disease of the skin (intergumentary system)

1. MEDICAL AND SURGICAL NURSING
TOPIC:PSORIAS
Done by:
ABDULLA KHAMIS NGWALI
2ND 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
i. 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
ii. Jennifer E. Helms, Claudia P. Barone,physiology And Treatment Of
Skin Disease, critical Care Nurse, Vol 28, No. 6, Dec.2008.
iii. Griffiths CE, Barker JN. Pathogenesis and clinical features of
psoriasis. Lancet 2007;370(9583):263-71.
iv. 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.