psoriasis /sərī″əsis/ [Gk, itch] , a chronic skin disorder characterized by circumscribed red patches covered by thick, dry, silvery adherent scales. Exacerbations and remissions are typical. Kinds include guttate psoriasis, pustular psoriasis, universe psoriasis. See also psoriatic arthritis. −psoriatic, adj. ▪ OBSERVATIONS: The onset of symptoms is gradual, and the disorder is characterized by periods of chronic exacerbation and remission. The scalp, elbows, knees, back, and buttocks are the most common sites. The nails, eyebrows, axillae, and anal and genital regions may also be affected. The lesions are well-defined, dry, nonpruritic papules or plaques overlaid with shiny silver scales, and they heal without scarring. The skin may be reddened and hot to touch. Affected nails are pitted, discolored, thickened, and crumbly. Diagnosis is based on evaluation of characteristic lesions. Common complications include psoriatic arthritis and exfoliative psoriatic dermatitis, which can lead to crippling and general debility. ▪ INTERVENTIONS: Limited disease is treated with topical corticosteroids. Calcipotriene, tar products and other keratolytics are used in lotion, cream, ointment, or shampoo form to treat lesions. Lubricants are used to soften skin. Exposure to sunlight and short-wave or long-wave ultraviolet light therapy may be useful to treat generalized disease. Antineoplastic agents such as methotrexate may used for severe recalcitrant disease. ▪ PATIENT CARE CONSIDERATIONS: Psoriasis is often more emotionally disabling than physically harmful. Nursing focus is on helping the individual adapt to the chronic relapsing nature of the disease. These individuals are at increased risk for alterations in body image and should be referred for counseling if body image is affected. Support groups and stress-reduction programs can be helpful. Instruction is needed to prevent mechanical injury to skin, and to reinforce the fact that lesions are not communicable.
