PSORIASIS - wd.nottinghamcitycare.nhs.uk

PSORIASIS Kate Blake Lead Nurse Dermatology Psoriasis Is a chronic inflammatory skin disease Affects 3% of U.K. population 75% are successfully managed in the community with topical treatments

(Griffiths,2004) Also common in India, Far East and parts of Africa Cause Strong genetic link No clear cut inheritance pattern Poorly understood

Trigger Factors Infection Medication Alcohol & Smoking Climate Change Skin Trauma

Stress Pathology Epidermal Hyperproliferation Accumulation of inflammatory cells Increased vascularity of the upper dermis

Chronic Plaque Psoriasis Most common Single or multiple plaques Red, scaly surface Vigorous rubbing causes capillary haemorrhage Chronic Plaque Psoriasis

Predilection for knees, elbows, base of spine Symmetrical, chronic, & stable mms to cms in diameter Sometimes causes itching

Treatment Options Dithranol / Micanol Dovonex / Dovobet Topical steroids Coal Tar Ultra Violet Light Systemics Biologics Guttate Psoriasis

Often follows sore throats Common in young adults Lesions about 1 cm diameter Paler pink than established psoriasis Often resolves rapidly May enlarge & become

stable plaques Treatment Options Tar based ointment Dovonex ; Dovobet Ultra violet light Ultra violet light plus tar based ointment Ultra violet light plus Dovonex

Flexural Psoriasis May accompany plaque psoriasis Occurs in groin,natal cleft, axillae & submammary folds Maceration leaves beefy erythematous rash Often itchy

Subject to secondary contact sensitivity Treatment Options Can be problematic Mild tar/corticosteroid mixtures may be effective Steroids can cause striae Low concentrations of dithranol may burn delicate areas

nUVB & PUVA can be effective if area is accessible Scalp Psoriasis Common Scalp alone may be affected Lesions very small to whole scalp cover

Occasionally thick and sticks in large chunks to hair Temporary hair loss Treatment Options Tar shampoos Betamoose Scalp Blitz UV combs

Chronic Palmo-plantar Psoriasis Usually found alone Erythematous with numerous pustules Pustules become brown scaly spots & peel off Painful

Small area or entire surface of palms or soles May cause considerable disability Treatment Options Topical treatments often ineffective PUVA may give some control

Relapse is common Nail Psoriasis Nail involvement frequent Nail pits Onycholysis Can become discolored Painful

Whole surface may become damaged Exfoliative Erythroderma Dermatological emergency Plaques merge to cover most of skin Can be slow or rapid

Systemic/ topical steroids may precipitate Acute Pustular Psoriasis Dermatological emergency With or without pre existing psoriasis Sudden development of widespread erythema

Pustules are sterile May coalesce to form lakes of pus High swinging temperature and unwell Patient may die from secondary infection Psoriatic Arthropathy Affects up to 10%

of people with psoriasis Is erosive and may result in joint destruction Interactive Time Questions

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