PSORIASIS

By

Dr S Nasir Shah

MBBS, MCPS, Dip. Derm, MRCP(UK)

Consultant Dermatologist
Norfolk & Norwich University Hospital,
NHS Foundation Trust

PSORIASIS - epidemiology

Northern Europe
Denmark
Faroe Isles
USA
China

2%
2.9%
2.8%
1.4%
0.4%

PSORIASIS - genetics
HLA
Cw6
DR7
Linkage studies
Chromosome 17q
Chromosome 4q

PSORIASIS - genetics
Family studies
Twin studies
monozygotic twins 65-70% concordance
dizygotic twins
15-20% concordance

PSORIASIS - epidemiology
Type 1

Type 2

PSORIASIS - epidemiology
Type 1
Early onset
Familial segregation
HLA Cw6

PSORIASIS - epidemiology
Type 2
Late onset
No familial segregation
HLA Cw2

PSORIASIS - triggers

bacterial infection
skin injury koebner phenomenon
stress
drugs
antimalarials
lithium
beta-blockers
systemic steroids

Histology of Skin

Histopathology of Psoriasis

Clinical features - 1

Clinical features - 2

Clinical features -3 - scalp

Clinical features - Scalp

Clinical features - scalp

Clinical features - nail

Clinical features - nails

Clinical features - umbilicus

Types of Ps - Flexural

Types of Ps Palmo-plantar

Differential Diagnosis

Types of Ps - Genital Ps

Types of ps - Genital

Types of Ps - acrodermatitis continua

of Hallupau

Types of Ps - pustular Ps

Types of Ps
Extensive Chronic
Plaque Ps
/Suberythroderma

Types of Ps
Erythrodermic Ps

Psoriatic arthritis 1

Arthritis Mutilans 2

PSORIASIS treatment
Mild to moderate psoriasis 10%

Short Contact dithranol

Vitamin D analogues
Topical Steroids
Topical retinoids
Combinations e.g Dovobet, 5% LPC in Betnovate RD

PSORIASIS - treatment
Dithranol
Stable chronic plaque
Start with low concentration and test an area
before increasing the concentration
Avoid normal skin
Avoid face and flexures

Dithranol treatment

Dithranol treatment

Dithranol treatment

Relapse after
injudicious treatment

PSORIASIS - treatment
Scalp psoriasis

Keratolytic agents (Cocois)

Vitamin D analogues
Potent topical steroids
Tar shampoo
Steroid shampoos/foams
Combinations

PSORIASIS treatment
Flexural Psoriasis
Moderately potent topical steroids
Combinations probably work better

PSORIASIS - treatment
Palmoplantar psoriasis

Keratolytic agents (5% salicylic acid in EO)

Vitamin D analogues
Potent topical steroids
Phototherapy

PSORIASIS - treatment
Psoriasis of the nail
Topical steroids
Methotrexate
Biologicals - etanercept

PSORIASIS - treatment
Palmoplantar pustular psoriasis

Potent topical steroids

Vitamin D analogues
PUVA
Acitretin ( Neotigason)

PSORIASIS treatment
Moderate to severe psoriasis

Phototherapy
Traditional systemic treatments
Biologicals
Hospital Admission

PSORIASIS - treatment
Phototherapy
UVB
Narrowband UVB
PUVA (psoralen + UVA)

Systemic treatments

Methotrexate
Acitretin
Ciclosprin
Biologicals
Fumerate

PSORIASIS - treatment
Hospital Admission
Dithranol in Lassars paste 0.1 2.0%
Crude Coal tar 1 30%

PSORIASIS - treatment
Systemic treatment absolute indications
Erythrodermic psoriasis
Pustular psoriasis

PSORIASIS - treatment
Systemic treatment relative indications
Extensive flexural psoriasis
Extensive chronic plaque psoriasis
elderly incapacitated
multiple frequent hospital admission
failure to respond to UVL
patient unable to have UVL

Current trends in psoriasis

Psoriasis as a metabolic disease
Biologicals in psoriasis
Anti TNFs
Anti IL12,13

 Dx?

D iagnosis

Dx?

End

Thank you very much