Ce diaporama a bien été signalé.
Le téléchargement de votre SlideShare est en cours. ×

Psoriasis.pdf

Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Publicité
Prochain SlideShare
Seizure Disorder.pdf
Seizure Disorder.pdf
Chargement dans…3
×

Consultez-les par la suite

1 sur 127 Publicité

Psoriasis.pdf

Télécharger pour lire hors ligne

Definition
Epidemiology
Causes and Risk Factors
Clinical Presentation
Types
Diagnosis
Treatment
Prognosis
Case Scenario
8 Roles of family physician in psoriasis
Management Options

Definition
Epidemiology
Causes and Risk Factors
Clinical Presentation
Types
Diagnosis
Treatment
Prognosis
Case Scenario
8 Roles of family physician in psoriasis
Management Options

Publicité
Publicité

Plus De Contenu Connexe

Plus récents (20)

Publicité

Psoriasis.pdf

  1. 1. PSORIASIS Saleh Al-Khalid Supervised by: Dr. Hanan Alotaibi
  2. 2. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  3. 3. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  4. 4. DEFINITION Psoriasis is a common chronic, disfiguring, inflammatory skin disease most commonly characterized by well-demarcated, erythematous plaques with silver scale and associated with a variety of comorbidities.
  5. 5. Well demarcated Erythematous Silver scale
  6. 6. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  7. 7. EPIDEMIOLOGY • A systematic worldwide review found the prevalence of psoriasis ranged: • 0.5 to 11.4 percent in adults • 0 to 1.4 percent in children • Psoriasis is common in Saudi Arabia as elsewhere: percentage of occurrence in the eastern Saudi Arabia is 5.3%
  8. 8. EPIDEMIOLOGY • There is no clear gender predilection for psoriasis. • Psoriasis is less common in children than adults. • Geographic location: prevalence tends to increase with increasing distance from the equator.
  9. 9. EPIDEMIOLOGY • Two peaks in age of onset: • 20–30 years (More severe disease with Positive family history) • 50–60 years
  10. 10. EPIDEMIOLOGY • Two-thirds of patients have mild disease. • One-third have moderate to severe disease
  11. 11. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  12. 12. RISK FACTORS • Family History • Direct skin trauma. • Streptococcal throat infection. • HIV • Smoking • Obesity • alcohol use and abuse. • Stress
  13. 13. RISK FACTORS • Vitamin D deficiency • Certain medications: • Lithium, Beta blockers, Antimalarial drugs ,Iodides, Rapid taper of systemic corticosteroids • Endocrine factors: Hypocalcemia, Pregnancy • Weather: worse in winter and improve during summer
  14. 14. GENETIC FACTORS • A positive family history 35- 90 %. • The risk of developing psoriasis is: • One parent affected - 14% • Both parents - 41% • One sibling - 6% • No parent or sibling affected - 2%
  15. 15. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  16. 16. SYMPTOMS • Common signs and symptoms include: • Red patches of skin covered with thick, silvery scales • Small scaling spots (commonly seen in children) • Dry, cracked skin that may bleed • Itching, burning • Thickened, pitted or ridged nails
  17. 17. COMPLICATIONS OTHER SYSTEMS INVOLVEMENT • Psoriatic arthritis • Eye conditions: Conjunctivitis, blepharitis and uveitis are common. • Metabolic syndrome: This cluster of conditions including HTN,Type 2 DM and abnormal cholesterol levels — increases the risk of cardiovascular diseases. • Autoimmune diseases: Celiac disease, inflammatory bowel disease (Crohn's disease) • Parkinson's disease • Kidney disease • Emotional problems • Cancers: Lymphomas and skin cancers
  18. 18. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  19. 19. CLASSIFICATION: (MORPHOLOGY) • Plaque psoriasis 80% • Guttate psoriasis 15% • Inverse psoriasis 2% • Pustular psoriasis 2% • Erythrodermic Psoriasis 1%
  20. 20. CLASSIFICATION: (MORPHOLOGY) • Plaque psoriasis 80% • Guttate psoriasis 15% • inverse psoriasis 2% • Pustular psoriasis 2% • Erythrodermic Psoriasis 1%
  21. 21. PLAQUE PSORIASIS • Most common • Characterized by well-defined round or oval plaques that differ in size covered by silvery scale. • Plaques may exhibit: • Auspitz sign (bleeding after removal of scale) • Koebner phenomenon (lesions induced by trauma)
