Psoriasis for Dummies

Ramesh Mehay
Programme 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 dont 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

 Lets 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

Whats 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