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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
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
psoriasis2
Psoriasis

Guttate

Emollients (anti-proliferatives effect)

Coal tar (1-10% in WSP – messy and offensive, but ‘psoriderm and alphosyl HC

psoriasis3
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
psoriasis4
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)

psoriasis5
Psoriasis
  • Flexural
  • Steroids
  • Vit D analogues – with caution
psoriasis6
Psoriasis

Pustular Palmar plantar (Pompholyx)

Potent steroid +/- occlusion

Combination with Vit D analogue

PUVA

Systemic treatment

DIFFICULT TO CONTROL

psoriasis7
Psoriasis
  • Erythrodermic Psoriasis
  • Immediate referral to specialist
  • Avoid by limited and careful use of steroids and healthy respect for active/ evolving disease