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Psoriasis

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Psoriasis. Onset 15-40 years of age; rare under 10. Prevalence varies ... Potent steroid /- occlusion. Combination with Vit D analogue. PUVA. Systemic treatment ... – PowerPoint PPT presentation

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Title: Psoriasis


1
Psoriasis


  • Onset 15-40 years of age rare under 10
  • Prevalence varies
  • (3) in northern Europe and Scandinavia
  • (0.5)North American Indians (!)
  • Genetics
  • 1 first degree rel 30 prevalence (60with 2)
  • Environment
  • Strep. / HIV
  • Trauma (Koebners)
  • Alcohol/ NSAIDS/ antimalarials/ ACE inhibitors/
    lithium
  • Stress

2
Psoriasis
Guttate Emollients (anti-proliferatives
effect) Coal tar (1-10 in WSP messy and
offensive, but psoriderm and alphosyl HC
3
Psoriasis
  • Stable plaque psoriasis (As above plus.)
  • Vit. D Analogues (Calcipotriol, Tacalcitol,
    Calcitriol) (NB UV, washing, calcium)
  • Not steroids on their own rebound and risk of
    erythroderma
  • Dithranol (0.1 - 3) must be stable, SCDT,
    avoid flexures and face
  • Tazarotene (Zorac) retinoid , up to 10 area
    with care, stable, 12 weeks
  • PUVA
  • Ciclosporin/ Methotrexate/ Etanercept
    (cytokines)/ Efalizumab (TNF)
  • Acitretin

4
Psoriasis
Scalp Psoriasis Cocois (12 coal tar/ salicylic
acid 2/ Sulphur 4/ coconut oil) Tar shampoos
(capasal/ polytar/ T-Gel) Potent topical steroids
(Betamethasone / Clobetasol ) Vit D analogue
(calcipotriol scalp soln. BD)
5
Psoriasis
  • Flexural
  • Steroids
  • Vit D analogues with caution

6
Psoriasis
Pustular Palmar plantar (Pompholyx) Potent
steroid /- occlusion Combination with Vit D
analogue PUVA Systemic treatment DIFFICULT TO
CONTROL
7
Psoriasis
  • Erythrodermic Psoriasis
  • Immediate referral to specialist
  • Avoid by limited and careful use of steroids and
    healthy respect for active/ evolving disease
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