Psoriasis

Question 1

What is the appearance of psoriasis: how is the presentation different in children?

Answer 1

• raised >5mm plaque
• symmetrical
• often on extensor surfaces
• has scale(white and silvery)
• chronic psoriasis is bright red elevated plaques

PRESENTATION IN KIDS: plaques less thick and lesions less scaly, may be in nappy region in infancy
LOOK UP IMAGES

Question 2

treatment of psoriasis

Answer 2

• CORTICOSTERIODS: (betamethasone) used in combo with a VITAMIN D ANALOUGE (calcipotriol, tacalcitol, calcitriol)
• if not responding to steriod + vitamin D, switch to daivobet
• FOR FACE: use just a steriod not a combo e.g. hydrocortisone

Question 3

We know that the management for psoriasis can differ depending on where the problem is? What is the management for SCALP psoriasis?

Answer 3

• use a POTENT topical corticosteroids used once daily for 4 weeks.
• if no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (for example, a shampoo or mousse) and/or a topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid

Question 4

Secondary care management of psoriasis

Answer 4

PHOTOTHERAPY:
narrow band ultraviolet B light is now the treatment of choice. If possible this should be given 3 times a week
photochemotherapy is also used - psoralen + ultraviolet A light (PUVA)
adverse effects: skin ageing, squamous cell cancer (not melanoma)

SYSTEMIC THERAPY:
oral methotrexate is used first-line. It is particularly useful if there is associated joint disease
ciclosporin
systemic retinoids
biological agents: infliximab, etanercept and adalimumab
ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials

Question 5

Treatment of systemic psoriasis

Answer 5

• phototherapy
• retinoids
• immunosuppressants
  3rd line: dithranol

Question 6

What is the management of face, flexural, genital psoriasis ? (first line)

Answer 6

NICE recommend offering a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks

Question 7

Management of chronic plaque psoriasis

Answer 7

FIRST LINE:
- NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment

SECOND LINE:
- if no improvement after 8 weeks then offer a vitamin D analogue twice daily

THIRD LINE: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily
short-acting dithranol can also be used

Question 8

what is chronic plaque psoriasis, what does it look like

Answer 8

Chronic plaque psoriasis is the most common presentation of psoriasis.

PRESENTATION: It presents as small to large, well-demarcated, red, scaly and thickened areas of skin. It most likely to affect elbows, knees, and lower back but may arise on any part of the body.

It tends to be a relatively persistent or chronic pattern of psoriasis that can be improved with treatment but is difficult to clear completely with topical treatments alone.

CHARACTERISATION :It is characterised by large flat areas (plaques) of psoriasis with a typical silvery scale. These plaques may join together to involve very extensive areas of the skin, particularly on the trunk and limbs. It is often accompanied by scalp and nail psoriasis.