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MSRA Dermatology [3] > [21] Psoriasis > Flashcards

[21] Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is psoriasis?

A

A long-lasting autoimmune disease characterised by abnormal patches of skin that are typically red, itchy, and scaly

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2
Q

How severe is psoriasis?

A

It varies in severity, from small localised patches, to complete body coverage which can have a major impact on quality of life

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3
Q

Describe the course of psoriasis?

A

The disease involves periods of improvement and then flare ups

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4
Q

At what age can people develop psoriasis?

A

It can affect anyone, but most commonly affects adults under 35 years old

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5
Q

What is psoriasis characterised by?

A

Abnormally excessive and rapid growth of the epidermal skin layer

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6
Q

What does the abnormally excessive and rapid growth of the epidermal basal layer cause in psoriasis?

A

Gross thickening of the prickle-cell layer and production of excessive stratum corneum

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7
Q

How quickly are skin cells replaced in psoriasis?

A

Every 3-5 days,compared to the normal 28-30 days

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8
Q

What is the mechanism of disease in psoriasis?

A

The exact mechanism is unknown, however these changes are belived to stem from premature maturation of keratinocytes induced by an inflammatory cascade the dermis

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9
Q

What is the role of genetics in psoriasis?

A

Psoriasis runs in families, with 1 in 3 people with psoriasis having a close relative with the condition, however the exact role genetics plays is unclear. It is likely that a combination of genes contributes to an increased vulnerability to the condition

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10
Q

How are triggers importantto psoriasis?

A

Most people’s psoriasis symptoms start or become worse because of a trigger

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11
Q

Why is it important that patients know their triggers?

A

As this can help prevent a flare up

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12
Q

What are the common triggers of psoriasis?

A 
Injury to the skin	
Excessive alcohol intake	
Smoking	
Stress	
Hormonal changes, particularly during puberty or menopause	
Certain medications	
Throat infections	
Other immune disorders, such as HIV
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13
Q

What is psoriasis developing as a result of injury to the skin known as?

A

Koebner response

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14
Q

What medications can trigger psoriasis?

A 
Lithium	
Some anti-malarials
NSAIDs	
ACE inhibitors	
Beta blockers
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15
Q

What are the main types of psoriasis?

A 
Plaque psoriasis (Psoriasis vulgaris)
Pustular psoriasis	
Guttate psoriasis	
Erythrodermic psoriasis
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16
Q

Can different forms of psoriasis co-exist?

A

Yes

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17
Q

What is the most common form of psoriasis?

A

Plaque psoriasis

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18
Q

What % of cases of psoriasis are plaque psoriasis?

A

About 80%

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19
Q

Describe the ‘plaques’ in plaque psoriasis

A

They are dry, red skin lesions, which are covered in silver scales. They can be itchy and/or sore

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20
Q

Where do the plaques in plaque psoriasis appear?

A

They normally appear on the elbows, knees, scalp, and lower back, however can be anywhere on the bodyThey usually do not appear on the face

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21
Q

What might happen in severe plaque psoriasis?

A

The skin around the joints may crack and bleed

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22
Q

On what basis does the extent of the rash vary in plaque psoriasis?

A

Varies between different people, and can vary from time to time in the same person

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23
Q

How severe is plaque psoriasis?

A

It varies - some people may have just a few small plaques of a cm or so, but some people have a more widespread rash with large plaques

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24
Q

What are the variations of plaque psoriasis?

A

Scalp psoriasis

Flexural psoriasis

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25
Q

Where does flexural psoriasis occur?

A

In the creases of the skin, such as the armpit, groin, under breasts, and in skin folds

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26
Q

Describethe affected skin appear in flexural psoriasis

A

Looks red and inflamed, but is smooth and does not have rough scaling

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27
Q

What makes flexural psoriasis worse?

A

Friction and sweating, so can be particularly uncomfortable in hot weather

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28
Q

What is pustular psoriasis?

A

A rarer type of plaque psoriasis that causes pus-filled blisters to appear on the skin

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29
Q

Does the pus indicate infection in pustular psoriasis?

A

No, it is not infectious

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30
Q

Describe the skin around the pustules in pustular psoriasis?

A

It is usually red and tender

31
Q

What are the different types of pustular psoriasis?

A

Generalised pustular psoriasis
Palmar pustular psoriasis
Acropustulosis

32
Q

What does generalised pustular psoriasis cause?

A

Pustules to develop on a wide area of skin

33
Q

Describe the course of pustular psoriasis

A

It can develop very quickly, and may reappear every few days or weeks in a cycle

34
Q

What can generalised pustular psoriasis cause during the start of the cycle?

A 
Fever
Chills	
Weight loss
Fatigue
35
Q

What does palmar pustular psoriasis cause?

