[21] Psoriasis Flashcards
What is psoriasis?
A long-lasting autoimmune disease characterised by abnormal patches of skin that are typically red, itchy, and scaly
How severe is psoriasis?
It varies in severity, from small localised patches, to complete body coverage which can have a major impact on quality of life
Describe the course of psoriasis?
The disease involves periods of improvement and then flare ups
At what age can people develop psoriasis?
It can affect anyone, but most commonly affects adults under 35 years old
What is psoriasis characterised by?
Abnormally excessive and rapid growth of the epidermal skin layer
What does the abnormally excessive and rapid growth of the epidermal basal layer cause in psoriasis?
Gross thickening of the prickle-cell layer and production of excessive stratum corneum
How quickly are skin cells replaced in psoriasis?
Every 3-5 days,compared to the normal 28-30 days
What is the mechanism of disease in psoriasis?
The exact mechanism is unknown, however these changes are belived to stem from premature maturation of keratinocytes induced by an inflammatory cascade the dermis
What is the role of genetics in psoriasis?
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
How are triggers importantto psoriasis?
Most people’s psoriasis symptoms start or become worse because of a trigger
Why is it important that patients know their triggers?
As this can help prevent a flare up
What are the common triggers of psoriasis?
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
What is psoriasis developing as a result of injury to the skin known as?
Koebner response
What medications can trigger psoriasis?
Lithium Some anti-malarials NSAIDs ACE inhibitors Beta blockers
What are the main types of psoriasis?
Plaque psoriasis (Psoriasis vulgaris) Pustular psoriasis Guttate psoriasis Erythrodermic psoriasis
Can different forms of psoriasis co-exist?
Yes
What is the most common form of psoriasis?
Plaque psoriasis
What % of cases of psoriasis are plaque psoriasis?
About 80%
Describe the ‘plaques’ in plaque psoriasis
They are dry, red skin lesions, which are covered in silver scales. They can be itchy and/or sore
Where do the plaques in plaque psoriasis appear?
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
What might happen in severe plaque psoriasis?
The skin around the joints may crack and bleed
On what basis does the extent of the rash vary in plaque psoriasis?
Varies between different people, and can vary from time to time in the same person
How severe is plaque psoriasis?
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
What are the variations of plaque psoriasis?
Scalp psoriasis
Flexural psoriasis
Where does flexural psoriasis occur?
In the creases of the skin, such as the armpit, groin, under breasts, and in skin folds
Describethe affected skin appear in flexural psoriasis
Looks red and inflamed, but is smooth and does not have rough scaling
What makes flexural psoriasis worse?
Friction and sweating, so can be particularly uncomfortable in hot weather
What is pustular psoriasis?
A rarer type of plaque psoriasis that causes pus-filled blisters to appear on the skin
Does the pus indicate infection in pustular psoriasis?
No, it is not infectious
Describe the skin around the pustules in pustular psoriasis?
It is usually red and tender
What are the different types of pustular psoriasis?
Generalised pustular psoriasis
Palmar pustular psoriasis
Acropustulosis
What does generalised pustular psoriasis cause?
Pustules to develop on a wide area of skin
Describe the course of pustular psoriasis
It can develop very quickly, and may reappear every few days or weeks in a cycle
What can generalised pustular psoriasis cause during the start of the cycle?
Fever Chills Weight loss Fatigue
What does palmar pustular psoriasis cause?
Pustules to appear on the palms of the hands and soles of the feet
Describe the course of palmar pustular psoriasis
The pustules gradually develop into circular brown, scaly spots, which then peel off. They may reappear every few days or weeks
What does acropustulosis cause?
Pustules to appear on the fingers and toes
What happens after the development of pustules in acropustulosis?
They burst, leaving bright red areas that may ooze or become scaly
Other than pustules, what can acropustulosis cause?
Painful nail deformities
What happens in guttate psoriasis?
Small (less than 1cm) round/oval plaques of psorasis develop over many areas of the body
What does guttate psoriasis normally occur following?
An infectious sore throat
How long does guttate psoriasis last?
It usually lasts a few weeks, however can last up to 3-4 months
What does guttate psoriasis sometimes develop into?
Plaque psoriasis
What proportion of people with any type of psoriasis will also have fingernail symptoms?
About half
What is affected in addition to the fingernails in some people?
Toenails
Can nail psoriasis occur alone, without the skin rash?
Yes
What can nail psoriasis cause?
Development of tiny dents/pits Discolouration Abnormal growth Nail to become loose and seperate from the nail bed Crumbling of nails in severe cases
What is erythrodermic psoriasis?
A rare form that affects nearly all of the skin of the body, which can cause intense itching or burning
What management does erythrodermic psoriasis require?
Urgent hospital treatment
Why does erythrodermic psoriasis require urgent hospital admission?
Because it can cause the loss of proteins and fluid, causing further problems such as infection, dehydration, heart failure, hypothermia, and malnutrition
How is a diagnosis of psoriasis made?
Psoriasis is usually a clinical diagnosis, and no tests are needed
Occassionally, a biopsy can be taken when there is doubt about the diagnosis
What does assessment needto be made regarding in any patient with any type of psorasis?
Disease severity
Impact of the disease on physical, psychological, and social wellbeing
The potential presence of psoriatic arthritis
Presence of co-morbidities
How often should assessment for psoriatic arthritis be made?
Annually, especially within the first 10 years of diagnosis
What should be identified and managed in adults with severe psoriasis?
Cardiovascular risk factors
What is the management of psoriasis determined by?
The type and severity, as well as the area of skin affected
What are the categories of treatment in psoriasis?
Topical Phototherapy Systemic
What is the first line treatment for mild to moderate psoriasis?
Topical treatments
How effective are topical treatments for mild to moderate psoriasis?
Some people find they are sufficient for control
How long might topical treatments take to work in psoriasis?
Up to 6 weeks
What should be done if topical therapy alone is unlikely to control the psoriasis?
You should offer second- or third-line treatment options at the same time as topical therapy
What are the second- and third-line treatment options after topical treatments?
Phototherapy or systemic therapy
Give two examples of why topical therapy alone is unlikely to control the disease?
If there is extensive disease If topical therapy is known to be ineffective in that part of the body, e.g. nail disease
What are the topical treatments that can be used in psoriasis?
Emollients Topical corticosteroids Vitamin D analogues Calcineurin inhibitors
What are emollients?
Moisturising treatments applied directly to the skin
What is the point in emollients?
To reduce water loss and cover the skin with a protective film
What are the main benefits of emollients?
Reduction in itching and scaling Some topical treatments are thought to work better on moisturised skin
What are topical corticosteroids commonly used for in psoriasis?
To treat mild to moderate psoriasis in most areas of the body
How do topical corticosteroids work in psoriasis?
They reduce inflammation, which slows the production of skin cells and reduces itching
What might continuous use of potent corticosteroids cause in psoriasis?
Irreversible skin atrophy and striae
Psoriasis to become unstable
Systemic side effects
When might potent topical corticosteroids cause systemic side effects?
If applied continuously to extensive psoriasis
What should patients be made aware of when starting topical corticosteroids?
The risk and benefits
How long can very potent corticosteroids be used for at any site?
No longer than 4 weeks
How long can potent corticosteroids be used for at any site?
No longer than 8 weeks
