| What are the clinical features of guttate psoriasis? | Shower of numerous erythematous papules < 1 cm on the trunk and extremities | CLINICAL FEATURES • Shower of numerous erythematous papules < 1 cm on the trunk and extremities • Seen more commonly in younger patients Primary health centre/Level • Antibiotics for streptococcal infection Secondary Level • Same as primary level care • Psoralen ultraviolet A Solar (PUVAsol) Tertiary Level • Same as primary level care • Narrow band UVB • Refractory cases- consider systemic treatments including novel small molecules Chronic erythematous well defined plaques symmetrically on palms and soles, and occassional nail involvement to be differentiated from palmoplantar eczema | 20 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | CLINICAL FEATURES • Shower of numerous erythematous papules < 1 cm on the trunk and extremities • Seen more commonly in younger patients Primary health centre/Level • Antibiotics for streptococcal infection Secondary Level • Same as primary level care • Psoralen ultraviolet A Solar (PUVAsol) Tertiary Level • Same as primary level care • Narrow band UVB • Refractory cases- consider systemic treatments including novel small molecules Chronic erythematous well defined plaques symmetrically on palms and soles, and occassional nail involvement to be differentiated from palmoplantar eczema | 1 | page=1,block=14 | 0.700 | valid |
| What is a clinical feature of generalised sterile pustules? | Crops of localized or generalised sterile pustules and lakes of pus with surrounding erythema, often associated with fever | CLINICAL FEATURES • Generalised erythema and scaling involving >90% of the BSA • Triggered by withdrawal of systemic corticosteroids/ potent topical steroids or HIV infection • Common D/D- dermatitis, drug reactions, pityriasis rubra pilaris, idiopathic erythroderma CLINICAL FEATURES • Crops of localized or generalised sterile pustules and lakes of pus with surrounding erythema, often associated with fever • In pregnancy- presents as impetigo herpetiformis,may lead to intrauterine growth retardation or still birth | 287 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | CLINICAL FEATURES • Generalised erythema and scaling involving >90% of the BSA • Triggered by withdrawal of systemic corticosteroids/ potent topical steroids or HIV infection • Common D/D- dermatitis, drug reactions, pityriasis rubra pilaris, idiopathic erythroderma CLINICAL FEATURES • Crops of localized or generalised sterile pustules and lakes of pus with surrounding erythema, often associated with fever • In pregnancy- presents as impetigo herpetiformis,may lead to intrauterine growth retardation or still birth |
| What distinguishes palmoplantar psoriasis from palmoplantar eczema? | Chronic erythematous well defined plaques symmetrically on palms and soles, and occassional nail involvement | CLINICAL FEATURES • Shower of numerous erythematous papules < 1 cm on the trunk and extremities • Seen more commonly in younger patients Primary health centre/Level • Antibiotics for streptococcal infection Secondary Level • Same as primary level care • Psoralen ultraviolet A Solar (PUVAsol) Tertiary Level • Same as primary level care • Narrow band UVB • Refractory cases- consider systemic treatments including novel small molecules Chronic erythematous well defined plaques symmetrically on palms and soles, and occassional nail involvement to be differentiated from palmoplantar eczema | 436 | comparison | 0.880 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | CLINICAL FEATURES • Shower of numerous erythematous papules < 1 cm on the trunk and extremities • Seen more commonly in younger patients Primary health centre/Level • Antibiotics for streptococcal infection Secondary Level • Same as primary level care • Psoralen ultraviolet A Solar (PUVAsol) Tertiary Level • Same as primary level care • Narrow band UVB • Refractory cases- consider systemic treatments including novel small molecules Chronic erythematous well defined plaques symmetrically on palms and soles, and occassional nail involvement to be differentiated from palmoplantar eczema |
