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PSORIASIS

PSORIASIS. IDENTIFICATION AND MANAGEMENT. How can psoriasis present?. Plaques Flexural Guttate Scalp Hands and feet nails. Plaque psoriasis. Guttate psoriasis. Flexural psoriasis. Scalp psoriasis. Nail psoriasis. Hand and foot psoriasis. Management- Plaques.

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PSORIASIS

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  1. PSORIASIS IDENTIFICATION AND MANAGEMENT

  2. How can psoriasis present? • Plaques • Flexural • Guttate • Scalp • Hands and feet • nails

  3. Plaque psoriasis

  4. Guttate psoriasis

  5. Flexural psoriasis

  6. Scalp psoriasis

  7. Nail psoriasis

  8. Hand and foot psoriasis

  9. Management- Plaques • Depends on amount of body surface affected. • Consider psychological impact and discuss • Emollient • Topical vitamin d analogue +/- moderately potent topical steroid short term. • Caution regarding Dovobet • Exorex for small multiple plaques • review

  10. Plaque continued • Dithranol an option if motivated and able to apply correctly • Limited response- consider UVB • Systemic therapy- Methotrexate / Neotigason • Biological agents

  11. Guttate psoriasis • May occur after a streptococcal throat infection • Often resolves after a few weeks • Topical tar e.g. Exorex • Mild topical steroid • Consider referral for UVB if not improving

  12. Flexural Psoriasis • Often treated as thrush- look for clues • Milder vitamin d analogue( tacalcitol / calcitriol). Topical steroid ( clobetasone butyrate) • Reduce frequency when settled to maintain control

  13. Scalp psoriasis • Challenging and requires dedication • Psoriasis association advice sheet explains how to apply treatments. • Mild - tar based shampoo used twice a week • Moderate - above+ calcipotriol or betamethasone scalp application 2-3 times a week • Severe – salicylic acid/ coal tar applied and left on overnight, comb out, wash then apply steroid/ vitamin d application.

  14. Scalp cont’d • Maintain with 1-2 x a week vitamin d analogue or weakest topical steroid that will control + tar based shampoo.

  15. Nail psoriasis • Exclude fungal infection- clippings • Nothing works topically. • Nail varnish for women

  16. Hands and feet • Can be a challenge. • Emollient – thicker and possibly urea based • Salicylic acid to soften scale • Potent topical steroid – ointment/ occlusion • Vitamin d analogues bit impractical as need to apply a thick layer • Refer for PUVA and possibly systemic treatment

  17. Pustular psoriasis • Does not mean infection

  18. Useful sources of information • www.bad.org.uk • www.pcds.org.uk • www.psoriasis-association.org.uk • www.dermnet.org.nz • www.patient.co.uk

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