psoriasis identification and management. how can psoriasis present? plaques flexural guttate scalp...
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PSORIASISPSORIASIS
IDENTIFICATION AND IDENTIFICATION AND MANAGEMENTMANAGEMENT
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How can psoriasis present?How can psoriasis present?
• Plaques
• Flexural
• Guttate
• Scalp
• Hands and feet
• nails
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Plaque psoriasisPlaque psoriasis
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Guttate psoriasisGuttate psoriasis
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Flexural psoriasisFlexural psoriasis
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Scalp psoriasisScalp psoriasis
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Nail psoriasisNail psoriasis
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Hand and foot psoriasisHand and foot psoriasis
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Management- PlaquesManagement- Plaques
• Depends on amount of body surface affected.• Consider psychological impact and discuss• Emollient• Topical vitamin d analogue +/- moderately
potent topical steroid short term.• Caution regarding Dovobet• Exorex for small multiple plaques• review
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Plaque continuedPlaque continued
• Dithranol an option if motivated and able to apply correctly
• Limited response- consider UVB
• Systemic therapy- Methotrexate / Neotigason
• Biological agents
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Guttate psoriasisGuttate psoriasis
• May occur after a streptococcal throat infection
• Often resolves after a few weeks
• Topical tar e.g. Exorex
• Mild topical steroid
• Consider referral for UVB if not improving
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Flexural PsoriasisFlexural Psoriasis
• Often treated as thrush- look for clues
• Milder vitamin d analogue( tacalcitol / calcitriol). Topical steroid ( clobetasone butyrate)
• Reduce frequency when settled to maintain control
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Scalp psoriasisScalp psoriasis
• Challenging and requires dedication• Psoriasis association advice sheet explains how
to apply treatments.• Mild - tar based shampoo used twice a week• Moderate - above+ calcipotriol or
betamethasone scalp application 2-3 times a week
• Severe – salicylic acid/ coal tar applied and left on overnight, comb out, wash then apply steroid/ vitamin d application.
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Scalp cont’dScalp cont’d
• Maintain with 1-2 x a week vitamin d analogue or weakest topical steroid that will control + tar based shampoo.
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Nail psoriasisNail psoriasis
• Exclude fungal infection- clippings
• Nothing works topically.
• Nail varnish for women
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Hands and feetHands and feet
• Can be a challenge.• Emollient – thicker and possibly urea based• Salicylic acid to soften scale• Potent topical steroid – ointment/ occlusion• Vitamin d analogues bit impractical as need to
apply a thick layer• Refer for PUVA and possibly systemic treatment
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Pustular psoriasisPustular psoriasis
• Does not mean infection
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Useful sources of informationUseful sources of information
• www.bad.org.uk
• www.pcds.org.uk
• www.psoriasis-association.org.uk
• www.dermnet.org.nz
• www.patient.co.uk