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Joints, bones and skin > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

Area where psoriasis is common

A

Extensor srufaces - Scalp, elbows, gluteal cleft + genitals, umbilicus, knees, nails, ears

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2
Q

Signs of psoriasis

A

Well demarcated plaques
Silvery adherent scale
Onycholysis
Subungal hyperkeratosis
Pitting

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3
Q

First line steroids for psoriasis

A

Hydrocortisone
Bethamethasone

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4
Q

What is guttate psoraiasis?

A

Psoriasis in demarcated ciricles - small scattered round or oval - water drop appearance, red, scaly papules
Occur over body 1-7 dyas esp trunk + proximal limbs
mOSTLY IN YOUNGER people

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5
Q

What is psoriasis?

A

Psoriasis is a systemic, immune-mediated, inflammatory skin disease which typically has a chronic relapsing-remitting course, and may have nail and joint involvement

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6
Q

What causes lesions to occur in psoriasis?

A

Epidermal hyperproliferation - cells multiplying wuickly
Abnormal keratinocyte differentiation

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6
Q

What causes lesions to occur in psoriasis?

A

Epidermal hyperproliferation - cells multiplying wuickly
Abnormal keratinocyte differentiation - cells not maturing
lymphocyte inflammatory infiltrate - cells which cause inflammation

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7
Q

What is pustular psoraiasis?

A

Rapidly developing widespread erythema followed by eruption of white, sterile non follicular pustules - coalesce -> large areas pus
Ass with fever, malaise, tachycardia, weight loss, arthralgia

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8
Q

Which psoriasis is ass with generalised systemic illness?

A

Pustular psoriasis
Usually in [people with existing or prev psoriasis, can occur with no history

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9
Q

What is erythrodermic psoriasis?

A

Diffuse, widespread severe psoriasis - 90% of body surface area
Gradual or abrupt development

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10
Q

Factors precipitating erythrodermic psoriasis

A

Systemic infection
Irritnats - coal tar, ciclosporin, phototherapy, sudden withdrawal of corticosteroids

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11
Q

What can erythrodermic psoraisis be ass with>

A

Warm lesions
Systemic illness eg fever, malaise, tachy, lymphadenopathy, peripheral oedema

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12
Q

What is lamotrigine used for?

A

Epilepsy and bipolar

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13
Q

What is auspitz sign?

A

When a plaque of psoriasis is gently removed -> glossy red membrane with pinpoint bleeding points

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14
Q

What is Woronoffs sign and what causes it?

A

Halo like effect around a plaque due to vasoconstriction

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15
Q

What can mid scaling around eyebrows and nasolabial folds be due to?

A

Co-exisitng facial psoriasis and seborrhoeic dermatitis

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16
Q

What form of psoraisis is itchy?

A

Flexural

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17
Q

Who are at an increased risk of flexural psoriasis?

A

Elderly, immobile, overweight or obese

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18
Q

What is flexural psoriasis + where?

A

Itchy psoriasis lesions well defined, may be little or no scaling due to friction in these area. Red and glazed, fissure in skin crease
Groin, genital area, axillae, inframmary folds, abdominal folds, sacral + gluteal cleft

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19
Q

When does guttate psoriasis often show up for the first time?

A

Acute strep URTI
Acute exacerbation of plaque psoriasis

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20
Q

How does nail psoriasis present?

A

Nial pitting
Discolouration orange yellow nail bed
Subungal hyperkeratosis - hyperproliferation of naul bed w accumulation of keratinocytes under nail
Oncholysis - detachment of nail from under bed
Complete nail dystrophy

21
Q

Differentials for guttate psoriasis

A

Viral exanthems
Pityriasis rosea
Drug eruptions

22
Q

Oustular psoriasis differnetials

A

Pyogenic infections.
Vasculitis.
Drug eruptions

23
Q

Lifestyle advice psoriasis

A

Smoking cessation
Alcohol within limits
Weight loss
Manage stress, anxiety, depression etc
Exercise for above

24
Q

Type of emollient for hairy areas

A

Lotions, solutions, gels

25
Q

Type of emollient for widespread psoraisis

A

Creams, lotions, gels

26
Q

What emollient use for thick scale psoriasis?

