Psoriasis for Dummies

Ramesh MehayProgramme 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 PowerPoint 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