  22. 22. CLASSIFICATION: (MORPHOLOGY) • Plaque psoriasis 80% • Guttate psoriasis 15% • inverse psoriasis 2% • Pustular psoriasis 2% • Erythrodermic Psoriasis 1%
  23. 23. GUTTATE PSORIASIS • Classical findings include 1 to 10 mm pink papules with fine scaling. • Lesions are usually located on the trunk. • More commonly seen in children. • Frequently preceded by an upper respiratory tract infection • group A beta-hemolytic streptococcal.
  24. 24. CLASSIFICATION: (MORPHOLOGY) • Plaque psoriasis 80% • Guttate psoriasis 15% • Inverse psoriasis 2% • Pustular psoriasis 2% • Erythrodermic Psoriasis 1%
  25. 25. INVERSE PSORIASIS • Erythematous and less scaly plaques in body folds like the axilla, groin, infra-mammary region • Localized dermatophyte, candidal or bacterial infections can be a trigger for inverse psoriasis.
  26. 26. CLASSIFICATION: (MORPHOLOGY) • Plaque psoriasis 80% • Guttate psoriasis 15% • inverse psoriasis 2% • Pustular psoriasis 2% • Erythrodermic Psoriasis 1%
  27. 27. PUSTULAR PSORIASIS • Present as: Sterile pustules in top of erythema. • Triggering factors include: • Pregnancy • Rapid tapering of corticosteroids (or other systemic therapies) • Hypocalcemia • Infections
  28. 28. PUSTULAR PSORIASIS •Four distinct patterns: • Von Zumbusch pattern • Annular pattern • Exanthematic type • Localized pattern
  29. 29. VON ZUMBUSCH PATTERN • Generalized eruption with erythema and pustulation. • The skin is painful. • Fever and ill Patient. • Associated with hypocalcemia, sepsis, and dehydration.
  30. 30. ANNULAR PATTERN • Annular erythematous scaly lesions with postulation.
  31. 31. EXANTHEMATIC TYPE • This is an acute eruption of small pustules. • It usually follows an infection or may occur as a result of administration of specific medications, e.g. lithium.
  32. 32. LOCALIZED PATTERN • Pustules appear within or at the edge of existing psoriatic plaques • Most commonly appear at hand and sole
  33. 33. CLASSIFICATION: (MORPHOLOGY) • Plaque psoriasis 80% • Guttate psoriasis 15% • inverse psoriasis 2% • Pustular psoriasis 2% • Erythrodermic Psoriasis 1%
  34. 34. ERYTHRODERMIC PSORIASIS • Life–Threatening Form of Psoriasis • Patients may become febrile, and dehydrated • May evolve from plaque psoriasis or appear as eruptive phenomenon • Complications: • Cardiac failure • Sepsis • Malabsorption • Anemia
  35. 35. NAIL PSORIASIS • 10–80% of cases. • Patients with nail involvement appear to have an increased incidence of psoriatic arthritis • Pits in the nails ,Leukonychia ,loss of transparency,“oil drop” phenomenon.
  36. 36. PSORIATIC ARTHRITIS • Sometimes the joint symptoms are the first or only manifestation of psoriasis or at times only nail changes are seen. • Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. • It can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.
  37. 37. SCALP PSORIASIS • 50% of cases • The lesions of psoriasis often advance onto the periphery of the face, the retro-auricular areas and the upper neck.
  38. 38. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  39. 39. DIAGNOSIS • In most cases, diagnosis of psoriasis is fairly straightforward. • Medical history and Physical exam. • Skin biopsy. Rarely
  40. 40. HISTORY • Important history points to ask when suspecting psoriasis: • Family history (1/3 of psoriasis patients have a positive family history) • Medications (Systemic corticosteroid withdrawal, Beta blockers, Lithium, Antimalaria, and Interferons) • Recent illnesses / Past medical history (Infections URTI, Joint complains…) • Social history (Smoking, Alcohol consumption, and High BMI)
  41. 41. EXAMINATION • Important sites of examination: • Scalp • Ears • Elbows • Knees (extensor surfaces) • Umbilicus • Gluteal cleft • Nails • Sites of recent trauma
  42. 42. INVESTIGATION • Skin biopsy. it can be helpful in difficult cases (Rarely done) Serum uric acid inflammation markers serum albumin
  43. 43. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  44. 44. MANAGEMENT • Psoriasis is a lifelong disease and can affect all aspects of a patient’s quality of life (QOL). • Remember to address both the physical, psychosocial and comorbidities aspects of psoriasis.
