{"id":447,"date":"2017-03-26T14:18:38","date_gmt":"2017-03-26T14:18:38","guid":{"rendered":"http:\/\/papergp.com\/index.php\/dermatology\/psorasis\/"},"modified":"2023-01-24T11:25:26","modified_gmt":"2023-01-24T11:25:26","slug":"psoriasis","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/dermatology\/psoriasis\/","title":{"rendered":"Psoriasis"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4>Differential diagnosis<\/h4>\n<ul>\n<li>Arthropathy<\/li>\n<li>Erythroderma &#8211; widespread fluid filled spots<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Data gathering<\/h4>\n<ul>\n<li>Red flags &#8211; joint pains, fluid filled spots on body, eye symptoms<\/li>\n<li>Others &#8211; nails, scalp, medications<\/li>\n<li>Examine &#8211; location, skin, scalp, nails, joints, eyes<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Clinical management<\/h4>\n<ul>\n<li>Explanation\n<ul>\n<li>Faster turnover of skin cells &#8211; leads to a buildup of cells on the top layer of skin causing plaques to form &#8211; not clear why this occurs<\/li>\n<li>Not due to infection. Cannot be passed on<\/li>\n<li>Triggers &#8211; stress, infections, medications, smoking<\/li>\n<li>Sometimes people with psoriasis get nail and joint problems<\/li>\n<li>Flare-ups happen<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>Lifestyle &#8211; avoid triggers, stop smoking, exercise, healthy diet<\/li>\n<li>Emollients<\/li>\n<li>Vitamin D based creams &#8211; reduces rate of cell division<\/li>\n<li>Steroid creams &#8211; reduce inflammation<\/li>\n<li>First line &#8211; Dovobet &#8211; vitamin D + steroid cream &#8211; use until improvement (max 4 weeks) then step down to just vitamin D (calcipotriol)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Follow-up \/ Safety net\n<ul>\n<li>Refer\n<ul>\n<li>severe, extensive, poor response to treatment, social and psychological problems, arthropathy<\/li>\n<\/ul>\n<\/li>\n<li>Admit\n<ul>\n<li>if widespread pustules ?erythroderma<\/li>\n<\/ul>\n<\/li>\n<li>Annual CV review &#8211; BP, BMI, bloods<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<h4>Specific treatments<\/h4>\n<ul>\n<li>Chronic plaque\n<ul>\n<li>First line\n<ul>\n<li>Emollients\/coal tar prep e.g. Evorex<\/li>\n<\/ul>\n<\/li>\n<li>Second line\n<ul>\n<li>Calcipotriol oinment (Dovonex &#8211; avoid face\/flexures) for 8\/52 + moderate steroid for 7 days\n<ul>\n<li>Calcitriol (Silkis) ointment less irriating than calcipotriol in long term treatment<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Others\n<ul>\n<li>Diprosalic &#8211; for thick scale<\/li>\n<li>Dithrocreme &#8211; for large plaques with gradual increase in concentration<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Palms and soles\n<ul>\n<li>very potent steroid e.g. Dermovate for 4 weeks<\/li>\n<li>Diprosalic &#8211; thick scale<\/li>\n<li>Emollients under occlusion<\/li>\n<\/ul>\n<\/li>\n<li>Flexural\/genital\/breasts\n<ul>\n<li>Emollients\/coal tar prep e.g. Evorex<\/li>\n<li>Consider steroid\/antifungal\/antibacterial &#8211; Trimovate 2-4 weeks<\/li>\n<li>Calcitriol for longer term use<\/li>\n<\/ul>\n<\/li>\n<li>Guttae\n<ul>\n<li>Emollients<\/li>\n<li>Consider early referral for phototherapy<\/li>\n<\/ul>\n<\/li>\n<li>Face\n<ul>\n<li>Mild steroid OD or BD for up to 4 weeks<\/li>\n<li>Coal tar prep e.g. Alphosyl HC sparingly for 2 weeks<\/li>\n<li>nb: calcipotriol can only be used on hair margins\/ears &#8211; may be better to use calcitriol<\/li>\n<\/ul>\n<\/li>\n<li>Scalp\n<ul>\n<li>First line:\n<ul>\n<li>Tar based shampoo e.g. polytar liquid<\/li>\n<li>Diprosalic scalp solution &#8211; if thick scale, leave overnight and wash off in the morning<\/li>\n<\/ul>\n<\/li>\n<li>Second line\n<ul>\n<li>Calcipotriol scalp application<\/li>\n<\/ul>\n<\/li>\n<li>Third line\n<ul>\n<li>Betamethasone valerate 0.1% scalp application up to 4 weeks<\/li>\n<\/ul>\n<\/li>\n<li>Fourth line\n<ul>\n<li>Steroid\/calcitriol e.g. Xamiol<\/li>\n<\/ul>\n<\/li>\n<li>Fifth line\n<ul>\n<li>Etrivex shampoo &#8211; leave on for 15 minutes &#8211; max 4 weeks<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Nail\n<ul>\n<li>Nail varnish, avoid manicure<\/li>\n<li>Treat co-exisitng fungal infections<\/li>\n<li>Difficult to treat &#8211; consider referral to podiatry if severe<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Differential diagnosis Arthropathy Erythroderma &#8211; widespread fluid filled spots &nbsp; Data gathering Red flags &#8211; joint pains, fluid filled spots on body, eye symptoms Others &#8211; nails, scalp, medications Examine &#8211; location, skin, scalp, nails, joints, eyes &nbsp; Clinical management Explanation Faster turnover of skin cells &#8211; leads to a buildup of cells on the &hellip; <a href=\"https:\/\/papergp.com\/index.php\/dermatology\/psoriasis\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Psoriasis<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":442,"menu_order":174,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-447","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/447","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=447"}],"version-history":[{"count":9,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/447\/revisions"}],"predecessor-version":[{"id":2037,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/447\/revisions\/2037"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/442"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=447"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}