psoriasis for dummies ramesh mehay programme director (bradford vts)
TRANSCRIPT
Psoriasis for Dummies
Ramesh MehayProgramme Director (Bradford VTS)
• This presentation will not concentrate on the aetiology/pathogenesis/epidemiology of psoriasis
• You can find all that in electronic text books• Instead, we will concentrate on the practical
side of things• Things which most doctors have difficulty with
Types of Psoriasis
• Can you spot which types of psoriasis these are?
• Each PowerPoint slide has notes which tells you more about the condition if you want to know more
• But I suggest you don’t spend too long here. • Being able to recognise them and noting their
specific key points is more important
• Remember, with all these slides if you are having difficulty recognising what it is, go back to basics and describe to yourself what you SEE
• Are you ready?
First one...
Psoriasis Vulgaris
• Is a common psoriatic pattern you see• Think: scalp, lumbosacral, elbows and knees• Can you describe what the lesions look like?
Characteristically, they are
1. well-defined, raised, erythematous and scaly lesions , which are "salmon pink" or "full rich red" in colour
2. surface silvery scale which may be easily removed often leading to pin - point capillary bleeding (Auspitz sign)
3. they may or may not itch but this is not usually a prominent feature
• Let’s go a bit quicker
Number Two
How do you treat it?
• often erupts suddenly after an acute group B haemolytic streptococcal pharyngitis
• So, may need to give antibiotics• Then wait and see• May rapidly disappear or form stable plaques• If stable plaques form: calcipotriol, high potency
steroids, light therapy• Tonsillectomy if recurrent sore throats with
guttate flare ups?
And the third
What’s important about this type of psoriasis?
• It can be life threatening• Esp: high output cardiac failure (so bell the
lungs!)• Thermoregulation problems, dehydration and
septicaemia can result.• (Admit them straightaway for methotrexate +
cyclosporin Rx)• One of the few dermatological emergencies.
Number Four
Why is this one important?
• Acute pustular psoriasis is a potentially life threatening disease
• Attacks may be precipitated by infection, drugs, pregnancy, or the withdrawal of topical or systemic corticosteroid therapy.
• The patient may present with a high, swinging fever of non -infective origin, but secondary infections may occur (and is potentially lethal).
• (Admit them straightaway for methotrexate + cyclosporin Rx)
• Another one of the few dermatological emergencies.
The Final Fifth
What do you do about it?Palmoplantar psoriasis is difficult to treat. Both hyperkeratosis and inflammation should be treated
separately • a keratolytic agent for hyperkeratosis • calcipotriol or a moderately potent topical
corticosteroid (e.g. betnovate-RD (R) ointment) may help.
• isotretinoin has also been used to treat pustular psoriasis
• acitretin or methotrexate may be needed in disabling palmoplantar psoriasis
Things that cause difficulty
• Unstable Psoriasis• Psoriatic arthritis• Scalp Psoriasis
General Treatment
Specific Treatment