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Psoriasis

Psoriasis. Psoriasis. Definition and causes Types GP management Pitfalls Hospital treatments. Psoriasis. Definition A chronic, non-infectious, inflammatory skin disorder, with well defined, erythematous plaques & large adherent silvery scales Prevalence 1.5-3%

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Psoriasis

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  1. Psoriasis

  2. Psoriasis • Definition and causes • Types • GP management • Pitfalls • Hospital treatments

  3. Psoriasis • Definition A chronic, non-infectious, inflammatory skin disorder, with well defined, erythematous plaques & large adherent silvery scales • Prevalence 1.5-3% • Age onset 20-30y or 50-60y

  4. Psoriasis • Epidermal hyperproliferation • Vascular dilatation • Inflammatory infiltrate

  5. What causes psoriasis ? • T cell mediated autoimmune disease → increased keratinocyte proliferation • Environmental and genetic factors

  6. Psoriasis • Genetics • 40% have FHx • 73% monozygotic twins concordant v 20% dizygotic twins • 1st degree relatives have 4-6 fold increased risk • Environmental triggers

  7. GP Management • Time (for proper examination and to communicate with the patient) • Explanation • Information and support sources (patient.co.uk, psoriasis-association.org.uk) • Follow-up

  8. GP Management • Emollients • Bath oils • Site-specific topical treatments

  9. Topical treatments • Vitamin D analoguesDovonex (calcipotriol)Dovobet (calcipotriol & betamethasone)Silkis (calcitriol)Curatorderm (tacalcitol)Zorac (tazarotene) • Dovonex cream and scalp application no longer available

  10. Topical treatments • Tar(Carbo-dome)(Exorex)Psoriderm(Alphosyl HC)Sebco(Cocois)Tar-based bath oils & shampoos

  11. Topical Treatments • SteroidsOften in conjunction with Vit D analogue as Dovobet or separate steroidEumovate(Trimovate)Scalp preparations (eumovate to dermovate strength) • BE CAREFUL (but not mean)

  12. Topical Treatments • DithranolDithrocreamMicanolPsorin • Stains skinHas to be washed offStart and low strength and build up

  13. Topical treatments • Nails difficult potent topical steroids dovonex tazarotene systemic therapy

  14. Topical Treatments • Scalp Remove scale firstCocois or Sebco messy but effective Tar or salicylic acid shampoo Topical steroids if necessary for short periods

  15. Types of psoriasis • Plaque • Guttate • Rupioid • Unstable • Pustular • Erythrodermic • ?palmo-plantar pustulosis

  16. Guttate psoriasis

  17. Pustular psoriasis

  18. Erythrodermic psoriasis

  19. Plantar pustulosis

  20. Acrodermatitis continua of Hallopeau

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