  45. 45. MANAGEMENT • Patients with localized plaque psoriasis can be managed by a primary care provider and it is managed by topical treatment: • 1-Eliminate trigger factors • 2-Emollients • 3-Topical therapies • Psoriasis of all other types should be evaluated by a dermatologist.
  46. 46. EMOLLIENTS • Alleviate pruritus • Reduce scale • Enhance penetration of topical therapy • Hydrate dry and cracked skin
  47. 47. TOPICAL THERAPIES • Topical corticosteroids • Vitamin D analogs • Retinoids • Coal tars • Salicylic acid • Calcineurin inhibitors • First line agents: high potency topical steroid + calcipotriene (vitamin D analog)
  48. 48. CALCIPOTRIOL/BETAMETHASONE OINTMENT • Provides rapid, effective psoriasis control • Once-daily treatment. • Most common adverse events include pruritus, rash and burning sensation
  49. 49. CORTICOSTEROIDS • It has an: • anti-inflammatory • Anti-proliferative • Immunomodulatory • Adverse effects associated with long-term use include: • Skin atrophy • Hypopigmentation • Striae • Rapid relapse on stopping therapy
  50. 50. KERATOLYTICS • This category include the following: • Salicylic acid • Urea • Help dissolve psoriasis scales. • Enhances penetration of other drugs.
  51. 51. TAZAROTENE (SYNTHETIC RETINOID) • For Chronic plaque psoriasis cases • Once daily • Commonly causes local irritation • pregnancy category X
  52. 52. COAL TAR • It helps to reduce inflammation and pruritus. • May cause local skin irritation. • Use limited by distinctive smell and ability to stain clothing and skin.
  53. 53. SYSTEMIC TREATMENT • In patients with moderate to severe disease, systemic treatment can be considered and should be supplemented with topical treatment • Oral steroids should never be used in psoriasis as they can severely flare psoriasis upon discontinuation • Systemic treatment include: • Phototherapy • Oral medications: methotrexate, acitretin • Biologic Agents:TNF-α inhibitors, IL 12/23 blocker, IL 17 blocker
  54. 54. REFERRAL • Confirmation of the diagnosis. • The response to treatment is inadequate. • There is significant impact on quality of life. • The patient has widespread severe disease. • In cases of psoriatic arthritis, referral and/or collaboration with a rheumatologist is indicated.
  55. 55. OUTLINE • Definition • Epidemiology • Causes and Risk Factors • Clinical Presentation • Types • Diagnosis • Treatment • Prognosis
  56. 56. PROGNOSIS • Chronic plaque psoriasis is in most cases a lifelong disease. • Guttate psoriasis is often a self-limited disease, lasting from 12 to 16 weeks without treatment. • 1/3 to 2/3 of these patients later develop the chronic plaque psoriasis • Erythrodermic and generalized pustular psoriasis have a poorer prognosis. • Life–Threatening Forms of Psoriasis
  57. 57. DISEASE IMPACT • Psoriasis causes significant psycho-social morbidity. • Problems with work, activities of daily living, and socialization. • Depression • Spend money in expensive treatment choices.
  58. 58. MCQ
  59. 59. You are examining a rash on the skin of a previously healthy 21-year-old white male. He had a mild cold a week ago, but otherwise has felt well. On examination his vital signs are normal and he appears healthy.The rash is characterized by numerous small, slightly scaly, oval-shaped lesions.The presentation is most consistent with which one of the following conditions? A) Guttate psoriasis B) Plaque psoriasis C) Erythrodermal Psoriasis D) Inverse psoriasis E) Scarlet fever
  60. 60. •A) Guttate psoriasis
  61. 61. EXPLANATION The answer is A:The condition of guttate psoriasis is characterized by numerous small, oval (teardrop-shaped) lesions that develop after an acute upper respiratory tract infection. These lesions are often not as scaly or as erythematous as the classic lesions of plaque- type psoriasis, which are usually located on extensor surfaces. Usually, guttate psoriasis must be differentiated from pityriasis rosea, another condition characterized by the sudden outbreak of red scaly lesions, which also often follows a mild upper respiratory tract infection.
