Alexandra Pyle Bsc (Hons)Registered Nurse

What is Psoriasis?

Psoriasis is a chronic inflammatory skin disorder characterised by thickened, scaly plaques

There is no definite cause for Psoriasis

But two factors that can contribute to the development of psoriasis are:

A Genetic Predisposition

Direct injury to the skin (knoeber Phenomenon)

Infection (streptococcal sore throat) Drugs / medications Stress Smoking Alcohol (to excess) Climatic changes

Chronic Plaque Psoriasis Scalp Psoriasis Guttate Psoriasis Flexural Psoriasis Localised Pustular Psoriasis Generalised Pustular Psoriasis Erthrodermic Psoriasis

Treatments Treatment choices include:

Step 1 Topical therapy Step 2 Phototherapy Step 3 Systemic therapy Step 4 Biologics

Emollients Moisturise dry skin, diminish desire to

scratch, and reduce need for topical therapies

Creams; Dermol 500, Diprobase, Cetomacrogol. Hydromol, Aveeno.

Ointments; 50:50 WSP, Epaderm/Hydromol, emulsifying ointment

Coal Tar One of the oldest and most widely used

treatments Slows rapid proliferation of skin cells and

restores skin appearance Reduces inflammation, itching and scaling Applied directly to the skin Strengths 2%, 5% and 10% New strength patch tested approx every 3

days

Dithranol Effective remedy for psoriasis lesions, used for

many years Dithranol accumulates in mitochondria where it interferes

with the supply of energy to the cell, probably by oxidation releasing free radicals. This impedes DNA replication and so slows the excessive cell division that occurs in psoriatic plaques. In addition Dithranol may act by reducing the elevated levels of cGMP that occurs in psoriasis. Applied directly to skin plaques

Strengths 0.1% to 15% Dose gradually increased as resistance is built up Can cause irritation and discolouration of skin not

affected by psoriasis

Vitamin D Analogues

Calcipotriol (dovonex) BD Calcitriol (Silkis) BD Tacalcitriol (Curatoderm) OD Dovobet –combines strong steroid with

dovonex Work well to clear psoriasis Have few side effects

Phototherapy Skin exposed to wavelengths of ultraviolet

light

2 types available – UVA and UVB

Treatment with UVA is helped by taking tablets known as psoralens – known as PUVA therapy

Tablet / Systemic therapy

Neotigason (Acitretin) – once daily

Ciclosporin – once daily

Methotrexate – once weekly

Mycophenolate mofetil – once daily

These are antibodies or receptor blockers to TNF alpha

Given via intravenously or subcutaneous administration and multiple dose

Main problems increased risk of infections, antibody formation, expense of the drug

Provides application of topical therapies

Provides support and education

Long stay patients can have more than 1 topical applications

Encourages self management of psoriasis

Difficult to reach areas can be treated e.g. Back, scalp, feet