Psoriasis Flashcards
—— is a chronic relapsing inflammatory disorder characterised by a variety of morphological lesions that present in a number of forms.
Psoriasis
the most common is called plaque psoriasis
State the epidemiology of Psoriasis
1-3% prevalence worldwide. 1-2% of UK population
More prevalent in 40-50 years old
Rare in infants and uncommon in children
State the signs and symptoms of Scalp Psoriasis
Can be mild, exhibiting slight redness of the scalp
Severe cases have marked inflammation and thick scaling
Redness often extends beyond the hair margin and is commonly seen behind the ears.
List the questions to ask a patient suffering from Psoriasis
Onset: first occurs most commonly in adults
Distribution: often symmetrical involving scalp & extensor aspects
Other symptoms: itch not normally present
Look at rash: scaling is obvious feature
Previous history: psoriasis is chronic & remitting
State the treatment options for Psoriasis available in primary care/pharmacy
1.Emollients (Doublebase, Diprobase, Cetraben)
Help soften scaling and soothe the skin to reduce irritation, cracking and drying.
Applied regularly and liberally.
- Tar-based products (Alphosyl, Cocois, Pinetharsol)
Anti-mitotic: slows down rate of cell production
S/E: local skin/scalp reaction & stain skin/clothes.
Facts about emollient used in Psoriasis
Emollients: May be all that is needed in mild cases
No upper limit on how they can be used.
Safe for all ages & P & BF mothers.
Facts about tar-based products used in treating psoriasis
Tar products: may be used on skin/scalp Possible increased risk of cancer Alphosyl: shampoo used every 2-3 days Cocois- for scalp, applied weekly Pinetharsol- for skin application as soap substitute
State facts about Dithranol used in Psoriasis
Dithranol
Combines with DNA to reduce mitosis & inhibits proliferation
Short contact-time is recommended because prolonged exposure can lead to irritation and burning skin.
Suitable for face, flexures, acutely inflamed psoriasis
E.g. Dithro-cream : apply for 20-60 minutes then wash off and apply emollient
List facts about Dithranol
Dithranol : partic. Useful in plaque psoriasis. Clears most psoriasis in 2-3 weeks
Burns skin, especially normal skin
Stains skin & clothing, hair & baths purple/brown colour
pH sensitive therefor salicylic acid is added as a stabiliser
Can Steriods be used in the treatment of Psoriasis?
May be prescribed but NOT licensed for OTC psoriasis
Self advise for patient suffering from Psoriasis
Remind patients that emollients should be used liberally and regularly
Some emollients will make bath slippery- so take care
Stress, alcohol, smoking can exacerbate the condition
Practice relaxation techniques, avoid alcohol & quit smoking
When to refer Psoriasis patient
Extensive lesions, follow recent infection or cause itching
No family history or past history
Pustular lesions
Dermatology treatment for Psoriasis
NEVER ORAL STEROIDS
Immunosupressants
Biological agents
Why oral steroid is contraindicated in Psoriasis
due to the risk forsteroid-induced conversion to pustularpsoriasis, the long-term side effects ofsteroids, and deterioration ofpsoriasisafter withdrawal ofsteroids
State the conditions to eliminate in Psoriasis
Pustular psoriasis: rare form. Pustules for on edge of lesions, typically on palms of hands & soles of feet- REFER
Seborrheic psoriasis: (aka flexural psoriasis) lesions affecting the scalp but less typically affect body folds. Itch can be prominent
Guttae psoriasis: (drop-like) multiple small plaques all over the body. Particularly in children post-strep. sore throat.
Ertythrodermic psoriasis: over 95% body affected. Can be life- threatening. - MEDICAL EMERGENCY
