Psoriasis

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It is an inherited inflammatory condition of the skin

Clinical presentation 

• Thick, silvery white scaly plaques affecting mainly scalp, sacral region and extensor body surfaces
• Usually symmetrically distributed, with a chronic relapsing course.
• Can involve joints

Note: Exclude  precipitating  factors  e.g.  alcohol,  deficiencies  of  B12  or  folate,  stress,  streptococcal  infections. 

Non-pharmacological Treatment 

Sun exposure to the lesions for half an hour or one hour daily may be of benefit 

Pharmacological Treatment 

C: crude coal tar 5% in Vaseline in the morning for not less than 3months 

AND 

C: salicylic acid 5% in Vaseline to de-scale, apply at night for not less than 3months 

AND 

C: betamethasone valerate ointment (topical) 0.25% 12hourly for not less than 12weeks. 

OR 

C:  betamethasone  dipropionate+  salicylic  ointment  (topical)  12hourly  for  not  less  than 4months 

In severe disease 

D:  clobetasol  propionate  cream/ointment  (topical)  0.05%  12hourly  for  not  less  than 4months 

For extensive involvement > 20% body surface area and involvement of joints 

ADD 

S: methotrexate (PO) 7.5-20mg weekly for not less than 6months 

Note: Systemic steroids should not be used in psoriasis due to their rebound effect.