Transcript Psoriasis - Barnsley VTS

Psoriasis
By Anna Hodge
19.12.12
Objectives
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Recognise psoriasis
Know the first line treatments for psoriasis
Use topical corticosteroids safely
Know when to refer
Psoriasis
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What is it?
What does it look like?
How do I treat it?
When should I refer?
What is Psoriasis?
• Immune-mediated disease affecting the
skin
• Causes over production of new skin cells
• Genetic component and can be triggered
by stress
• Also affects nails and joints
What does it look like?
• Red scaly patches
• Well defined
• Symmetrical
• Plaque psoriasis
• Scalp psoriasis
• Guttate psoriasis
NICE guidance
• Topical therapy is first line
• Offer referral for phototherapy or systemic
therapy
– Extensive disease (<10% of body affected)
– Where topical Rx is ineffective
How to use topical steroids safely
• Risks
– Irreversible skin atrophy or striae
– Unstable psoriasis
– Systemic side effects
How to avoid s/e
• Very potent corticosteroids
– 4 weeks max
• Potent corticosteroids
– 8 weeks max
• 4 week break between courses
• Use non-steroid based Rx in the break eg
Vitamin D or coal tar preparations
• Do not use potent or v. potent topical steroid on
face, flexures, genitals
• Or in children
Topical Corticosteroids
• Very potent (600x Hc)
– Clobetasol dipropionate (Dermovate)
• Potent (100-150x Hc)
– Betamethasone Valerate (Betnovate)
– Mometasone Furoate (Elocon)
• Moderate (20-50x Hc)
– Betamethasone Valerate 1:4 (Betnovate RD)
– Clobetason Butyrate (Eumovate)
• Mild
– Hydrocortisone
Management
• Step 1
– Potent steroid mane
– Vitamin D nocte
– For 4-8 weeks
• Step 2
– Vit D BD
– 8-12 weeks
Management continued
• Step 3
– Potent corticosteroid BD for up to 4 weeks
• OR
– Coal tar preparation OD or BD
• Offer once daily combined Steroid and
Vit D if this would improve compliance
Reviewing Rx
• Review 4 weeks after starting a new
topical treatment
– Evaluate tolerability, initial response
– Reinforce importance of adherence
– Reinforce importance of 4 week break
between potent and v potent steroid courses
• Patients should have annual rv
Review
• Ensure patients understand that relapse
occurs in most people after treatment
stopped
• Topical treatments can be used when
needed to maintain satisfactory disease
control
• If psoriasis cannot be controlled with
topical therapy alone- specialist referral
2nd and 3rd Line Therapy
• Phototherapy
• Systemic therapy- methotrexate,
ciclosporin etc
• Biologics- Infliximab etc
Summary
• Psoriasis is an immune mediated condition
affecting skin, nails, joints
• Topical treatment is 1st line
– Potent steroids and Vit D
– Coal tar preparations
• Effective communication with patient to aid
compliance with treatment
• Refer for Phototherapy/systemic therapy if
not responding