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''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