1. Clive Tubb CNS Dermatology
Psoriasis
Clive Tubb
CNS Dermatology

2. 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)

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

4. 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.

5. Triggers
Infection
Climate change
Trauma
Alcohol & smoking
Stress

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

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

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

9. Pattern
Disseminated small lesions with random site (guttate psoriasis)

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

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

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

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

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

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

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

17. 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