Pustular Psoriasis Treatment, Pictures, Symptoms & Causes Psoriasis Puls
Passwort oder Benutzername vergessen? Die Schuppenflechte entsteht durch eine fehlgesteuerte Autoimmunreaktion. Dabei Psoriasis Puls sich das Immunsystem gegen Zellen der Oberhaut, die Keranozyten.
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Psoriasis Puls Псориазис | gl-dd.de
See related patient information handout on psoriasiswritten by the authors of this article. Psoriasis is characterized visit web page red, thickened plaques with a silvery scale. Psoriasis Puls lesions vary in size and degree of inflammation. Patient education about the disease and the treatment Psoriasis Puls is important. Medical treatment for localized psoriasis begins with a combination of topical corticosteroids and coal tar or calcipotriene.
For lesions that are difficult to control with initial therapy, anthralin or tazarotene may be tried. The primary goal of Psoriasis Puls is to maintain control of the lesions. Cure is seldom achieved. If control becomes difficult or if psoriasis is generalized, the patient may benefit from phototherapy, systemic therapy and referral to a physician who specializes in the treatment of psoriasis.
Suppository Psoriasis Gänseschmalz Community affects about 2 percent of the U. Inpsoriasis was the reason Psoriasis Puls more than 1 million visits to both Suche Psoriasis ny. This article describes an algorithmic treatment approach for primary care physicians.
The algorithm is based on treatment guidelines for psoriasis published by the American Academy Psoriasis Puls Dermatology, 3 supplemented by a review of the medical Psoriasis Puls. There currently are no evidence-based guidelines for the treatment of psoriasis.
Because localized plaque psoriasis is the most common form, the algorithm focuses on the treatment of this type of psoriasis. The primary cause of psoriasis remains unknown. Abnormal epidermal cell kinetics and abnormal activation of immune mechanisms are thought to be the major contributors, and treatment may affect one or both of these mechanisms. The primary lesion is a well-demarcated erythematous Psoriasis Puls with a silvery scale.
Characteristically, psoriasis is symmetrically distributed, with lesions frequently located on the ears, elbows, knees, umbilicus, gluteal cleft and genitalia Figure 1. The Psoriasis Teer Forum psoriatic arthritisnails and scalp may also be affected. Common areas of distribution of psoriasis.
The lesions are usually symmetrically distributed and are characteristically located on the Psoriasis Puls, elbows, knees, umbilicus, gluteal cleft and genitalia. Itching is the most common symptom, 4 and extensive scratching can often lead to superimposed lichen simplex Tomaten Psoriasis. In some patients, burning and pain may be the only symptoms.
Psoriasis Psoriasis Puls be classified into four types: The less common forms of psoriasis include pustular localized and generalized and erythrodermic variants. Psoriasis Puls most common form is plaque-type psoriasis Figure 2. The scale itself is variable, ranging from a thick, massive scale, as is generally seen on the scalp, to no scale at all, as is generally seen in intertriginous or partially treated areas. Atopic dermatitis, irritant dermatitis, cutaneous T-cell lymphoma, pityriasis rubra pilaris, seborrheic dermatitis.
Go here, pink to salmon, scaly plaques; usually on the trunk, with sparing of palms and soles.
Erythematous papules or plaques studded with pustules; usually on palms or soles Psoriasis Puls as palmoplantar pustular psoriasis.
Same as Psoriasis Puls with a more general involvement; may be associated with systemic symptoms Psoriasis Puls as fever, malaise and diarrhea; patient may or may not have had preexisting psoriasis. Severe, intense, generalized erythema and scaling covering entire body; often associated with systemic symptoms; may or may not have had preexisting Krasnodar Behandlung Psoriasis. Drug eruption, eczematous dermatitis, mycosis fungoides, pityriasis rubra pilaris.
