the topical management of psoriasis
DESCRIPTION
The Topical Management of Psoriasis. Alexandra Pyle Bsc (Hons) Registered Nurse. What is Psoriasis?. Psoriasis is a chronic inflammatory skin disorder characterised by thickened, scaly plaques. Causes of Psoriasis. There is no definite cause for Psoriasis - PowerPoint PPT PresentationTRANSCRIPT
Alexandra Pyle Bsc (Hons)Registered Nurse
What is Psoriasis?
Psoriasis is a chronic inflammatory skin disorder characterised by thickened, scaly plaques
There is no definite cause for Psoriasis
But two factors that can contribute to the development of psoriasis are:
A Genetic Predisposition
Direct injury to the skin (knoeber Phenomenon)
Infection (streptococcal sore throat) Drugs / medications Stress Smoking Alcohol (to excess) Climatic changes
Chronic Plaque Psoriasis Scalp Psoriasis Guttate Psoriasis Flexural Psoriasis Localised Pustular Psoriasis Generalised Pustular Psoriasis Erthrodermic Psoriasis
Treatments Treatment choices include:
Step 1 Topical therapy Step 2 Phototherapy Step 3 Systemic therapy Step 4 Biologics
Emollients Moisturise dry skin, diminish desire to
scratch, and reduce need for topical therapies
Creams; Dermol 500, Diprobase, Cetomacrogol. Hydromol, Aveeno.
Ointments; 50:50 WSP, Epaderm/Hydromol, emulsifying ointment
Coal Tar One of the oldest and most widely used
treatments Slows rapid proliferation of skin cells and
restores skin appearance Reduces inflammation, itching and scaling Applied directly to the skin Strengths 2%, 5% and 10% New strength patch tested approx every 3
days
Dithranol Effective remedy for psoriasis lesions, used for
many years Dithranol accumulates in mitochondria where it interferes
with the supply of energy to the cell, probably by oxidation releasing free radicals. This impedes DNA replication and so slows the excessive cell division that occurs in psoriatic plaques. In addition Dithranol may act by reducing the elevated levels of cGMP that occurs in psoriasis. Applied directly to skin plaques
Strengths 0.1% to 15% Dose gradually increased as resistance is built up Can cause irritation and discolouration of skin not
affected by psoriasis
Vitamin D Analogues
Calcipotriol (dovonex) BD Calcitriol (Silkis) BD Tacalcitriol (Curatoderm) OD Dovobet –combines strong steroid with
dovonex Work well to clear psoriasis Have few side effects
Phototherapy Skin exposed to wavelengths of ultraviolet
light
2 types available – UVA and UVB
Treatment with UVA is helped by taking tablets known as psoralens – known as PUVA therapy
Tablet / Systemic therapy
Neotigason (Acitretin) – once daily
Ciclosporin – once daily
Methotrexate – once weekly
Mycophenolate mofetil – once daily
These are antibodies or receptor blockers to TNF alpha
Given via intravenously or subcutaneous administration and multiple dose
Main problems increased risk of infections, antibody formation, expense of the drug
Provides application of topical therapies
Provides support and education
Long stay patients can have more than 1 topical applications
Encourages self management of psoriasis
Difficult to reach areas can be treated e.g. Back, scalp, feet