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PSORIASIS

PSORIASIS

Definition:

- A chronic skin disease characterized by scaling and

inflammation. Scaling occurs when cells in the outer layer of
skin reproduce faster than normal and pile upon the skin’s
surface.
Immune System
- Normal immune system includes the T cells and WBC’s
- Abnormal Immune System
o Causes activity by T cells in the skin triggering inflammation and
excessive skin cell formation
o

CONTRIBUTING FACTORS:
- Periods of emotional stress and anxiety
- Trauma
- Infections
- Seasonal and hormonal changes
- Race – Caucasians
- Genetic predisposition
-

SYMPTOMS:
1. Lesions (red, raised, dry, pruritic patches with silvery scales) appear on
the trunk, limbs, scalp
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PSORIASIS

2. Vividly red plaques on the scalp, elbows and knees, lower part of the
back, genitalia and nails
3. Nails – pitting and discolored with crumbling beneath the free edges and
separation of the nail plates

MEDICAL MANAGEMENT
Goals:
⚫ Slow the rapid turnover of epidermis
⚫ Promote resolution of psoriatic lesions
⚫ Control the natural cycle of the disease
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PSORIASIS

1. Assessment of life & management of stress

2. Daily baths – may add olive oil or coal tar preparations (Balnetar) & use a
soft brush

3. Emolient creams w/ alpha-hydroxy acids (Lac-Hydrin, Penederm) or

salicylic acid

Pharmacologic Therapy
1. Topical corticosteroids – for 4 weeks or 2x daily
Considerations: 2-week break before repeating treatment w/ very potent agents;
occlusive dressing to increase absorption; highly-potent – not for large areas
affected ==> adrenal suppression
2. Topical Non-steroidal Treatment
- for large areas
- Calcipotriene (Dovonex) & Tazarotene (Tazorac) == suppress
epidermopoiesis
3. Oral Agents
- Methothrexate == inhibits DNA synthesis in epidermal cells reducing the
turnover time of psoriatic epidermis (toxic to liver, kidneys & bone
marrow)
4. Photochemotherapy
- photosensitizing oral medication + UV-A light
- decreases cellular proliferation
- for widespread psoriasis (50% of the body)

NURSING MANAGEMENT
1. Health teaching
- disease process
- skin care
- treatment regimen
2. Prevent skin injury
- don’t pick/scratch
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PSORIASIS

3. Prevent skin dryness

- emolients
- avoid excessive washing
- use warm (not hot) water
- pat dry
4. Use of therapeutic relationship for support & aid coping