  62. 62. REFERENCE • UpToDate • Mayo clonic • AAFP • National Psoriasis Foundation • Amarican Academy of Dermatology
  63. 63. THANKS
  64. 64. CAN STRESS BE DISFIGURING Saleh Al-Khalid Supervised by: Dr. Asma’a Alrefae
  65. 65. OUTLINE • Case Scenario • 8 Roles of family physician in psoriasis • Management Options
  66. 66. CASE SCENARIO • A 52-year-old male smoker presented with a mildly pruritic rash that began three months earlier on his back and spread to his scalp, trunk, and extremities, including the palms and soles. He had a history of alcoholic cirrhosis. He had no recent new exposures, including medications. • Physical examination revealed numerous well-circumscribed, erythematous, non-blanching plaques with adherent white scale involving approximately 70% of his body. His palms and soles displayed thick scale with fissures, and he had oil spots and onycholysis affecting several fingernails.
  67. 67. WHAT IS THE DIAGNOSIS? A. Plaque psoriasis B. Guttate psoriasis C. inverse psoriasis D. Pustular psoriasis E. Erythrodermic Psoriasis A. Plaque psoriasis
  68. 68. 8 ROLES OF FAMILY PHYSICIAN IN PSORIASIS 1. Be convinced about Clinical diagnosis of psoriasis by knowing important hx and ex. 2. Holistic approach 3. Include impacted comorbidities in the psoriasis management. 4. Patient education about the chronicity of disease and reassure about contagious, about risk factor avoidance, proper sun exposure, proper skin moisturizing are very effective. 5. Aware about all details of treatment modalities. 6. Referral: Dermatology or Rheumatology 7. EBM 8. Cost effective : stop unjustified investigation as it is clinical diagnosis ( ESR, ANA, etc.)
  69. 69. PLAQUE PSORIASIS • Most common • Characterized by well-defined round or oval plaques that differ in size covered by silvery scale. • Plaques may exhibit: • Auspitz sign (bleeding after removal of scale) • Koebner phenomenon (lesions induced by trauma)
  70. 70. 8 ROLES OF FAMILY PHYSICIAN IN PSORIASIS 1. Be convinced about Clinical diagnosis of psoriasis by knowing important hx and ex. 2. Holistic approach 3. Include impacted comorbidities in the psoriasis management. 4. Patient education about the chronicity of disease and reassure about contagious, about risk factor avoidance, proper sun exposure, proper skin moisturizing are very effective. 5. Aware about all details of treatment modalities. 6. Referral: Dermatology or Rheumatology 7. EBM 8. Cost effective : stop unjustified investigation as it is clinical diagnosis ( ESR, ANA, etc.)
  71. 71. DIAGNOSIS Clinical diagnosis • In most cases, diagnosis of psoriasis is fairly straightforward. • Medical history and Physical exam. • Skin biopsy. Rarely
  72. 72. HISTORY • Important history points to ask when suspecting psoriasis: • Family history (1/3 of psoriasis patients have a positive family history) • Medications (Systemic corticosteroid withdrawal, Beta blockers, Lithium, Antimalaria, and Interferons) • Recent illnesses / Past medical history (Infections URTI, Joint complains…) • Social history (Smoking, Alcohol consumption, and High BMI)
  73. 73. EXAMINATION • Important sites of examination: • Scalp • Ears • Elbows • Knees (extensor surfaces) • Umbilicus • Gluteal cleft • Nails • Sites of recent trauma
  74. 74. 8 ROLES OF FAMILY PHYSICIAN IN PSORIASIS 1. Be convinced about Clinical diagnosis of psoriasis by knowing important hx and ex. 2. Holistic approach 3. Include impacted comorbidities in the psoriasis management. 4. Patient education about the chronicity of disease and reassure about contagious, about risk factor avoidance, proper sun exposure, proper skin moisturizing are very effective. 5. Aware about all details of treatment modalities. 6. Referral: Dermatology or Rheumatology 7. EBM 8. Cost effective : stop unjustified investigation as it is clinical diagnosis ( ESR, ANA, etc.)
  75. 75. Once you diagnose patient with psoriasis please screen and provide management for Depression or Anxiety or stress either as a cause or impact
