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Psoriasis is an emotionally and physically debilitating disease which can significantly affect quality of life. Support with psychosocial factors and advice on lifestyle interventions is important. Topical treatments are first choice for mild psoriasis. Systemic treatments are used for severe symptoms and are usually initiated in secondary care. Dr Amanda OakleySpecialist Dermatologist and Clinical Associate Professor, Tristram Clinic, Hamilton.

Psoriasis Transfer is an immune-mediated chronic scaly skin disorder in which there is upregulation of protein expression resulting in excessive keratinocytic proliferation, abnormal keratinocyte differentiation and inflammation. Normally keratinocytes require 28 — 44 days to migrate from the basal cell layer of the epidermis to the stratum corneum, but in people with psoriasis this migration takes only four days. Psoriasis Transfer cornification hardens the surface of the thickened plaques, which are red because of prominent vascularity.

Psoriasis is one of the most prevalent autoimmune diseases affecting both men and women equally. Psoriasis most often appears in the late teens or in the 50s, but can develop at any age. There is a genetic predisposition and approximately one third of people with psoriasis report having an affected relative. It is an emotionally and physically Psoriasis Transfer disease which can have a significant impact on quality of life and can lead to depressive illness.

Psoriasis is diagnosed clinically, occasionally with the support of Psoriasis Transfer. There are no specific blood tests to diagnose or monitor psoriasis. Cardiovascular risk should be monitored due to the association between cardiovascular disease and psoriasis. There are several different types of psoriasis Box 1. It may be widespread or localised to one part of the body, such as Psoriasis Transfer scalp or fingernails. Psoriasis affecting the face, hands and feet may be particularly debilitating.

Clinical trials may use the more complex Psoriasis Area and Severity Index PASI score to assess effectiveness of treatment. Educating the patient about the chronic nature of psoriasis and possible Psoriasis Transfer is important. Reassure them that Psoriasis Transfer is not contagious and that treatment can help.

The patient may require support to cope with the psychosocial aspects of the disease. Some patients may choose not to treat the skin disease itself as treatments can be burdensome and associated with adverse effects. Provide general advice regarding the benefits of not smoking, maintaining optimal weight and avoiding excessive alcohol. Although sun exposure is often helpful, fair skinned people should be cautioned regarding the risk of sunburn and long term overexposure, leading to aging of the skin and skin cancer.

Treatment has to be individualised. It Psoriasis Transfer vary depending on the characteristics of the psoriasis being treated: Regular use of a thick emollient such as fatty cream is helpful to prevent cracking and irritation. Coal tar or pine tar emollient solutions in bathwater may be soothing, reduce itch and allow gentle removal of scale.

Topical corticosteroids are used by the majority of people Gruppe Behinderung mit Psoriasis psoriasis, particularly those click to see more limited disease.

Corticosteroids have anti-inflammatory, immunosuppressive and antiproliferative properties. Lower potency corticosteroids should generally be used Psoriasis Transfer limited periods of time on the face and other areas of thin skin and in infants. Pimecrolimus is an alternative anti-inflammatory cream for psoriasis affecting the face or genitals, but is not effective on other sites where plaques are thick. In other areas and in adults moderate or high-potency corticosteroids are generally Psoriasis Transfer as initial therapy.

Thick chronic plaques and plaques on Psoriasis Transfer and Psoriasis Transfer may require treatment read article the highest potency agents for a maximum of three weeks. Ointments are the best choice for dry, scaly plaques. One Psoriasis Transfer the drawbacks of corticosteroid therapy is associated tachyphylaxis, leading to decreased efficacy with continued use, and sometimes resulting in an acute flare-up when therapy is stopped.

Once the lesions have Psoriasis Transfer, these effects can be minimised by switching patients to less potent formulations, or Psoriasis Transfer them to apply the medication less frequently, i. Another strategy is the use of corticosteroid-free times.

Calcipotriol Daivonex, fully subsidised is a vitamin D analogue that acts mainly by reducing the proliferation of keratinocytes. Treated areas become less scaly but may remain red. It is Psoriasis Transfer recommended for severe extensive psoriasis unless calcium status is carefully monitored, because of the Psoriasis Transfer of hypercalcaemia secondary to excessive absorption of calcipotriol.

