Psoriasis: Nursing Care Plan (2024)

Overview: Psoriasis

This content is intended as a Quick Reference for psoriasis and will cover an overview as well as nursing considerations utilizing the nursing process.

Psoriasis Etiology and Epidemiology

Psoriasis is an inflammatory skin condition that causes painful and sometimes itchy patches on the skin, scalp, skin folds, and nail beds. Psoriasis affects more than 7 million people in the U.S. (Armstrong et. al., 2021). The cause of psoriasis is unclear; however, it is an immune response that causes a hyperproliferation of the keratinocytes in the epidermis. Genetics also appear to play a role in the disease. One in three people diagnosed with psoriasis has a relative with the disease (National Psoriasis Foundation, 2021).

While it can show up at any age, psoriasis symptoms often show up in both men and women of all races between 15 and 25 years old and are caused by an environmental trigger (National Psoriasis Foundation, 2021). The inflammatory response is commonly triggered by:

• Skin injury or sunburn
• Infections such as HIV or streptococcus
• Medications such as beta-blockers, lithium, chloroquine, indomethacin, terbinafine, and interferon-alfa
• Lifestyle factors including alcohol consumption, smoking, and stress.
• Obesity

ICD-10 Code Category for Psoriasis: L40

Types of Psoriasis

There are five different types of psoriasis (National Psoriasis Foundation, 2021):

1. Guttate psoriasis affects approximately 8% of people with psoriasis. Symptoms typically show up in children and young adults and include large clusters of small red spots on the arms, legs, and torso.
2. Pustular psoriasis affects approximately 3% of people with psoriasis. Symptoms include inflamed skin and painful white pus-filled bumps on the hands and feet.
3. Plaque psoriasis affects approximately 80% of people with psoriasis. Symptoms include raised red patches or plaques that are itchy, red, and scaly. Plaques can appear anywhere on the body and are often symmetrical. Individuals with plaque psoriasis often have psoriasis on their nails as well. Nails present with discoloration, pitting, and crumbling.
4. Inverse psoriasisaffects 25% of people with psoriasis. Symptoms include patches of reddened and inflamed skin that is painful and often accompanied by severe pruritus.
5. Erythrodermic psoriasis affects about 2% of people with psoriasis. It can be life threatening as it causes tachycardia, fever, and dehydration. Symptoms include large sheets of red skin, skin shedding, severe pruritus, and pain. It can affect the entire body.
6. Psoriatic arthritis is a type of inflammatory arthritis that affects people who have psoriasis. Symptoms typically develop years after an individual’s first psoriasis flare up. It affects about 30% of people diagnosed with psoriasis.

Psoriasis Diagnosis

The diagnosis of psoriasis requires a thorough history, intake, and physical examination by the healthcare provider. The provider will evaluate family history, lifestyle, and the appearance and distribution of lesions. A biopsy of the affected area may be taken to rule out other conditions.

Lab tests may include:

• Rheumatoid factor (RF) to diagnose autoimmune disorders
• Erythrocyte sedimentation rate (ESR)
• Uric acid level
• Neutrophils (fluid is taken from pustules to assess for infection)
• Fungal tests

Psoriasis Management

Non-pharmacological management can include:

• UV light therapy
• Smoking cessation
• Weight loss
• Stress management

Pharmacological treatment can include (Das, 2021):

• Topical treatments including:
  • Emollients
  • Salicylic acid
  • Corticosteroids
  • Vitamin D3 analogs such as calcitriol (Vectical®)
• Immunosuppressants
• Immunomodulatory agents such as etanercept (Enbrel®, Erelzi®, Eticovo®)
• Systemic retinoids

Psoriasis Nursing Care Plan

Psoriasis Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for psoriasis are listed below.

Assessment

Assess signs and symptoms, such as:

• Skin inflammation, redness, plaques, or lesions
• Joint or skin pain
• Psychological and social well-being
• Fever and signs of infection
• Vital signs

Psoriasis Nursing Diagnosis/Risk For

• Disturbed body image related to visible skin lesions on body as evidenced by:
  • Verbalizes negative thoughts and feelings about skin
  • Hides affected area
  • Self-isolation
• Impaired comfort related to irritated skin as evidenced by:
  • Pain
  • Pruritus
  • Difficulty sleeping
• Impaired skin integrity related to lesions and plaques on body as evidenced by:
  • Inflammation
  • Dry, flaky skin
  • Blisters
  • Pruritus

Nursing Interventions for Psoriasis

• Monitor skin condition and changes
• Educate on keeping skin clean and dry
• Encourage individual to express feelings
• Monitor pain level
• Administer medications as ordered
• Educate on factors that trigger flare ups
• Monitor for signs of infection

Expected Outcomes

• Maintains optimal skin integrity
• Demonstrates effective coping skills
• Achieves improved comfort reducing pain and pruritus related to condition
• Verbalizes or demonstrates a decrease in pain

Individual/Caregiver Education

• Condition, treatment, and expected outcomes
• Side effects of medications
• Medication administration
• Environmental and lifestyle factors related to psoriasis triggers
• Signs and symptoms of infection
• Notify healthcare provider or seek immediate medical care for:
  • Fever
  • Increasing pain
  • Tachycardia
• Recommended follow-up with healthcare provider

Release Date

4/1/2022

Content Expiration

12/31/2027

Writer

Annette Brownlee BSN, RN

Annette Brownlee, BSN, RN is an SME Writer for the Post-Acute Care team. She has a Bachelor of Arts in advertising from Michigan State University and a Bachelor of Science in nursing from the University of Northern Colorado. Annette has worked in skilled nursing and home health. Her most recent experience includes being a Staff Development Coordinator and Infection Preventionist.

Disclosures

Annette Brownlee BSN, RN has no relevant financial or non-financial relationship(s) with ineligible companies to disclose.

Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.

All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.

References

• Armstrong, A., Mehta, M., Schupp, C., Gondo, G., Bell, S., & Griffiths, C. (2021). Psoriasis prevalence in adults in the United States. JAMA Dermatol. doi:10.1001/jamadermatol.2021.2007
• Das, S. (2021). Merck Manual Professional Version: Psoriasis https://www.merckmanuals.com/professional/dermatologic-disorders/psoriasis-and-scaling-diseases/psoriasis#v962308
• National Psoriasis Foundation. (2021). About psoriasis. https://www.psoriasis.org/about-psoriasis/