Psoriasis

Question 1

Subtypes

Answer 1

Plaque: most common; well-demarcated red, scaly patches on extensor surfaces, sacrum and scalp

Flexural: smooth

Guttate: transient; triggered by strep throat

Pustular: commonly on palms and soles

Question 2

Other features

Answer 2

Nail pitting

Onycholysis

Arthritis

Question 3

Complications

Answer 3

Psoriatic arthropathy

Increased incidence of metabolic syndrome

Increased incidence of CVD

Increased incidence of VTE

Psychological distress

Question 4

Chronic plaque psoriasis management

Answer 4

Regular emollients to reduce scale loss and reduce pruritus

1st line: potent corticosteroid OD and vitamin D analogue up to 4 weeks

2nd line: if no improvement after 8 weeks offer vitamin D analogue BD

3rd line: if no improvement after 8-12 weeks offer potent corticosteroid BD or coal tar preparation

Question 5

Secondary care management

Answer 5

Phototherapy: UV B light 3x week

Systemic
- oral methotrexate first line
- ciclosporin
- systemic retinoids
- biological agents: infliximab, atanercept, adalimumab

Question 6

Scalp psoriasis management

Answer 6

Potent topical corticosteroids OD for 4 weeks

If no improvement use different formation (e.g. shampoo or mousse) and/or topical agents to remove adherent scale before application of steroid

Question 7

Face, flexural and genital psoriasis management

Answer 7

Mild or moderate potency corticosteroid applied OD/BD for maximum of 2 weeks

Question 8

Vitamin D analogues

Answer 8

Cacipotriol, calcitriol and tacalcitol

Decrease cell division and differentiation so decrease epidermal proliferation

May be used long term

Should be avoided in pregnancy