| What are some common differential diagnoses for generalised erythema and scaling? | dermatitis, drug reactions, pityriasis rubra pilaris, idiopathic erythroderma | CLINICAL FEATURES • Generalised erythema and scaling involving >90% of the BSA • Triggered by withdrawal of systemic corticosteroids/ potent topical steroids or HIV infection • Common D/D- dermatitis, drug reactions, pityriasis rubra pilaris, idiopathic erythroderma CLINICAL FEATURES • Crops of localized or generalised sterile pustules and lakes of pus with surrounding erythema, often associated with fever • In pregnancy- presents as impetigo herpetiformis,may lead to intrauterine growth retardation or still birth | 189 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | CLINICAL FEATURES • Generalised erythema and scaling involving >90% of the BSA • Triggered by withdrawal of systemic corticosteroids/ potent topical steroids or HIV infection • Common D/D- dermatitis, drug reactions, pityriasis rubra pilaris, idiopathic erythroderma CLINICAL FEATURES • Crops of localized or generalised sterile pustules and lakes of pus with surrounding erythema, often associated with fever • In pregnancy- presents as impetigo herpetiformis,may lead to intrauterine growth retardation or still birth |
| What conditions should be assessed for alongside psoriatic arthritis? | metabolic syndrome (obesity, dyslipidemia, diabetes, hypertension) | *GENERAL PRINCIPLES OF MANAGEMENT • Establish the diagnosis ▶ Usually clinical and by bed side tests (Auspitz sign, Grattage test) ▶ If in doubt, refer to higher centre for evaluation & skin biopsy • Assess for psoriatic arthritis and metabolic syndrome (obesity, dyslipidemia, diabetes, hypertension) • Counsel about variable natural course of disease and expected treatment outcome, and lifestyle modifications (including weight reduction, avoidance of smoking and alcohol) • Assess for requirement of systemic treatment, in addition to topical treatment • Advise regular use of emollients/ moisturizers. | 235 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | *GENERAL PRINCIPLES OF MANAGEMENT • Establish the diagnosis ▶ Usually clinical and by bed side tests (Auspitz sign, Grattage test) ▶ If in doubt, refer to higher centre for evaluation & skin biopsy • Assess for psoriatic arthritis and metabolic syndrome (obesity, dyslipidemia, diabetes, hypertension) • Counsel about variable natural course of disease and expected treatment outcome, and lifestyle modifications (including weight reduction, avoidance of smoking and alcohol) • Assess for requirement of systemic treatment, in addition to topical treatment • Advise regular use of emollients/ |
| What infections should be ruled out before systemic immunosuppressive treatment? | tuberculosis, HIV, Hepatitis B and C | Antihistamines if pruritic • Avoid Methotrexate and Cyclosporine A in children scheduled for live vaccines • Rule out tuberculosis, HIV, Hepatitis B and C infections before systemic immunosuppressive treatment • Pregnancy test-prior to systemic therapy (Acitretin avoided in child bearing age group) • Systemic steroids should not be given for the treatment of psoriasis, except for generalized pustular psoriasis of pregnancy • If first-line treatment options fail or are contraindicated, refer to tertiary care center for combination. | 118 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | Antihistamines if pruritic • Avoid Methotrexate and Cyclosporine A in children scheduled for live vaccines • Rule out tuberculosis, HIV, Hepatitis B and C infections before systemic immunosuppressive treatment • Pregnancy test-prior to systemic therapy (Acitretin avoided in child bearing age group) • Systemic steroids should not be given for the treatment of psoriasis, except for generalized pustular psoriasis of pregnancy • If first-line treatment options fail or are contraindicated, refer to tertiary care center for combination. |
| What is recommended for scalp treatment besides tar-based shampoo? | topical steroids +/- salicylic acid lotions | • Continue emollients • Avoid irritants & prolonged use of topical steroids • Systemic treatment- refer to treatment overview • If these fail or are contraindicated, refer to tertiary level for combination or rotational therapy/ novel small molecules/ biologicals Scalp- Tar based shampoo and topical steroids +/- salicylic acid lotions Erythematous plaques with silvery white scales | 293 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | • Continue emollients • Avoid irritants & prolonged use of topical steroids • Systemic treatment- refer to treatment overview • If these fail or are contraindicated, refer to tertiary level for combination or rotational therapy/ novel small molecules/ biologicals Scalp- Tar based shampoo and topical steroids +/- salicylic acid lotions Erythematous plaques with silvery white scales | 1 | page=1,block=25 | 0.700 | valid |
