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