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Psoriasis

Psoriasis. Dr Fayyaz Chaudhri Maryport Health Services. The Meeting Today. Learn about psoriasis Treatment options. Acknowledgements. http://www.dermnetnz.org/. Psoriasis. Male=female Late teens or over 50 2% of population Wide spectrum of disease Upto 20% associated arthritis

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Psoriasis

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  1. Psoriasis • Dr Fayyaz Chaudhri • Maryport Health Services

  2. The Meeting Today • Learn about psoriasis • Treatment options

  3. Acknowledgements • http://www.dermnetnz.org/

  4. Psoriasis • Male=female • Late teens or over 50 • 2% of population • Wide spectrum of disease • Upto 20% associated arthritis • Familial

  5. March of psoriasis disease progression: IL /TNF skin co-morbidities

  6. Look for associated conditons • Fatty (non alcohol) liver – 47% vs 28% normal pop. • High prevalence alcohol problems – death rate 4-5x higher • Non melanoma skin cancers • Depression and suicide risk, anxiety • Metabolic syndrome – BP sugar , cholesterol • High risk cardiovascular problems • Arthritis – upto 30%, ask specifically, EMS , heel pain ( MXR does not prevent it, biologicals might) • Crohns

  7. Types of Psoriasis • Small plaque • Large plaque • Flexural /genital • Guttate • Palmar-plantar ( pustular) • Scalp psoriasis • Nail psoriasis

  8. Occupation Home circumstances expectations Where is the psoriasis What problems Any specific requests History – patient’s story

  9. Guttate Psoriasis TREATMENT OPTIONS MOISTURISERS Coal Tar Mild topical steroid Streptococcal infection UVB therapy

  10. Scalp Psoriasis • Salicylic acid/coconut oil/ coal tar /sulphur compounds – to lift scale • Steroid scalp applications • Calcipotriol (dovonex) scalp lotions • Xamiol gel – combi steroid/calcipotriol • Tar shampoos • moisterisers

  11. Chronic Plaque Psoriasis • Emollients - moisterisers • Salicylic Acid • Coal Tar (exorex lotion) • Calcipotriol (dovonex) • Dithranol • Topical steroids (betnovate) • Combination = dovobet

  12. Chronic Plaque Psoriasis • Emollients - moisterisers • Salicylic Acid • Coal Tar • Calcipotriol • Dithranol • Topical steroids • Combination steroid/calcipotriol =dovobet

  13. Chronic Plaque Psoriasis • Emollients - moisterisers • Salicylic Acid • Coal Tar • Calcipotriol • Dithranol • Steroids

  14. Flexural psoriasis • In some patients, psoriasis localises to the skin folds and genitals: • Armpits • Groin • Under the breasts • Umbilicus (navel) • Penis • Vulva • Natal cleft (between the buttocks) • Around the anus • Many patients have typical psoriasis elsewhere.

  15. Scalp psoriasis Sebo-psoriasis Sebo-psoriasis is an overlap between psoriasis and seborrhoeic dermatitis

  16. Palmoplantar psoriasis • Psoriasis of the palms and soles • Psoriasis may predominantly affect the palms and soles in various ways: • Typical scaly, red patches similar to psoriasis elsewhere • Generalised thickening and scaling of the palms and soles (keratoderma) • Sheets of tiny yellow-brown pustules (palmoplantar pustulosis).

  17. pitting

  18. Total nail destruction

  19. Subungal hyperkeratosis

  20. onycholysis

  21. Dermatology services • Messy treatments • Oral drugs – methotrexate, biologicals, retinoids • UVB/ UVA • Expertise & support

  22. NICE guidelines on the way • Continuous vs interrupted therapy; have a logical approach to systemic therapies – lower threshold to use systemic Rx nowadays: • Methotrexate – consider Pro collagen 3 every 2m as well as LFTs • Acitretin • Ciclosporin (not for over 50s due to age related renal impairment, best in kids and pregnancy) • Fumaric acid esters – not licensed in UK • Biologicals • Combinations

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