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Psoriasis

  

Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales.


Psoriasis is a common disorder with a strong genetic disposition.

It is frequently encountered as plaques which the size of and involvement of vary widely.

Classical sites are the scalp, knees, elbows and base of spine, however, lesions of psoriasis can appear anywhere on the body surface

Record patient history
  1. Duration of psoriasis
  2. Possible triggers – infection, stress, alcohol, drugs
  3. Family history of psoriasis
  4. Occupation (including effect of disease)
  5. Medical history
  6. Drug history
  7. Patient expectations and ability to comply with treatment
  8. Quality of Life
Physical examination
  1. Check sites (elbows, knees, trunk, scalp, flexures, nails)
  2. Note character of lesions (demarcation, scales, thickness, erythema, pustulation)
  3. Note extent of cover
  4. Assess degree of itching and pain
  5. Assess associations, eg. arthropathy
Types of psoriasis and recommended treatments
Chronic Plaque Psoriasis

  • Usually symmetrically distributed
  • Large or small plaques
  • Often seen on extensor surfaces & scalp
  • White silvery scales on a salmon pink base                            
Treatments

  • Emollients
  • Tar preparations: Exorex
  • Vitamin D Analogues
  • (Dovonex ®, Curatoderm ®)
Facial Psoriasis

  • Commonly on eyelids and hairline

 

  • Emollients
  • Mild – Moderate topical steroid – HC 1%, Eumovate

 

Guttate Psoriasis

  • Numerous scaly ‘droplet’ lesions over trunk
  • May follow Streptococcal infection
  • Most common in children / adolescents

Self limiting 4 – 6 months

 

  • Emollients
  • Consider referral for Phototherapy
  • Systemic antibiotics if  Streptococcal infection is confirmed by throat swab

 

Flexural Psoriasis

  • Smooth glazed shiny red areas of skin, well demarcated (hairline, axillary, submammary, perineal)
  • More commonly seen in the elderly
  • May be secondarily infected with yeasts

 

 

Use mild – moderately potent steroid –  Hydrocortisone, Eumovate,  Daktacort ®,Trimovate ®

 

 

Scalp Psoriasis

White silvery scales on a salmon pink base

 

 

 

  • Tar based shampoo- Polytar ®, Capasal  ®
  • Tar based ointment to soften scale- Cocois ®  (medical supervsion under 12years)
  • Vitamin D analogue e.g. Dovonex  Scalp Lotion ®
  • Topical steroids – Bettamouse ® , Betnovate Scalp Lotion ®

 

Pre referral investigations

FBC, LFTs, fasting lipids, three sets of U&Es (within last 4 months) if patient is likely to start systemic therapy

Referral criteria
  • The rash fails to respond to management in primary care.
  • The rash is in a sensitive area (face, hands, feet, genitalia) and the symptoms are particularly troublesome.
  • The rash is sufficiently extensive to make self-management impractical.
  • The condition is causing severe social and psychological problems.
  • The patient has widespread guttate psoriasis (so that he /she can benefit from early phototherapy)
  • The patient’s psoriasis is acutely unstable.
  • The patient has generalised pustular or erythrodermic psoriasis.
  • Possible use and consideration of systemic therapy for management of widespread or unstable psoriasis.
  • The rash is leading to time off work or school.
  • The patient requires assessment for the management of associated arthropathy.
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Coventry Guidance

Coventry Dermatology Clinical Nurse Specialist

Tina Diaz, Dermatology Clinical Nurse Specialist
Coventry and Warwickshire Partnership Trust
CAS Services, 1st Floor
Coventry and Warwickshire Hospital

Tel: 07786963705
Email: Tina.Diaz@covwarkpt.nhs.uk

Rugby Guidance

Clinic Nurse Specialist not available.
Refer to dermatology when first line prescriptions fail.

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