PSORIASIS IDENTIFICATION AND MANAGEMENT. How can psoriasis present? Plaques Flexural Guttate Scalp...

PSORIASISPSORIASIS

IDENTIFICATION AND IDENTIFICATION AND MANAGEMENTMANAGEMENT

How can psoriasis present?How can psoriasis present?

• Plaques

• Flexural

• Guttate

• Scalp

• Hands and feet

• nails

Plaque psoriasisPlaque psoriasis

Guttate psoriasisGuttate psoriasis

Flexural psoriasisFlexural psoriasis

Scalp psoriasisScalp psoriasis

Nail psoriasisNail psoriasis

Hand and foot psoriasisHand and foot psoriasis

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

Plaque continuedPlaque continued

• Dithranol an option if motivated and able to apply correctly

• Limited response- consider UVB

• Systemic therapy- Methotrexate / Neotigason

• Biological agents

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

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

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.

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.

Nail psoriasisNail psoriasis

• Exclude fungal infection- clippings

• Nothing works topically.

• Nail varnish for women

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

Pustular psoriasisPustular psoriasis

• Does not mean infection

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