A

Ointments

27
Q

What is classified as moderate and above psoriasis?

A

More than 10% of body covered

28
Q

When are topical corticosteroids suitable for psoriasis?

A

Localised areas

29
Q

What do you prescribe with topical corticosteroids for psoriasis?

A

Vitamin D preparations
Once a dya, at a different time to the steroid

30
Q

What topical treamtnet can be described specifically for scale?

A

Salicyclic acid

31
Q

How ling can you apply potent corticosteroids on one site?

A

8 weeks maximum
Stop as soon as skin is clear or nearly

32
Q

What can be tried if non response to treatment agter 4 weeks

A

Coal tar products

33
Q

How long does it take for guttate psoriasis to resolve?

A

Self limiting 3-4 months

34
Q

What does dithranolm achieve?

A

Makes lesions flat

35
Q

What treatments are available for severe psoriasis?

A

Topical calcineurin inhibtiors
Phototherapy - narrow bran ultraviolet - UVB (PUVA for pustular)
Systemiv
Biologic

36
Q

Medications systemic therapy psoriasis

A

Methotrexate
Ciclosporin
Acitretin
Apremilast

37
Q

When is immunosupressant therapy used for psoriasis?

A

When phototherapy ineffective, contraindicated or rapid relapse in 3 months

38
Q

Important info know when taking immunosupression - systemic or biologics for psoriasis

A

Teratogenic
Live vaccines containdicated
Increased risk flu and oenumococcal infection

39
Q

Biologic therapy for psoriasis

A

TNF alpha inhibitors - adalimumab, etanercept, infliximab
Interleukin inhibiting monoclonal antibodies

40
Q

Interleukin inhibiting monoclonal antibodies, what ILs do they target

A

ustekinumab, brodalimumab, guselkumab, ixekizumab, risankizumab, tildrakizumab and secukinumab
IL12/23, 17. 23

41
Q

How is infliximab administered vs etanercept. adalimumab?

A

Infliximba - IV infusion
Etanercept, adalimumuab - Injection

42
Q

When are biologics used in psoriasis?

A

When phototherapy and systemic options dont work, contraindicated or not tolerated

43
Q

Features of psoriatic arthritis

A

Inflammatory pain or peripheral joint swelling or dactylitis
Axial skeletin + tendon insertion pain (enthesitis) esp @ achilles tendon or plantar fascia - inflammatory or night oain
Nail changes

44
Q

Ass conditions with psoriasis

A

Metabolic syndromes - obesity, hyperlipidemia HPTN, T2DM, non alcoholic fatty liver disease
IHD
IBD
anxiety and depression
VTE
Non melanoma skin cancer
Lymphoma
Opthalmological conditions
Coeliac disease

45
Q

Complications of Erythrodermic psoriasis

A

Impacts temp regulation, haemodynamics, intestinal absorption, protein and water metabolsim
HF
Malabsorption
hypothermia
Dehydration
Mild aneamia - skin losses iron deficienct

46
Q

Psoraiss complciations

A

Becomes erythrodermic
Pustular can be life threatening
Pregnancy

47
Q

Gene ass with psoriasis

A

HLA -B27 - psortiatic arthropathies
Also HLAC, B13 etc for different types

48
Q

Factors ass with onset or exacerbation of psoriasis

A

Strep infection - guttate, after URTI
Drugs
UV exposure
Trauma
Hormonal changes
HICV infection + AIDS
Psychological stress
Smoking
Alcohol
Obesity

49
Q

Drugs ass with exaerbation psoriasis

A

lithium,
antimalarial drugs - chloroquine, beta-blockers
(NSAIDs),
(ACE) inhibitors,
trazodone
terfenadine,
antibiotics - tetracycline + penicillin
Sudden or potent topical corticosteroid withdrawal - severe rebound phenomenon

Joints, bones and skin (31 decks)

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