Psoriasis Clive Tubb CNS Dermatology
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)
Cause • Strong genetic link • No clear cut inheritance pattern • Poorly understood • ???
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.
Triggers • Infection • Climate change • Trauma • Alcohol & smoking • Stress
Salmon-pink plaques, sharply marginated with white scale Scales are, loose and easily removed by scratching Skin lesions
Distribution • Single lesion or lesions localised to one area. • Regional involvement (scalp, palmar/plantar) • Generalised
Bilateral, often symmetrical, favours elbows, knees and scalp. Pattern
Disseminated small lesions with random site (guttate psoriasis) Pattern
Stigma Body image Experiences of being an outsider Less social contact & understanding from friends Difficulties in personal & sexual relationships Resignation & helplessness Frustration Psychosocial implications
Realistic goal setting Agreed management plan Hydrate plaques and soften scale with emollients Discuss topical treatment options and plan review Management
Emollient Topical steroid, hydrocortisone 1%, eumovate cream. Calcitriol Tacalcitol Management
Widespread Guttate psoriasis Generally requires referal to secondary care UVL therapy Topical treatments can help but slow and difficult for patient Management
Scalp psoriasis often stubborn and troublesome Soften scale and lift scale Topical lotions more acceptable for patients Management
Palmar/Plantar psoriasis Soften hyperkeratosis Topical steroid agents Usually requires higher strength to be effective UVL therapy Management
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