It may be reduced to once daily when the condition improves, however it is most effective if applied consistently twice daily. Calcipotriol is not as well absorbed from the cream formulation as the ointment, so the cream is only used if there is a strong patient preference. Calcipotriol is not usually recommended for use Psoriasis Transfer the face because it may cause itching and erythema of the Psoriasis Transfer skin.

However some patients are able to use the cream formulation successfully on the face. Irritation may be reduced with hydrocortisone cream. When patients are applying calcipotriol to other parts of their body, they should be advised to wash their hands after application, to Psoriasis Transfer inadvertent transfer to the face.

Hypercalcaemia has been reported rarely at the recommended dose, however serum calcium and renal function should Psoriasis Transfer monitored at three monthly intervals, if patients are applying larger quantities.

To avoid the risk of hypercalcaemia, calcipotriol should not be used concurrently with calcium or vitamin D supplements.

Direct sunlight and UV radiation may inactivate calcipotriol, so it is best applied after exposure. Calcipotriol use in children. For children aged 6—12 years the maximum weekly dose should not exceed 50 g, while for children over 12 years the maximum weekly dose is 75 g.

Combined use of calcipotriol and other psoriasis treatments. When using multiple topical treatments, instruct patients to apply them at separate times. For example a topical corticosteroid may be used in the morning and calcipotriol used in the evening or calcipotriol may be used twice daily on weekdays, and the topical corticosteroid geptral Psoriasis Bewertungen daily at weekends.

Calcipotriol should not be used at the same time as topical salicylic acid because it is inactivated by it. Dithranol Micanol cream, fully subsidised belongs to the family of hydroxyanthrones which have been used in the treatment of psoriasis for more than a century. In the archaic Ingram regimen, a thick paste is applied to large plaques twice daily, under carefully applied dressings. It is then removed in a tar bath and the patient exposed to UV radiation.

Psoriasis Transfer regimen is too difficult for home use as dithranol is very irritating to normal skin and causes permanent stains on clothing and click here. A short-contact regimen may be suitable for well motivated patients with small numbers of Psoriasis Transfer plaques of psoriasis. The application time can be Psoriasis Transfer gradually over seven days to a maximum of 30 minutes.

It should not be applied to areas of thin skin such as face, genitalia, intertriginous Psoriasis Transfer and should be avoided in pregnancy, lactation Psoriasis Transfer in children.

Patients should be reminded that it Psoriasis Transfer cause staining of skin, hair, fingernails gloves are recommended when applying itclothing and bed linen. If redness or burning occurs the Psoriasis Transfer should be reduced or stopped. It is not well understood how coal or pine tar Psoriasis Transfer for psoriasis, but it appears to have an anti-pruritic nature and is keratoplastic Psoriasis Transfer i. Coal and pine tar are used mainly as a bath additive or scalp application.

Coal or pine tar preparations or Egopsoryl TA gel unsubsidised can be directly applied to plaques. See below for a list of products. For example, a prescription may be written as: They are used one to two times per week Psoriasis Transfer as necessary and are best left on the scalp for several minutes before rinsing off. Coco-scalp fully subsidised is an ointment made from coal tar, sulphur, salicylic acid and coconut oil that can be applied to scaly plaques and left for a minimum of one hour before washing off.

It can safely be occluded e. It is unsuitable for blonde or grey hair as it may stain. Topical corticosteroids are applied to the scalp once or twice daily for short courses up to one month in duration, and then two to three days each week for maintenance if required.

Overuse may cause psoriasis to worsen. Topical corticosteroids are particularly useful to reduce pruritus although alcohol-based lotions may sting on application and they are ineffective through thick scale.

Dose of the solution should not exceed 60 mL per week. If cosmetically acceptable to the patient, calcipotriol in a cream base may be more effective than the solution. Treatment of nail psoriasis is often ineffective. The patient should be advised that it may take months or longer for results as nails grow slowly e.

Coal tar can irritate the skin so patients need to Psoriasis Transfer with different products. A higher concentration Psoriasis Transfer coal tar is more effective but Psoriasis heilen Ich a greater risk of irritation.

Photochemotherapy PUVA has been discontinued in most centres except for use in localised hand and foot treatment. Systemic therapies are not always effective and they may have potential serious adverse effects and risks. Narrowband UVB Psoriasis Transfer is available in larger hospitals and some private dermatological practices. The patient stands in Psoriasis Transfer cabinet containing 24 to 56 fluorescent bulbs, primarily emitting a wavelength of — nm, and is exposed to increasing doses two or three times weekly Psoriasis Transfer 20 to 40 treatments.

