Clive Tubb CNS Dermatology Psoriasis Clive Tubb CNS Dermatology

What is it? Psoriasis is a chronic inflammatory skin disease Affects 3% of UK population 75% are successfully managed in the community with topical treatments (Griffiths 2004)

Cause Strong genetic link No clear cut inheritance pattern Poorly understood ???

Pathology Epidermal hyperproliferation Principally affecting cell kinetics of keratinocytes The major change is shortening of cell cycle from 311 to 36h, resulting in 28 times the normal production of epidermal cells.

Triggers Infection Climate change Trauma Alcohol & smoking Stress

Skin lesions Salmon-pink plaques, sharply marginated with white scale Scales are, loose and easily removed by scratching

Distribution Single lesion or lesions localised to one area. Regional involvement (scalp, palmar/plantar) Generalised

Pattern Bilateral, often symmetrical, favours elbows, knees and scalp.

Pattern Disseminated small lesions with random site (guttate psoriasis)

Pattern Can also affect specific sites only such as scalp, palms and feet.

Psychosocial implications Stigma Body image Experiences of being an outsider Less social contact & understanding from friends Difficulties in personal & sexual relationships Resignation & helplessness Frustration

Management Realistic goal setting Agreed management plan Hydrate plaques and soften scale with emollients Discuss topical treatment options and plan review

Management Emollient Topical steroid, hydrocortisone 1%, eumovate cream. Calcitriol Tacalcitol

Management Widespread Guttate psoriasis Generally requires referal to secondary care UVL therapy Topical treatments can help but slow and difficult for patient

Management Scalp psoriasis often stubborn and troublesome Soften scale and lift scale Topical lotions more acceptable for patients

Management Palmar/Plantar psoriasis Soften hyperkeratosis Topical steroid agents Usually requires higher strength to be effective UVL therapy

Finally Explanation of treatment options. Realistic goal setting Assessments/reviews & support with treatments and lifestyle An agreed skin care plan and monitoring Encouragement and motivation