Psoriasis: Risk Factors
Psoriasis: Risk Factors
Psoriasis: Risk Factors
RISK FACTORS:
Stress and anxiety
Smoking
Trauma
Medication
o Lithium
o Antimalarial drugs
o Inderal
o Quinidine
o Indomethacin
Infections
Family history
Immunocompromised
Other things that may trigger psoriasis include:
o Allergies
o Diet
o Weather
TYPES OF PSORIASIS
Most people have only one type at a time. Sometimes, after the symptoms go away, a new
form of psoriasis will appear in response to a trigger.
1. Plaque Psoriasis. It is also known as Psoriasis Vulgaris. This is the most common type.
About 8 to 10 people with psoriasis have this kind.
Symptoms:
o Plaque psoriasis causes raised, inflamed, red skin covered with silvery,
white scales. These patches may itch and burn. It can appear anywhere on
the body, but it often pops up in these areas: scalp, elbows, lower back,
knees.
Plaque Psoriasis. Image from https://www.webmd.com
2. Guttate Psoriasis. This type often starts in children or young adults. It happens 2% of
cases. This type of psoriasis may go away within a few weeks, even without treatment.
Some cases, though, are more stubborn and require treatment.
Symptoms:
o Guttate psoriasis small, pink-red spots on the skin. They often appear on the
scalp, upper arms, trunk, and thighs.
3. Inverse Psoriasis. The common triggers are friction, sweating, and fungal infection.
Symptoms:
o Patches of skin that are bright red, smooth, and shiny, but don't have scales
and getting worse with sweating and rubbing. This type usually found in
these locations: armpits, groin, under the breasts, and skin folds around the
genitals and buttocks.
5. Erythrodermic or Exfoliative Psoriasis. This type is the least common, but it's very serious
and affects most of the body. Triggers include: suddenly stopping the systemic psoriasis
treatment, allergic drug reaction, severe sunburn, infection, medications such as lithium,
antimalarial drugs, cortisone, or strong coal tar products. This may also happen if the
psoriasis is hard to control.
Symptoms:
Widespread, fiery skin that appears to be burned.
Severe illness from protein and fluid loss, infection, pneumonia, or congestive
heart failure.
Other symptoms include:
o Severe itching, burning, or peeling
o Tachycardia
o Changes in body temperature
Erythrodermic Psoriasis. Image from https://www.webmd.com
6. Nail Psoriasis
Up to half of those with psoriasis have nail changes. Nail psoriasis is even more
common in people who have psoriatic arthritis, which affects the joints.
Symptoms:
o Pitting of your nails
o Tender, painful nails
o Separation of the nail from the bed
o Color changes (yellow-brown)
o Chalk-like material under your nails
7. Psoriatic Arthritis. It is a condition where the affected person have both psoriasis
and arthritis. In 70% of cases, people have psoriasis for about 10 years before
getting psoriatic arthritis. About 90% of people with it also have nail changes.
Symptoms:
o Painful, stiff joints that are worse in the morning and after rest
o Sausage-like swelling of the fingers and toes
o Warm joints that may be discolored
Psoriatic Arthritis. Image from https://www.webmd.com
CLINICAL MANIFESTATIONS
Symptoms range from a cosmetic annoyance to a physically disabling and disfiguring
affliction.
Lesions appear as red, raised patches of skin covered with silvery scales.
If scales are scraped away, the dark red base of lesion is exposed, with multiple
bleeding points.
Patches are dry and may or may not itch.
The condition may involve nail pitting, discoloration, crumbling beneath the free
edges, and separation of the nail plate.
In erythrodermic psoriasis, the patient is acutely ill, with fever, chills, and an
electrolyte imbalance.
Psychological Considerations
Psoriasis may cause despair and frustration; observers may stare, comment,
ask embarrassing questions, or even avoid the person.
The condition can eventually exhaust resources, interfere with work, and
negatively affect many aspects of life.
Teenagers are especially vulnerable to its psychological effects.
Medical Management
Goals of management: To slow the rapid turnover of epidermis, to promote resolution of the
psoriatic lesions, and to control the natural cycles of the disease. There is no known cure.
The therapeutic approach should be understandable, cosmetically acceptable, and not too
disruptive of lifestyle.
Topical Therapy
Topical treatment is used to slow the overactive epidermis.
Topical corticosteroid therapy acts to reduce inflammation.
Medications include tar preparations (eg, coal tar topical [Balnetar]), alpha-hydroxy or
salicylic acid, and corticosteroids. Calcipotriene (Dovonex; not recommended for use
by elderly patients because of their more fragile skin, or in pregnant or lactating
women); and tazarotene (Tazorac) as well as vitamin D are additional nonsteroidal
agents.
Occlusive (plastic) dressing may improve effectiveness. Medications may be in the
form of lotions, ointments, pastes, creams, and shampoos.
NURSING ALERT!
Assess the flammability of any plastic substances used;
caution patient not to smoke or go near open flame.
Systemic Therapy
Biologic agents act by inhibiting activation and migration, eliminating the T cells
completely, slowing postsecretory cytokines or inducing immune deviation: infliximab
(Remicade), etanercept (Enbrel), efalizumab (Raptiva), alefacept (Amevive), and
adalimumab (Humira). Biological agents have significant side effects, making close
monitoring essential.
Oral agents: methotrexate (patients should avoid drinking alcohol, should not be
administered to pregnant women), cyclosporine A, oral retinoids (ie, synthetic
derivatives of vitamin A and its metabolite, vitamin A acid), etretinate; laboratory
studies are monitored to ensure that hepatic, hematopoietic, and renal systems are
functioning adequately.
Photochemotherapy
Psoralens and ultraviolet A (PUVA) therapy may be used for severely debilitating
psoriasis.
Photochemotherapy is associated with long-term risks of skin cancer, cataracts, and
premature aging of the skin.
Ultraviolet B (UVB) light therapy may be used to treat generalized plaque and may be
combined with the topical cream, calcipotriene (Dovonex). Excimer laser therapy may
be another treatment.
NURSING PROCESS
ASSESSMENT
*Assessment focuses on how the patient is coping with the skin condition, the appearance of
“normal” skin, and the appearance of skin lesions.
Examine areas especially affected: elbows, knees, scalp, gluteal cleft, and all nails (for
small pits.
Assess the impact of the disease on the patient and the coping strategies used for
conducting normal activities and interactions with family and friends.
Instruct patient that the condition is not infectious, is not a reflection of poor personal
hygiene, and is not skin cancer.
Create an environment in which the patient feels comfortable discussing important
quality-of life issues related to his or her psychosocial and physical response to this
chronic illness.
DIAGNOSIS
Risk for infection
Disturbed body Image
Impaired skin integrity
Social isolation
Hopelessness
Helplessness
Deficient knowledge related to Psoriasis
NURSING INTERVENTIONS
Promoting Understanding
Explain with sensitivity that there is no cure and that lifetime management is
necessary; the disease process can usually be controlled.
Review pathophysiology of psoriasis and factors that provoke it: any irritation or injury
to the skin (cut, abrasion, sunburn), any current illness, emotional stress, unfavorable
environment (cold), and drug (caution patient about nonprescription medication).
Review and explain treatment regimen to ensure compliance; provide patient
education materials in addition to face-to-face discussions.
EVALUATION
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References:
Huether, S.E. and Mc Kance, K. L.(2009). Understanding Pathophysiology, 4th ed. China:
Mosby Elsevier, Inc.
Smeltzer, S., et al.,(2010). Brunner and Suddarth’s Textbook of Medical-surgical Nursing, 12th
ed. Philadelphia: Lippincott Williams and Wilkins