4th Year Psoriasis

Question 1

precipitating factors for development of psoriasis

Answer 1

stress
infection (strep throat > guttate)
drugs
Koebner's phenomena
smoking

Question 2

what is the risk with prednisolone in psoriasis?

Answer 2

rebound flare

Question 3

histological findings in psoriasis

Answer 3

parakeratosis
absence of granular layer
expanded prickle cell layer
collections of neutrophils in epidermis (Munro microabscesses)

Question 4

two categories for psoriasis

Answer 4

1. psutular

2. non-pustular

Question 5

where is pustular psoriasis normally located?

Answer 5

hands and feet

Question 6

triggers for pustular psoriasis

Answer 6

pregnancy
steroid withdrawal
infections
hypoglycaemia
drugs (salicylates, lithium)

Question 7

complications of pustular psoriasis

Answer 7

hypoalbuminuria
hypocalcaemia
acute RTN
liver failure

Question 8

management of pustular psoriasis

Answer 8

remove trigger
supportive with emollients, fluids and protein replacement
systemic therapies

Question 9

systemic therapies used in pustular psoriasis

Answer 9

acitretin
methotrexate
pregnancy= use prednisolone
PUVA

Question 10

non-pustular psoriasis types

Answer 10

1. chronic plaque psoriasis/ psoriasis vulgaris
2. guttate psoriasis
3. scalp psoriasis
4. flexural psoriasis
5. palmoplantar psoriasis
6. palmoplantar pustulosis
7. generalised pustular psoriasis
8. erythrodermic psoriasis

Question 11

describe the appearance of chronic plaque psoriasis

Answer 11

erythematous scaly plaques
extensors
symmetrical
silver scale
Auspitz sign
Koebner's

Question 12

describe the appearance of guttate psoriasis

Answer 12

raindrop pattern
younger
post-strep throat

Question 13

management of scalp psoriasis

Answer 13

olive oil
tar shampoos (polytar)
coconut oil (cocois)

rarely causes permanent alopecia

Question 14

describe the appearance of flexural psoriasis

Answer 14

shiny, red, well-demarcated plaques
groin
axilla
inframammary areas

Question 15

describe the appearance of palmoplantar psoriasis

Answer 15

plaques on palms and soles
painful
thickened

Question 16

presentation of palmoplantar pustular psoriasis

Answer 16

sterile pustules that fade from yellow > brown
smoking
chronic

Question 17

describe erythrodermic psoriasis

Answer 17

>90% body SA
deteriorating patient
hypothermia
cardiogenic shock
dehydration
anaemia
hypoproteinaemia

Question 18

arthritis types in psoriasis

Answer 18

asymmetric oligoarthritic
symmetrical polyarthritis
distal phalangeal joint disease
destructive arthritis
axial arthritis

Question 19

topical treatments for psoriasis

Answer 19

emollients
tar preparations (staining)
vit D analogues e.g. dononex
salicylic acid
dithranol (staining, short-contact regimes)
topical steroids

Question 20

why are topical steroids usually avoided in psoriasis?

Answer 20

rebound flare

Question 21

systemic options for psoriasis

Answer 21

phototherapy for 6-8 weeks?
methotrexate (+folic acid)
ciclosporin (hypertension, renal impairment)
retinoids (teratogenic)
biologics