Psoriasis
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Transcript of Psoriasis
OBJECTIVES
Define psoriasis
List causes of psoriasis
Mention types of psoriasis
Outline Pathophysiology of psoriasis
List sign and symptom of psoriasis
Explain diagnosis of psoriasis
Describe treatment of psoriasis
Psoriasis
• Psoriasis is an inflammatory skin disease in which skin cells replicate at an extremely rapid rate. New skin cells are produced about eight times faster than normal--over several days instead of a month--but the rate at which old cells slough off is unchanged. Or
• Psoriasis is a chronic, noninfectious, inflammatory disease of the skin in which the production of epidermal cells occurs at a rate that is about six to nine times faster than normal
Definition cont…
• This causes cells to build up on the skin's surface, forming thick patches, or plaques, of red sores (lesions) covered with flaky, silvery-white dead skin cells (scales)
• Onset may occur at any age but is most common between the ages of 15 and 50 years
Causes of psoriasis
• The cause of psoriasis is not known, but it is believed to have a genetic component.
• Several factors are thought to aggravate psoriasis. These include stress, excessive alcohol consumption and smoking.
• Individuals with psoriasis may suffer from depression and loss of self-esteem.
• As such, quality of life is an important factor in evaluating the severity of the disease.
• Certain medicines, including lithium salt and beta blockers, have been reported to trigger or aggravate the disease.
Types of psoriasis
• Plaque psoriasis (psoriasis
vulgaris) is the most
common form of
psoriasis. It affects 80 to
90% of people with
psoriasis. Plaque psoriasis
typically appears as raised
areas of inflamed skin
covered with silvery white
scaly skin. These areas are
called plaques
Conti…..
• Flexural psoriasis (inverse
psoriasis) appears as smooth
inflamed patches of skin. It
occurs in skin folds, particularly
around the genitals (between the
thigh and groin), the armpits,
under an overweight stomach
(pannus), and under the breasts
(inframammary fold). It is
aggravated by friction and sweat,
and is vulnerable to fungal
infections.
Conti…..
• Guttate psoriasis is characterized
by numerous small oval
(teardrop-shaped) spots. These
numerous spots of psoriasis
appear over large areas of the
body, such as the trunk, limbs,
and scalp. Guttate psoriasis is
associated with streptococcal
throat infection
Conti…..
• Pustular psoriasis appears as
raised bumps that are filled
with non-infectious pus
(pustules). The skin under and
surrounding pustules is red
and tender. Pustular psoriasis
can be localized, commonly to
the hands and feet
Conti…..
• Nail psoriasis produces a
variety of changes in the
appearance of finger and toe
nails. These changes include
discoloring under the nail
plate, pitting of the nails,
lines going across the nails,
thickening of the skin under
the nail
Pathophysiology
• The basal skin cells divide too quickly, and the
newly formed cells become evident as profuse scales
or plaques of epidermal tissue. Psoriatic cells may
travel from the basal cell layer of the epidermis to
the stratum conium (skin surface) and be cast off in
3 to 4 days, in sharp contrast to the normal 26 to 28
days.
Because of the rapid cell passage, the normal events
of cell maturation and growth cannot take place and
the normal protective layers of the skin cannot form.
conti….
They appears to be a hereditary defect that causes overproduction of keratin. The primary defect is unknown. Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes are trigger factors. Psoriasis is considered mild if it affects less than 5% of the surface of the body; moderate, if 5–30% of the skin is involved, and severe, if the disease affects more than 30% of the body surface
Sign and symptoms
• Pain
• Erythema- with in the dermis blood vessels
dilate and increase blood flow to skin causing
generalized redness and heat loss
• Scaling
• Pustules inflammatory condition
• itching
Diagnositic test
• Skin biopsy
• Skin swab flexural psoriasis
• Auspitz sign- gentle removal of the silvery
scale from a plaque
• Routine blood tests viral check of full blood
count
Treatment
This may involve tropical, systematic drug and
phototherapy
Drug therapy:
• Antihistamines such as cetrizen, Promethazine,
• Analgesics such as ibuprofen ,diclofenac,
paracetamol
• Antibiotics such as cloxaciline, penicillin
,doxycycline, floxaciline, ampiciline
conti….
• Steroid-based creams. decrease
inflammation, relieve itching, and block the
production of cells that are overproduced in
psoriasis. E.g. hydrocortisone
,dexathamethasone
• salicylic acid ointment
which smoothes the skin by promoting the
shedding of psoriatic scales e.g. silver nitrates
General nursing management• Assessment focuses on how the patient is
coping with the skin condition, the appearance of “normal” skin, and the appearance of skin lesions.Promoting Understanding
• Explain with sensitivity that there is no cure and that lifetime management is necessary; the disease process can usually be controlled
• Teaching Patient regarding the disease, skin care, and treatment regimen.
Conti.....
• Measures to prevent skin injury: avoid picking or scratching
• Measures to prevent skin dryness: use emollients, avoid excessive washing, use warm (not hot) water, and pat dry
• Use of the therapeutic relationship for support and to aid coping
• Development of self-acceptance
• Absence of complications
Reference
i. International Study Of Pain: An Unpleasant Experience That We
Primarily Associate With Tissue Damage Or Describe In Terms Of
Tissue Damage Or Both." Merskey, H. (1964), An Investigation Of
Pain
ii. Jennifer E. Helms, Claudia P. Barone,physiology And Treatment Of
Skin Disease, critical Care Nurse, Vol 28, No. 6, Dec.2008.
iii. Griffiths CE, Barker JN. Pathogenesis and clinical features of
psoriasis. Lancet 2007;370(9583):263-71.
iv. Reich K, Kruger K, Mossner R, Augustin M. Epidemiology and
clinical pattern of psoriatic arthritis in Germany: a prospective
interdisciplinary epidemiological study of 1511 patients with
plaque-type psoriasis. Br J Dermatology 2009;160:1040-7.