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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

Which infectious pathogens can trigger psoriasis?

A
  • Beta-haemolytic streptococci
  • Staphylococcal infections
  • HIV
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2
Q

Which drugs can trigger psoriasis?

A
  • Beta-blockers
  • Chloroquine
  • Lithium
  • Interferon
  • ACE-Is
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3
Q

Which HLA subtypes is psoriasis correlated with?

A
  • HLA-Cw6
  • HLA-B17
  • HLA-B57
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4
Q

Describe the typical appearance of psoriatic lesions.

A
  • Few lesions appear which usually become confluent
  • Well-demarcated
  • Erythematous
  • Silvery-white scaling plaques
  • Pruritic
  • Demonstrate Auspitz sign
  • Demonstrate Koebner phenomenon
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5
Q

What is the Auspitz sign?

A

Small pin-point bleeding where scales have been scraped off

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6
Q

What is the Koebner phenomenon?

A

When physical stimuli or skin injury leads to development of skin lesion on previously healthy skin

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7
Q

Describe the typical distribution of psoriasis.

A
  • Scalp
  • Back
  • Elbows (extensor surface)
  • Knees (extensor surface)
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8
Q

What nail changes are typically seen with psoriasis?

A
  • Nail pitting
  • Brittle nails
  • Onycholysis
  • Oil drop sign/Salmon spot: well-circumscribed, yellow-reddish discolouration of the nail
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9
Q

What are the clinical features of psoriatic arthritis?

A
  • Oligoarthritis (70% of cases)
  • Spinal involvement (40%) of cases
  • Onycholysis and nail pitting
  • Enthesitis
  • Tenosynovitis
  • Dactylitis
  • Arthritis mutilans: destruction of IP joints (esp DIP) and resporation of phalanges
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10
Q

What changes are usually seen on an x-ray of a hand in psoriatic arthritis?

A
  • Joint destruction

- Pencil-in-cup deformity (DIPs)

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11
Q

What changes are usually seen on an x-ray of a spine in psoriatic arthritis?

A
  • Joint destruction

- Syndesmophytes + asymmetric paravertebral ossification

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12
Q

What is the management of psoriatic arthritis?

A
  1. NSAIDs
  2. Methotrexate/sulfasalazine/ DMARDS (similar to RA)
  3. Ustekinumab/Secukinumab
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13
Q

What are the different cutaneous subtypes of psoriasis, and which is the most common?

A
  1. Chronic plaque psoriasis –> most common
  2. Flexural psoriasis
  3. Guttate psoriasis
  4. Pustular psoriasis
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14
Q

What is guttate psoriasis usually precipitated by?

A

Streptococcal infection (2-4 weeks prior to lesions appearing)

  • more common in children and adolescents
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15
Q

Describe the appearance of guttate psoriasis.

A
  • ‘Tear drop’, scaly papules

- Usually on trunk and arms

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16
Q

Which HLA subtype is closely correlated to pustular psoriasis?

A

HLA-B27

17
Q

Why is it important to promptly diagnose and treat pustular psoriasis?

A

*Occurs on palms and soles

Can lead to erythroderma, which may lead to severe illness with fever and dehydration, and can be fatal

18
Q

What is 1st-line treatment for chronic plaques psoriasis?

A
  • Always - regular emollients

- Potent corticosteroid (Eumovate/Betnovate) OD + vitamin D analogue OD

19
Q

What is 2nd-line treatment for chronic plaques psoriasis?

A

If no improvement after 8 weeks then apply vitamin D analogues BD

20
Q

What is 3rd-line treatment for chronic plaques psoriasis?

A
  • If no improvement after 8-12 weeks
  • Potent corticosteroid (Betnovate/Dermovate) applied BD for up to 4 weeks, OR
  • Coal tar preparation applied OD/BD
  • Short-acting dithranol can also be used
21
Q

What management for psoriasis can be provided by secondary care?

A
  • Phototherapy –> narrowband UVB light 3x/week

- Photochemotherapy (psoralen + UVA/PUVA)

22
Q

What are the important adverse effects of phototherapy?

A
  • Skin ageing

- SCC

23
Q

What systemic therapies can be provided if topical/photodynamic therapy fails?

A
  • 1st-line: Oral methotrexate
  • Ciclosporin
  • Systemic retinoids
  • Biological agents: infliximab, etanercept, adalimumab
24
Q

What is the management for scalp psoriasis?

A
  • Potent topical steroids (betnovate/dermovate) OD for 4 weeks
  • No improvement after 4 weeks –> use different corticosteroid formulation and/or topical agent to remove adherent scale before steroid application
25
Q

What is the management of face/flexural/genital psoriasis?

A

Mild (hydrocortisone) or moderate (eumovate) corticosteroid applied OD/BD for a max of 2 weeks

26
Q

What are the potential side effects of topical steroids? What is done to prevent/minimise this in management of psoriasis?

A

Side effects:

  • Skin atrophy
  • Striae
  • Rebound symptoms

Prevention:

  • Scalp/face/flexures: prone to steroid atrophy therefore do not use for >1-2 weeks per month
  • Aim for 4 weeks breaks before starting another course of topical steroids
  • Use potent steroids (betnovate) for no more than 8 weeks at a time
  • Use very potent steroids (dermovate) for no more than 4 weeks at a time
27
Q

Which conditions is someone with psoriasis at increased risk of?

A
  • Metabolic syndrome
  • CV disease (HTN, CHD, MI, Stroke)
  • CKD

Dermatology (17 decks)

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