Psoriasis Flashcards
Area where psoriasis is common
Extensor srufaces - Scalp, elbows, gluteal cleft + genitals, umbilicus, knees, nails, ears
Signs of psoriasis
Well demarcated plaques
Silvery adherent scale
Onycholysis
Subungal hyperkeratosis
Pitting
First line steroids for psoriasis
Hydrocortisone
Bethamethasone
What is guttate psoraiasis?
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
What is psoriasis?
Psoriasis is a systemic, immune-mediated, inflammatory skin disease which typically has a chronic relapsing-remitting course, and may have nail and joint involvement
What causes lesions to occur in psoriasis?
Epidermal hyperproliferation - cells multiplying wuickly
Abnormal keratinocyte differentiation
What causes lesions to occur in psoriasis?
Epidermal hyperproliferation - cells multiplying wuickly
Abnormal keratinocyte differentiation - cells not maturing
lymphocyte inflammatory infiltrate - cells which cause inflammation
What is pustular psoraiasis?
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
Which psoriasis is ass with generalised systemic illness?
Pustular psoriasis
Usually in [people with existing or prev psoriasis, can occur with no history
What is erythrodermic psoriasis?
Diffuse, widespread severe psoriasis - 90% of body surface area
Gradual or abrupt development
Factors precipitating erythrodermic psoriasis
Systemic infection
Irritnats - coal tar, ciclosporin, phototherapy, sudden withdrawal of corticosteroids
What can erythrodermic psoraisis be ass with>
Warm lesions
Systemic illness eg fever, malaise, tachy, lymphadenopathy, peripheral oedema
What is lamotrigine used for?
Epilepsy and bipolar
What is auspitz sign?
When a plaque of psoriasis is gently removed -> glossy red membrane with pinpoint bleeding points
What is Woronoffs sign and what causes it?
Halo like effect around a plaque due to vasoconstriction
What can mid scaling around eyebrows and nasolabial folds be due to?
Co-exisitng facial psoriasis and seborrhoeic dermatitis
What form of psoraisis is itchy?
Flexural
Who are at an increased risk of flexural psoriasis?
Elderly, immobile, overweight or obese
What is flexural psoriasis + where?
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
When does guttate psoriasis often show up for the first time?
Acute strep URTI
Acute exacerbation of plaque psoriasis
How does nail psoriasis present?
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
Differentials for guttate psoriasis
Viral exanthems
Pityriasis rosea
Drug eruptions
Oustular psoriasis differnetials
Pyogenic infections.
Vasculitis.
Drug eruptions
Lifestyle advice psoriasis
Smoking cessation
Alcohol within limits
Weight loss
Manage stress, anxiety, depression etc
Exercise for above
Type of emollient for hairy areas
Lotions, solutions, gels
Type of emollient for widespread psoraisis
Creams, lotions, gels
What emollient use for thick scale psoriasis?
Ointments
What is classified as moderate and above psoriasis?
More than 10% of body covered
When are topical corticosteroids suitable for psoriasis?
Localised areas
What do you prescribe with topical corticosteroids for psoriasis?
Vitamin D preparations
Once a dya, at a different time to the steroid
What topical treamtnet can be described specifically for scale?
Salicyclic acid
How ling can you apply potent corticosteroids on one site?
8 weeks maximum
Stop as soon as skin is clear or nearly
What can be tried if non response to treatment agter 4 weeks
Coal tar products
How long does it take for guttate psoriasis to resolve?
Self limiting 3-4 months
What does dithranolm achieve?
Makes lesions flat
What treatments are available for severe psoriasis?
Topical calcineurin inhibtiors
Phototherapy - narrow bran ultraviolet - UVB (PUVA for pustular)
Systemiv
Biologic
Medications systemic therapy psoriasis
Methotrexate
Ciclosporin
Acitretin
Apremilast
When is immunosupressant therapy used for psoriasis?
When phototherapy ineffective, contraindicated or rapid relapse in 3 months
Important info know when taking immunosupression - systemic or biologics for psoriasis
Teratogenic
Live vaccines containdicated
Increased risk flu and oenumococcal infection
Biologic therapy for psoriasis
TNF alpha inhibitors - adalimumab, etanercept, infliximab
Interleukin inhibiting monoclonal antibodies
Interleukin inhibiting monoclonal antibodies, what ILs do they target
ustekinumab, brodalimumab, guselkumab, ixekizumab, risankizumab, tildrakizumab and secukinumab
IL12/23, 17. 23
How is infliximab administered vs etanercept. adalimumab?
Infliximba - IV infusion
Etanercept, adalimumuab - Injection
When are biologics used in psoriasis?
When phototherapy and systemic options dont work, contraindicated or not tolerated
Features of psoriatic arthritis
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
Ass conditions with psoriasis
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
Complications of Erythrodermic psoriasis
Impacts temp regulation, haemodynamics, intestinal absorption, protein and water metabolsim
HF
Malabsorption
hypothermia
Dehydration
Mild aneamia - skin losses iron deficienct
Psoraiss complciations
Becomes erythrodermic
Pustular can be life threatening
Pregnancy
Gene ass with psoriasis
HLA -B27 - psortiatic arthropathies
Also HLAC, B13 etc for different types
Factors ass with onset or exacerbation of psoriasis
Strep infection - guttate, after URTI
Drugs
UV exposure
Trauma
Hormonal changes
HICV infection + AIDS
Psychological stress
Smoking
Alcohol
Obesity
Drugs ass with exaerbation psoriasis
lithium,
antimalarial drugs - chloroquine, beta-blockers
(NSAIDs),
(ACE) inhibitors,
trazodone
terfenadine,
antibiotics - tetracycline + penicillin
Sudden or potent topical corticosteroid withdrawal - severe rebound phenomenon
