PLAQUE PSORIASIS
Presentation
- Chronic condition affecting about 2% of the population at any age
- Any area can be affected, but most commonly extensor surfaces
- Well-demarcated plaques with thick, silvery scale, which bleed if picked
Management
- Treatment includes emollients, topical vitamin D derivatives or vitamin D/steroid combinations
- UV light usually beneficial
- Severe cases require referral to secondary care
- Phototherapy can be helpful
- In severe cases, biological agents can be beneficial
Guttate psoriasis
GUTTATE PSORIASIS
Presentation
- Typically 1-10mm drop-like salmon-coloured papules with surface scale
- Monomorphic appearance, starts on torso before spreading to limbs
- Acute onset usually follows URTI from group B haemolytic streptococcus
- Most common in under-30s age group
- May be seen in association with beta-blockers and lithium
- Biopsy can aid diagnosis
Management
- Usually self-limiting, resolves in weeks to months. Emollients can help
- May progress to plaque psoriasis
- In severe cases, phototherapy can be beneficial
Palmoplantar psoriasis
PALMOPLANTAR PSORIASIS
Presentation
- Thought to be a disorder of eccrine sweat glands
- Affects palms and soles, although 10-20% have psoriasis elsewhere
- Rarely occurs in children. More common in women than men
- More common in smokers
- Differential diagnoses include fungal infections
Management
- No known cure. If a smoker, advise on cessation
- Regular application of emollients will help
- Treatments include topical steroids, acitretin, psoralen plus UVA light
- In severe cases, biological agents can be beneficial
Flexural psoriasis
FLEXURAL PSORIASIS
Presentation
- Common condition affects armpits, groin, submammary folds, umbilicus
- Scale usually absent and skin looks red, shiny and smooth
- Borders usually well demarcated
- Psoriasis may also be present in non-flexural areas
- Secondary infections common
Management
- Treatment includes emollients and topical steroids
- Vitamin D analogues helpful but may be poorly tolerated due to irritation
- Topical calcineurin inhibitors are an alternative to steroids
- Phototherapy is relatively ineffective in most cases
Dr Nigel Stollery is a GP in Leicestershire
