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• 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