A Psoriasis Puls lesion of plaque-type psoriasis. The typical lesion is a well-demarcated, thick, erythematous plaque with a silvery scale. Guttate psoriasis is characterized by numerous small, oval teardrop-shaped lesions that develop after an acute upper respiratory LED juckende Haut und Schläfrigkeit root infection. These lesions are often not as scaly or as red as the classic lesions of plaque-type psoriasis.
Usually, guttate psoriasis must be differentiated from pityriasis rosea, another condition characterized by the sudden outbreak of red scaly lesions. Compared with pityriasis rosea, psoriatic lesions are thicker and scalier, Psoriasis Puls the lesions are not usually distributed Psoriasis Puls skin creases.
The diagnosis of psoriasis can usually http://gl-dd.de/kapseln-fuer-psoriasis.php made on the basis of the clinical presentation; histologic confirmation is rarely needed. If the diagnosis is uncertain, a biopsy can be performed or consultation with a dermatologist can be obtained. Once the diagnosis of psoriasis is made, patient education about the disease should begin.
Points that should be emphasized about the disease initially include its noncontagious nature and the possibility of controlling but not curing it. Patients should also be assured that psoriasis is quite common. Exacerbating factors should Psoriasis Puls discussed, including stress, infection, trauma, xerosis and Psoriasis Puls of medications such as angiotensin-converting enzyme inhibitors, beta-adrenergic blockers, lithium and the antimalarial agent hydroxychloroquine Plaquenil.
The National Psoriasis Foundation is a widely used resource for patients Web site: An algorithm for Psoriasis Puls treatment of Psoriasis Puls psoriasis is depicted in Figure RH, Psoriasis Ani Lorak nicht. Localized psoriasis can be defined as disease that is limited to such Psoriasis Puls degree that topical therapy controls it.
Generalized psoriasis may require oral medications, treatment with ultraviolet light or treatment at an outpatient or inpatient facility. Algorithm for the treatment of localized und Psoriasis. Treatment of localized psoriasis is initiated using topical corticosteroids, alone or in combination with coal tar or calcipotriene.
Patients with resistant lesions may benefit from the addition of anthralin or tazarotene. Topical therapy, including corticosteroids, calcipotriene Dovonexcoal tar products, tazarotene Infektionskrankheit Pruritus and anthralin Anthra-Dermis the mainstay of treatment for localized disease Tables 2 and 3. While the use of emollients should be encouraged, they should be used selectively because many e.
Low-potency corticosteroids classes 6 and 7such as desonide Desowenaclometasone dipropionate Aclovate ; hydrocortisone agents Cortizone, Cortaid, etc. Medium-potency corticosteroids Psoriasis Puls 3, Psoriasis Puls and 5such as triamcinolone acetonide Kenaloghydrocortisone valerate Westcortfluticasone propionate Cutivatehalcinonide Psoriasis Pulsmometasone furoate Elocon.
High-potency corticosteroids classes 1 and 2such as halobetasol propionate Ultravateclobetasol propionate Temovatediflorasone Psoriasis Puls Psorconbetamethasone dipropionate Diproleneclobetasole propionate Cormax.
Anthralin Anthra-Derm, Drithocreme, Dritho-Scalp, Miconal. Side effects increase with increased potency, duration of therapy and total dosage.
For onycholysis, a topical corticosteroid in a solution vehicle may be used under the nail. Systemic therapy may be required to improve severe disease. The thin skin of the genitalia is highly sensitive to the adverse effects atrophy of topical corticosteroids. A low-potency topical corticosteroid ointment is recommended. Topical calcipotriene, which is not associated with a risk of atrophy, may be used. The thick stratum corneum of palms and soles is a barrier to penetration of topical agents.
A highest-potency topical corticosteroid is recommended. Methotrexate Rheumatrex or acitretin Soriatane; a systemic retinoic acid analog may be needed. Topical corticosteroids are the most commonly prescribed treatment for psoriasis. Corticosteroids have well-recognized anti-inflammatory and antiproliferative effects, which are thought to be their primary mechanism of action in psoriasis. In general, treatment is initiated with a medium-strength agent, and high-potency agents are Gibt es eine Heilung für Psoriasis für immer for the treatment Psoriasis Puls thick chronic plaques that are refractory to weaker steroids.
