Psoriasis

Question 1

What causes psoriasis?

Answer 1

-Chronic inflammatory disease, thought to be autoimmune
-Abnormally rapid rate of skin cell growth and abnormal shedding leading to skin cells accumulating to form plaques and thickened skin

Question 2

What risk factors are there for developing psoriasis?

Answer 2

NB not contagious
-Genetics
-Onset can occur at energy
Triggers:
-Skin injury (Koebner response)
-Drinking large amounts of alcohol
-Smoking
-Stress
-Hormonal changes eg menopause, stopping steroids
-Sun exposure (in 10%, for most it is beneficial)

Question 3

How does psoriasis present?

Answer 3

-Clearly defined, red and scaly plaques
-Silvery white scale (moist, peeling surface in skin fold areas)
-Most common sites are scalp, elbows, knees
-Itch (normally mild but can be severe)
-Painful cracks / fissures may occur
-Lichenification
-Cleared up plaques may leave brown / pale marks

Question 4

What is the most common type of psoriasis?

Answer 4

-Chronic plaque psoriasis
-NB Erythrodermic psoriasis is a medical emergency and can lead to death

Question 5

How is psoriasis diagnosed?

Answer 5

-Clinical diagnosis
-Skin biopsy to confirm in some cases

Question 6

What treatment would you consider for someone with psoriasis?

Answer 6

-Avoid triggers
-Phototherapy
MILD (topical therapies)
-Emollients
-Coal tar preparations
-Calcipotriol (vit D analogue)
-Topical corticosteroids
-Tacrolimus (calcineurin inhibitor)
MODERATE - SEVERE (systemic)
-Methotrexate
-Ciclopsorin
SEVERE (biologics)
-TNF inhibitors eg infliximab (rule out TB first)
-IL-12/23 antagonists