40, no. 7 july 2011. Psoriasis. Philip Clarke. Background. Psoriasis is one of the more common rashes presenting to general practice. Objective. This article outlines the assessment and management of psoriasis in the general practice setting. Practice Essentials. Long-term, steroid-responsive rash with recent presentation of joint pain. Chronic stationary psoriasis (psoriasis vulgaris): Most common type of psoriasis; involves the scalp, extensor surfaces, genitals, umbilicus, and lumbosacral and retroauricular regions. Cyclosporine, generally used intermittently for inducing a clinical response with one or several courses over a 3 to 6 months. Department of Emergency Medicine, Massachusetts General Hospital; Assistant Professor of Surgery, Harvard Medical School. Understand how to recognise common skin conditions in primary care, e.g. eczemas, psoriasis and infections, and instigate appropriate treatment. Up to 7 of psoriasis sufferers are affected by psoriatic arthropathy, which for some can be the first presentation of the illness, even before the onset of any rash.
The diagnosis and management of skin disease makes up a large component of primary care and most GPs develop diagnostic and surgical skills to deal with this demand. Age – infectious diseases are more common in children but malignancy gets more common with advancing age. Psoriasis is said to be non-itchy but there may be pruritus in the genital area. Familial atypical mole and melanoma (FAMM) syndrome should be considered where several family members have multiple melanocytic lesions, some atypical, with at least one case of melanoma in the family. If a rash exists, consider its morphology. Subscribe to Housecall. Our general interest e-newsletter keeps you up to date on a wide variety of health topics. Psoriasis signs and symptoms can vary from person to person but may include one or more of the following:. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely. When assessing new presentations of multiple joint pain from the perspective of general practice, determining whether it is indicative of a significant underlying rheumatological condition is not always straightforward. Her GP thinks that the joint pains are early OA and that the rash is likely to be rosacea.
Psoriasis is one of the more common rashes presenting to general practice. Generalized rashes are among the most common conditions seen by primary care physicians,1,2 and the most common reason for new patient visits to dermatologists. Psoriasis. Rocky Mountain spotted fever. Staphylococcal scalded skin syndrome. Subacute cutaneous lupus erythematosus. Psoriasis is a common chronic skin disorder most commonly characterized by well-demarcated erythematous plaques with silver scale (). Other presentations, such as guttate, pustular, erythrodermic, inverse, and nail psoriasis also occur (). Most cases. A systematic review of international population-based studies found wide variation in the global prevalence of psoriasis 1. To continue reading this article, you must log in with your personal, hospital, or group practice subscription.
Dermatological History And Examination. Patient
Staphylococcus aureus is the most common cutaneous bacterial infection in persons with HIV disease. When cellulitis of any significance or symptoms of bacteremia are present, hospital admission for treatment with intravenous antibiotics is appropriate. One patient with advanced HIV disease and with chronic leg ulcers due to excoriation and folliculitis developed Pseudomonas overgrowth. In general, psoriasis responds poorly to less than medium- or high-potency topical steroids. Use of potent topical steroids over large areas of the body, however, leads to systemic absorption, adrenal suppression, and possibly immunosuppression, obviously undesirable effects in patients with HIV infection. In a busy general practice it gives you a basis on which to approach most of the common rashes you will see. If there are, then it is a form of eczema, probably discoid eczema, rather than psoriasis or one of the other red scaly disorders. E Erythema nodosum This red non scaly rash is also quite distinctive presenting as tender deeper nodules on the anterior shins or sometimes on the calves. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Presentations of background materials on zoster and the vaccine were made during ACIP meetings in October 2005 and the three meetings in 2006. In general, thoracic, cervical, and ophthalmic involvement are most common (Figure 1) (26–28). More frequently, zoster is confused with the rash of herpes simplex virus (HSV), including eczema herpeticum (4,31,64–66). A common presenting complaint in general practice is an eruptive scaly rash sometimes associated with itching. These can usually be distinguished by a discriminating history and examination. Atopic eczema starts most commonly on the face in infants and then spreads to involve the flexures. However, it can sometimes just affect the extensor surfaces or may be present in coin-like lesions (discoid eczema). A patient who develops a morbilliform drug eruption will usually have the same reaction to that specific drug or to chemically related ones on each challenge. Rashes in response to drugs are not common; however, most patients with infectious mononucleosis treated with amoxycillin will develop an erythematous macular-papular rash. Don’t be RASH: Emergency Physician’s Approach to the Undifferentiated Lesion, by Genine Siciliano MD. Practice updates. I chose this topic because I feel it is one that the emergency medicine (EM) physician does not necessarily feel very comfortable discussing. Examples of common primary lesions include: papule, macule, nodule, plaque, pustule, vesicle, bulla, petechiae, purpura, scales. This is a rare form of psoriasis in which most or almost all the skin surface is involved with scaly, erythematous, pus-filled blisters and plaques. If you have psoriasis you need to know that the rash gets worse when your skin is dry, injured, and unhealthy. In part 2, titled Lifestyle Changes to Help Heal Psoriasis, I summarized my lifestyle recommendations to help control these general health conditions and support healing of psoriatic skin. To look for and treat foot fungus because it’s extremely common, can look like psoriasis, and it’s just one more rash that psoriasis patients don’t need to suffer from. Introducing the New Dermatologist in Our Sonoma County Practice.
Epidemiological evidence suggests that many cases of skin disease do not reach the general practitioner (GP) or even the local pharmacist; nevertheless, each year about 15 of the population consult their GPs about skin complaints. Explanation needs to be given as to why you may be undressing them when the rash is only on one part of their body. Primary lesions are those present at the initial onset of the disease: Macule – a flat mark; circumscribed area of colour change: brown, red, white or tan. The most common cause of itching is a primary skin disease such as eczema, urticaria, lichen planus, psoriasis, dermatitis herpetiformis, insect bites and scabies. The most common presentation in children is chronic plaque psoriasis. 20 May 2010 1 comment. From a GP’s perspective, it is important to bear this diagnosis in mind when assessing a child with a rash because around 10 per cent of cases present before the age of 10 years and 2 per cent before the age of two years. Although the infection can be passed onto others in the form of shingles, it is more common in the form of chickenpox. Pain that persists for longer than one to three months after resolution of the rash is generally accepted as the sign of postherpetic neuralgia. However, he was asked to resign his post in 2004 by Department chair Barbara Gilchrest, MD, for presenting a view that conflicts with that from American Academy of Dermatology that any sunlight exposure would increase the risk of skin cancer. It is claimed that yoga and meditative practices help psoriasis patients by ‘detoxifying’ the body any by the reduction of stress. Not only are symptoms common, they are also often chronic and can substantially interfere with sexual function.1 Correct diagnosis and treatment in general practice should reduce morbidity.