  76. 76. 8 ROLES OF FAMILY PHYSICIAN IN PSORIASIS 1. Be convinced about Clinical diagnosis of psoriasis by knowing important hx and ex. 2. Holistic approach 3. Include impacted comorbidities in the psoriasis management. 4. Patient education about the chronicity of disease and reassure about contagious, about risk factor avoidance, proper sun exposure, proper skin moisturizing are very effective. 5. Aware about all details of treatment modalities. 6. Referral: Dermatology or Rheumatology 7. EBM 8. Cost effective : stop unjustified investigation as it is clinical diagnosis ( ESR, ANA, etc.)
  77. 77. OTHER THAN SKIN • Psoriatic arthritis • Eye conditions: Conjunctivitis, blepharitis and uveitis are common. • Metabolic syndrome: This cluster of conditions including HTN,Type 2 DM and abnormal cholesterol levels — increases the risk of cardiovascular diseases. • Autoimmune diseases: Celiac disease, inflammatory bowel disease (Crohn's disease) • Parkinson's disease • Kidney disease • Emotional problems • Cancers: Lymphomas x3 and skin cancers SCC x14
  78. 78. INVESTIGATION • Skin biopsy. it can be helpful in difficult cases (Rarely done) Serum uric acid Inflammation markers Serum albumin
  79. 79. 8 ROLES OF FAMILY PHYSICIAN IN PSORIASIS 1. Be convinced about Clinical diagnosis of psoriasis by knowing important hx and ex. 2. Holistic approach 3. Include impacted comorbidities in the psoriasis management. 4. Patient education about the chronicity of disease and reassure about contagious, about risk factor avoidance, proper sun exposure, proper skin moisturizing are very effective. 5. Aware about all details of treatment modalities. 6. Referral: Dermatology or Rheumatology 7. EBM 8. Cost effective : stop unjustified investigation as it is clinical diagnosis ( ESR, ANA, etc.)
  80. 80. Causes and Risk Factors
  81. 81. RISK FACTORS • Family History (genetics ) • Direct skin trauma. • Streptococcal throat infection. • HIV • Obesity • Smoking • alcohol use and abuse. • Stress
  82. 82. RISK FACTORS • Vitamin D deficiency • Certain medications: Lithium, Beta blockers, Antimalarial drugs ,Iodides, Rapid taper of systemic corticosteroids • Endocrine factors: Hypocalcemia, and pregnancy state • Weather: worse in winter and improve during summer
  83. 83. GENETIC FACTORS • A positive family history 35- 90 %. • The risk of developing psoriasis is: • One parent affected - 14% • Both parents - 41% • One sibling - 6% • No parent or sibling affected - 2%
  84. 84. 8 ROLES OF FAMILY PHYSICIAN IN PSORIASIS 1. Be convinced about Clinical diagnosis of psoriasis by knowing important hx and ex. 2. Holistic approach 3. Include impacted comorbidities in the psoriasis management. 4. Patient education about the chronicity of disease and reassure about contagious, about risk factor avoidance, proper sun exposure, proper skin moisturizing are very effective. 5. Aware about all details of treatment modalities. 6. Referral: Dermatology or Rheumatology 7. EBM 8. Cost effective : stop unjustified investigation as it is clinical diagnosis ( ESR, ANA, etc.)
  85. 85. OUTLINE OF MANAGMENT - Topical - Systemic - Intra-lesion injection - Phototherapy - Biological • Non pharmacological
  86. 86. MANAGEMENT • Psoriasis is a lifelong disease and can affect all aspects of a patient’s quality of life (QOL). • Remember to address both the physical, psychosocial and social aspects of psoriasis.
  87. 87. MANAGEMENT • Patients with localized plaque psoriasis can be managed by a primary care provider and it is managed by topical treatment: • 1-Eliminate trigger factors • 2-Emollients • 3-Topical therapies • Psoriasis of all other types should be evaluated by a dermatologist.
  88. 88. WHAT MAKES PSORIASIS WORSE? • Obesity • Infections • Medication. • Lithium • beta blockers • ACE-I • Ibuprofen • Winter weather • Xerosis (dry skin) • Sunburn • Smoking / alcohol • Stress
  89. 89. PROPER SUNLIGHT EXPOSURE? • Sunlight can help psoriasis, but be careful not to stay in the sun too long. • You should use sunscreen on the parts of your skin that aren't affected by psoriasis, especially face.
  90. 90. EMOLLIENTS • Alleviate pruritus • Reduce scale • Enhance penetration of topical therapy • Hydrate dry and cracked skin
