Question

A 22 year old client comes in for evaluation of a skin rash. She think she may have psoriasis. For several years, she has completed of a white scaly rash that comes and goes.

1. When preforming an initial work up history, what questions would you ask the client regarding the skin rash?

2. The client asks you to explain what kind of disease psoriasis is and would like you to discuss how the scaly patches develop. What is your response?

3. The client is diagnosed with psoriasis and wants to know how to get rid of the rash and prevent if from coming back again. What methods do you suggest?

4. She has been prescribed to use coal tar shampoo along with topical steroids as a first line therapy on her skin. What other over the counter products would be useful for psoriasis?

Answer 1

When preforming an initial work up history, what questions would you ask the client regarding the skin rash?

When taking medical history, we usually begin by asking about symptoms and how they are affecting the client. The questions those can be asked regarding the rash are as follows:

• When did they first appear?
• Where are they located?
• What do they feel like?
• Did you notice any kind of injury to the skin where the lesions developed?
• Is there anything that makes them feel better?
• Have you tried any treatments or medicines, and if so, did they help?

A series of questions that can be asked about client's health, family history, and lifestyle. These informations may include:

• Information about any health conditions you have or have had in the past
• Any allergies you have
• Any medications you take currently, or have taken recently
• Your emotional health
• How often you get sun exposure
• Your diet and exercise routines
• Your job, and whether you come into contact with anything that might irritate the skin
• Any travelling you have done recently
• Your skin, hair, and nail care routines, including how often you shower or bathe and at what temperatures, what types of soaps, shampoos, cosmetics, and other products you use
• Your hobbies
• Whether you use tobacco, alcohol, or recreational drugs

The client asks you to explain what kind of disease psoriasis is and would like you to discuss how the scaly patches develop. What is your response?

• Psoriasis is a dermatological disorder that is characterized by the appearance of dry, swollen, scaly white to silvery patches on the skin. It is associated with itching and irritation. Psoriasis is an autoimmune disorder of the skin in which the body cells are killed by phagocytosis by the other body cells assuming them to be foreign invaders.

• Psoriasis usually affects hands, legs, thighs, back, arms, nails, palms of hands or soles of feet, etc. In some cases, the scalp also affected.

• Psoriasis is an immune response triggered by stress, infection, unfavorable conditions, etc.

• There may be visible signs of the inflammation such as raised plaques (plaques may look different for different skin types) and scales on the skin. This occurs because the overactive immune system speeds up skin cell growth. Normal skin cells completely grow and shed (fall off) in a month. With psoriasis, skin cells do this in only three or four days. Instead of shedding, the skin cells pile up on the surface of the skin. Some people report that psoriasis plaques itch, burn and sting. Plaques and scales may appear on any part of the body, although they are commonly found on the elbows, knees, and scalp.

The client is diagnosed with psoriasis and wants to know how to get rid of the rash and prevent if from coming back again. What methods do you suggest?

TREATMENT OF PSORIASIS

Medication

Some medication to treat psoriasis includes:

• Topicals Prescription and over-the-counter (OTC) treatments that are applied directly to the skin can minimize symptoms of psoriasis. These therapies contain different active ingredients and come as lotions, creams, shampoos, gels, sprays, or ointments.
• Biologics Biologic drugs alter the immune system and are usually given as an injection. They include Enbrel (etanercept), Remicade (infliximab), Humira (adalimumab), Stelara (ustekinumab), Simponi (golimumab), Cosentyx (secukinumab), Taltz (ixekizumab), brodalumab, tildrakizumab, and Skyrizi (risankizumab).
• Otezla (apremilast) This medicine comes as a pill and works by suppressing an enzyme that’s involved in inflammation.
• Oral Retinoids These types of drugs are usually given if you have severe psoriasis that doesn’t respond to other treatments.
• Rheumatrex (methotrexate) This drug helps control inflammation.  
• Cyclosporine(Gengraf, Neoral) This medicine suppresses the immune system but can be taken for only short periods of time.

Light Therapy

Light therapy involves exposing your skin to controlled amounts of natural or artificial ultraviolet light to help reduce symptoms of psoriasis. You may receive this treatment alone or along with other medication.

PREVENTION OF PSORIASIS

There’s no way to prevent psoriasis, but there are things you can to do to improve your symptoms and help lessen the number of outbreaks you experience.

Some ways to reduce your risk of a psoriasis flare-up include:

• Diet – Consume plenty of fruits, vegetables, whole grains and avoid saturated and trans fats, refined carbohydrate and processed foods. Dietary supplementation with oily fish such as mackerel, salmon, sardine or herring, might be a useful addition in the treatment.
• Take daily baths
• Keep skin moisturized
• Avoid triggers if you can
• Get a small amount of sunlight each day

What other over the counter products would be useful for psoriasis?

Salicylic Acid: Salicylic acid is classified as a keratolytic, or peeling agent. It works by causing the outer layer of skin to shed. It is a common and effective treatment for a wide variety of skin problems. As a psoriasis treatment, it acts as a scale lifter, helping to soften and remove psoriasis scales.

Moisturizers :Keeping the skin lubricated daily is an important part of psoriasis care because it reduces redness and itching and helps the skin heal. Dermatologists recommend heavy creams and ointments that lock water into the skin. Cooking oils and even shortening can be effective as economical substitutes for commercial moisturizers. Here are some quick tips for keeping your skin moisturized:

• Use fragrance-free products
• Apply moisturizers after showering and after washing your hands
• Wash with moisturizing soaps
• Limit lukewarm showers to 10 minutes or less

Bath Solutions: These can be beneficial in treating psoriasis. Adding oil, oatmeal, Epsom salts or Dead Sea salts in a bath have been effective for some when it comes to removing psoriasis scales and soothing itch. Soak for around 15 minutes and apply a moisturizer or oil to the skin immediately after getting out of the bath.

Scale Lifters (Keratolytics) :Scale lifters help loosen and remove scale, allowing medications to reach the psoriasis plaques. There are scale-lifting products designed for the scalp and body. Note that scalp products are usually stronger and may be too harsh for other skin sites. OTC products that contain an active ingredient of salicylic acid, lactic acid, urea or phenol can be used as scale lifters.

Alternative Therapies

• Aloe extract cream. Taken from the leaves of the aloe vera plant, aloe extract cream may reduce redness, scaling, itching and inflammation. You might need to use the cream several times a day for a month or more to see any improvement in your skin.
• Fish oil supplements. Oral fish oil therapy used in combination with UVB therapy might reduce the amount of affected skin. Applying fish oil to the affected skin and covering it with a dressing for six hours a day for four weeks might improve scaling.
• Oregon grape. Also known as barberry, this product is applied to the skin and may reduce the severity of psoriasis.
• Essential oils. Essential oils used for aromatherapy have been shown to reduce stress and anxiety.