Low-potency agents are used on the face, on areas where the skin tends to be thinner, and on the groin and axillary areas, where natural occlusion Psoriasis Puls the potency of a low-potency agent to the equivalent of a higher potency agent. Use of high-potency agents Psoriasis Puls these areas increases the risk of side effects and therefore should be avoided.
Potential side effects from corticosteroids include cutaneous atrophy, telangiectasia and striae, acne eruption, glaucoma, hypothalamus-pituitary-adrenal axis suppression and, in children, growth retardation. The true incidence of corticosteroid-induced hypothalamus-pituitary-adrenal suppression is unknown, but it is of concern with Psoriasis Puls use.
Careful long-term follow-up of patients receiving topical corticosteroid therapy is highly recommended Psoriasis Puls detect potential complications. Although corticosteroids are rapidly effective in the treatment of psoriasis, Psoriasis Puls are associated with a rapid flare-up of disease after discontinuation, and they have many potential side effects. Consequently, topical corticosteroids are frequently used in conjunction with another agent to maintain control.
Topical calcipotriene is often used in combination with topical corticosteroids to speed clearing of the lesions and maintain control after the initial phase of treatment is completed. Calcipotriene is a vitamin D 3 analog available in cream, ointment and solution formulations. It inhibits epidermal cell proliferation and enhances normal keratinization. This agent has a slow onset of action, and patients should be aware that the effects of calcipotriene may not be noticeable for up to six to eight weeks after Psoriasis Puls initiation of therapy.
Although calcipotriene monotherapy has been shown to be moderately effective in reducing the thickness, scaliness and erythema of psoriatic lesions, 8 Psoriasis Puls benefits are achieved when calcipotriene is used in combination with potent topical corticosteroids. This second phase helps prevent rebound from abrupt withdrawal of corticosteroids. When the lesions have remained flat and the intensity of their color has declined from bright red to pink, the maintenance phase begins, with use Psoriasis Puls calcipotriene alone and discontinuation of the weekend use of topical corticosteroids.
After appropriate control of the disease is maintained, topical Psoriasis Puls can be discontinued until a flare-up occurs. Use of emollients should be recommended, to reduce the scaly appearance of the lesions Psoriasis Puls to potentially reduce the amount of corticosteroid needed.
The only cutaneous side effect of calcipotriene is local irritation, which occurs in approximately Psoriasis Puls percent of patients. Hypercalcemia is a potential side effect of this agent when the dosage exceeds g per week. This effect does not usually occur with weekly use of g or less.
For localized psoriasis, the recommended dosages do not require monitoring of serum or urinary calcium levels. However, calcipotriene should be used with caution in patients with compromised renal function or a history of renal calculi. Coal tar is a black viscous fluid that was first described by Goeckerman inwhen it was combined with ultraviolet light for the treatment of psoriasis.
It is thought to suppress epidermal DNA synthesis. Coal tar is available Psoriasis Puls an ointment, cream, lotion, shampoo, Psoriasis Puls oil and soap. Coal tar is most effective when it is used in combination with other agents, especially ultraviolet B Psoriasis Puls. Like calcipotriene, coal tar is effective when it is combined with topical corticosteroids.
Coal tar shampoo can be used in combination with a corticosteroid scalp solution for the treatment of psoriasis on the scalp. Because coal tar is messy and malodorous and can stain clothing, nighttime application is recommended. Patients should be advised to use link bed linens Psoriasis Puls and to wear old pajamas when Psoriasis Puls are using coal tar.
Tar products can cause folliculitis, but they otherwise are generally not associated with side effects. If good control of psoriasis is not achieved with лефлуномида was Sie können und haben nicht Psoriasis the corticosteroids, alone or in combination with calcipotriene or coal tar, consideration should be given to the Psoriasis Puls of anthralin or tazarotene therapy.
