Troublesome rash Flashcards
features of psoriatic nails
- periungal erythema
- pitting
- subungal hyperkeratosis - scalling over plaques
- oncholysis
presentation of psoriasis
erythmatous, flaky plaques
typical distribution - extensor
- ears
- umbilicus
- genetalia
- nails
- knees
- toe nails
- scalp
- elbows
- natal cleft
Guttate psorisasis
small pink plaques of psoriasis seen on trunk
often after streptococcal sore throat
more common in younger individuals
1/3 get chronic plaque psoriasis
erythradermic psoriasis
if psoriasis flares up and becomes inflammed and covers >90% of body surface area = erythroderma
skin hot, red, painful
plaques no longer well defined
patients can be unwell and hypotensive
should be admitted to hospital
generalised pustular psoriasis
rarely psoriasis can become red, hot painful and develop pustules within plaques
emergency
trigger = withdrawal of super potent topical steroid which has been used for several months over a large body surface area or systemic corticosteroid therapy
Triggers:
- psychological stress
- alcohol
- medications: antimalarials, NSAIDs, beta blockers, lithium, terbinafine (oral antifungal)
- FH
Managment of psoriasis
- avoid triggers
- emolliants
- shampoos for scalp
- topical corticosteroids - face and flexures
- vitamin D analogues - trunk and limbs
- coal tar preparations
- phototherapy - UVB and UVA
- methotrexate, retinoids, ciclosporin
- biological therapy if methotrexate and ciclosporin dont work
Referring to dermatology
- erythroderma or pustular - same day
- diagnosis uncertain
- extensive >10% total body surface area
- severe disabiling psoriasis - major impact physically, psychologically or socially
- failure to respond to topical therapies
- unstable/rapidly extending psoriasis
- nail disease major functional or cosmetic impact
- acute guttate psoriasis that requires phototherapy
patients with severe psoriasis are now known to have an
increased risk of T2DM, hyperlipidaemia and metabolic syndrome
