Psoriasis

Question 1

What is this a presentation of?

Red, scaly patches typically following a relapsing remitting course.

Answer 1

Psoriasis

Question 2

What is the pathogenesis of psoriasis?

Answer 2

Epidermis is hyperproliferative, dilation of blood vessels and infiltration of T-cells and neutrophils.

Question 3

What are the classic triggers for psoriasis?

Answer 3

Stress, infection (especially streptococcal), skin trauma, lithium, NSAIDs, B-blockers, antimalarials, alcohol, smoking, climate.

Question 4

What is this a presentation of?

Symmetrical, well-defined, red plaques with silvery scale on extensor surfaces of elbow, knees, scalp, and sacrum.

Answer 4

Chronic plaque psoriasis

Question 5

What is this a presentation of?
Most flexural areas (axilla, groin, submammary, umbilicus) affected with red, scaly patches. Skin is smooth and less scaly than other forms of condition.

Answer 5

Flexural psoriasis

Question 6

What is this a presentation of?
Large numbers of small teardrop plaques (<1cm) over trunk and limbs, young patient, recent streptococcal infection, lasts 3-4 months.

Answer 6

Guttate psoriasis

Question 7

What is this a presentation of?

Yellow brown pustules affecting palms and soles, female.

Answer 7

Pustular psoriasis

Question 8

What are the nail changes seen in psoriasis?

Answer 8

Pitting, onycholysis

Question 9

Which joint condition is associated with psoriasis?

Answer 9

Arthritis

Question 10

What is it important to educate psoriasis patients about?

Answer 10

Disease must be controlled, cannot be cured.

Question 11

What is the management of a psoriasis plaque?

Answer 11

1. Topical corticosteroid OD (morning) plus topical vitamin D overnight, review at 4 weeks.
2. If not improvement after 8 weeks - vitamin D BD
3. If no improvement after 12 weeks - potent steroid for 4 weeks/coal tar preparation OD/BD

Question 12

What is the management of the scalp in psoriasis?

Answer 12

Potent topical corticosteroids OD for 4 weeks

Question 13

What is the management for face, flexural, and genital lesions in psoriasis?

Answer 13

Mild-moderate corticosteroid OD/BD for maximum of 2 weeks on sensitive areas.

Question 14

What can be used for guttate/plaque psoriasis that cannot be controlled with topical treatment or is widespread (>10% BSA)?

Answer 14

Narrow band UVB phototherapy

Question 15

What is the systemic therapy used in severe/joint involved psoriasis?

Answer 15

1. Methotrexate - elderly, hepatic fibrosis risk in young
2. Ciclosporin - can cause HTN and renal dysfunction
3. Systemic retinoids - teratogenic, dry mucous membranes

Question 16

What agents can be used as a last resort in psoriasis?

Answer 16

Biological agents - inhibit immune reaction

Infliximab, etanercept, adalimumab, ustekinumab

Question 17

What are the key complications of psoriasis?

Answer 17

1. Psoriatic arthropathy
2. Increased metabolic syndrome, CVD, VTE
3. Psychological distress