Psoriasis (2)

Psoriasis (2)

Area of the body affected
1. Scalp
  1. Overnight treatment of salicylic acid
  2. Tar preparations
  3. Oil preparations
    1. Olive oil or coconut oil
2. Facial and flexor surfaces
  1. Moderate corticosteroids e.g. cloebastone butyrate first
  2. Vitamin D analogues or tacrolimus ointment for intermittent use
3. Widespread
  1. Dithranol and potent steroids are not recommended
Second line management
1. Narrow-band UVB
  1. Offered to patients with plaque psoriasis which is not controlled by topical steroids
  2. Given 2/3 times a week
  3. Time and accessibility to UVB equipment
2. Photochemotherapy
  1. Treats more extensive or resistant disease
  2. Given 2/3 times a week
  3. Side effects
    1. Nausea, burning sensation and pruritus
    2. Increased risk of skin damage and cancer
  4. Combined with oral retinoid derivative to decrease dose of UVA
3. Systemic agents
  1. Given for severe or refractory psoriasis
  2. Given to those with resistant psoriasis with significant impact on physical and psychological wellbeing
  3. First choice
    1. Ciclosporin for rapid or short term control, palmopalantar pustulosis or considering contraception
      1. Short term use 4-12 weeks
    2. Everyone else- methotrexate
      1. Extensive chronic plaque psoriasis
      2. Increase transamines and long term associated with liver fibrosis
  4. Second choice
    1. Acitretin
      1. Severe extensive psoriasis resistant to other therapy
        Combined with other treatments
    2. Fumaric acid
      1. Alternative others mentioned
Biological therapies
1. TNF medications
  1. Disease must be severe
  2. Psoriasis is not responding to alternative treatments
Prognosis
1. Early onset and family history- poor indicators
2. Pustular flares may be provoked by systemic corticosteroid therapy
Triggers
1. Strepococci infection
  1. Guttate psoriasis
    1. Appearance
      1. Scaly skin eruption which is symmetrical
      2. Mainly form over the trunk and limbs
      3. Crops of papules and small plaques with overlying scaling
    2. Seen in young adults
    3. Management
      1. UVB phototherapy for thin plaques
      2. Erythromycin for throat
    4. Can evolve into chronic plaque psoriasis in patients with positive family history of psoriasis
  2. Group A beta-haemolytic streptococci
Erythrodemic psoriasis
1. Entire skin becomes red
2. Dermatological emergency which is associated with fever, rigor and lymphadenopathy
3. Management
  1. Mild topical steroids
  2. Enter text here
4. Other causes of erythrodema
  1. Atopic eczema
  2. Cutaneous T cell lymphoma
  3. Allergic contact dermatits
  4. Seborrhoeic dermatits

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