DR Medhat MRCP

Plaque psoriasis Flexural psoriasis Guttate psoriasis Pustular psoriasis
• Complications of psoriasis :
Psoriatic arthropathy (around 10%)
Increased incidence of metabolic syndrome
Increased incidence of cardiovascular disease
Psychological distress
• Treatment :
First line : topical ttt
Onycolysis
o Emollients.
o Vit D analogues e.g calcipotriol ( epidermal proliferation)
o Steroids ( especially in palms,soles,scalp,flexures →SE: cut. atrophy)
o Dithranol (-- DNA synthesis , SE burning & staining so need wash)
o Coal Tar (-- DNA synthesis)
2 nd line : phototherapy ultraviolet (UV) or psoralin with UVA (PUVA)
SE ; squamous cell skin cancer (not melanoma).
3rd line : systemic ttt
o Oral retinoids
o Methotrexate (if associated with arthropathy or erythroderma)
o Ciclosporin
o Hydroxy urea (carbamid)
4th line : new biological ttt (for sever resistant cases)
o Infleximab (SE : ↑ risk of associated TB)
o Etanercept
o Efalizumab.
سؤال مهم (emergency): • TTT of erythrodermic psoriasis
Admission to hospital + I.V fluids + emollients X 5 days (1 st line).
Methotrexate : if failed to improve with 1 st line
• Prognosis :
- Usually relapsing & remitting.
- Guttate psoriasis has better prognosis (most cases resolve within 2-3 months).
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