Psoriasis

Question 1

What is it?

Answer 1

Chronic inflammatory skin condition

1. Epidermal proliferation
2. Inflammatory infiltration of dermis and epidermis by TNF-alpha, activated T cells, macrophages and dendritic cells

Question 2

Rx Factors/Triggers and Associations

Answer 2

Rx Factors/Triggers: 
Family Hx (HLA associations) 
Recent strep infection 
Stress 
Skin Trauma 
Drugs (lithium, NSAIDs, BB) 
Alcohol + Smoking
Obesity

Associations: 
Inflammatory arthritis (30% develop) 
IBD 
Uveitis 
Coeliac disease 
Metabolic Syndrome

Question 3

Examination

Answer 3

Symmetrical, well defined red plaques with silvery scale on the extensor surfaces, scalp and sacrum
Flexures also affected by lesions not scaly
Itch generally mild but can be severe
Nail changes - oncholysis, subungual hyperkeratosis
Sterile pustular variants on palms and soles
Systemic upset = fever + dehydration
Pinpoint bleeding on scale removal

Question 4

Sub types

Answer 4

many - dependent upon where their lesions are or how they started
eg. Post-strep, Flexural psoriasis

Question 5

Differential

Answer 5

Eczema
Tinea
Seborrheic dermatitis

Question 6

Management

Answer 6

Non-Pharm:
Education - control is aim, not cure
Encourage a support group
Remove triggers

Pharmacological: 
MILD 
  - Davobet cream
  - Emollients 
  - Tar preparations 
  - Salicylic acid 

MODERATE/SEVERE:

• warrants systemic treatment and/or phototherapy
• methotrexate, ciclosporin, acitretin
• narrowband UVB, broadband UVB, chemophototherapy
• Consider biologics eg etanercept

Psoriatic arthritis
- etanercept, infliximab or methotrexate