1. IDENTIFICATION AND MANAGEMENT
PSORIASIS
IDENTIFICATION AND MANAGEMENT

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

3. Plaque psoriasis

4. Guttate psoriasis

5. Flexural psoriasis

6. Scalp psoriasis

7. Nail psoriasis

8. Hand and foot psoriasis

9. 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

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

11. 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

12. 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

13. 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.

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

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

16. 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

17. Pustular psoriasis
Does not mean infection

18. Useful sources of information