Psoriasis Flashcards
What is Psoriasis?
A chronic Inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration
Describe the pathophysiology of Psoriasis
Injury/infection increases activated pro-inflammatory markers such as IL6 and TNF APC
These then activate TH1 and TH17
Resulting in abnormal keratinocyte differentiation (decreasing keratinocyte transit time)
Involves raised Th1 cells; effector cells and biomarkers of systemic inflammation therefore psoriasis is a systemic disease
State four subtypes of Psoriasis
Chronic Plaque (most common)
Guttate (raindrop lesions)
Seborrhoeic (scalp and behind ears)
Pustular (plantar, palmar)
How does Psoriasis present and in which locations
Well demarcated erythematous scaly plaques, common on extensor surfaces and scalp
50% cases also have some nail involvement
Differentials for psoariasis?
- Seborrhoeic dermatitis
- Fungal skin and/or nail infection
- Eczema
- Secondary syphilis - (consider if palmar or plantar involvement)
Describe 4 nail changes seen in Psoriasis
- Nail pitting
- Oncholysis
- Nail bed erythema
- Subungual Hyperkeratosis
________ Psoriasis is seen in the image below and is ________ to diagnose and the most common
Chronic Plaque, Easy
Presentation of chronic plaque psoriasis? (Incl locations)
Monomorphic patches of ‘salmon’ pink erythema with overlying silver thickened plaque
Occurs on the scalp, behind the ears, trunk, buttocks, periumbilical area, and extensor surfaces
Plaques vary in size, smaller ones are harder to treat because it is difficult to apply topical therapy precisely
List 4 pieces of general lifestyle advice which can be given to a patient with psoriasis
- weight loss (if overweight)
- regular excersise
- stress management
- minimum alcohol
- smoking cessation
- investigation and managemnet of associated health conditions
List 2 examples of Topical treatments for psoriasis
- Emolliants
- CS with occlusion
- Vitamin D
- Keratolytics (urea, salicylic acid)
- Coal tar
List 2 examples of oral treatments for psoriasis
- Methotrexate
- Retinoids (Acitretin)
- Biologics
According to NICE, what are the first line treatments for psoriasis on the trunk and limbs?
- General lifestyle advice
- Emolliants
- Topical CS + topical vitamin D preperation
*Review after 4 weeks
What is the purpose of phototherapy as a treatment for psoriasis?
Uses UV light, to reduce inflammation and slow down the creation of skin cells - may cure/ease pain and itchiness
What other condition may be associated with Psoriasis?
How does this present and how is it treated?
Psoriatic arthritis
Similar presentation and treatment to RA (MSK rheumatology)
How does psoriasis present on the scalp?
Itchy, painful scalp with dandruff - may lead to hair loss
Can be an isolated disease or part of widespread disease
What is the treatment for scalp psoriasis?
- Potent topical CS
- Coal tar shampoo
- Vitamin D preparation - Calcipotriol (if potent CS not tolerated)
Others: Salicylic acid, other coal tar products
How does Guttatte Psoriasis present?
Widespread red, scaly, small teardrop-shaped plaques
Guttatte Psoriasis usually occurs as a result of what?
In which age group is it most common?
Usually a post-streptococcal infection
More common among children and teenagers
hroat manifestation stuff???
Differentials for Guttate Psoriasis?
- Viral exanthems
- Pityriasis rosea
- Drug eruptions
Treatment of Guttate Psoriasis?
- Antibiotics
- Phototherapy
How does Plamoplanter psorasis present, and where specifically does it affect?
Presents as keratoderma (thickened skin), painful fisuring and yellow pustules
Occurs on the palms and/or soles
How does Flexural psoriasis present, and where does it commonly occur?
Thickened, well defined salmon pink patch, smooth, shiny but NO silvery plaque present
Affects body folds, genitals, perianal area
Flexural Psoriasis is commonly mistaken for what 2 conditions?
What MUST be excluded before we can diagnose flexural psoriasis?
Eczema or Candidal infection
Need to exclude Tinea!
What is Erythrodermic psoriasis and how does it present?
Erythrodermic psoriasis is an uncommon, aggressive, inflammatory form of psoriasis
Presents as a peeling rash across entire surface of the body which spreads quickly, may itch or burn intensely
What is the clinical signifcance of recognising Erythrodermic psoriasis immediately?
Skin barrier is comprimised so may result in systemic illness with temperature disregulation, electrolyte imbalance, cardiac failure
Can be life- threatening (Erythroderma from ANY cause is the ONLY derm emergency)
Is Erythrodermic psoriasis preceded by other forms of psoriasis?
Is it acute or chronic?
May or may not be ➞ can be either acute or chronic
Management of Erythrodermic psoriasis
- Hospitilisation for supportive care incl. IV fluids and temp regulation
- Bland emolliants and cooling wet dressings
- Bed rest
- Treatment of complications ie. antibiotics, diuretics, nutritional support
- Low dose methotrexate, ciclosporin or acitretin
- Biologics
What is Auspitz Sign?
Scratch and gentle scale removal causes capillary bleeding in Psoriasis
Name a complication of Psoriasis
Erythroderma
What determines blister fragility?
Depends on the level of split within the skin
More fragile - intraepidermal
Less fragile - subepidermal
