Psoriasis Flashcards
Psoriasis:
What is psoriasis?
- autoimmune inflammation with fluctuate severity
- Presenting as erythema, with or without scale
Psoriasis:
Risk factors and age presentation?
- Familial Link
- Presents at any age
- Sometimes triggers include Infection, Trauma, Stress, Drugs
Psoriasis:
Causes of psoriasis flares?
- Sunburn
- hypocalcaemia
- Hormone changes
- Steroid cream withdrawal
- Medication:- Lithium, Chloroquine, Hydroxychloroquine, Interferon alpha
Psoriasis:
Four types of psoriasis?
1) Plaque
2) Guttate
- droplet shape
- trunk and proximal limbs
- can be strep pyogenes triggered (2 -3 weeks delay of symptoms)
- responds to mild treatments
3) Pustular (Can be generalised; Which requires Hospital or specialist input, Or localised; such as Palmoplantar pustular psoriasis which can be managed by GP)
4) Erythrodermic (It involves entire skin surface, Quick onset, systemic symptoms, Requires hospital treatment due to complications)
Psoriasis:
What is the significance of nail signs?
Patients with nail signs are more likely to have psoriatic Arthritis
Psoriasis:
General management considerations?
- Lifestyle modification (Psoriasis is an independent risk factor for CVD)
- Gentle sunlight exposure (Sunburn can cause flares)
- Monitor mental health
- Avoid skin irritants such as Soap
Psoriasis:
Treatment principles?
- emollients daily
- Control flares with corticosteroids and once settled wean steroids while adding in tar or another agent topical therapy
- Alternate therapies to prevent tachyphylaxis
- Therapies should begin to be effective within 2 to 4 weeks
- Never use oral corticosteroids
- 30g of cream = 20g of ointment = adequate to cover an adults total body surface area
Psoriasis:
Corticosteroid pearls with psoriasis?
- Mechanism of action is anti-inflammatory and anti-mitotic
- Timing of use should be morning while tar in the evening
- Pulsing for 2 to 4 weeks is effective
Psoriasis:
Tar pearls with psoriasis?
- Mechanism of action is anti-inflammatory and antipruritic
- Preparations are often mixed with keratolytics such as salicylic acid
- LPC (Liquour Picis Carbonis)
- Common mix LPC 6%/Salicylic acid 3% (Both components can go to a maximum of 10%)
- Tars cannot be used in pregnancy
- An alternative to tars is Ichthammol 1% In aqueous cream
Psoriasis:
Calcipotriol pearls with psoriasis?
- vitamin D analogue
- Mechanism of action regulates proliferation and differentiation of keratinocytes
- Can take six weeks to be effective
- Can cause erythema and irritation
- Ideally combined with corticosteroid cream for best tolerance
Psoriasis:
Treatments based on location?
Steroid then tar:
Scalp
Initialy to remove scale (and increase treatment absorption)
-EgoPsoryl TA
-Cocoscalp
(Salacylic acid and tar mixes)
Put in before bed
In morning comb out (may need help)
Then add medicated shampoo
-sebitar, Tgel
-steroid/anti-inflammatory- enstilar foam (do at night, wash out in morning)
Flexural/genital areas
1) methylpred 0.1% until clear (or <2 weeks if nappy wearing child)
2) when flare settled LPC 2% ointment of ichthammol 1%
Face 1) Central - methylpred 0.1% 2) ears/hairline - Mometasone 0.1% 3) Children - Hydrocortisone 0.1% *once settled add LPC 2%/SA 2% and wean steroid DO NOT USE CALCIPOTRIOL ON FACE
Tar then steroid:
Trunk and limbs
-Coal tar emulsion for four weeks and if not successful add in steroids
Palms and soles
1) Hyperkeratotic - LPC/SA combination for 4 weeks then add in calcipotriol/steroid combination if required
2) Pustular - LPC/SA combination for 2 weeks then add in mometasone 0.1%
*calcipotriol 0.005% + betamethasone 0.05% combinations exist in gel, foam and ointment BUT are only on PBS if failed potent steroid monotherapy
Psoriasis:
Other specialist treatments?
UV B light Methotrexate Acitretin Cyclosporin Biologics - early referral required
