Psoriasis Flashcards
What is Psoriasis?
A chronic autoimmune condition that causes recurrent symptoms of Psoriatic Skin Lesions.
Differential Diagnoses of Scaly Rash (7).
- Pityriasis Rosea.
- Tinea.
- Seborrheic Dermatitis.
- Bowen’s Disease.
- Discoid Eczema.
- Mycosis Fungoides.
- Discoid Lupus.
- Scabies.
Pathophysiology of Psoriasis.
Rapid generation of new skin cells, resulting in an abnormal buildup and thickening of skin in those areas.
Types of Psoriasis (4).
- Plaque Psoriasis (Adults : Commonest).
- Guttate Psoriasis (Children : Commonest).
- Pustular Psoriasis.
- Erythrodermic Psoriasis.
Key Features of Plaque Psoriasis (2).
- Thickened Erythematous Plaques with Silver Scales.
2. Extensor Surfaces and Scalp.
Key Features of Guttate Psoriasis (5).
- Small Raised Mildly Erythrematous and Slightly Scaly Papules (Teardrop).
- Trunk and Limbs.
- Over time, papule turn into Plaques.
- Triggered by Streptococcal Throat Infection, Stress or Medications.
- Resolves spontaneously within 3-4 months.
Key Features of Pustular Psoriasis (4).
- Rare Severe Form.
- Pustules form under areas of erythematous skin.
- Pus is not infectious.
- Systemically Unwell; Medical Emergency; Admission.
- Soles and Palms.
Key Features of Erythrodermic Psoriasis (4).
- Rare Severe Form.
- Extensive Erythematous Inflamed Areas Covering Most Skin.
- Exfoliation - Skin comes away in large patches resulting in raw exposed areas.
- Medical Emergency - Admission.
Clinical Features of Psoriasis (2).
- Dry, Flaky, Scaly and faintly Erythematous Skin Lesions.
2. Raised and Rough Plaques over Extensor Surfaces and Scalp.
Specific Signs of Psoriasis (3).
- Auspitz Sign (Small Points of Bleeding where Plaques are Scraped Off).
- Koebner Phenomenon (Development of Psoriasis to Areas Affected by Trauma).
- Residual Pigmentation (of skin after lesions resolve).
Key Features of Nail Psoriasis (5).
- Nail Pitting.
- Nail Thickening.
- Nail Discolouration.
- Nail Ridging.
- Onycholysis (Separation of Nail from Nail Bed).
Exacerbating Factors of Psoriasis (4).
- Trauma.
- Alcohol.
- Drugs.
- Withdrawal of Systemic Steroids.
Drugs that Exacerbate Psoriasis (6).
- B-Blockers.
- Lithium.
- Antimalarials (Chloroquine, Hydrochloroquine).
- NSAIDs.
- ACE Inhibitors.
- Infliximab.
Investigations of Psoriasis..
Diagnosis - Clinical.
Main Lines of Management of Psoriasis (3).
- Topical Steroids + Topical Calcipotriol (Vitamin D Analogue) Once Daily for 4 weeks.
- Vitamin D Analogue BD after 8 weeks.
1st Line : A Potent Corticosteroid (AM) + Vitamin D Analogue (PM) Applied Once Daily for 4 weeks.
2nd Line : After 8 Weeks - Vitamin D Analogue Twice Daily.
3rd Line : After 8-12 Weeks : Potent Corticosteroid Applied Twice Daily for 4 weeks (or Coal Tar Preparation).
Other Medical Options in Management of Psoriasis (2).
- Topical Dithranol.
2. Topical Calcineurin Inhibitor - Tacrolimus (ADULTS).
Systemic Management of Psoriasis (4).
1st Line : Oral Methotrexate.
- Ciclosporin.
- Systemic Retinoids.
- Biologics.
Phototherapy of Psoriasis (3).
- Treatment of Choice : 3x Weekly - Narrowband UVB Light.
- Photochemotherapy - PUVA (Psoralen + UV A Light).
- Adverse Effects : Skin Ageing, SCC.
How does Dithranol work? (3)
- Inhibits DNA Synthesis.
- Wash off after 30 minutes.
- Adverse Effects : Burning and Staining.
How do Vitamin D Analogues work? (5)
- Reduce cell division and differentiation to reduce epidermal proliferation.
- Can be used long-term unlike steroids.
- No staining or smell like coal tar or dithranol.
- Reduce scale and thickness of plaques but not erythema.
- Avoid in pregnancy.
Steroid Mangement in Psoriasis (3).
- Adverse Effects : Skin Atrophy, Striae, Rebound Symptoms.
- Do Not Use More than 1-2 weeks/months.
- 4 week break before starting another course of topical steroids.
Adverse Effects of Ciclosporin (5).
5Hs :
- Hypertrophy (Gum).
- Hypertrichosis.
- Hypertension.
- Hyperkalaemia.
- Hyperglycaemia (Diabetes).
Associated Diseases with Psoriasis (5).
- Arthritis.
- CVD.
- Metabolic Syndrome.
- VTE.
- Psychological Distress.