Prolonged remissions are common. Risks of this therapy include burns, presumed increase in skin cancer and premature aging of the skin. Methotrexate is a folate antagonist and T-cell suppressive. Supplementary folic acid 5 mg once weekly may reduce Vitamin diprospan Gebrauchsanweisung Psoriasis specific risk of adverse effects such as gastrointestinal disturbance and mouth ulceration.

Methotrexate is absolutely contraindicated in pregnancy and lactation. It also affects sperm and men should not father children while taking it. Significant liver disease, especially when resulting from alcohol misuse, precludes treatment. Other folate antagonists such as trimethoprim and sulfonamides must not be prescribed with methotrexate, because of an increased risk of marrow suppression.

Monitoring blood count, liver function and serum creatinine every one to three months is essential. Long term liver fibrosis and cirrhosis is a risk and additional specialist monitoring may be required. Acitretin is a synthetic aromatic analogue of retinoic acid. It acts by normalising epidermal cell proliferation, differentiation and cornification. It is particularly useful for erythrodermic and pustular forms of psoriasis. The thickness and scaling of chronic plaque psoriasis usually improves on treatment.

Like isotretinoin, it has recently become fully funded when special authority criteria are fulfilled. However there are significant adverse effects and risks from treatment. The initial dose article source 10—30 mg daily and the maintenance dose depends on clinical efficacy and tolerability. Blood donation is prohibited during, and for one year after completion of therapy. Alcohol must be avoided during treatment and for two Psoriasis Transfer after treatment with acitretin, particularly by women of child bearing potential.

This is because it can lead Behandlungsvorrichtung Psoriasis the formation of etretinate, a retinoid that is stored in fat cells, and takes several years for the body to clear. Acitretin is contraindicated in patients who are breastfeeding, or those with severely impaired renal or hepatic function, or chronically abnormal elevated blood lipid values. Hepatic function and serum lipids should be regularly monitored throughout treatment.

Acitretin may result in a reversible hyperlipidaemia requiring active management. People with diabetes may experience a change in their glucose tolerance both improvement or Psoriasis Transfer can occur and Psoriasis Transfer blood glucose levels may require more intensive monitoring in the early stages of treatment. The most common adverse effects observed are dryness of the lips, epistaxis, peeling palms and soles, dry skin, asteatotic dermatitis and diffuse hair loss which may be severe.

These are symptoms of hypervitaminosis A. Many patients are unable to tolerate acitretin because Psoriasis Transfer fatigue, Psoriasis Transfer, arthralgia or ophthalmic effects e.

Ciclosporin is rapidly Service Anamnese der Psoriasis vulgaris stationäre Phase patients for psoriasis in doses ranging from 2. However, as psoriasis tends to relapse quickly on discontinuing the drug, many people take it for prolonged periods risking hypertension, renal impairment, increased risk of skin cancer and other adverse effects.

Treatment is well tolerated and often very effective for psoriasis. Long-term studies are ongoing to determine safety, as these agents may increase granulomatous Psoriasis Transfer, such as tuberculosis and have been reported to exacerbate Psoriasis Transfer failure and demyelinating conditions e. It is reserved for very severe psoriasis and can be administered in both hospital or outpatient settings.

Adalimumab is now funded on Special Authority application initially by a specialist for small numbers of patients with severe psoriasis in whom current treatments are ineffective or contraindicated. Follow us on facebook. Login to my bpac. Allergies and immunology Dermatology. The treatment of psoriasis in primary care Psoriasis is an emotionally and physically debilitating disease which can significantly affect quality of life. In this article Diagnosis and monitoring Management Topical skin therapies Specialist referral References In this article.

Key concepts Psoriasis is an emotionally and physically debilitating disease which can Psoriasis Transfer affect quality of life Psoriasis is aggravated by factors including smoking, high alcohol intake, high glycaemic diet, certain medications particularly lithium and emotional stress Management includes support with the psychosocial aspects of the disease and advice on lifestyle interventions Topical treatments are the first choice for mild psoriasis, and are also used Psoriasis Transfer for resistant lesions in patients with more extensive disease Calcipotriol and intermittent potent topical corticosteroids are prescribed for the majority of patients Systemic treatments are used for severe disease and are usually initiated by specialists.

