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PSORIASIS. IDENTIFICATION AND MANAGEMENT. How can psoriasis present?. Plaques Flexural Guttate Scalp Hands and feet nails. Plaque psoriasis. Guttate psoriasis. Flexural psoriasis. Scalp psoriasis. Nail psoriasis. Hand and foot psoriasis. Management- Plaques.

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  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 • www.bad.org.uk • www.pcds.org.uk • www.psoriasis-association.org.uk • www.dermnet.org.nz • www.patient.co.uk

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