4. PSORIASIS Flashcards
a chronic, noninfectious, inflammatory disease of the skin in which the production of epidermal cells occurs faster than norma
Psoriasis
Psoriasis may occur at any age but is most common between the ages of ___ and ___ years.
15 and 35
Main sites of the body affected:
- scalp
- areas over the elbows and knees
- lower part of the back
- genitalia
- nails
Psoriasis may be associated with _________ factor–negative arthritis of multiple joints
asymmetric rheumatoid
An _____________ may develop in which the disease progresses to involve the total body surface (erythrodermic psoriatic state).
exfoliative psoriatic state
PSORIASIS RISK FACTORS:
- Stress
- Smoking
- Trauma
- Medication
- Infections
- Family history
- Immunocompromised
Psoriasis may cause _____ and _____; observers may stare, comment, ask embarrassing questions, or even avoid the person
despair and frustration
PSORIASIS CLINICAL MANIFESTATIONS:
- Lesions -red, raised patches of skin covered with silvery scales.
- Multiple bleeding points
- Nail pitting, discoloration, crumbling beneath the free edges, and separation of the nail plate.
- Acutely ill, with fever, chills, and an electrolyte imbalance -erythrodermic psoriasis
Who are especially vulnerable to its
psychological effects.
Teenagers
What must be addressed first
any precipitating or aggravating factors
An assessment is made of _____, because psoriasis is significantly affected by stress.
lifestyle
Most important principle of psoriasis
treatment:
Gentle removal of scales (bath oils, coal tar preparations and a soft brush used to scrub the psoriatic plaques).
* bath oils
* coal tar preparations
* soft brush
Application of emollient creams containing ____ or ____ after bathing–to soften thick scales.
alpha-hydroxy acids (Lac-Hydrin, Penederm) or salicylic acid
Three types of therapy are standard:
- topical
- systemic
- phototherapy
Three types of therapy are standard:
used to slow the overactive
epidermis
Topical Therapy/Treatment
Topical corticosteroid therapy acts to reduce inflammation.
Medications include tar preparations (eg, coal tar topical [Balnetar]), alpha-hydroxy or salicylic acid, and corticosteroids.
Three types of therapy are standard:
TYPES of Topical Therapy
Calcipotriene (Dovonex**; not recommended for use by elderly patients because of their more fragile skin, or in pregnant or lactating women)
**Tazarotene (Tazorac) as well as vitamin D are additional nonsteroidal agents.
*Occlusive (plastic) dressing may improve effectiveness.
Three types of therapy are standard:
Biologic agents act by inhibiting activation and migration, eliminating the T cells completely, slowing postsecretory cytokines or inducing immune deviation:
* Infliximab (Remicade)
* Etanercept (Enbrel)
* Efalizumab (Raptiva)
* Alefacept (Amevive)
* Adalimumab (Humira)
Systemic Therapy
Three types of therapy are standard:
TYPES of oral agents Systemic Therapy
2 types of systemic theraphy: Oral agents and Photochemotherapy
- Methotrexate –patients should avoid drinking alcohol, should not be administered to pregnant women.
- Cyclosporine A
- Oral retinoids –ie: synthetic derivatives of vitamin A and its metabolite, Vitamin A acid
- Etretinate
Three types of therapy are standard:
TYPES of Photochemotherapy Systemic Therapy
- Psoralens and ultraviolet A (PUVA) therapy
- Ultraviolet B (UVB) light therapy
- Excimer laser therapy
It is associated with long-term risks of skin cancer, cataracts, and premature aging of the skin.
Photochemotherapy
TYPES of Photochemotherapy Systemic Therapy
may be used for severely debilitating psoriasis.
Psoralens and ultraviolet A (PUVA) therapy
TYPES of Photochemotherapy Systemic Therapy
may be used to treat generalized plaque and may be combined with the topical cream, calcipotriene (Dovonex).
Ultraviolet B (UVB) light therapy
TYPES of Photochemotherapy Systemic Therapy
may be another treatment.
Excimer laser therapy
PSORIASIS DIAGNOSIS
*Risk for infection
*Disturbed body Image
*Impaired skin integrity related
* Social isolation
*Hopelessness
*Helplessness
*Deficient knowledge related to Psoriasis
Goals for the patient may include:
- achievement and maintenance of skin integrity
*improved thought processes - absence of infection
*improved thought processes
*increased comfort
*increased socialization
*increased knowledge regarding disease - absence of complications
PSORIASIS ASSESSMENT:
Examine areas especially affected:
- elbows
- knees
- scalp
- gluteal cleft
- all nails (for small pits)
factors that provoke it:
- any irritation or injury to the skin
- any current illness
- emotional stress
- unfavorable environment
- drug
Consult a _____ to assist in the diagnosis and treatment of the arthropathy
rheumatologist
Advise patient that topical ______ preparations on face and around eyes predispose to cataract development.
corticosteroid
