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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 • 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 Plaque continued • Dithranol an option if motivated and able to apply correctly • Limited response- consider UVB • Systemic therapy- Methotrexate / Neotigason • Biological agents 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 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 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. Scalp cont’d • Maintain with 1-2 x a week vitamin d analogue or weakest topical steroid that will control + tar based shampoo. Nail psoriasis • Exclude fungal infection- clippings • Nothing works topically. • Nail varnish for women 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 Pustular psoriasis • Does not mean infection 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
