Psoriasis

Question 1

What is psoriasis?

Answer 1

A life long chronic inflammation disease of the skin
It is not contagious
There are recurrent exacerbations and remissions

Question 2

When is typical onset of psoriasis?

Answer 2

Typical onset is between 16 and 22 (more severe) and 57 and 60 (less severe)
It is rare in children under 5

Question 3

What is the most common form?

Answer 3

Plaque psoriasis

Question 4

Where is psoriasis found?

Answer 4

Scalp, buttocks, arms, legs, elbows, knees, ears, palms and soles

Question 5

What are risk/aggravating factors?

Answer 5

Genetic predisposition
Skin trauma
Environmental (alcohol ingestion, obesity, stress, pregnancy)
Medications (beta-blockers, NSAIDs, anti-malarial, lithium)
Infections (respiratory infections, HIV, streptococcal infection)

Question 6

What are the signs and symptoms of psoriasis?

Answer 6

Thickened red plaque with silvery-white scales
Bleed easily
Most have symmetrical lesions
Minimal itching

Question 7

What are assessment questions?

Answer 7

How severe are the symptoms?
Duration of irritation?
Area of involvement?
How often do symptoms occur?
Medical history?
Has anything been tried yet?
Has your doctor diagnosed you with psoriasis?

Question 8

What are red flags? (when to refer?)

Answer 8

Under 2 years of age
If diagnosis has not been made
No improvement after 2 weeks
Over 3% of the body surface area (BSA) involved
Severity and type of psoriasis
Location of lesions (hands, forearms and face)

Question 9

What are the treatment goals?

Answer 9

Control or eliminate the signs and symptoms (inflammation, scaling, itching)
Prevent or minimize the likelihood of flares

Question 10

What does choice of treatment depend on?

Answer 10

Severity
Location of plaques
Convenience
Patient compliance
Financial considerations
Physical accessibility to treatment

Question 11

What are non-pharmacologic treatment options?

Answer 11

Do not rub, scratch or pick the skin (it irritates the area and may cause bleeding leading to infection)
Avoid rubbing medications onto the area (dab)
Mild cleansers and warm water used for cleansing (avoid fragrences, irritating chemicals and warm not hot water to decrease drying effect)
Moisturize skin (rehydration of skin)
Avoid triggers (smoking, alcohol, stress)
Moisturize air in home (cool mist humidifier, avoid electric heat)

Question 12

What are treatment options?

Answer 12

Topical therapy (first line of therapy for mild to moderate psoriasis)
Phototherapy (narrow band UVB or UVA light used)
Systemic therapy (various prescriptions products are used)
Biologic therapy (target the immunological causes of psoriasis)
Combination therapy

Question 13

What are topical prescription products available?

Answer 13

Corticosteroids (medium, high potency)
Compounds with coal tar or salicylic acid
Tazarotene
Calcipotriol (alone or combined with a corticosteroid)

Question 14

What are oral prescriptions products available?

Answer 14

Various immunosuppression medications

Question 15

Are there biologic prescription products available?

Answer 15

For chronic moderate to severe plaque psoriasis

Question 16

What are OTC treatment options?

Answer 16

Corticosteroids (hydrocortisone 0.5% and 1.0% are available OTC therefore only used for mild cases)
Coal tar products (mild to moderate psoriasis in combination with other topical treatments)
Keratolytic agents (mild to moderate psoriasis in combination with other treatments)
Rehydration with moisturizers (ointments are most effective, creams are less greasy and lotions relieves itching)

Question 17

What are OTC products that are available?

Answer 17

Coal tar (deniers regular or extra strength and target)
Salicylic acid (dreamers medicated shampoo, sebcur, psoriasin S/A therapeutic shampoo)
Combination products: salicylic acid and coal tar (politar shampoo, sebcur/T, tartan shampoo, targel SA
Corticosteroids (hydrocortisone 0.5% cream)

Question 18

What are the monitoring parameters?

Answer 18

Thickness of scales (monitor daily for 50% decrease for 6-8 weeks)
Scaling (monitor daily for 50% decrease in 7-10 days)
Itching (monitor daily for relief for 1-2 weeks)
Redness (monitor daily for 50% decrease for 8-12 weeks)
Side effects of treatment (monitor daily for side effects, allergic reactions or treatment failure)