Psoriasis

disease of the skin (intergumentary system)

1. MEDICAL AND SURGICAL NURSING TOPIC:PSORIAS Done by : ABDULLA KHAMIS NGWALI 2 ND YEAR BSc,N STUDENT

2. OBJECTIVES Define psoriasis List causes of psoriasis Mention types of psoriasis Outline Pathophysiology of psoriasis List sign and symptom of psoriasis Explain diagnosis of psoriasis Describe treatment of psoriasis

3. Psoriasis Psoriasis is an inflammatory skin disease in which skin cells replicate at an extremely rapid rate. New skin cells are produced about eight times faster than normal--over several days instead of a month--but the rate at which old cells slough off is unchanged. Or Psoriasis is a chronic, noninfectious, inflammatory disease of the skin in which the production of epidermal cells occurs at a rate that is about six to nine times faster than normal

4. Definition cont… This causes cells to build up on the skin's surface, forming thick patches, or plaques, of red sores (lesions) covered with flaky, silvery-white dead skin cells (scales) Onset may occur at any age but is most common between the ages of 15 and 50 years

5. Picture of skin

6. Causes of psoriasis The cause of psoriasis is not known, but it is believed to have a genetic component. Several factors are thought to aggravate psoriasis. These include stress, excessive alcohol consumption and smoking. Individuals with psoriasis may suffer from depression and loss of self-esteem. As such, quality of life is an important factor in evaluating the severity of the disease. Certain medicines, including lithium salt and beta blockers, have been reported to trigger or aggravate the disease.

7. Types of psoriasis Plaque psoriasis (psoriasis vulgaris ) is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques

8. Conti….. Flexural psoriasis (inverse psoriasis) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections.

9. Conti….. Guttate psoriasis is characterized by numerous small oval (teardrop-shaped) spots. These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. Guttate psoriasis is associated with streptococcal throat infection

10. Conti….. Pustular psoriasis appears as raised bumps that are filled with non-infectious pus (pustules). The skin under and surrounding pustules is red and tender. Pustular psoriasis can be localized, commonly to the hands and feet

11. Conti… .. Nail psoriasis produces a variety of changes in the appearance of finger and toe nails. These changes include discoloring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail

12. Pathophysiology The basal skin cells divide too quickly, and the newly formed cells become evident as profuse scales or plaques of epidermal tissue. Psoriatic cells may travel from the basal cell layer of the epidermis to the stratum conium (skin surface) and be cast off in 3 to 4 days, in sharp contrast to the normal 26 to 28 days. Because of the rapid cell passage, the normal events of cell maturation and growth cannot take place and the normal protective layers of the skin cannot form.

13. conti …. They appears to be a hereditary defect that causes overproduction of keratin. The primary defect is unknown. Periods of emotional stress and anxiety aggravate the condition, and trauma, infections, and seasonal and hormonal changes are trigger factors. Psoriasis is considered mild if it affects less than 5% of the surface of the body; moderate, if 5–30% of the skin is involved, and severe, if the disease affects more than 30% of the body surface

14. Sign and symptoms Pain Erythema- with in the dermis blood vessels dilate and increase blood flow to skin causing generalized redness and heat loss Scaling Pustules inflammatory condition itching

15. Diagnositic test Skin biopsy Skin swab flexural psoriasis Auspitz sign- gentle removal of the silvery scale from a plaque Routine blood tests viral check of full blood count

16. Treatment This may involve tropical, systematic drug and phototherapy Drug therapy: Antihistamines such as cetrizen, Promethazine, Analgesics such as ibuprofen ,diclofenac, paracetamol Antibiotics such as cloxaciline, penicillin ,doxycycline, floxaciline, ampiciline

17. conti …. Steroid-based creams.  decrease inflammation, relieve itching, and block the production of cells that are overproduced in psoriasis. E.g. hydrocortisone ,dexathamethasone salicylic acid ointment which smoothes the skin by promoting the shedding of psoriatic scales e.g. silver nitrates

18. General nursing management Assessment focuses on how the patient is coping with the skin condition, the appearance of “ normal ” skin , and the appearance of skin lesions. Promoting Understanding Explain with sensitivity that there is no cure and that lifetime management is necessary; the disease process can usually be controlled Teaching Patient regarding the disease, skin care, and treatment regimen .

19. Conti..... Measures to prevent skin injury: avoid picking or scratching Measures to prevent skin dryness: use emollients, avoid excessive washing, use warm (not hot) water, and pat dry Use of the therapeutic relationship for support and to aid coping Development of self-acceptance Absence of complications

20. Reference International Study Of Pain: An Unpleasant Experience That We Primarily Associate With Tissue Damage Or Describe In Terms Of Tissue Damage Or Both." Merskey, H. (1964), An Investigation Of Pain Jennifer E. Helms, Claudia P. Barone, physiology And Treatment Of Skin Disease, critical Care Nurse, Vol 28, No. 6, Dec.2008. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet 2007;370(9583):263-71. Reich K, Kruger K, Mossner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatology 2009;160:1040-7.

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