Psoriasis


Psoriasis is a chronic, recurrent disorder. The classic lesion is a well-marginated, erythematous plaque with silvery-white surface scale. Distribution includes extensor surfaces (i.e., knees, elbows, and buttocks); may also involve palms, soles and scalp (particularly anterior scalp margin). It may be associated with psoriatic arthritis and nail changes (onycholysis, pitting or thickening of nail plate with accumulation of subungual debris).

Management

  • Maintain cutaneous hydration
  • Topical glucocorticoids
  • Topical vitamin D analogue (calcipotriol)
  • Topical retinoid (tazarotene)
  • UV light (PUVA when UV used in combination with psoralens)
  • For severe disease methotrexate or cyclosporine
  • Acitretin can also be used but is teratogenic
  • Biologics - Efalizumab (humanized monoclonal antibody directed against CD11a) or alefacept (dimeric fusion protein: LFA-3/Fc human IgG1) can be considered for chronic, moderate to severe plaque psoriasis. Etanercept (dimeric fusion protein: TNF receptor/Fc human IgG1) is approved for psoriatic arthritis and psoriasis.

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