PSORIASIS

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PSORIASIS

• IDENTIFICATION AND MANAGEMENT

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How can psoriasis present?

• Plaques
• Flexural
• Guttate
• Scalp
• Hands and feet
• nails

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Plaque psoriasis
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Guttate psoriasis
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Flexural psoriasis
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Scalp psoriasis
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Nail psoriasis
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Hand and foot psoriasis
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Management- Plaques

• Depends on amount of body surface affected.
• Consider psychological impact and discuss
• Emollient
• Topical vitamin d analogue /- moderately potent
  topical steroid short term.
• Caution regarding Dovobet
• Exorex for small multiple plaques
• review

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Plaque continued

• Dithranol an option if motivated and able to
  apply correctly
• Limited response- consider UVB
• Systemic therapy- Methotrexate / Neotigason
• Biological agents

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Guttate psoriasis

• May occur after a streptococcal throat infection
• Often resolves after a few weeks
• Topical tar e.g. Exorex
• Mild topical steroid
• Consider referral for UVB if not improving

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Flexural Psoriasis

• Often treated as thrush- look for clues
• Milder vitamin d analogue( tacalcitol /
  calcitriol). Topical steroid ( clobetasone
  butyrate)
• Reduce frequency when settled to maintain control

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Scalp psoriasis

• Challenging and requires dedication
• Psoriasis association advice sheet explains how
  to apply treatments.
• Mild - tar based shampoo used twice a week
• Moderate - above calcipotriol or betamethasone
  scalp application 2-3 times a week
• Severe salicylic acid/ coal tar applied and
  left on overnight, comb out, wash then apply
  steroid/ vitamin d application.

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Scalp contd

• Maintain with 1-2 x a week vitamin d analogue or
  weakest topical steroid that will control tar
  based shampoo.

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Nail psoriasis

• Exclude fungal infection- clippings
• Nothing works topically.
• Nail varnish for women

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Hands and feet

• Can be a challenge.
• Emollient thicker and possibly urea based
• Salicylic acid to soften scale
• Potent topical steroid ointment/ occlusion
• Vitamin d analogues bit impractical as need to
  apply a thick layer
• Refer for PUVA and possibly systemic treatment

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Pustular psoriasis

• Does not mean infection

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Useful sources of information

• www.bad.org.uk
• www.pcds.org.uk
• www.psoriasis-association.org.uk
• www.dermnet.org.nz
• www.patient.co.uk