Assessing Severity Severity can be defined by how much of the body surface area is affected: Diagnosis and monitoring Psoriasis is diagnosed clinically, occasionally with the support of histology. There are several different Psoriasis Transfer of psoriasis Psoriasis Transfer are several different types of psoriasis Box 1. Guttate psoriasis — 5 to 10 mm red plaques on the trunk and limbs, often appearing suddenly after a This web page Psoriasis Transfer viral upper respiratory tract infection.

Flexural psoriasis — bright red smooth shiny skin lesions found in skin folds: Generalised pustular psoriasis — a Psoriasis Transfer acute illness characterised by fever associated with crops of sterile pustules arising in or around painful red skin. It can be triggered by systemic or potent topical steroids and other medications, over-exposure to UV light, infections and stress. Erythrodermic psoriasis — a Psoriasis Transfer inflammatory form of psoriasis that affects most of or the entire body surface and can lead to hypothermia, hypoalbuminaemia and cardiac failure.

Severe cases require hospitalisation. Known triggers Psoriasis Transfer the abrupt withdrawal of a systemic psoriasis treatment, allergic Psoriasis Transfer, over-exposure to UV light, infection and some medications e.

Pictures supplied by DermNet NZ. Management Educating the patient about the Psoriasis Transfer nature of psoriasis and possible co-morbidities is important. Treatments most commonly initiated in Psoriasis Transfer practice include: Topical skin therapies Regular use of a thick emollient such as fatty cream is Psoriasis Transfer to prevent cracking and irritation.

Corticosteroids Topical corticosteroids are used by the majority of people with psoriasis, particularly those with limited disease.

Note that calcipotriol is poisonous to dogs. Dithranol 7 Dithranol Micanol cream, fully subsidised belongs to the family of hydroxyanthrones which have been used in the treatment of psoriasis for more than a century.

Corticosteroid scalp applications include in increasing potency: Nail treatments Treatment of nail psoriasis is often ineffective. Specialist referral Referral for phototherapy or systemic therapy should be considered for those with: Phototherapy Narrowband UVB phototherapy is available in larger hospitals and some private dermatological practices. Methotrexate Methotrexate is a folate antagonist and T-cell suppressive.

Acitretin Products Teer Salbe für Psoriasis Surgery is a synthetic Psoriasis Transfer analogue of retinoic acid. Psoriasis Transfer, methotrexate and vitamin A or other retinoids must be avoided. Ciclosporin Ciclosporin is rapidly effective for psoriasis in doses ranging from 2. References National Psoriasis Foundation.

Griffiths CEM, Barker JN. Pathogenesis jemand geheilt von Psoriasis clinical features of psoriasis. Lancet ; Federman DG, Shelling M, Prodanovich S, et al. Br J Dermatol ; Menter A, Griffiths CEM. Current and future management of psoriasis. Medicine safety data sheets. Make a comment Comments Anisha Dubey said: Very useful resource special thanks to Amanda Oakley.

Please login to make a comment. This article is 7 years and 9 months old. Psoriasis Transfer this issue Topical corticosteroid treatment for skin conditions The treatment of psoriasis in primary care Managing eczema Having a senior moment?

Cervical smears - achieving equity Upfront: Psoriasis Transfer Not Want Not. Reducing wastage Management of acute exacerbations of COPD in primary care Quiz feedback: How to treat acne Practice tips: PPIs and Paraffin Correspondence: You may also like Topical antibiotics for skin infections: Choosing a topical treatment for patients with chronic plaque psoriasis 3.

Monitoring patients with moderate to severe psoriasis Prescribing isotretinoin for patients with acne in primary care How to use fluorouracil and imiquimod for non-melanoma skin cancer in a general practice setting Childhood eczema: Psoriasis is Psoriasis Transfer emotionally and physically debilitating disease which Psoriasis Transfer significantly affect quality of life Psoriasis is aggravated by factors including smoking, high alcohol intake, high glycaemic diet, certain medications particularly lithium and emotional stress Management includes support with the psychosocial aspects of http://julia-kuhn.de/psoriasis-anti-allergie-tabletten.php Psoriasis Transfer and advice on lifestyle interventions.

Topical treatments are the first choice for mild psoriasis, and are also used adjunctively for resistant lesions in patients with more extensive disease Calcipotriol and intermittent potent topical corticosteroids are prescribed for the majority of patients Systemic treatments are used for severe disease and are usually initiated by specialists.


Psoriasis Transfer The treatment of psoriasis in primary care - BPJ 23 September

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