydration and barrier function. Not suitable for application to large or open wounds. 

For Combination Therapies:

Tell your doctor you are using this cream. 

The aim of topical emollient therapy is to improve the condition of the skin by providing physical, structural and physio-chemical elements that enable the skin to more effectively retain moisture. By normalising the skin, natural responses such as itch and inflammation are reduced, and drug based dermal treatments can be more readily absorbed. Some topical treatments do not work particularly well until scales that reduce drug and light penetration are removed.

This cream is not medicated, however it contains substances that physically interact with the skin and may affect the way in which some other medications and treatments work. Your doctor will advise on how Graham’s Natural Psoriasis Cream may be used as part of combined psoriasis therapies.

Grahams Natural Psoriasis Cream

• Has been designed to be suitable for use in combination with phototherapy. Data indicates that ingredients are considered non-phototoxic and non-photosensitising.
• Can typically be used in combination with Salicylic acid, Topical Vitamin A & Vitamin D analogues &/or Corticosteroid treatments.

IMPORTANT: For Combination Therapies using Dithranol (Anthralin);

The skin should be clear of Grahams Natural Psoriasis Cream prior to Dithranol (Anthralin); treatment, however its use maybe beneficial as a follow up.

             Grahams Natural Psoriasis Cream is rich in antioxidants; it therefore has the potential to quench the ROS  romoted by Dithranol (Anthralin) application. Similarly the low pH and aqueous nature of the cream may trigger chemical degradation of Dithranol (Anthralin).

Use of Grahams Natural Psoriasis Cream following Dithranol (Anthralin) treatment may help to remedy irritation.

Your doctor will advise the most suitable regime for you. 

About this formulated medical device:

Important:

• What works well for one person, may not be as effective for others.
• Some individuals may be sensitive to constituent ingredients, CHECK before using this or any topical product and PATCH test before use.
• Excluding a personal intolerance to one or more of the ingredients, adverse affects are not anticipated when this device is used as directed.
• Psoriasis treatment using Dithranol (anthralin) may need special consideration, see Important Instructions for Use.

The device is formulated as complex ‘oil-in-water’ cream. It has been designed to provide a light, cool, soothing skin feel, to be very mild and to provide gentle, targeted epidermal replenishment and scale removal.

Intended use: This non-sterile topical emollient therapy is for use in conjunction with professional medical management of psoriasis. It may be used alone or with phototherapy and/or other treatments. Emollient therapy can help to redress skin plaques characteristic of psoriasis; symptoms of which including scaling, together with dry, inflamed, itchy, flaky, denuded, thickened &/or red skin. This product acts by softening, soothing and lubricating the surface, enhancing scale removal and facilitating epidermal re-hydration. Humectants, antioxidants and gentle keratolytic agents complement the emollient / moisturising action, helping to normalise the appearance, structure and function of the epidermis. 

Ingredients: Purified Water, Cetostearyl Alcohol, Medium-chain Triglycerides, Castor Oil, Honey / Mel, Glycerin, Urea, Calendula officinalis (Calendula) Flower Extract, Centella asiatica (Gotu Kola) Extract , Sodium hyaluronate, Persea gratissima (Avocado) Oil, Simmondsia chinensis (Jojoba) Seed Oil, Macrogol Cetostearyl Ether / Polyoxyl 20 Cetostearyl Ether, Butyrospermum parkii (Shea) Nut Butter, Phenoxyethanol, Hydrogenated Castor Oil, Tocopheryl Acetate & Tocopherol, Carnauba Wax, White Beeswax, Glyceryl Monocaprylate, Lactic Acid, Ethyl Ascorbic Acid.

Moisturisers & Humectants include Urea, Glycerin, Sodium Hyaluronate and Honey.

Humectants draw water from the aqueous formulation base, the atmosphere, and from the underlying epidermis to increase skin hydration. The stratum corneum of unaffected psoriatic skin reveals no deficit in natural urea content, however levels in psoriatic lesions can be reduced by 40%. Application of moisturisers containing urea, have been shown to exert positive changes in the stratum corneum, hydrate severely compromised skin, and support and enhance barrier function.

Sodium Hyaluronate is high molecular weight polysaccharide naturally present in the skin. In the healthy epidermis it regulates water balance, osmotic pressure, functions as an ion exchange resin, and regulates the environment outside and between the cells. It can also function as a lubricant, as a shock absorber, and as a structural molecule. In psoriatic lesions partially degraded hyaluronate is present in the lower papillary dermis and may be the mechanism for the marked capillary proliferation and inflammation in this region that. The sodium hyaluronate in this formulation is maintained as a high molecular weight substance, protecting the epidermal layers.

Emollients oils and lipid include Medium-chain Triglycerides, Castor Oil, Avocado oil, Jojoba oil, Shea butter, Carnauba Wax and Bees wax. The acid mantle of the healthy stratum corneum consists mainly of triglycerides, wax/sterol esters, squalene and some free fatty acids. Graham’s Natural Psoriasis Cream uses a range of varied emollient lipids to more closely match that of healthy skin.  Two types of emollient lipids are favoured, those that play the role of intercellular, lamellar barrier supporting and cushioning skin cells and semi-occlusive lipids that stay on the skin surface, reducing trans-epidermal moisture loss and softening scale.  

Antioxidants include Calendula officinalis (Calendula) Flower Extract, Centella asiatica (Gotu Kola) Extract, Tocopheryl Acetate & Tocopherol  (Vitamin E) and Ethyl Ascorbic Acid (Vitamin C). Oxidative stress and the increased formation of free radicals have been related to skin inflammation and are reported to be among the most important factors in the pathogenesis of psoriasis. Studies demonstrate that individuals with psoriasis have high levels of markers of lipid peroxidation and decreased antioxidant status. Both simple (ie purified vitamin) and complex (herbal extracts, honey) substances are used as antioxidants. This provides both lipid and water soluble antioxidant activity, permitting quenching of reactive oxygen species in both lipid and aqueous environments, as well as a range of different anti-oxidant activities.

Mild Exfoliant and Keratolytic agents include both Urea and Glycerol, that act as keratolytic (dead skin dissolving) agents in addition to their humectant activities. Urea acts by unfolding proteins, thus solubilising and denaturing them. Clinical studies have shown use of urea cream results in 29% decrease epidermal thickness (P<0.01) and 51% decrease in proliferation (P<0.005) as well as increased hydration and decreased TEWL.

Healthy skin requires a balance between degradation and production of desmosome (Linkage between skin cells). After about a week of glycerol treatment, re-activation of stratum corneum protease activity occurs (simply by elevated water activity). This protease is responsible of the regulation of maturation and natural loss of external skin cells, (corneocytes desquamation) resulting in improved (reduced) stratum corneum thickness.

 Very mild, temporary pH modification mildly, weakly acidic pH is achieved using very dilute Lactic acid. (Honey also has a buffering action). Acidic pH of the skin is regarded as particularly useful in reducing bacterial colonisation on the skin and is important for re-establishing skin health.

The formulated cream appears as an opaque pale, neutral brown colour and has an intrinsic mild honey odour. Initially it moves rapidly and easily across the skin, as the moisture and low molecular weight lipids are rapidly absorbed it leaves a non-sticky, moist, soft matt waxy protective finish.

This product has been manufactured in Australian, under GMP using (excipient, non-drug) pharmaceutical and food grade ingredients. It is NOT intended for and not suitable for application to large open wounds. Store below 30^oC, in closed original container, protect from freezing. If the cream develops an atypical odour or changes in consistency it is important NOT to use it. Discard and replace as merited.