1. Kate Blake Lead Nurse Dermatology
PSORIASIS
Kate Blake
Lead Nurse Dermatology

2. Psoriasis Is a chronic inflammatory skin disease
Affects 3% of U.K. population
75% are successfully managed in the community with topical treatments (Griffiths,2004)
Also common in India, Far East and parts of Africa

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

4. Trigger Factors
Infection
Medication
Alcohol & Smoking
Climate Change
Skin Trauma
Stress

5. Pathology Epidermal Hyperproliferation
Accumulation of inflammatory cells
Increased vascularity of the upper dermis

6. Chronic Plaque Psoriasis
Most common
Single or multiple plaques
Red, scaly surface
Vigorous rubbing causes capillary haemorrhage

7. Chronic Plaque Psoriasis
Predilection for knees, elbows, base of spine
Symmetrical, chronic, & stable
mms to cms in diameter
Sometimes causes itching

8. Treatment Options Dithranol / Micanol Dovonex / Dovobet
Topical steroids
Coal Tar
Ultra Violet Light
Systemics
Biologics

9. Guttate Psoriasis Often follows sore throats Common in young adults
Lesions about 1 cm diameter
Paler pink than established psoriasis
Often resolves rapidly
May enlarge & become stable plaques

10. Treatment Options Tar based ointment Dovonex ; Dovobet
Ultra violet light
Ultra violet light plus tar based ointment
Ultra violet light plus Dovonex

11. Flexural Psoriasis May accompany plaque psoriasis
Occurs in groin,natal cleft, axillae & submammary folds
Maceration leaves beefy erythematous rash
Often itchy
Subject to secondary contact sensitivity

12. Treatment Options Can be problematic
Mild tar/corticosteroid mixtures may be effective
Steroids can cause striae
Low concentrations of dithranol may burn delicate areas
nUVB & PUVA can be effective if area is accessible

13. Scalp Psoriasis Common Scalp alone may be affected
Lesions very small to whole scalp cover
Occasionally thick and sticks in large chunks to hair
Temporary hair loss

14. Treatment Options
Tar shampoos
Betamoose
Scalp Blitz
UV combs

15. Chronic Palmo-plantar Psoriasis
Usually found alone
Erythematous with numerous pustules
Pustules become brown scaly spots & peel off
Painful
Small area or entire surface of palms or soles
May cause considerable disability

16. Treatment Options Topical treatments often ineffective
PUVA may give some control
Relapse is common

17. Nail Psoriasis Nail involvement frequent Nail pits Onycholysis
Can become discolored
Painful
Whole surface may become damaged

18. Exfoliative Erythroderma
Dermatological emergency
Plaques merge to cover most of skin
Can be slow or rapid
Systemic/ topical steroids may precipitate

19. Acute Pustular Psoriasis
Dermatological emergency
With or without pre existing psoriasis
Sudden development of widespread erythema
Pustules are sterile
May coalesce to form lakes of pus
High swinging temperature and unwell
Patient may die from secondary infection

20. Psoriatic Arthropathy
Affects up to 10% of people with psoriasis
Is erosive and may result in joint destruction

21. Interactive Time

22. Questions