Anthralin, also known as dithranol, is an antipsoriatic topical preparation derived from wood tar. Anthralin is source in 0. It is generally used on notably thick, large plaques of psoriasis, and therapy is initiated at low concentrations for short periods. The concentration and duration of contact with each treatment is gradually increased, up to a maximum of 30 minutes per application.
Patients should be warned that anthralin has a tendency to stain any surface, including the skin, clothing Journal Birkenteer Salbe für Psoriasis gonorrhcea bathtub. Its use should be limited to well-demarcated plaques, and it should be applied with a cotton-tipped applicator or a gloved hand. Patients should be warned that normal skin surrounding the psoriatic lesion may become irritated if it comes in contact with anthralin.
Topical tazarotene is the first topical receptor-selective retinoid approved for the treatment of psoriasis. It is available only in gel form and exerts its effects through gamma and beta retinoic acid receptors.
Tazarotene helps to normalize the proliferation and differentiation of keratinocytes, as well as to decrease cutaneous inflammation. As monotherapy, tazarotene has been shown to significantly reduce plaque elevation in mild to moderate psoriasis.
The primary side effect of topical tazarotene is minor skin irritation and increased Psoriasis Puls. Tazarotene is classified as a pregnancy category X drug and its use Psoriasis Puls be avoided in Psoriasis Puls of childbearing age.
Sun exposure in addition to topical therapy may be beneficial when multiple areas are affected with psoriasis. Patients should be encouraged to obtain natural sunlight exposure or Psoriasis Puls light exposure for a few minutes a day, and then to slowly increase the duration of exposure as tolerated.
Unaffected areas should be covered with a sunscreen, especially the face. Ultraviolet light exposure can Psoriasis Puls used judiciously to prevent flare-ups during the maintenance phase of therapy. Psoriatic plaques that fail to respond to topical therapy may be improved by administration of intralesional corticosteroid injections. Triamcinolone Kenalog is often used for this purpose. The agent is injected directly into the dermis of a small, persistent plaque. The concentration is generally 3 to 10 mg per mL, depending on the size, thickness and area of the lesion.
The dose of triamcinolone is released Psoriasis Puls over three to four weeks; additional injections may be needed every four to six weeks to improve the response. Disadvantages of intralesional injections include pain during the injection and potential side effects of local atrophy and systemic absorption.
The patient with refractory lesions may benefit from more advanced forms of treatment, such as phototherapy ultraviolet B alone or psoralens plus ultraviolet Aoutpatient treatment at a clinic specializing in psoriasis and systemic therapy with oral retinoids, methotrexate Rheumatrex or cyclosporine Sandimmune.
Combination therapy has also been shown to be effective, especially phototherapy in combination with topical anthralin, coal tar or calcipotriene Table 4. Used for many years, highly effective.
May cause acute phototoxicity. Little to no long-term side effects. UVB can be used at home for maintenance therapy. Highly effective; can be used as maintenance therapy. High risk of acute phototoxicity. Long-term risks include high risk of cutaneous malignancy.
Moderately effective; best for pustular psoriasis. Potent teratogen; use in women of childbearing potential should be avoided. Causes dryness of skin. May cause elevation of triglycerides. Hyperostosis with long-term use. Highly effective and can be used on a long-term basis. Should not be Psoriasis Puls in noncompliant patients or when there click to see more preexisting hepatic disease.
Can cause acute or chronic hepatotoxicity, and acute neutropenia and pancytopenia. The long-term risk of renal toxicity, which may not be detectable by blood tests, Psoriasis Puls long-term use. Frequently used or well-studied combination therapies. Achieving and maintaining control of psoriatic lesions is the central goal in treatment.
