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01.07 Nursing Care and Pathophysiology for Psoriasis

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Overview

Pathophysiology: An autoimmune disorder where there is hyperproliferation of the epidermis and inflammation which leads to scaly patches of skin on skin. 

  1.  Psoriasis
    1. Autoimmune
    2. Scaly patches on skin

Nursing Points

General

  1. Common skin condition
    1. Body inflammatory response
      1. T cells attack healthy cells
      2. Overproduction of skin cells–>Buildup of cells on skin
      3. Cell death
  2. Immune response triggered by various factors
    1. Genetics
    2. Stress
    3. Smoking and alcohol
    4. Infections
    5. Obesity
    6. Cold, dry air
  3. May go into remission and come back
    1. Stress causes flare ups
  4. Types of Psoriasis
    1. Erythrodermic–>very red and rashlike
      1. Lesions nondefined
      2. Rare
      3. Temperature variations
      4. Dysregulation–> fluid and protein deficit
    2. Guttate–>pinkish/red spot
      1. Activated by upper respiratory infections
    3. Inverse–>Located in armpits, groin, skin folds
      1. Friction worsens
    4. Plaque (most common)–>Patches that are thick, red, with white scales
    5. Pustular–>Pus filled blisters and red skin
      1. Activated by chemicals, medications, infections

Assessment

  1. Presentation
    1. Assess skin on entire body
    2. Red patches with dry skin
    3. Cracked itchy skin
    4. Painful joints–>may result in psoriatic arthritis
  2. Considerations–>Secondary infections
    1. Fungal
    2. Bacterial/cellulitis

Therapeutic Management

  1. Moisturize skin
    1. Emollients
    2. Salicylic acid
    3. Corticosteroids
    4. Antifungal
  2. Medications for severe case–>supress immune system
    1. Methotrexate
    2. Biologic therapy–>last option
  3. UV Phototherapy

Nursing Concepts

  1. Patient Education–>to avoid flare ups
    1. Avoid stressors
    2. Moisturize
  2. Tissue/Skin Integrity
    1. Skin has lesions from buildup of cells
  3. Immunity–>autoimmune disease
  4. Infection Control–>may be initiated by or lead to infection

Patient Education

  1. Manage stress
  2. Moisturize skin
  3. Quit smoking and drinking
  4. Get sun, avoid sunburn

Reference Links

Study Tools

Video Transcript

Hey guys! Welcome to the lesson on psoriasis! By the end of this video, I want you to understand what psoriasis is and how it is treated.

Psoriasis is a common skin condition that typically shows as scaly patches on the skin. Psoriasis is actually an autoimmune disorder. Let’s explore what that means.

What happens is a stressor such as infection, smoking, alcohol, cold/dry air, obesity, or just stress in general occurs, and the body reacts inappropriately to that stress by going into an inflammatory response where the T cells begin attacking the healthy cells. This results in the overproduction of skin cells, which then build up on the skin. The layers of skin aren’t able to sufficiently be supplied with oxygen and nutrients that they need, so they die. This leaves those itchy, white, flaky patches on the skin. Now, psoriasis is a also genetic disorder that is more likely to happen in people with family members that have it.

Living with psoriasis can be stressful. If a patient can manage their stress and care for the skin lesions well, the psoriasis may go into remission. Unfortunately, it very easily flares back up with any of those stressors we talked about. Next, let’s talk about the different types of psoriasis that there are.

Plaque psoriasis is the most common type, and it’s probably what you think about when you hear the word psoriasis. These patients have thick patches of red skin with white scales on them.

Inverse psoriasis is located in the armpits, groin, and skin folds. This type of psoriasis worsens with friction, which is difficult to avoid in those areas of the body.

Guttate psoriasis looks more like pinkish/reddish spots. This type is usually comes about after an upper respiratory infection.

Pustular psoriasis shows as pus filled blisters with red skin. Chemicals, medication, and infections may bring about this type of psoriasis. For example, it’s been found that the chemicals in cigarettes can trigger pustular psoriasis in people.

Erythrodermic psoriasis is the most rare, and the most dangerous form of the disease. It appears as a very red rash that covers large areas of the body. The lesions aren’t defined like in the other types. You might actually see systemic effects in these patients. The patient may have variations in their temperatures, and may become deficit in fluid and protein because of the dysregulation of the skin. This type of psoriasis may occur after the sudden withdrawal of treatment.

Whenever you have a new patient, you should assess their skin. Check all areas of the body, including the scalp. Remember, psoriasis usually shows as red patches with dry skin, or cracked itchy skin. The patient with psoriasis may complain of painful joints, and may be at risk for psoriatic arthritis. This is a disease that a rheumatologist would have to address with the patient as it is more complicated than just skin lesions.

Whenever you have a patient with psoriasis, it’s important to check out the skin lesions and make sure that they aren’t infected. The patient may be scratching at them, breaking them open and allowing bacteria in and possibly resulting in cellulitis. Fungal infections are more likely to occur in those patients that have inverse psoriasis in those moist areas of the body like the groin and skin folds.

Okay, so next let’s talk about treatment. Psoriasis results in dry, crusty skin, so it’s important to keep it moisturized to avoid cracking and help it heal. Emollients are great to keep the skin moist. Salicylic acid and corticosteroids  can help to heal the psoriasis patches by tackling the inflammation. Antifungals may be needed for the patient with inverse psoriasis that grows infected with yeast.

Sometimes skin topicals aren’t enough to keep the psoriasis under control. Severe cases might call for methotrexate or biologic therapy, which help by suppressing the immune system to slow the attacking of the T cells. Biologic therapy is typically the last option due to the expense and side effects of the medications.

Sometimes skin topicals aren’t enough to keep the psoriasis under control. Severe cases might call for methotrexate or biologic therapy, which help by suppressing the immune system to slow the attacking of the T cells. Biologic therapy is typically the last option due to the expense and side effects of the medications.

Alright, so with patients that are trying to manage their psoriasis, we need to remind them to try and manage the stress in their life, moisturize their skin regularly, quit smoking and drinking, and get sun while avoiding sunburns.

Our priority nursing concepts for the patient with psoriasis include immunity, tissue/skin integrity, and infection control.

Okay, now let’s review the key points. Psoriasis is an autoimmune response where the T cells attack the healthy cells and cause the skin cells to multiple too fast, resulting in cell buildup on the skin and cell death. The types of psoriasis include plaque, which is the most common, guttate, pustular, and erythrodermic, which is the most rare and dangerous form. Triggers for psoriasis flare ups include stress, smoking, alcohol, obesity, genetics, infections, and cold/dry air. People with psoriasis must keep their skin moisturized, and may use emollients, corticosteroids, salicylic acid, and antifungals to help heal the skin lesions. Those with psoriasis may use UV light therapy to help clear the lesions. Methotrexate and biologic therapy are the last resort and may be used to suppress the immune system to slow the attack of T cells on the healthy cells.

Thanks so much for listening! I hope you’ve gotten a good grasp on what psoriasis is and how to treat it. Now go out and be your best self today, and as always, happy nursing!

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