Psoriasis
General Overview
General Overview
- Red scaly (silver white) plaques with well-defined edges
- Subtypes
- Post-streptococcal acute guttate psoriasis
- Small plaques psoriasis (<3cm)
- Chronic plaque psoriasis (>3cm)
- Unstable plaque psoriasis (stressor, rapid extension)
- Flexural psoriasis
- Scalp psoriasis
- Sebopsoriasis (overlap of seborrheic dermatitis)
- Palmoplantar psoriasis
- Nail psoriasis (onycholysis, pitting, splinter hemorrhages, oil drop sign)
- Erythrodermic psoriasis (rare systemic illness)
- Associated health conditions
- Inflammatory arthritis “psoriatic arthritis” and spondyloarthropathy - 30%
- Inflammatory bowel disease (Crohn disease and ulcerative colitis), Coeliac disease
- Uveitis (inflammation of the eye)
- Metabolic syndrome
Treatment
Treatment
- Mild-moderate plaque psoriasis
- Dovobet (Calcipotriol 50 mcg/g and betamethasone 0.5 mg/g) ointment apply once daily x 4 weeks
- High-potency topical corticosteroids (eg. Clobetasol 0.05% ointment) with ONE of the following:
- Vitamin D analogs (Calcitriol, Calcipotriol)
- Retinoids (Tazarotene 0.1% Gel)
- UVB phototherapy
- Alternatives
- Tar / Anthralin (15% LCD solution)
- Severe may need phototherapy, systemic therapy (methotrexate, retinoid), biologic immune modifying agents (infliximab)
- Psoriatic arthritis: NSAID, DMARD (MTX), biologics (TNF inhibitor)
Other
- Scalp psoriasis
- Consider topical treatments above in different forms, eg. Clobetasol shampoo, betamethasone valerate foam or Dovobet gel.
- Facial/intriginous/genital psoriasis
- Low-potency Hydrocortisone 1% cream or ointment often sufficient
- Calcineurin inhibitors may be used (Tacrolimus 0.1% ointment, Pimecrolimus 1% cream)
References:
- Canadian Psoriasis Guidelines 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5014087/
- AAFP 2013. http://www.aafp.org/afp/2013/0501/p626.html
- CFP 2005. http://www.cfp.ca/content/cfp/51/4/519.full.pdf
- DermNet NZ. https://www.dermnetnz.org/topics/psoriasis/