The Topical Management of Psoriasis Alexandra Pyle Bsc

The Topical Management of Psoriasis Alexandra Pyle Bsc (Hons) Registered Nurse

What is Psoriasis? Psoriasis is a chronic inflammatory skin disorder characterised by thickened, scaly plaques

Causes of Psoriasis There is no definite cause for Psoriasis But two factors that can contribute to the development of psoriasis are: A Genetic Predisposition Direct injury to the skin (knoeber Phenomenon)

Triggers include Infection (streptococcal sore throat) Drugs / medications Stress Smoking Alcohol (to excess) Climatic changes

7 Types of Psoriasis Chronic Plaque Psoriasis Scalp Psoriasis Guttate Psoriasis Flexural Psoriasis Localised Pustular Psoriasis Generalised Pustular Psoriasis Erthrodermic Psoriasis

Plague Psoriasis

Scalp Psoriasis

Guttate Psoriasis

Flexural Psoriasis

Localised Pustular Psoriasis

Palmar Pustular Psoriasis

Generalised Pustular Psoriasis

Erthrodermic Psoriasis

Treatments Treatment choices include: Step 1 2 3 4 Topical therapy Phototherapy Systemic therapy Biologics

Emollients Moisturise dry skin, diminish desire to scratch, and reduce need for topical therapies Creams; Dermol 500, Diprobase, Cetomacrogol. Hydromol, Aveeno. Ointments; 50: 50 WSP, Epaderm/Hydromol, emulsifying ointment

Coal Tar One of the oldest and most widely used treatments Slows rapid proliferation of skin cells and restores skin appearance Reduces inflammation, itching and scaling Applied directly to the skin Strengths 2%, 5% and 10% New strength patch tested approx every 3 days

Dithranol Effective remedy for psoriasis lesions, used for many years Dithranol accumulates in mitochondria where it interferes with the supply of energy to the cell, probably by oxidation releasing free radicals. This impedes DNA replication and so slows the excessive cell division that occurs in psoriatic plaques. In addition Dithranol may act by reducing the elevated levels of c. GMP that occurs in psoriasis. Applied directly to skin plaques Strengths 0. 1% to 15% Dose gradually increased as resistance is built up Can cause irritation and discolouration of skin not affected by psoriasis

Vitamin D Analogues Calcipotriol (dovonex) BD Calcitriol (Silkis) BD Tacalcitriol (Curatoderm) OD Dovobet –combines strong steroid with dovonex Work well to clear psoriasis Have few side effects

Phototherapy Skin exposed to wavelengths of ultraviolet light 2 types available – UVA and UVB Treatment with UVA is helped by taking tablets known as psoralens – known as PUVA therapy

Tablet / Systemic therapy Neotigason (Acitretin) – once daily Ciclosporin – once daily Methotrexate – once weekly Mycophenolate mofetil – once daily

Biologic Therapy These are antibodies or receptor blockers to TNF alpha Given via intravenously or subcutaneous administration and multiple dose Main problems increased risk of infections, antibody formation, expense of the drug

Dermatology Day Care Unit Provides application of topical therapies Provides support and education Long stay patients can have more than 1 topical applications Encourages self management of psoriasis Difficult to reach areas can be treated e. g. Back, scalp, feet