2. INTRODUCTION
Psoriasis is a chronic skin disease result in
patches of thick red skin covered with the silvery
scales. These patches are referred as plaque
which usually occur on the elbow, knees, legs,
scalp, lower back, face, palm and sole of the
feet, nails too
3. HISTORY
The word psoriasis is derive from greek word
‘psora’ means ‘itching’. The greek physician Galen
of perganon (130-200 BC) use the term Psoriasis
vulgaris to refer all dermo and epidermopathies
accompanied by pruiritis. Since 1950 local
application and systemic medications are used for
the psoriasis.
4. DEFINITION
Psoriasis is a chronic , non infectious
inflammatory disease of the skin in which the
production of epidermal cells occur
at a rate that is about 6 to 9 times faster
than normal .
( B.T Basuvanthappa)
5. .
“ Psoriasis is defined as a persistent skin
disease causes cell to build rapidly on the
surface of the skin, forming thick silvery
scales, itchy, dry and red patches.”
( Lewis)
6. INCIDENCE
1 to 3% of world population
Affects 7.5 million of Americans
Onset may occur at any age
Median onset is at 28 years
More prevalent women, Caucasians,&
obese people.
10. .
.
Epidermis infiltration & keratinocytes proliferation.
Deregulated Inflammatory process
Large production of various cytokines (interferon & Interleukin
12)
11. .
.
Superficial blood vessel dilated and vascular engorgement
Epidermal hyperplasia and improper cell maturation
Fails to release adequate lipids which lead to flaking, scaling
presentation of psoriasis lesion
Silver scaling of skin
12. CLINICAL
FEATURES
The symptoms ranges from cosmetic
annoyance to physically disabling and
disfiguring affliction.
The lesions appears as red, raised, patches
of skin covered with silvery scales.
Dry patching, itching
13. .
Nail pitting, discoloration
Separation of nail plates.
If psoriasis occurs on the palms and soles ,
pustular lesions may develop.
Fever, chills
Electrolyte imbalance
Despair and Frustration
14. TYPES
There are mainly 4 types of psoriasis . They
are
1. Psoriasis vulgaris or plaque psoriasis
2. Generalised pustular psoriasis
3. Guttate psoriasis
4. Generalised erythodermic psoriasis
15. .
PSORIASIS VULGARIS ( PLAQUE PSORIASIS)
Also known as chronic stationary psoriasis
Most common form
Affect 85% to 90% of people
Appears on inflamed skin with silvery white scaly
skin.
Most commonly found on the elbows, knees, scalp
and back.
16. .
Generalized Pustular psoriasis
Rare form of psoriasis
Also called as zumbusch’s psoriasis
The Erythema suddenly appears in flexural
areas and migrate to other body surface.
Patient become toxic , febrile and develop
leucocytosis.
17. .
GUTTATE PSORIASIS
Characterized by eruption of small (0.5 to 1.5 cm in
diameter) papules over the upper trunk and proximal
extremities
• Manifests at an early age
• Streptococcal throat infection frequently precedes .
First episode before the age of 20
May resolve spontaneously in weeks or month
18. .
GENERALIZED ERYTHODERMIC PSORIASIS
Severe , unstable highly liabile manifestation
of psoriasis.
Usually comes in patients with previous
history of psoriasis
Precipitating factors include administration of
systematic corticosteroid, topical steroid etc.
19. .
Other types include
Light sensitive psoriasis
Psoriasis of scalp
Psoriasis of nail
Psoriasis over palms and soles
Pustular psoriasis of the digits
20. DIAGNOSTIC MEASURES
History collection
Physical examinations
Skin biopsy : under local anaesthesia
Blood and radiography test was done to rule
out psoriatic arthritis
21. MANAGEMENT
The goal of Management are
to slow the rapid turn over of epidermis to
promote to promote resolution of psoriatic
lesion and to control natural cycle of disease
Remove scales and smooth skin, which is
particularly remove by topical treatment.
23. .
TOPICAL CORTICOSTEROID
• These are commonly first-line therapy in mild to
moderate psoriasis and in sites such as the flexures
and genitalia, where other topical treatments can
induce irritation and skin folds.
• Improvement is usually achieved within 2 to 4
weeks.
• They slows the cells turnover by suppressing the
immune system which reduce inflammation and
relieves associated itching
• Strong corticosteroids use for smaller area of skin
like hands and feet.
• Long term use may cause thinning of skin and
resistance too.
• Low potency steroids are usually recommended for
sensitive area and treating wide spread patches
damage skin.
24. .ADVANTAGES
Rapid response
Control of inflammation and itching
Best for intertriginous areas and face
DISADVANTAGES
Temporary relief
Less effective
Atropy, expensive
25. .
