2. OVERVIEW
5. Case studies
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4. Managing psoriasis
3. Diagnosing psoriasis
2. Clinical presentation
1. Epidemiology and pathophysiology
3. WHAT IS PSORIASIS?
– Inflammatory and hyperplastic
disease of skin
– Characterised by erythema and
elevated scaly plaques
– Chronic, relapsing condition
– Course of disease often
unpredictable
.
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4. SYMPTOMS OF PSORIASIS
Adapted from Krueger G et al. Arch Dermatol 2001; 137: 280–4.
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Most frequently
experienced symptoms
5. EPIDEMIOLOGY
• Common skin disorder
• Prevalence variable: ~ 0.3–2.5%
• Prevalence equal in males and females
• Estimated incidence: ~ 60 per 100,000 per year
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6. AGE OF ONSET
• Mean age: ~ 23–37 years
• Current theory:
2 distinct peaks with possible genetic associations
– Early onset (16–22 years)
•
•
More severe and extensive
More likely to have affected first-degree family member
– Late onset (57–60 years)
•
•
Milder form
Affected first-degree family members nearly absent
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8. CLINICAL PRESENTATION:
CLASSIC PSORIASIS
– Well-defined and
sharply demarcated
– Round/oval-shaped
lesions
– Usually
symmetrical
– Erythematous,
raised plaques
– Covered by white,
silvery scales
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9. TYPES OF PSORIASIS
•
•
•
•
Chronic plaque
Guttate
Flexural
Erythrodermic
• Pustular
– Localised and generalised
• Local forms
–
–
–
Palmoplantar
Scalp
Nail (psoriatic
onychodystrophy)
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10. CHRONIC PLAQUE PSORIASIS
– Most common type – affects
approximately 85%
– Features pink, well-defined
plaques with silvery scale
– Lesions may be single or
numerous
– Plaques may involve large
areas of skin
– Classically affects elbows,
knees, buttocks and scalp
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11. FLEXURAL PSORIASIS
– Lesions in skin folds
articularly groin,
gluteal cleft, axillae and
submammary regions
– Often minimal or
absent scaling
– May cause diagnostic
difficulty when genital
or perianal region is
affected in isolation
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12. PALMOPLANTAR PSORIASIS
– Can be hyperkeratotic
or pustular
– May mimic dermatitis –
look for psoriatic
manifestations
elsewhere to aid
diagnosis
– Possibly aggravated by
trauma
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13. NAIL PSORIASIS
– May be present in patients with
any type of psoriasis
– Can take several forms:
• Pitting: discrete, well-
circumscribed depressions on
nail surface
• Subungual hyperkeratosis:
silvery white crusting under
free edge of nail with some
thickening of nail plate
• Onycholysis: nail separates
from nail bed at free edge
• ‘Oil-drop sign’: pink/red colour
change on nail surface
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14. PSORIATIC ARTHRITIS
– Approximately 5–20%
have associated arthritis
– Five major patterns of
psoriatic arthritis:
• Distal interphalangeal
involvement
• Symmetrical polyarthritis
• Psoriatic spondylarthropathy
• Arthritis mutilans
• Oligoarticular, asymmetrical
arthritis
– Clinical expressions often
overlap
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16. DETERMINING PSORIASIS SEVERITY
• PsoriasisArea and Severity Index (PASI)
– Score indicates severity of disease at a given time
– Single number that considers severity of lesions and
extent of disease across four major body sites (head,
trunk, upper limbs and lower limbs)
– Score ranges from 0 (no disease) to 72 (maximal
disease)
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17. MANAGING PSORIASIS
• Determine clinical setting before
selecting treatment, considering
– Disease pattern, severity and extent
– Sites of disease
– Coexistent medical conditions
– Patient’s perception of disease severity
– Time commitments and treatment expense
– Previous treatments for psoriasis
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18. MANAGING PSORIASIS
• Goals of management
– Tailor management to individual and address both
medical and psychological aspects
– Improve quality of life
– Achieve long-term remission and disease control
– Minimise drug toxicity
– Evaluate and monitor efficacy and suitability of
individual treatments
– Remain flexible and respond to changing needs
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19. TREATMENT OPTIONS FOR PSORIASIS
• Stepwise approach is advised
• Treatments include:
– General measures and topical therapy
– Phototherapy
– Systemic and biological therapies
• Combination therapies : may
reduce toxicity and improve outcomes
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20. TOPICAL THERAPIES:
CORTICOSTEROIDS
• Possess anti-inflammatory, antiproliferative and
immunomodulatory properties
• Reduce superficial inflammation within plaques
• Potency choice depends on disease severity,
location and patient preference
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21. TOPICAL THERAPIES: CALCIPOTRIOL/BETAMETHASONE
DIPROPIONATE GEL
• Newly TGAapproved product not yet available in
Australia
• Specially formulated for the scalp
• Provides rapid, effective control of scalp psoriasis
– More effective than treatment with individual actives alone
– 53.2% (more than half) of patients had absent or
very mild disease after just two weeks of gel application
• Once-daily formulation may
encourage compliance
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22. DIAGNOSIS AND MANAGEMENT OF
PSORIASIS: SUMMARY
•
•
•
•
•
Chronic, inflammatory disease of skin
T-cell mediated disorder
Classic presentation characterised by red, scaly
plaques
Management should address both medical and
psychological aspects
Treatments include topical therapy, phototherapy,
systemic therapy and biological agents
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