  91. 91. TOPICAL THERAPIES • Corticosteroids ( topical) • Vitamin D analogs ( calcipotriene) • Retinoids • Coal tars • Anthraline • Salicylic acid • Calcineurin inhibitors •First line agents: high potency topical steroid + calcipotriene (vitamin D analog)
  92. 92. CALCIPOTRIOL/BETAMETHASONE OINTMENT • Provides rapid, effective psoriasis control • Once-daily treatment. • Most common adverse events include pruritus, rash and burning sensation
  93. 93. ULTRA-POTENT CORTICOSTEROID • It has an: • anti-inflammatory • Anti-proliferative • Immuno-modulatory • Adverse effects associated with long-term use include: • Skin atrophy • Hypopigmentation • Striae • Rapid relapse on stopping therapy
  94. 94. POTENCY • Low-potency: are used in delicate skin areas, such as the face, genitals or flexures. • Increased risk for cutaneous atrophy • Mid-potency: are used for lesions on the chest, back and extremities. • High-potency: are usually used on lesions on the palms and soles.
  95. 95. FORM • Ointments are the best choice for dry, scaly, hyperkeratotic plaques. • Lotions and gels are best suited for the treatment of the scalp. • Creams can be used on all areas.
  96. 96. TACHYPHYLAXIS • Is define as: rapid decrease in response to repeated doses over a short time period. • Managed by Free- period of steroid
  97. 97. IS IT SAFE TO USE TOPICAL CORTICOSTEROIDS FOR LONG TIME ? • Long-term use of steroid creams can damage your skin and cause side effects that don't go away, like making skin thin and bruised.
  98. 98. FOR HOW LONG TOPICAL STEROIDS CAN BE USED? For 2 weeks maximum
  99. 99. KERATOLYTICS - SALICYLIC ACID • This category include the following: • Salicylic acid • Urea • Help dissolve psoriasis scales. • Enhances penetration of other drugs. • Careful of Salicylism in pediatric age group
  100. 100. TAZAROTENE (SYNTHETIC RETINOID) • For Chronic plaque psoriasis cases • Once daily • Commonly causes local irritation • Pregnancy category X
  101. 101. COAL TAR • It helps to reduce inflammation and pruritus. • May cause local skin irritation. • Use limited by distinctive smell and ability to stain clothing and skin. • It may exacerbate Asthma.
  102. 102. ANTHRALIN
  103. 103. SYSTEMIC TREATMENT • In patients with moderate to severe disease, systemic treatment can be considered and should be supplemented with topical treatment. • Oral steroids should never be used in psoriasis as they can severely flare psoriasis upon discontinuation. • Systemic treatment include: • Phototherapy • Oral medications: methotrexate, acitretin, cyclosporin • Biologic Agents:TNF-α inhibitors, IL 12/23 blocker, IL 17 blocker
  104. 104. WHEN WE CAN EXPECT THE IMPROVEMENT AFTER STARTING THERAPY? •Scales foes away Immediately. •Normal skin thickness takes 2-6 weeks. •Redness may last several months.
  105. 105. 8 ROLES OF FAMILY PHYSICIAN IN PSORIASIS 1. Be convinced about Clinical diagnosis of psoriasis by knowing important hx and ex. 2. Holistic approach 3. Include impacted comorbidities in the psoriasis management. 4. Patient education about the chronicity of disease and reassure about contagious, about risk factor avoidance, proper sun exposure, proper skin moisturizing are very effective. 5. Aware about all details of treatment modalities. 6. Referral: Dermatology or Rheumatology 7. EBM 8. Cost effective : stop unjustified investigation as it is clinical diagnosis ( ESR, ANA, etc.)
  106. 106. REFERRAL • Un availability of medication as in our PHC • Confirmation of the diagnosis. • The response to treatment is inadequate. • There is significant impact on quality of life. • The patient has widespread severe disease. • In cases of psoriatic arthritis, referral and/or collaboration with a rheumatologist is indicated.
  107. 107. SUMMERY 1- Avoidance For all triggers is crucial as dryness, smoking, stress, alcohol …. 2- Proper sun exposure. 3- Remember the psychosocial impact of psoriatic patient such as social embarrassment, mood disturbance ,,,etc.) 4- Referral when indicated.
  108. 108. REFERENCE • UpToDate • Mayo clonic • AAFP • National Psoriasis Foundation • Amarican Academy of Dermatology
  109. 109. THANKS

×