A

Pustules to appear on the palms of the hands and soles of the feet

36
Q

Describe the course of palmar pustular psoriasis

A

The pustules gradually develop into circular brown, scaly spots, which then peel off. They may reappear every few days or weeks

37
Q

What does acropustulosis cause?

A

Pustules to appear on the fingers and toes

38
Q

What happens after the development of pustules in acropustulosis?

A

They burst, leaving bright red areas that may ooze or become scaly

39
Q

Other than pustules, what can acropustulosis cause?

A

Painful nail deformities

40
Q

What happens in guttate psoriasis?

A

Small (less than 1cm) round/oval plaques of psorasis develop over many areas of the body

41
Q

What does guttate psoriasis normally occur following?

A

An infectious sore throat

42
Q

How long does guttate psoriasis last?

A

It usually lasts a few weeks, however can last up to 3-4 months

43
Q

What does guttate psoriasis sometimes develop into?

A

Plaque psoriasis

44
Q

What proportion of people with any type of psoriasis will also have fingernail symptoms?

A

About half

45
Q

What is affected in addition to the fingernails in some people?

A

Toenails

46
Q

Can nail psoriasis occur alone, without the skin rash?

A

Yes

47
Q

What can nail psoriasis cause?

A 
Development of tiny dents/pits
Discolouration
Abnormal growth	
Nail to become loose and seperate from the nail bed	
Crumbling of nails in severe cases
48
Q

What is erythrodermic psoriasis?

A

A rare form that affects nearly all of the skin of the body, which can cause intense itching or burning

49
Q

What management does erythrodermic psoriasis require?

A

Urgent hospital treatment

50
Q

Why does erythrodermic psoriasis require urgent hospital admission?

A

Because it can cause the loss of proteins and fluid, causing further problems such as infection, dehydration, heart failure, hypothermia, and malnutrition

51
Q

How is a diagnosis of psoriasis made?

A

Psoriasis is usually a clinical diagnosis, and no tests are needed
Occassionally, a biopsy can be taken when there is doubt about the diagnosis

52
Q

What does assessment needto be made regarding in any patient with any type of psorasis?

A

Disease severity
Impact of the disease on physical, psychological, and social wellbeing
The potential presence of psoriatic arthritis
Presence of co-morbidities

53
Q

How often should assessment for psoriatic arthritis be made?

A

Annually, especially within the first 10 years of diagnosis

54
Q

What should be identified and managed in adults with severe psoriasis?

A

Cardiovascular risk factors

55
Q

What is the management of psoriasis determined by?

A

The type and severity, as well as the area of skin affected

56
Q

What are the categories of treatment in psoriasis?

A

Topical Phototherapy Systemic

57
Q

What is the first line treatment for mild to moderate psoriasis?

A

Topical treatments

58
Q

How effective are topical treatments for mild to moderate psoriasis?

A

Some people find they are sufficient for control

59
Q

How long might topical treatments take to work in psoriasis?

A

Up to 6 weeks

60
Q

What should be done if topical therapy alone is unlikely to control the psoriasis?

A

You should offer second- or third-line treatment options at the same time as topical therapy

61
Q

What are the second- and third-line treatment options after topical treatments?

A

Phototherapy or systemic therapy

62
Q

Give two examples of why topical therapy alone is unlikely to control the disease?

A

If there is extensive disease If topical therapy is known to be ineffective in that part of the body, e.g. nail disease

63
Q

What are the topical treatments that can be used in psoriasis?

A 
Emollients	
Topical corticosteroids	
Vitamin D analogues	
Calcineurin inhibitors
64
Q

What are emollients?

A

Moisturising treatments applied directly to the skin

65
Q

What is the point in emollients?

A

To reduce water loss and cover the skin with a protective film

66
Q

What are the main benefits of emollients?

A

Reduction in itching and scaling Some topical treatments are thought to work better on moisturised skin

67
Q

What are topical corticosteroids commonly used for in psoriasis?

A

To treat mild to moderate psoriasis in most areas of the body

68
Q

How do topical corticosteroids work in psoriasis?

A

They reduce inflammation, which slows the production of skin cells and reduces itching

69
Q

What might continuous use of potent corticosteroids cause in psoriasis?

A

Irreversible skin atrophy and striae
Psoriasis to become unstable
Systemic side effects

70
Q

When might potent topical corticosteroids cause systemic side effects?

A

If applied continuously to extensive psoriasis

71
Q

What should patients be made aware of when starting topical corticosteroids?

A

The risk and benefits

72
Q

How long can very potent corticosteroids be used for at any site?

A

No longer than 4 weeks

73
Q

How long can potent corticosteroids be used for at any site?

A

No longer than 8 weeks

MSRA Dermatology [3] (26 decks)

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