Psoriasis for Dummies

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Psoriasis for Dummies

• Ramesh Mehay
• Programme Director (Bradford VTS)

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• This presentation will not concentrate on the
  aetiology/pathogenesis/epidemiology of psoriasis
• You can find all that in electronic text books
• Instead, we will concentrate on the practical
  side of things
• Things which most doctors have difficulty with

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Types of Psoriasis

• Can you spot which types of psoriasis these are?
• Each PowerPoint slide has notes which tells you
  more about the condition if you want to know more
• But I suggest you dont spend too long here.
• Being able to recognise them and noting their
  specific key points is more important

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• Remember, with all these slides if you are having
  difficulty recognising what it is, go back to
  basics and describe to yourself what you SEE
• Are you ready?

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First one...
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Psoriasis Vulgaris

• Is a common psoriatic pattern you see
• Think scalp, lumbosacral, elbows and knees
• Can you describe what the lesions look like?

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Characteristically, they are

• well-defined, raised, erythematous and scaly
  lesions , which are "salmon pink" or "full rich
  red" in colour
• surface silvery scale which may be easily removed
  often leading to pin - point capillary bleeding
  (Auspitz sign)
• they may or may not itch but this is not usually
  a prominent feature

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• Lets go a bit quicker

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Number Two
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How do you treat it?

• often erupts suddenly after an acute group B
  haemolytic streptococcal pharyngitis
• So, may need to give antibiotics
• Then wait and see
• May rapidly disappear or form stable plaques
• If stable plaques form calcipotriol, high
  potency steroids, light therapy
• Tonsillectomy if recurrent sore throats with
  guttate flare ups?

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And the third
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Whats important about this type of psoriasis?

• It can be life threatening
• Esp high output cardiac failure (so bell the
  lungs!)
• Thermoregulation problems, dehydration and
  septicaemia can result.
• (Admit them straightaway for methotrexate
  cyclosporin Rx)
• One of the few dermatological emergencies.

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Number Four
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Why is this one important?

• Acute pustular psoriasis is a potentially life
  threatening disease
• Attacks may be precipitated by infection, drugs,
  pregnancy, or the withdrawal of topical or
  systemic corticosteroid therapy.
• The patient may present with a high, swinging
  fever of non -infective origin, but secondary
  infections may occur (and is potentially lethal).
• (Admit them straightaway for methotrexate
  cyclosporin Rx)
• Another one of the few dermatological
  emergencies.

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The Final Fifth
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What do you do about it?

• Palmoplantar psoriasis is difficult to treat.
• Both hyperkeratosis and inflammation should be
  treated separately
• a keratolytic agent for hyperkeratosis
• calcipotriol or a moderately potent topical
  corticosteroid (e.g. betnovate-RD (R) ointment)
  may help.
• isotretinoin has also been used to treat pustular
  psoriasis
• acitretin or methotrexate may be needed in
  disabling palmoplantar psoriasis

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Things that cause difficulty

• Unstable Psoriasis
• Psoriatic arthritis
• Scalp Psoriasis

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General Treatment
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Specific Treatment