Transcript Psoriasis_Talk_Higham_Hall-14.3.12

•
Psoriasis
• Dr Fayyaz Chaudhri
• Maryport Health Services
The Meeting Today
• Learn about psoriasis
• Treatment options
Acknowledgements
• http://www.dermnetnz.org/
Psoriasis
•
•
•
•
•
•
Male=female
Late teens or over 50
2% of population
Wide spectrum of disease
Upto 20% associated arthritis
Familial
March of psoriasis
disease progression:
IL /TNF
skin
co-morbidities
Look for associated conditons
•
•
•
•
•
•
•
Fatty (non alcohol) liver – 47% vs 28% normal pop.
High prevalence alcohol problems – death rate 4-5x higher
Non melanoma skin cancers
Depression and suicide risk, anxiety
Metabolic syndrome – BP sugar , cholesterol
High risk cardiovascular problems
Arthritis – upto 30%, ask specifically, EMS , heel pain
( MXR does not prevent it, biologicals might)
• Crohns
Types of Psoriasis
•
•
•
•
•
•
•
Small plaque
Large plaque
Flexural /genital
Guttate
Palmar-plantar ( pustular)
Scalp psoriasis
Nail psoriasis
History – patient’s story
• Occupation
• Where is the psoriasis
• Home circumstances
• What problems
• expectations
• Any specific requests
Guttate Psoriasis
TREATMENT OPTIONS
MOISTURISERS
Coal Tar
Mild topical steroid
Streptococcal infection
UVB therapy
Scalp Psoriasis
• Salicylic acid/coconut oil/ coal tar /sulphur
compounds – to lift scale
• Steroid scalp applications
• Calcipotriol (dovonex) scalp lotions
• Xamiol gel – combi steroid/calcipotriol
• Tar shampoos
• moisterisers
Chronic Plaque Psoriasis
•
•
•
•
•
•
•
Emollients - moisterisers
Salicylic Acid
Coal Tar (exorex lotion)
Calcipotriol (dovonex)
Dithranol
Topical steroids (betnovate)
Combination = dovobet
Chronic Plaque Psoriasis
•
•
•
•
•
•
•
Emollients - moisterisers
Salicylic Acid
Coal Tar
Calcipotriol
Dithranol
Topical steroids
Combination steroid/calcipotriol =dovobet
Chronic Plaque Psoriasis
•
•
•
•
•
•
Emollients - moisterisers
Salicylic Acid
Coal Tar
Calcipotriol
Dithranol
Steroids
Flexural psoriasis
In some patients, psoriasis localises to the skin folds and genitals:
•Armpits
•Groin
•Under the breasts
•Umbilicus (navel)
•Penis
•Vulva
•Natal cleft (between the buttocks)
•Around the anus
Many patients have typical psoriasis elsewhere.
Scalp psoriasis
Sebo-psoriasis
Sebo-psoriasis is an overlap between psoriasis and
seborrhoeic dermatitis
Psoriasis of the palms and soles
Psoriasis may predominantly affect the palms and soles in various ways:
•Typical scaly, red patches similar to psoriasis elsewhere
•Generalised thickening and scaling of the palms and soles
(keratoderma)
•Sheets of tiny yellow-brown pustules (palmoplantar pustulosis).
Palmoplantar psoriasis
pitting
Total nail destruction
Subungal hyperkeratosis
onycholysis
Dermatology services
•
•
•
•
Messy treatments
Oral drugs – methotrexate, biologicals, retinoids
UVB/ UVA
Expertise & support
• NICE guidelines on the way
• Continuous vs interrupted therapy; have a logical
approach to systemic therapies – lower threshold
to use systemic Rx nowadays:
• Methotrexate – consider Pro collagen 3 every 2m
as well as LFTs
• Acitretin
• Ciclosporin (not for over 50s due to age related
renal impairment, best in kids and pregnancy)
• Fumaric acid esters – not licensed in UK
• Biologicals
• Combinations