Psoriasis

Question 1

HISTORY
i) is there often family history? what is the koebner phenomenon?
ii) name three triggers? what advise should be given about ETOH and smoking? what other disease should be checked for in the hx?
iii) does it affect males or females more?
iv) what is seen on the skin?

Answer 1

i) yes FH is common
koebner - new lesions appear on skin secondary to trauma
ii) triggers - HIV, strep throat, covid, stress
- reduce to minimal ETOH and smoking cessation
- check for IBD in the hx
iii) M=F
iv) clearly defined red and scaly plaques

Question 2

CLINICAL FEATURES and types
i) what is the most common type? how does it look
ii) what does guttate psoriasis occur after? how does it look?
iii) which type of psoriasis is a medical emergency? how is it characterised?

Answer 2

i) plaque psoriasis - thickened erythematous plaques with silver scales on extensor surfaces and scalp
ii) guttate - post strep infection - widespread small plaques that resolves within several months
iii) erythrodermic - extensive erythema covering most of skin surface > skin comes away resulting in exposed areas

Question 3

TYPES OF PSORIASIS
i) where does flexural affect? how does it look? what can it be colonised with?
ii) name three characteristics of nail psoriasis? what other condition may this be associated with?
iii) what should every patient be asked about?

Answer 3

i) affects body folds and genitals > smooth well defined patches that can be colonised with candida yeast
ii) pitting, oncholysis (seperation - white opaque nail), yellowing and ridging
can be associated with inflammatory arthritis
iii) always ask about gential involvement - high impact site and often see vulval lichen sclerosis co exisiting

Question 4

TRIGGERS FOR PSORIASIS
i) name an infective trigger?
ii) name three drug triggers
iii) three other triggers
iv) sudden cessation of which drug can cause it
v) what screening tool can be used?

Answer 4

i) strep throat
ii) beta blockers, lithium and anti malarials
iii) sunlight, alcohol, scars, burns
iv) sudden cessation of systemic steroids
v) PEST score - psoriasis epidemology screening tool

Question 5

PSORIATIC ARTHROPATHY
i) what % of patients does it affect? does it affect men or females more?
iii) what are the four subtypes? what pest score qualifies?

Answer 5

i) aff 20-30% of patients M=F
ii) distal (sausage digits), rheumatoid like, mutilans and akylosing spondilytis
pest score 3/5

Question 6

TREATMENT
i) name four topical txs
ii) what is second line therapy if topicals dont work?
iii) name a systemic therapy that can be given? what must be co prescribed? what can be given if this is not tolerated?
iv) when is immunotherapy given? give an example
v) what is acitretin? when is it given? name two things that need to be monitored? what is an absolute contraindication

Answer 6

i) topical corticosteroids, vitamin D analogues, CS+vit D analog, shampoo/ointment/cream, antifungals
ii) phototherapy (for plaque psoriasis)
iii) methotrexate co prescribed with folate
or give ciclosporin if MTX is not tolerated
iv) given immunotherapy if systemic tx doesnt work eg adalimumab
v) acitrein is a second generation retinoid used in severe resistant psoriasis
- monitor LFTs and lipid profile
- dont give if pregnant or planning pregnancy in next 3 years