Psoriasis Skin Condition : What Is It ? Treatment and Advice For Patient (7)
Psoriasis is a common disease which affects about 3% of the population. Psoriasis typically waxes and wanes with periods of relapse and remission. It is probably linked to several genes so occurrence within families varies. It may be precipitated by hormonal changes, infection such as a streptococcal throat infection or trauma. Medications and emotional stress can also be a trigger. There are several different forms of psoriasis. Here we describe two of the more common presentations:
chronic plaque psoriasis and guttate or small plaque psoriasis.
Approximate age group
It can occur at any age but often begins between the ages of 15 and 25 years.
Presentation
Chronic plaque psoriasis
The lesions are bright red with clearly defined edges and a silvery scale. The scale will flake off easily. The lesions tend to be symmetrical, commonly affecting the scalp, elbows, knees, sacral area and lower legs.
The appearance will be quite different if flexural areas such as axillae, groins, sub-mammary or natal cleft are affected, presenting as smooth and non-keratotic with a shiny glazed appearance. This mainly affects older patients but can also present in children. Note that fungal or bacterial infection may also be present in flexural areas.
The genitals, palms, soles and nails may also be affected in some individuals. Most patients have a few stable plaques but psoriasis can become unstable and extensive. A small proportion of patients will have joint involvement (psoriatic arthropathy).
Guttate/small plaque psoriasis
This is an acute form of psoriasis which appears suddenly, often after a streptococcal throat infection. The lesions are typical of psoriasis − bright red, well demarcated with silvery scale − but are uniformly small (0.5−1.0cm in diameter). The rash can be very widespread. It often resolves spontaneously in about 2−3 months. It may be the first episode of psoriasis for the patient but it can occur in someone who has had psoriasis for years.
Treatment
The majority of individuals with psoriasis can be treated with topical treatments.
Chronic plaque psoriasis: treatment depends on the type, size and number of lesions. Topical treatments include: emollient, vitamin D analogues or vitamin D analogue in combination with a potent topical steroid; tar preparations; saliyclic acid ointments; dithranol. phototherapy, systemic treatments and some of the more potent topical treatments is usually administered in dermatology departments.
Guttate psoriasis: as the condition usually resolves spontaneously, reassurance is all that is needed. Complete emollient therapy is useful if the skin is itchy or a mild topical steroid or weak tar solution may be indicated to give symptomatic relief. In some cases, ultra violet light treatment may be necessary: this would be administered in a dermatology department.
Traffic light
If more than 30% of the body surface area is affected by chronic plaque psoriasis, referral to dermatology should be considered. Erythrodermic psoriasis, where the entire skin surface is inflamed, must be referred to secondary care.
Generalised pustular psoriasis is an acute form of the disease which develops rapidly and may be associated with withdrawal of systemic or potent topical steroids. Sheets of erythema studded with sterile pustules come in waves, with an associated fever or malaise. This is a dermatological emergency and patients should be admitted to hospital.
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Psoriasis Skin , Natural Treatment , Skin Condition, Colour
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