| What lifestyle modifications are advised in the general principles of management? | weight reduction, avoidance of smoking and alcohol | *GENERAL PRINCIPLES OF MANAGEMENT • Establish the diagnosis ▶ Usually clinical and by bed side tests (Auspitz sign, Grattage test) ▶ If in doubt, refer to higher centre for evaluation & skin biopsy • Assess for psoriatic arthritis and metabolic syndrome (obesity, dyslipidemia, diabetes, hypertension) • Counsel about variable natural course of disease and expected treatment outcome, and lifestyle modifications (including weight reduction, avoidance of smoking and alcohol) • Assess for requirement of systemic treatment, in addition to topical treatment • Advise regular use of emollients/ moisturizers. | 424 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | *GENERAL PRINCIPLES OF MANAGEMENT • Establish the diagnosis ▶ Usually clinical and by bed side tests (Auspitz sign, Grattage test) ▶ If in doubt, refer to higher centre for evaluation & skin biopsy • Assess for psoriatic arthritis and metabolic syndrome (obesity, dyslipidemia, diabetes, hypertension) • Counsel about variable natural course of disease and expected treatment outcome, and lifestyle modifications (including weight reduction, avoidance of smoking and alcohol) • Assess for requirement of systemic treatment, in addition to topical treatment • Advise regular use of emollients/ |
| What phototherapy options are available for more than 5% body surface area involvement? | Narrow band UVB, Targeted phototherapy, Topical/systemic PUVA or Psoralens with sunlight (PUVAsol) | Baseline investigations to be carried out These principles should be used only as a general guide to choose a treatment; final decision should be made on case-to-case basis TREATMENT OVERVIEW TOPICAL THERAPY {<5% BODY SURFACE AREA (BSA)} • Moisturizers like white soft paraffin • Topical corticosteroids, Tacrolimus ointment, Tazarotene, Calcipotriol, Coal tar, Dithranol, Salicylic acid combinations PHOTOTHERAPY (>5% BSA/ PALMOPLANTAR PSORIASIS) • Narrow band UVB, Targeted phototherapy, Topical/systemic PUVA or Psoralens with sunlight (PUVAsol) SYSTEMIC THERAPY (>5% BSA/ SEVERE RECALCITRANT DISEASE/ PALMOPLANTAR PSORIASIS/ ARTHRITIS) • Methotrexate/ Cyclosporine A/ Retinoids-isotretinoin (may be preferred in adolescent girls), Acitretin/ oral antibiotics (guttate psoriasis)/ novel small molecules • Resistant cases- Biologics | 450 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | Baseline investigations to be carried out These principles should be used only as a general guide to choose a treatment; final decision should be made on case-to-case basis TREATMENT OVERVIEW TOPICAL THERAPY {<5% BODY SURFACE AREA (BSA)} • Moisturizers like white soft paraffin • Topical corticosteroids, Tacrolimus ointment, Tazarotene, Calcipotriol, Coal tar, Dithranol, Salicylic acid combinations PHOTOTHERAPY (>5% BSA/ PALMOPLANTAR PSORIASIS) • Narrow band UVB, Targeted phototherapy, Topical/systemic PUVA or Psoralens with sunlight (PUVAsol) SYSTEMIC THERAPY (>5% BSA/ SEVERE RECALCITRANT |
| Which drugs should be considered in the history to rule out acute generalized exanthematous pustulosis? | Beta-lactams, Macrolides, Calcium channel blockers | SPECIFIC MANAGEMENT • Skin biopsy, if in doubt • Methotrexate or Cyclosporine A • Maintenance- Acitretin/ NbUVB/ PUVA • If patient fails to respond, consider biologics SPECIFIC MANAGEMENT • Assess patient • Take drug history (particularly Beta-lactams, Macrolides, Calcium channel blockers) to rule out acute generalized exanthematous pustulosis • Generalized pustular psoriasis - admit the patient and follow general measures as for psoriatic erythroderma • In addition to blood tests as listed previously, serum calcium (patients may have hypocalcemia) should also be estimated • Acitretin/ Methotrexate/ Cyclosporine TREATMENT REFER TO GENERAL PRINCIPLES OF MANAGEMENT* • Stabilize patient & treat secondary infection • Maintain temperature/ fluid and electrolyte balance • Admit if febrile & unstable vitals • High protein diet • Lab investigations: Complete Hemogram, Liver & Kidney Function test • Refer to higher center for specific management | 239 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967366_psoriasis.pdf | SPECIFIC MANAGEMENT • Skin biopsy, if in doubt • Methotrexate or Cyclosporine A • Maintenance- Acitretin/ NbUVB/ PUVA • If patient fails to respond, consider biologics SPECIFIC MANAGEMENT • Assess patient • Take drug history (particularly Beta-lactams, Macrolides, Calcium channel blockers) to rule out acute generalized exanthematous pustulosis • Generalized pustular psoriasis - admit the patient and follow general measures as for psoriatic erythroderma • In addition to blood tests as listed previously, serum calcium (patients may have hypocalcemia) should also be estimated • Acitretin/ |