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Psoriasis
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''exacerbate psoriasis'' trauma alcohol drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors withdrawal of systemic steroids well defined red plaques with silvery scale - symmetrical - elbows, knees, scalp, umbilicus, seldom itchy nail dystrophy - pitting, onycholysis, subungal hyperkeratosis Exacerbated by .... infection (strep A - guttate), alcohol, trauma drugs - BB, lithium, anti-malarials, alcohol, NSAID and withdrawing steroids Mx (see NICE guide) Topical - always emollient, ?steroid (not potent as can make stable Psoriasis unstable) and then vit D, then .... ?? (tar and dithranol - old fashioned, vitA problematical) Steroids - useful for short term 4/52 on 4/52 off max (flexure, face, 1-2/52 on max) Vit D - Calcipotriol (Dovonex) - good for plaques, use calcitriol or Tacocalcitol in flexures as less irritant Vit A - retinoid - Tazarotene - use sparingly to plaques ONLY as irritant ++ - MUST have effective contraception If very scaly - try anti-keratolytic -salicylic acid - esp useful on scalp Coal Tar - effective but messy - eg Cocois (easier) - inhibits DNA synthesis Dithranol - anthralin - effective but takes 3-4/52 to have effect, stains clothing and is irritant so unpopular, inhibits DNA synthesis 1st line on scalp - topical potent steroids daily for 4/52 then change formulation or add in salicylic acid / emollient to lift scale Refer urgently if erythrodermic or generalized pustular else if not responding to topicals NICE 1st emollients steroids od vit D od (not at same time) 2nd inc vit D to bd 3rd steroid bd or coal tar 2ndary care UVB 3x/wk, PUVA, (beware skin ageing and SCC) Systemic non-biologic - Acitretin (vit A), Methotrexate(esp if joint disease also), Ciclosporin Systemic biologic DD Tinea Discoid eczema Pityriasis - versicolor or rosea Psoriasis Topical Emollients daily other .... coal tar - alphayl HC - cheap odourless - exovex lotion Vit D - Dovonex / dovobet - irritant so not on good skin - month on month off ?? Steroids - flexures, groin, face Protopic - thinner areas (eyelids) - really an eczema Rx Dithranol - good for stubborn thick plaque - increase dose slowly - stains the skin Inc acute MI with inc severity of Psoriasis - ? related to general inflammation ? related to drugs ?? Classic behind ears / in scalp, may itch, thick scaly plaques, well demarcated with normal skin in between, nail pitting, FH (genes plus immune factors) genitals / axillae - tend to be clear in eczema and bad in psoriasis aSx - remember tinea may start with stressful life event - trauma, bacterial infection (esp strep), psychology, drugs (lithium, BB, stopping steroid), koebernisation onset - 7-8yrs and 40-50yrs, F>M 4% childhood skin disease is psoriasis (cf to eczema at 20%), cf to 2% adult Pityriasis amoiontacea - psoriasis of scalp - goes up hair shaft - use cocois and capasal shampoo DD - tinea, lice, scabies, discoid eczema note ciclosporin inc BP, acitretin inc lipids
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Dermatology