PSORIASIS

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 NursingBulletin: Psoriasis
• A chronic non infectious, inflammatory skin disorder
involving keratin synthesis that results in psoriatic
patches.
• Formerly considered idiopathic, now thought to be
genetically linked and immune system modulated.
• Possible causes of the disorder include stress,
trauma, infection, and changes in climate.
• Condition tends to be lifelong, with flare-ups and
remissions. Maybe exacerbated by infection; drugs,
such as lithium,beta blockers,antimalarial drugs and
indomethacin.
 NursingBulletin: Psoriasis
• It is a chronic skin disorder in which red or deep
pink raised patches covered by white scales
appear on the skin.
• It usually causes no discomfort but it can get
slightly itchy, especially on scalp or around the
anus.
• The main problem is the unsightly appearance of
the rash but fortunately it is usually covered by
clothing.
• You may have single patch or several large
ones.
• The cause of psoriasis is unknown and It shows
a tendency to run in families
• In psoriasis, areas of the
skin grow much faster
than normal and form red,
scaling patches.

• FIGURE 1. Common areas

of distribution of
psoriasis. The lesions are
usually symmetrically
distributed and are
characteristically located
on the ears, elbows,
knees, umbilicus, gluteal
cleft and genitalia. The
joints (psoriatic arthritis),
nails and scalp may also
be affected.
 Pathophysiology
Causes:UNKNOWN
The skin in the patches of psoriasis is growing much faster
than normal skin.
↓
As your skin is worn away, it is replaced by cells produced
beneath the surface.
↓
In psoriasis, the normal rate of cell production is speeded
up, and does not allow the cells to manufacture a
substance called keratin that gives its hard surface
↓
The result is unsightly flaking of the skin
 Types of Psoriasis
• Plaque or psoriasis vulgaris:
most common type, occurs on
knees, elbows, scalp and other areas.
• Guttate – occurs in trunk, arms, legs; triggered by
streptococcal infection.
• Inverse – affects flexural areas, such as axilla and
groin.
• Erythrodermic - severe form that affects most of the
body.
• Pustular – blisters contain pus-like material on hand
and feet or on widespread area.
 Signs and Symptoms
• Pruritus ( may or may not be present if
present only mild).
• Shedding, silvery, white scales on a raised,
reddened, round plaque that usually affects
the scalp ears ,knees, elbows, extensor
surfaces of arms and legs, and sacral
regions; with bilateral symmetry
• A yellow discoloration, pitting and thickening
of nails and separation of nail plates if they
are affected.
 How is psoriasis diagnosed?
• A doctor can make a diagnosis on the
appearance of the rash without the need
for tests.
• If there is any doubt, a piece of skin can
be removed for examination (a BIOPSY)
 Important Facts:
• It is worse in winter, due to lack of sunlight
• An outbreak is often triggered by a period of mental
stress
• Yellow blisters can occur in patches on the soles and
palms
• It is most unlikely to appear on the face
• It should not prevent you from enjoying a normal life
• It can temporarily disappear, especially during summer
• It tends to flare up around puberty and the menopause in
women
• Psoriasis is not an infection and is not contagious
• Avoid sunburn? See next page why 
 Management:
TOPICAL THERAPY
• Administer and instruct the client regarding daily soaks and tepid, wet
compresses, as prescribed, to the affected areas to remove scales;
oils or tar preparations (Balnetar) are added to the bath water.
• Remove the scales during the soak, using a soft wash cloth and gentle
circular motions; creams and salicylic acid is applied to the affected
areas after bath to continue to soften thick scales.
• Coal tar preparations are photosensitizing agents so patient should be
warned not to expose treated skin to the sun.
• A daily tar shampoo and an application of steroid lotion for scalp
lesion.
• Occlusive dressings Hydrocoloid (Duoderm)
• Use plastic wrap or bags as the occlusive dressing, and use rubber
gloves on the client’s hands, plastic bag on the feet, and a shower cap
on the head if affected.
• Anthralin preparations (Anthra-Derm, Dritho-Crème, Lasan)
for thick psoriatic plaques resistant to other coal tar or
steroid preparations.
• Warn patient that coal tar and anthralin preparations may
stain clothing; let dry before dressing or should be covered
in some way. The hands must be washed after
• Topical corticosteroids are used for short periods because
of their side effects ( striae, thinning of the skin, adrenal
suppression).
• Psoriasis may quickly reappear once steroid is stopped
(rebound phenomenon) Repeated eye contact associated
with cataract development.

INTRALESIONAL THERAPY:
• Injections into highly visible or isolated patches of psoriasis
that are resistant. Triamcinolone acetonide ( aristocort,
kenolog-10, trymex) is injected, and care is taken so that
normal skin is not injected
SYSTEMIC THERAPY
Methotrexate have been used in treating extensive psoriasis that fails to
respond to other forms of therapy. Should monitor hepatic,
haematopoietic and renal systems.
Reinforce women of childbearing age that retinoids and methotrexate
are teratogenic; women must be using birth control.
Oral retinoids (synthetic derivatives of Vitamin A and its metabolite,
Vitamin A acid)
Hydroxyurea (Hydrea). Monitor signs ands symptoms of bone marrow
depression.

PHOTOTHERAPY
A treatment for severely debilitating psoriasis is psoralen and
ultraviolet A (PUVA) therapy, which involves taking a photosensitizing
drug (usually 8-methoxypsoralen) in a standard dose with subsequent
exposure to long-wave ultraviolet light when peak drug plasma levels
are obtained.
UVB light is also used to treat generalized plaque.
Advise patient to wear goggles to prevent cataracts and follow up with
periodic eye exams. Should wear sunscreen and sunglasses.
Contraceptives should be used since teratogenic effect has not been
established yet.
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Nursing Licensure Examinations, Nursing Board
Exams Results, Nursing Updates 