Physicians and patients need to understand that there is no definitive cure for psoriasis Figure Psoriasis Puls. Control of the disease may Psoriasis Puls that lesions are not as Psoriasis Puls or as red as they were before Jucken der Füße, but some degree Psoriasis Puls erythema may remain.
Most often, treatment does not result in complete clearing of the lesions. A treated lesion of psoriasis. The goals of treatment for localized psoriasis include a decrease in the size and redness of the plaque, as well as a reduction in the amount of scale on the lesion. Compared with the lesion in Figure 2this lesion is flat, and the scale is not obvious.
It does retain mild redness. This is the result that should be expected in the treatment of localized psoriasis. Although the algorithm serves Psoriasis Puls a guide to Psoriasis Puls treatment of localized psoriasis, various paths can be taken to achieve control of localized disease. The treatment path should be decided on a patient-to-patient basis.
As mentioned previously, generalized psoriasis may require more complex forms of therapy. Consultation with a dermatologist may be beneficial for patients who require such therapy. Already a member or subscriber? She is a graduate of West Virginia University Als Abstrich Psoriasis of Medicine, Morgantown. He graduated from Duke University School of Medicine, Durham, N. Feldman completed a dermatology residency at the University of North Carolina, Chapel Hill.
He is a member of the editorial board of the Journal of the American Academy of Dermatolog y. She completed undergraduate training at the University of North Carolina, Chapel Hill, and physician assistant training at Emory University School of Medicine, Atlanta. Address correspondence to Asha G. Reprints are not available Psoriasis Puls the authors. Feldman has received honoraria from Westwood-Squibb Pharmaceuticals and Glaxo Wellcome, Inc.
Fleischer AB Jr, Feldman SR, Bradham DD. Office-based physician services provided by dermatologists in the United States in Fleischer AB Jr, Feldman SR, Rapp SR, Reboussin DM, Exum ML, Clark AR, et al.
Disease severity measures in a population of psoriasis patients: American Academy of Dermatology. Committee Psoriasis Puls Guidelines of Care, Task Force on Psoriasis. Guidelines of care for psoriasis. J Am Acad Dermatol. Lebwohl M, Abel E, Zanolli M, Koo J, Drake L. Topical therapy for psoriasis. Mechanism of glucocorticoid action. Psoriasis Puls Fla Med Assoc.
Walsh P, Aeling JL, Huff L, Weston WL. Hypothalamus-pituitary-adrenal axis suppression by superpotent topical steroids. Dubertret L, Wallach D, Souteyrand P, Perussel M, Kalis B, Meynadier J, et al.
Efficacy and safety of calcipotriol MC ointment in psoriasis vulgaris: Sequential therapy for psoriasis. Vitamin D 3 analogues. Kragballe K, Gjersten BT, De Hoop D, Karlsmark T, van de Kerkhof PC, Larko O, et al. Cunliffe WJ, Berth-Jones J, Claudy A, Fairiss G, Psoriasis Puls D, Gratton D, et al. Comparative study of calcipotriol MC ointment and betamethasone valerate ointment in patients with psoriasis vulgaris. UVB phototherapy and coal tar. Foster RH, Brogden RN, Benfield P.
Duvic M, Asano AT, Hager C, Mays S. The pathogenesis of psoriasis and the mechanism of action of tazarotene. Weinstein GD, Krueger GG, Lowe NJ, Duvic M, Freidman DJ, Jegasothy BV, et al. Tazarotene gel, a new retinoid for topical therapy of psoriasis: Krueger GG, Drake LA, Elias PM, Lowe NJ, Guzzo C, Weinstein GD, et al. The safety and efficacy of tazarotene gel, a topical acetylenic retinoid, in the treatm of psoriasis.
Want to use this article elsewhere? Urinary Tract Infections During Pregnancy. An Algorithm-Based Approach for Primary Care Physicians. Feb 1, Issue. Abstract Diagnosis Topical Therapy Intralesional Injections, Phototherapy and Systemic Therapy Goals of Therapy and When to Refer References. Article Sections Psoriasis Puls Diagnosis Topical Therapy Intralesional Injections, Phototherapy and Systemic Therapy Goals of Therapy and When to Refer References.
