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