IDENTIFICATION AND MANAGEMENT PSORIASIS IDENTIFICATION AND MANAGEMENT

How can psoriasis present? Plaques Flexural Guttate Scalp Hands and feet nails

Plaque psoriasis

Guttate psoriasis

Flexural psoriasis

Scalp psoriasis

Nail psoriasis

Hand and foot psoriasis

Management- 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 continued Dithranol an option if motivated and able to apply correctly Limited response- consider UVB Systemic therapy- Methotrexate / Neotigason Biological agents

Guttate 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 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 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’d Maintain with 1-2 x a week vitamin d analogue or weakest topical steroid that will control + tar based shampoo.

Nail psoriasis Exclude fungal infection- clippings Nothing works topically. Nail varnish for women

Hands 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 psoriasis Does not mean infection

Useful sources of information www.bad.org.uk www.pcds.org.uk www.psoriasis-association.org.uk www.dermnet.org.nz www.patient.co.uk