TOPICAL CALCINEURIN INHIBITOR
Topical Calcineurin inhibitor common side
effects such as tacrolimus and pimecrolimbus
block the synthesis of cytokines.
These drugs do not cause atropy as topical
corticosteroid
The most common side effects includes
burning sensation
Contraindicated in pregnant and nursing
mothers
26. .
VITIMIN D ANALOGUES
Vitamin D Analogues are effective , safe
and well tolerated for the short and long term
treatment of psoriasis.
Up to 100gm/ week can be used.
Example Calcipotriene, calcitrol, Tazarotene
27. .
COAL TAR
Coal tar is a thick dark liquid which is the by
product of the production of coal.
It is effective treatment for psoriasis
According to National psoriasis foundation
coal tar is a valuable , safe treatment option
for people with psoriasis
O.5 to 5% are considered safe and effective
for psoriasis.
29. .
SYSTEMIC THERAPY
Systemic therapy is used for the treatment of
psoriasis.
Systemic drug therapy mainly include
methotrexate, cyclosporine, and biological agents
METHOTREXATE
o Methotrexate 2.5 mg tab & 50 mg/lm vial Action
Blocks dihydrofolate reductase leading to
inhibition of purine and pyrimidine synthesis.
Leading to accumulation of anti-inflammatory
adenosine
o Dosage Start with a test dose of 2.5 mg and then
gradually increase dose until a therapeutic level is
achieved (average range, 10-15 mg weekly;
maximum, 25- 30 mg weekly)
30. .
Cyclosporine
cyclosporine , a cyclic peptide is used to
prevent rejection of transplanted organs, has
shown some success in treatment.
Side effects includes Nephrotoxicity,
Hypertension, Immuno-suppression
Neurotoxicity Increased risk of malignancy
Contraindication
Pregnancy Lactation
Renal abnormalities
31. .
BIOLOGIC AGENTS
The newest line of treatment
These agents act by inhibiting & eliminating T
-cell completely.
32. .
PHOTOTHERAPY
ULTRA VIOLET THERAPY
Ultraviolet light therapy has been used for
decades to successfully treat psoriasis.
o Ultraviolet light is a wavelength of light in a
range too short for human eye to see. -When
exposed to the UV light ,the activated t –cells
in the skin are destroy which lead reduces
scaling and inflammation.
33. .
PHOTOTHERAPY
PhotOtherapy involves taking light sensitizing
medication (psoralen) before exposure to UVA
light.
-UVA light penetrate deeper in skin and
psoralen make more responsive to UVA
exposure
Side effect: nausea, headache, burning and
itching, wrinkle skin or skin cancer.
35. NURSING DIAGNOSIS
Impaired skin integrity r/t lesion and inflammatory
response as evidence by itching all over body.
Fear and anxiety related to change in appearance
Anxiety related to changes in health status
secondary to psoriasis.
Impaired self concept related to the crisis of
confidence
Knowledge deficit
Risk for infection
36. .
Improving skin integrity
Advice the patient not to pick or scratch
areas
Encourage the patient to prevent the skin
from drying out
Inform the patient that water should not be too
hot and skin should be dried by patting with
towel
Teach the patient to use bath oil or emolinent
cleansing agent for sore and scaling
37. .
IMPROVING SELF CONCEPT AND
BODYIMAGE
Introduce coping strategies and suggestions for
reducing with stressful situations, to facilitate
positive outlook and acceptance of disease
MONITORING AND MANAGING
COMPLICATIONS
o Educate the patient about care and
treatment
o Assist the patient o take rest
38. HEALTH EDUCATION
Take daily bath
Use moisturizer
Expose small amount of skin to sunlight
Cover the affected area over night
Apply medication cream or ointment
Avoid drinking alcohol and smoking Eat
healthy diet
39. RESEARCH STUDIES
A study to assess psychological distress in
patients with psoriasis , low
consensus between a dermatologist
and patient
40. CONCLUSION
Psoriasis is considered as one of the most
common chronic non communicable skin
disease , psoriasis is typically characterized by
appearance of slivery plague that most
commonly appears on the skin over elbow,
knees, scalp, lower back and buttocks.
41. BIBLIOGRAPHY
Suddarth and Brunner , text book of Medical
surgical Nursing, wolter publication New
Delhi; 13th Edition;2013 page no 1782 –
1784.
B.T Basuvanthapa textbook of Medical
Surgical Nursing, Wolter and Jaypee
Publication New Delhi; 3rd Edition Page No :
1304 – 1306.
Clinical dermatology , text book of Medcine
,Elsevier's publication New Delhi
Page no 1203 -1204
