PSORIASIS

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NursingBulletin: Psoriasis

• A chronic non infectious, inflammatory skin disorder involving keratin synthesis that results in psoriatic patches.

• Formerly considered idiopathic, now thought to be genetically linked and immune system modulated.

• Possible causes of the disorder include stress, trauma, infection, and changes in climate.

• Condition tends to be lifelong, with flare-ups and remissions. Maybe exacerbated by infection; drugs, such as lithium,beta blockers,antimalarial drugs and indomethacin.

NursingBulletin: Psoriasis• It is a chronic skin disorder in which red or deep

pink raised patches covered by white scales appear on the skin.

• It usually causes no discomfort but it can get slightly itchy, especially on scalp or around the anus.

• The main problem is the unsightly appearance of the rash but fortunately it is usually covered by clothing.

• You may have single patch or several large ones.

• The cause of psoriasis is unknown and It shows a tendency to run in families

• In psoriasis, areas of the skin grow much faster than normal and form red, scaling patches.

• FIGURE 1. Common areas of distribution of psoriasis. The lesions are usually symmetrically distributed and are characteristically located on the ears, elbows, knees, umbilicus, gluteal cleft and genitalia. The joints (psoriatic arthritis), nails and scalp may also be affected.

Pathophysiology

Causes:UNKNOWNThe skin in the patches of psoriasis is growing much faster

than normal skin.↓

As your skin is worn away, it is replaced by cells produced beneath the surface.

↓In psoriasis, the normal rate of cell production is speeded

up, and does not allow the cells to manufacture a substance called keratin that gives its hard surface

↓The result is unsightly flaking of the skin

Types of Psoriasis

• Plaque or psoriasis vulgaris: most common type, occurs on knees, elbows, scalp and other areas.• Guttate – occurs in trunk, arms, legs; triggered by streptococcal infection.• Inverse – affects flexural areas, such as axilla and groin.• Erythrodermic - severe form that affects most of the body.• Pustular – blisters contain pus-like material on hand and feet or on widespread area.

Signs and Symptoms

• Pruritus ( may or may not be present if present only mild).

• Shedding, silvery, white scales on a raised, reddened, round plaque that usually affects the scalp ears ,knees, elbows, extensor surfaces of arms and legs, and sacral regions; with bilateral symmetry

• A yellow discoloration, pitting and thickening of nails and separation of nail plates if they are affected.

How is psoriasis diagnosed?

• A doctor can make a diagnosis on the appearance of the rash without the need for tests.

• If there is any doubt, a piece of skin can be removed for examination (a BIOPSY)

Important Facts:

• It is worse in winter, due to lack of sunlight• An outbreak is often triggered by a period of mental

stress• Yellow blisters can occur in patches on the soles and

palms• It is most unlikely to appear on the face• It should not prevent you from enjoying a normal life• It can temporarily disappear, especially during summer• It tends to flare up around puberty and the menopause in

women• Psoriasis is not an infection and is not contagious• Avoid sunburn? See next page why

Management:

TOPICAL THERAPY

• Administer and instruct the client regarding daily soaks and tepid, wet compresses, as prescribed, to the affected areas to remove scales; oils or tar preparations (Balnetar) are added to the bath water.

• Remove the scales during the soak, using a soft wash cloth and gentle circular motions; creams and salicylic acid is applied to the affected areas after bath to continue to soften thick scales.

• Coal tar preparations are photosensitizing agents so patient should be warned not to expose treated skin to the sun.

• A daily tar shampoo and an application of steroid lotion for scalp lesion.

• Occlusive dressings Hydrocoloid (Duoderm)

• Use plastic wrap or bags as the occlusive dressing, and use rubber gloves on the client’s hands, plastic bag on the feet, and a shower cap on the head if affected.

• Anthralin preparations (Anthra-Derm, Dritho-Crème, Lasan) for thick psoriatic plaques resistant to other coal tar or steroid preparations.

• Warn patient that coal tar and anthralin preparations may stain clothing; let dry before dressing or should be covered in some way. The hands must be washed after

• Topical corticosteroids are used for short periods because of their side effects ( striae, thinning of the skin, adrenal suppression).

• Psoriasis may quickly reappear once steroid is stopped (rebound phenomenon) Repeated eye contact associated with cataract development.

INTRALESIONAL THERAPY:• Injections into highly visible or isolated patches of psoriasis

that are resistant. Triamcinolone acetonide ( aristocort, kenolog-10, trymex) is injected, and care is taken so that normal skin is not injected

SYSTEMIC THERAPYMethotrexate have been used in treating extensive psoriasis that fails to respond to other forms of therapy. Should monitor hepatic, haematopoietic and renal systems. Reinforce women of childbearing age that retinoids and methotrexate are teratogenic; women must be using birth control.Oral retinoids (synthetic derivatives of Vitamin A and its metabolite, Vitamin A acid) Hydroxyurea (Hydrea). Monitor signs ands symptoms of bone marrow depression.

PHOTOTHERAPYA treatment for severely debilitating psoriasis is psoralen and ultraviolet A (PUVA) therapy, which involves taking a photosensitizing drug (usually 8-methoxypsoralen) in a standard dose with subsequent exposure to long-wave ultraviolet light when peak drug plasma levels are obtained.UVB light is also used to treat generalized plaque. Advise patient to wear goggles to prevent cataracts and follow up with periodic eye exams. Should wear sunscreen and sunglasses. Contraceptives should be used since teratogenic effect has not been established yet.

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