1. Department of Dermatology
Psoriasis
Karolyn Wanat, MD
Department of Dermatology
University of Iowa

2. Objectives Describe clinical features of psoriasis
Recognize comorbidities of psoriasis
List first line therapies for psoriasis

4. Clinical Presentation
Common
Chronic
Recurrent
Common (1-2% of population), chronic, recurrent
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5. Guttate
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6. Palmoplantar
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7. Inverse
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8. Nail Findings
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9. Clinical Presentation
Red papules and plaques with adherent silvery scale
Extensors, scalp, umbilicus, posterior auricular areas, gluteal cleft, nails
Intertriginous areas: macerated not scaly (Inverse psoriasis)
Nail changes: pitting, onycholysis, oil spots, hyperkeratosis
Koebnerization: Development at sites of trauma
Pt can have mix of pso vulgaris and inverse

10. Types of Psoriasis Plaque psoriasis Guttate Inverse
Generalized pustular psoriasis (von Zumbusch)
Acrodermatitis continua of hallopeau
Impetigo herpetiformis
Erythrodermic psoriasis
Sebopsoriasis

11. Differential Diagnosis
Seborrheic dermatitis Psoriasis
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12. Differential Diagnosis
Lichen simplex chronicus Psoriasis
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13. Differential Diagnosis
Atopic Dermatitis Psoriasis
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14. Differential Diagnosis
Nummular Dermatitis Psoriasis
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15. Differential Diagnosis
Dermatophyte Psoriasis
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16. Risk Factors? Genetic predisposition
~40% of patients with psoriasis or psoriatic arthritis have a family history of these disorders in first-degree relatives
Multiple susceptibility loci for psoriasis
MHC Class I associations
Often family history

17. Triggers Drugs Beta blockers Lithium ACEIs Antimalarials Terbinafine
CCBs
Interferon
G-CSF
Stress
Infections
Strep
URI
HIV

19. Morbidity/Associations
Arthritis
Obesity
Hypertension
Diabetes
Metabolic syndrome
Cardiovascular, cerebrovascular, and peripheral vascular disease
Malignancy
Inflammatory bowel disease
Alcohol use
Serious infections
Autoimmune disorders
Ocular disease

20. Evaluation of Psoriatic Patient
Joint involvement?
10% of patients have Psoriatic Arthritis (PsA)
Estimated body surface area (BSA)?
Palm of patient = 1% total BSA
Disease Severity:
Mild <5% BSA
Moderate = 5-10% BSA
Severe >=10% BSA
Evaluation for co-morbidities: HTN, diabetes, hyperlipidemia
Counseling on smoking, alcohol, weight loss

22. Therapy Topicals Systemic Phototherapy: nbUVB Methotrexate Emollients
Corticosteroids
Tazarotene
Calcipotriene
Tacrolimus
Tar
Anthralin
Phototherapy: nbUVB
Systemic
Methotrexate
Cyclosporine
Acitretin
Anti-TNF agents
Infliximab
Adalimumab
Etanercept
Ustekinumab (IL-12, IL-23 antagonist)
Apremilast
IL17 inhibitors
Oral steroids result in REBOUND
Ambient sun exposure in very mild cases

23. Topical Therapy Corticosteroids
On face and in folds: hydrocortisone 2.5% ointment
On body: Mid to high potency for 4 weeks
To avoid atrophy: pulse therapy: two weeks on, two weeks off; 3x/week
Alternate with non-steroidal: calcipotriene, tacrolimus
Refer if >5%, guttate, arthritis for systemic therapy
Ambient sun exposure in very mild cases

24. Thank you!!