Psoriasis for Dummies Ramesh Mehay Programme Director Bradford

Psoriasis for Dummies Ramesh Mehay Programme Director (Bradford VTS)

• This presentation will not concentrate on the aetiology/pathogenesis/epidemiology of psoriasis • You can find all that in electronic text books • Instead, we will concentrate on the practical side of things • Things which most doctors have difficulty with

Types of Psoriasis • Can you spot which types of psoriasis these are? • Each Power. Point slide has notes which tells you more about the condition if you want to know more • But I suggest you don’t spend too long here. • Being able to recognise them and noting their specific key points is more important

• Remember, with all these slides if you are having difficulty recognising what it is, go back to basics and describe to yourself what you SEE • Are you ready?

First one. . .

Psoriasis Vulgaris • Is a common psoriatic pattern you see • Think: scalp, lumbosacral, elbows and knees • Can you describe what the lesions look like?

Characteristically, they are 1. well-defined, raised, erythematous and scaly lesions , which are "salmon pink" or "full rich red" in colour 2. surface silvery scale which may be easily removed often leading to pin - point capillary bleeding (Auspitz sign) 3. they may or may not itch but this is not usually a prominent feature

• Let’s go a bit quicker

Number Two

How do you treat it? • often erupts suddenly after an acute group B haemolytic streptococcal pharyngitis • So, may need to give antibiotics • Then wait and see • May rapidly disappear or form stable plaques • If stable plaques form: calcipotriol, high potency steroids, light therapy • Tonsillectomy if recurrent sore throats with guttate flare ups?

And the third

What’s important about this type of psoriasis? • It can be life threatening • Esp: high output cardiac failure (so bell the lungs!) • Thermoregulation problems, dehydration and septicaemia can result. • (Admit them straightaway for methotrexate + cyclosporin Rx) • One of the few dermatological emergencies.

Number Four

Why is this one important? • Acute pustular psoriasis is a potentially life threatening disease • Attacks may be precipitated by infection, drugs, pregnancy, or the withdrawal of topical or systemic corticosteroid therapy. • The patient may present with a high, swinging fever of non -infective origin, but secondary infections may occur (and is potentially lethal). • (Admit them straightaway for methotrexate + cyclosporin Rx) • Another one of the few dermatological emergencies.

The Final Fifth

What do you do about it? Palmoplantar psoriasis is difficult to treat. Both hyperkeratosis and inflammation should be treated separately • a keratolytic agent for hyperkeratosis • calcipotriol or a moderately potent topical corticosteroid (e. g. betnovate-RD (R) ointment) may help. • isotretinoin has also been used to treat pustular psoriasis • acitretin or methotrexate may be needed in disabling palmoplantar psoriasis

Things that cause difficulty • Unstable Psoriasis • Psoriatic arthritis • Scalp Psoriasis

General Treatment

Specific Treatment