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Psoriasis

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Psoriasis

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

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

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

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

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

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

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

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

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

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

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

  17. Explanation of treatment options. Realistic goal setting Assessments/reviews & support with treatments and lifestyle An agreed skin care plan and monitoring Encouragement and motivation Finally