psoriasis by anna hodge 19.12.12. objectives recognise psoriasis know the first line treatments for...
TRANSCRIPT
Psoriasis
By Anna Hodge
19.12.12
Objectives
• Recognise psoriasis
• Know the first line treatments for psoriasis
• Use topical corticosteroids safely
• Know when to refer
Psoriasis
• What is it?
• What does it look like?
• How do I treat it?
• When should I refer?
What is Psoriasis?
• Immune-mediated disease affecting the skin
• Causes over production of new skin cells
• Genetic component and can be triggered by stress
• Also affects nails and joints
What does it look like?
• Red scaly patches• Well defined• Symmetrical
• Plaque psoriasis
• Scalp psoriasis
• Guttate psoriasis
NICE guidance
• Topical therapy is first line
• Offer referral for phototherapy or systemic therapy– Extensive disease (<10% of body affected)– Where topical Rx is ineffective
How to use topical steroids safely
• Risks– Irreversible skin atrophy or striae– Unstable psoriasis– Systemic side effects
How to avoid s/e
• Very potent corticosteroids– 4 weeks max
• Potent corticosteroids– 8 weeks max
• 4 week break between courses• Use non-steroid based Rx in the break eg
Vitamin D or coal tar preparations• Do not use potent or v. potent topical steroid on
face, flexures, genitals• Or in children
Topical Corticosteroids
• Very potent (600x Hc)– Clobetasol dipropionate (Dermovate)
• Potent (100-150x Hc)– Betamethasone Valerate (Betnovate)– Mometasone Furoate (Elocon)
• Moderate (20-50x Hc)– Betamethasone Valerate 1:4 (Betnovate RD)– Clobetason Butyrate (Eumovate)
• Mild– Hydrocortisone
Management
• Step 1– Potent steroid mane– Vitamin D nocte– For 4-8 weeks
• Step 2– Vit D BD– 8-12 weeks
Management continued
• Step 3– Potent corticosteroid BD for up to 4 weeks
• OR
– Coal tar preparation OD or BD
• Offer once daily combined Steroid and
Vit D if this would improve compliance
Reviewing Rx
• Review 4 weeks after starting a new topical treatment– Evaluate tolerability, initial response– Reinforce importance of adherence– Reinforce importance of 4 week break
between potent and v potent steroid courses
• Patients should have annual rv
Review
• Ensure patients understand that relapse occurs in most people after treatment stopped
• Topical treatments can be used when needed to maintain satisfactory disease control
• If psoriasis cannot be controlled with topical therapy alone- specialist referral
2nd and 3rd Line Therapy
• Phototherapy
• Systemic therapy- methotrexate, ciclosporin etc
• Biologics- Infliximab etc
Summary
• Psoriasis is an immune mediated condition affecting skin, nails, joints
• Topical treatment is 1st line– Potent steroids and Vit D– Coal tar preparations
• Effective communication with patient to aid compliance with treatment
• Refer for Phototherapy/systemic therapy if not responding