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Psoriasis

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 (60%with 2) Environment Strep. / HIV Trauma (Koebners)

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Psoriasis

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  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 (60%with 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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