MEDICAL AND SURGICAL NURSINGTOPIC:PSORIAS

Done by:

ABDULLA KHAMIS NGWALI

2ND YEAR BSc,N STUDENT

OBJECTIVES

Define psoriasis

List causes of psoriasis

Mention types of psoriasis

Outline Pathophysiology of psoriasis

List sign and symptom of psoriasis

Explain diagnosis of psoriasis

Describe treatment of psoriasis

Psoriasis

• Psoriasis is an inflammatory skin disease in which skin cells replicate at an extremely rapid rate. New skin cells are produced about eight times faster than normal--over several days instead of a month--but the rate at which old cells slough off is unchanged. Or

• Psoriasis is a chronic, noninfectious, inflammatory disease of the skin in which the production of epidermal cells occurs at a rate that is about six to nine times faster than normal

Definition cont…

• This causes cells to build up on the skin's surface, forming thick patches, or plaques, of red sores (lesions) covered with flaky, silvery-white dead skin cells (scales)

• Onset may occur at any age but is most common between the ages of 15 and 50 years

Picture of skin

Causes of psoriasis

• The cause of psoriasis is not known, but it is believed to have a genetic component.

• Several factors are thought to aggravate psoriasis. These include stress, excessive alcohol consumption and smoking.

• Individuals with psoriasis may suffer from depression and loss of self-esteem.

• As such, quality of life is an important factor in evaluating the severity of the disease.

• Certain medicines, including lithium salt and beta blockers, have been reported to trigger or aggravate the disease.

Types of psoriasis

• Plaque psoriasis (psoriasis

vulgaris) is the most

common form of

psoriasis. It affects 80 to

90% of people with

psoriasis. Plaque psoriasis

typically appears as raised

areas of inflamed skin

covered with silvery white

scaly skin. These areas are

called plaques

Conti…..

• Flexural psoriasis (inverse

psoriasis) appears as smooth

inflamed patches of skin. It

occurs in skin folds, particularly

around the genitals (between the

thigh and groin), the armpits,

under an overweight stomach

(pannus), and under the breasts

(inframammary fold). It is

aggravated by friction and sweat,

and is vulnerable to fungal

infections.

Conti…..

• Guttate psoriasis is characterized

by numerous small oval

(teardrop-shaped) spots. These

numerous spots of psoriasis

appear over large areas of the

body, such as the trunk, limbs,

and scalp. Guttate psoriasis is

associated with streptococcal

throat infection

Conti…..

• Pustular psoriasis appears as

raised bumps that are filled

with non-infectious pus

(pustules). The skin under and

surrounding pustules is red

and tender. Pustular psoriasis

can be localized, commonly to

the hands and feet

Conti…..

• Nail psoriasis produces a

variety of changes in the

appearance of finger and toe

nails. These changes include

discoloring under the nail

plate, pitting of the nails,

lines going across the nails,

thickening of the skin under

the nail

Pathophysiology

• The basal skin cells divide too quickly, and the

newly formed cells become evident as profuse scales

or plaques of epidermal tissue. Psoriatic cells may

travel from the basal cell layer of the epidermis to

the stratum conium (skin surface) and be cast off in

3 to 4 days, in sharp contrast to the normal 26 to 28

days.

Because of the rapid cell passage, the normal events

of cell maturation and growth cannot take place and

the normal protective layers of the skin cannot form.

conti….

They appears to be a hereditary defect that causes overproduction of keratin. The primary defect is unknown. Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes are trigger factors. Psoriasis is considered mild if it affects less than 5% of the surface of the body; moderate, if 5–30% of the skin is involved, and severe, if the disease affects more than 30% of the body surface

Sign and symptoms

• Pain

• Erythema- with in the dermis blood vessels

dilate and increase blood flow to skin causing

generalized redness and heat loss

• Scaling

• Pustules inflammatory condition

• itching

Diagnositic test

• Skin biopsy

• Skin swab flexural psoriasis

• Auspitz sign- gentle removal of the silvery

scale from a plaque

• Routine blood tests viral check of full blood

count

Treatment

This may involve tropical, systematic drug and

phototherapy

Drug therapy:

• Antihistamines such as cetrizen, Promethazine,

• Analgesics such as ibuprofen ,diclofenac,

paracetamol

• Antibiotics such as cloxaciline, penicillin

,doxycycline, floxaciline, ampiciline

conti….

• Steroid-based creams. decrease

inflammation, relieve itching, and block the

production of cells that are overproduced in

psoriasis. E.g. hydrocortisone

,dexathamethasone

• salicylic acid ointment

which smoothes the skin by promoting the

shedding of psoriatic scales e.g. silver nitrates

General nursing management• Assessment focuses on how the patient is

coping with the skin condition, the appearance of “normal” skin, and the appearance of skin lesions.Promoting Understanding

• Explain with sensitivity that there is no cure and that lifetime management is necessary; the disease process can usually be controlled

• Teaching Patient regarding the disease, skin care, and treatment regimen.

Conti.....

• Measures to prevent skin injury: avoid picking or scratching

• Measures to prevent skin dryness: use emollients, avoid excessive washing, use warm (not hot) water, and pat dry

• Use of the therapeutic relationship for support and to aid coping

• Development of self-acceptance

• Absence of complications

Reference

i. International Study Of Pain: An Unpleasant Experience That We

Primarily Associate With Tissue Damage Or Describe In Terms Of

Tissue Damage Or Both." Merskey, H. (1964), An Investigation Of

Pain

ii. Jennifer E. Helms, Claudia P. Barone,physiology And Treatment Of

Skin Disease, critical Care Nurse, Vol 28, No. 6, Dec.2008.

iii. Griffiths CE, Barker JN. Pathogenesis and clinical features of

psoriasis. Lancet 2007;370(9583):263-71.

iv. Reich K, Kruger K, Mossner R, Augustin M. Epidemiology and

clinical pattern of psoriatic arthritis in Germany: a prospective

interdisciplinary epidemiological study of 1511 patients with

plaque-type psoriasis. Br J Dermatology 2009;160:1040-7.