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plaque type psoriasis

Psoriasis

aggrevating factor

  1. physical trauma

  2. infection , 1-2 week after infection

  3. medication , NSAID, beta blocker , ACEI,chloroquine, gemfibrosil , lithium , interferon

  4. stress

type

  1. plaque type psoriasis : well- circumcribe erythematous plaque with silvery scale usually at extensor area

  2. guttate psoriasis : small < 1 cm salmon pink papule with or without scale , mainly at trunk , happen 2-3 week after URI may be associate with strep infection

  3. pustular psoriasis: sterile pustules appearing on the palms and soles or diffusely over the body.

  4. erythrodermic psoriasis : generalized erythema, pain, itching, and fine scaling 

  5. inverse psoriasis : smooth inflame lesion without scaling 

psoriatic nail

  1. pitting nail 

  2. Oil spot 

  3. Subungual hyperkeratosis

  4. Onycholysis

  5. Onychodystrophy

psoriatic arthritis classification [caspar criteria ]

treatment

lesion < 20 % BSA => topical

topical medication

  1. topical steroid : tape off ID => od

  2. tar preparation : not associate with CA , LCD [liquid carbonis detergent ]

  3. vitamin D : calciprotriol [diavonex once or twice ][not more than 100 mg per week ]or calciprotriol plus steroid

  4. calcineurin inhibitor : tarcolimus , pimercolimus od or bid , suitable for face

  5. salicylic acid  , increase absorbtion of other drug , make scale thinner

oral medication

MTX

  1. short term bone marrow suppression

  2. cirrhosis

narrow band UVB

 PUVA

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