Psoriasis

Question 1

What is psoriasis?

Answer 1

A systemic, immune mediated, inflammatory skin disease which has a chronic relapsing-remitting course, and may have nail and joint involvement.

Question 2

What is the pathophysiology of psoriasis?

Answer 2

• Epidermal hyperproliferation (cells multiply too quickly)
• Keratinocytes don’t mature properly
• Lymphocytes infiltrate and cause inflammation

Question 3

What are triggers for psoriasis?

Answer 3

• Streptococcal infection (guttate psoriasis)
• Drugs (lithium, anti malarials, NSAIDS, ACEi)
• UV light
• Trauma
• Hormonal changes eg puberty, post partum, menopause
• Smoking
• Alcohol
• HIV/AIDs

Question 4

What are associated conditions with psoriasis?

Answer 4

• Psoriatic arthritis
• Metabolic syndrome
• IHD
• IBD
• Anxiety and depression
• VTE
• Non melanoma skin cancer

Question 5

What are the two types of psoriasis which are a life threatening emergency?

Answer 5

Pustular psoriasis - Rapidly developing widespread erythema, followed by the eruption of white, sterile non follicular pustules. These coalesce to form large lakes of pus

Erythrodermic psoriasis - Diffuse, widespread severe psoriasis which affects more than 90% of the body surface area.

Question 6

What is chronic plaque psoriasis?

Answer 6

• Well demarcated, erythematous plaques (palpable scaling raised lesion >0.5cm in diameter)
• Overlying silver scales
• On extensor surfaces of joints/scalp/behind ears/periumbilicus/face
• Symmetrical distribution

Question 7

What is flexural psoriasis?

Answer 7

• Lesions affect the groin, genital area, axilla, inframammary folds, abdominal folds, sacral and gluteal cleft
• Elderly, immobile and obese patients are at risk
• Presents as chronic plaque psoriasis but without scales due to friction

Question 8

What is guttate psoriasis?

Answer 8

• Small, scattered, round, oval (2mm to 1cm) scaly papules, which may be pink or red
• Lesions occur all over the body over 1-7 days particularly on the trunk and proximal limbs
• First presents classically after acute streptococcal upper resp tract infection or as an acute exacerbation of plaque psoriasis

Question 9

What is nail psoriasis?

Answer 9

• Common in up to 90% of those with psoriatic arthritis

- Nail pitting, discolouration, subungual hyperkeratosis, onycholysis, nail dystrophy

Question 10

What lifestyle modifications are there for psoriasis?

Answer 10

• Stop smoking
• Reduce alcohol
• Weight loss
• Stress management

Question 11

What can be given topically for psoriasis?

Answer 11

• Emollients for scales and pruritis
• Topical steroids for localised areas of psoriasis, stop once skin is clear and not for more than 8 weeks
• Vitamin D preparation

Question 12

What can be given for extensive disease?

Answer 12

• Phototherapy

- DMARD’s eg methotrexate, mycophenolate motefil

Question 13

What is a complication of psoriasis?

Answer 13

Erythroderma - inflamed, oedematous and scaly skin covering 90% of the skins surface

• Systemically unwell
• Treated with wet wraps and emolients