Psoriasis Flashcards
Describe chronic plaque psoriasis
well-defined
erythematous patches
scaly
extensor surfaces = elbows, knees, scalp, hands and feet
Describe guttate psoriasis
rain drop psoriasis
common in children
small scaly plaques
streptococcal infection
responds well to phototherapy
Describe generalised pustular psoriasis
generalised painful erythema and sterile pustules
pyrexia and ill patients
life threatening
Complications of generalised pustular psoriasis
secondary infection
disturbed protein
electrolyte imbalance
renal and liver impairment
Describe palmoplantar pustulosis
localised to palms and soles
sterile yellowish and brownish pustule
may have chronic plaque psoriasis elsewhere
Describe acrodermatitis continua of hallopeau
very rare
pustules on distal portion of fingers and sometimes toes
shedding of nail can occur if involved
Describe flexural psoriasis
inverse psoriasis
localised to skin folds (flexures) + genitals
shiny + smooth
fungal and bacterial trigger may exist
Describe plaque psoriasis
common site in chronic plaque psoriasis
well-defined scaly plaques
can extend from hairline to extend neck
hair loss is usually transient
What findings are present in nail psoriasis?
nail pitting
onycholysis (loosening of nail)
subungual hyperkeratosis (thickening of nail)
Psoriasis epidemiology
inflammatory skin disease
equal in males and females
two peaks: 10-20 years and 50-60 years
complex inheritance
Which infections can trigger psoriasis?
streptococcal
HIV
What drugs can trigger psoriasis?
lithium
beta blockers
anti-malarial
tapering down systemic steroids
Psoriasis treatment ladder
topical treatment
phototherapy
oral treatments
injected (biologic treatments)
What topical treatments can treat psoriasis?
salicylic acid
vit D3 analogues
corticosteroids
dithranol
retinoid
coal tar
Adverse effects of topical corticosteroids
skin atrophy
perioral dermatitis
steroid rosacea
allergic contact dermatitis
suppression of pituitary adrenal axis
What type of drug is salicylic acid?
keratolytic
reduces scales –> enhances penetration of topical medication
Adverse effects phototherapy
skin burn
increases skin cancer risk
cataract with PUVA-ingested
Describe the use of methotrexate in psoriasis treatment
severe psoriasis
reduces lymphocyte proliferation
once weekly dose (IM, SC or oral)
fatal if given daily
folic acid given too
blood monitoring = FBC, LFTs, U+Es
Adverse effects methotrexate
nausea
pancytopenia
oral erosions
opportunistic infections
hepatitis
cirrhosis
interstitial pneumonitis
Systemic retinoids mechanism of action
inhibit epidermal proliferation and the activation of polymorphic leukocytes
Systemic retinoids monitoring
LFTs
fasting lipids
Side effects of systemic retinoids
teratogenic (for 2 years after) = only given to men + post-menopausal women
dryness of skin + mucosal membranes
hepatic toxicity
hyperlipidemia ( can cause pancreatitis)
depression
What classes as severe psoriasis?
PASI>10
DLQI>10
Adverse effects of biologic therapies
infections (TB)
malignancy
demyelinating disease
heart failure
allergic reaction
lupus-like syndromes
rarely severe hepatitis
What is PASI?
psoriasis area severity index
assesses severity of psoriasis in 4 body areas (head, upper limbs, lower limbs, trunk)
range = 0-72
severe = PASI>10
What does DLQI assess?
impact of skin disease on patient
dermatology life quality index