Psoriasis Puls of Psoriasis, Associated Findings and Treatment Options Type Psoriasis Puls psoriasis Clinical features Precipitating factors Differential diagnosis Treatment options Plaque-type psoriasis Red, thick, scaly lesions with silvery scale Stress, infection, trauma, medications, xerosis Atopic dermatitis, irritant dermatitis, cutaneous T-cell lymphoma, pityriasis rubra pilaris, seborrheic dermatitis Localized: Treatment of Localized Psoriasis FIGURE 3.
Treatment of Psoriasis in Problem Areas Site Special problem Treatment options Scalp Hair-bearing areas are not receptive to ointment vehicles. Nails The thick keratin of the nail blocks absorption of topical agents. Genitalia The thin skin of the genitalia is highly sensitive to the adverse effects atrophy of topical corticosteroids. Palms and soles The thick stratum corneum of palms and soles is a barrier to penetration of topical agents. Therapy for Generalized Psoriasis Therapy Characteristics that guide the choice of therapy Ultraviolet B UVB light Used for many years, highly effective.
Psoralen plus ultraviolet A PUVA Highly effective; can be used as maintenance therapy. Retinoids acitretin [Soriatane] Moderately effective; best for pustular psoriasis. Methotrexate Rheumatrex Highly effective and can be used on a long-term basis.
Cyclosporine Sandimmune Highly effective. Frequently used or well-studied combination therapies UVB plus topical calcipotriene Dovonex UVB plus topical coal tar PUVA plus topical calcipotriene PUVA plus retinoids Acitretin plus topical calcipotriene Cyclosporine plus topical calcipotriene Infrequently used or less well-studied therapies UVB plus methotrexate PUVA plus methotrexate. Read the full article. Get immediate access, anytime, anywhere.
Choose a Psoriasis Puls article, issue, or full-access subscription. Earn up Psoriasis Puls 6 CME credits per issue. See My Options jetzt Schlamm aus dem Toten Meer für Psoriasis can. To see the full article, log in or purchase access. The Authors show all author info ASHA G.
REFERENCES show all references 1. More in Pubmed Citation Related Articles. MOST RECENT ISSUE Jun 15, Access the latest issue of American Family Physician Read the Issue. Sign up for the free AFP email table of contents. Continue Psoriasis eine psychische Störung from February 1, Previous: Urinary Tract Infections During Pregnancy Next: Red, thick, scaly lesions with silvery scale.
Stress, infection, trauma, medications, xerosis. Pityriasis rosea, secondary syphilis, drug eruption. Ultraviolet B phototherapy, natural sunlight. Pustular drug eruption, dyshidrotic eczema, subcorneal pustular dermatosis.
Same as for plaque-type psoriasis. Pustular drug eruption, subcorneal pustular dermatosis. Psoriasis Puls Moisturel, Cetaphil, Curel, Nivea, etc. Duration of safe use unknown.
Super-high potency safe for up to 4 weeks. Psoriasis Puls for up to 52 weeks; pregnancy category C. Hair-bearing areas are not receptive to ointment vehicles. The thick keratin of the nail blocks absorption of topical agents.
Ultraviolet B UVB light. Psoralen Psoriasis Puls ultraviolet A PUVA. UVB plus topical calcipotriene Dovonex. UVB plus topical coal tar. PUVA plus topical calcipotriene.
Acitretin plus topical calcipotriene. Cyclosporine plus topical calcipotriene. Psoriasis Puls used or less well-studied therapies. See My Options close Already a member or subscriber?
- sintomitsinovaja Salbe für Psoriasis
Pustular psoriasis is an uncommon form of psoriasis. Pustular psoriasis appears as clearly defined, raised bumps that are filled with a white, thick fluid composed of.
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