This document provides information about psoriasis and psoriatic nails. It lists the systemic complications of severe psoriasis such as psoriatic arthritis, uveitis, and risk of chronic kidney disease. It also identifies possible aggravating factors for psoriasis including chronic infections, stress, scratching, excessive alcohol, obesity, and climate changes. Finally, it discusses treatment options for psoriasis including topical treatments as well as second-line options like phototherapy, acitretin, and methotrexate. It also notes the physical and psychological difficulties patients may experience.
3. Be familiar with the different clinical presentations
of psoriasis
4.
5. List the systemic complications
of severe psoriasis
> Psoriatic arthritis
> Uveitis
> Risk of CKD
6. List at least five possible
aggravating factors for psoriasis
> Chronic infections
> Stress
> Scratching
> Excessive alcohol
> Obesity
> Climate changes
7. Know the various topical treatment
options for psoriasis
Emollients
Vitamin D analogues
(calcipotriol)
Keratolytics
Coal tar
Dithranol
Topical corticosteroids
(eumovate)
Why don’t we use systemic steroids?
8. Know the various second line treatment options
for psoriasis
Phototherapy
Acitretin
Methotrexate
Cyclosporin
9. Understand the difficulties, physical
and psychological, experienced by
patients
Dermatology quality of life index
> Pain, itching, soreness, stinging
> Embarrassment and self consciousness
> Effect on shopping or looking after the home/garden
> Clothes
> Social/leisure activities
> Problems with partner, close friends or relatives
> Sexual difficulties
> Problems from treatment
10. Psoriatic Nail Disease
> Rarely seen without skin psoriasis.
> Nail pitting
> Onycholysis
> Subungual hyperkeratosis
> Beau’s lines
> Fungal nail infections
Arthritis is seen in 30% of sufferers of chronic psoriasis.
Also, higher rates of T2DM, obesity and cardiovascular disease
Monitoring
NB. there can be a substantial difference between the clinical severity and the impact on a persons life
Pitting
Onycholysis - the nail separates from the skin underneath the nail. At first this looks like a white or yellow patch at the tip of the nail. This patch gradually gets bigger and reaches the base of the nail. The gap between the nail and the skin underneath the nail can become infected and change colour. On the right there is a pseudomonas infection superimposing the onycholysis.
Subungual hyperkeratosis - chalk-like material builds up under the nail. The nail becomes raised and often tender
Beau's lines: transverse lines in the nails due to intermittent inflammation causing growth arrest lines
Consider differentials and overlying infections - bacteria and fungi.
