Psoriasis

Question 1

Describe chronic plaque psoriasis

Answer 1

well-defined
erythematous patches
scaly
extensor surfaces = elbows, knees, scalp, hands and feet

Question 2

Describe guttate psoriasis

Answer 2

rain drop psoriasis
common in children
small scaly plaques
streptococcal infection
responds well to phototherapy

Question 3

Describe generalised pustular psoriasis

Answer 3

generalised painful erythema and sterile pustules
pyrexia and ill patients
life threatening

Question 4

Complications of generalised pustular psoriasis

Answer 4

secondary infection
disturbed protein
electrolyte imbalance
renal and liver impairment

Question 5

Describe palmoplantar pustulosis

Answer 5

localised to palms and soles
sterile yellowish and brownish pustule
may have chronic plaque psoriasis elsewhere

Question 6

Describe acrodermatitis continua of hallopeau

Answer 6

very rare
pustules on distal portion of fingers and sometimes toes
shedding of nail can occur if involved

Question 7

Describe flexural psoriasis

Answer 7

inverse psoriasis
localised to skin folds (flexures) + genitals
shiny + smooth
fungal and bacterial trigger may exist

Question 8

Describe plaque psoriasis

Answer 8

common site in chronic plaque psoriasis
well-defined scaly plaques
can extend from hairline to extend neck
hair loss is usually transient

Question 9

What findings are present in nail psoriasis?

Answer 9

nail pitting
onycholysis (loosening of nail)
subungual hyperkeratosis (thickening of nail)

Question 10

Psoriasis epidemiology

Answer 10

inflammatory skin disease
equal in males and females
two peaks: 10-20 years and 50-60 years
complex inheritance

Question 11

Which infections can trigger psoriasis?

Answer 11

streptococcal
HIV

Question 12

What drugs can trigger psoriasis?

Answer 12

lithium
beta blockers
anti-malarial
tapering down systemic steroids

Question 13

Psoriasis treatment ladder

Answer 13

topical treatment
phototherapy
oral treatments
injected (biologic treatments)

Question 14

What topical treatments can treat psoriasis?

Answer 14

salicylic acid
vit D3 analogues
corticosteroids
dithranol
retinoid
coal tar

Question 15

Adverse effects of topical corticosteroids

Answer 15

skin atrophy
perioral dermatitis
steroid rosacea
allergic contact dermatitis
suppression of pituitary adrenal axis

Question 16

What type of drug is salicylic acid?

Answer 16

keratolytic
reduces scales –> enhances penetration of topical medication

Question 17

Adverse effects phototherapy

Answer 17

skin burn
increases skin cancer risk
cataract with PUVA-ingested

Question 18

Describe the use of methotrexate in psoriasis treatment

Answer 18

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

Question 19

Adverse effects methotrexate

Answer 19

nausea
pancytopenia
oral erosions
opportunistic infections
hepatitis
cirrhosis
interstitial pneumonitis

Question 20

Systemic retinoids mechanism of action

Answer 20

inhibit epidermal proliferation and the activation of polymorphic leukocytes

Question 21

Systemic retinoids monitoring

Answer 21

LFTs
fasting lipids

Question 22

Side effects of systemic retinoids

Answer 22

teratogenic (for 2 years after) = only given to men + post-menopausal women
dryness of skin + mucosal membranes
hepatic toxicity
hyperlipidemia ( can cause pancreatitis)
depression

Question 23

What classes as severe psoriasis?

Answer 23

PASI>10
DLQI>10

Question 24

Adverse effects of biologic therapies

Answer 24

infections (TB)
malignancy
demyelinating disease
heart failure
allergic reaction
lupus-like syndromes
rarely severe hepatitis

Question 25

What is PASI?

Answer 25

psoriasis area severity index
assesses severity of psoriasis in 4 body areas (head, upper limbs, lower limbs, trunk)
range = 0-72
severe = PASI>10

Question 26

What does DLQI assess?

Answer 26

impact of skin disease on patient
dermatology life quality index