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Psoriasis (Clinical presentation & Treatment (Chronic plaque psoriasis…

- - - - Scalp involvement is common and is most seen at the hair margin
      - Thickened epidermis
      - Well-demarcated disc-shaped, SALMON-PINK SILVERY PLAQUES occur on the exterior surface of the limbs, particularly the elbows and knees
      - New plaques of psoriasis occur at sites of skin trauma
      - Most common
    - - Emollients e.g. E45
      - Topical vitamin D analogues
        
        Inhibit cell proliferation and stimulate keratinocyte differentiation
      - Topical corticosteroids e.g. hydrocortisone
      - Topical retinoids e.g. Tazarotene
      - UV B or Coal Tar
      - Anti mitotic e.g. dithranol - USE ON LARGE PLAQUES ONLY
      - For extensive plaques
        
        Phototherapy with UV A
        
        Immunosuppressant e.g. Ciclosporin
        
        Disease modifying anti-rheumatic drug (DMARD)
        
        Inhibits folic acid metabolism thus inhibits DNA replication
        
        Leads to anti-proliferative and anti-inflammatory effect
        
        MUST give FOLIC ACID SUPPLEMENTS 48HRS AFTER TREATMENT
        
        Example - oral methotrexate
        
        Side effect - hepatotoxic
        
        Contraindications
        
        Pregnancy/breast feeding
        
        Hepatic disease/alcoholism
        
        Renal impairment
        
        Active infection
        
        Live vaccines
  - - - Scaling is ABSENT
      - Confined to flexures e.g. groin, natal cleft, sub-mammary areas
      - Well-demarcated red, glazed, non-scaly plaques
      - Can be mistaken for candida interring - but this will normally show satellite lesions
      - Tends to occur later in life
    - - 1st line
        
        Topical mild-moderate corticosteroids e.g. hydrocortisone
        
        Short course to avoid atrophy
      - 2nd line
        
        Topical vitamin D analogue
  - - - Generalised, concentrating on the trunk, upper arms and legs
      - An explosive eruption of very small circular or oval plaques appears over the trunk about 2 weeks after a STREP sore throat
      - Most commonly in children and young adults
    - - Topical mild-moderate corticosteroids
      - UV B
      - Coal Tar
  - - - Thickening of the palms and soles
    - - Keratolytic agents
      - Potent topical corticosteroids
      - Emollients
      - Phototherapy with UV A
      - Oral retinoid e.g. Acitretin
        
        Vitamin A derivative
        
        Anti-proliferative action
        
        Used alongside phototherapy
        
        Side effects: dry lips, eyes & mucosa, hyperlipidaemia, disturbed liver functions
        
        Tetratogenic thus contraindicated in pregnancy