psoriasis Flashcards
what is the aetiology of psoriasis ?
t cell mediated disease
associated with shortening of the keratinocytes
resulting in hyper proliferation in keratinocytes and an increase in cell turn over
what is the immune basis of psoriasis pathogenesis ?
Th1
IL-17
IL-22
what are the associated co-morbities in psoriasis ?
metabolic syndrome
cardioivascular
disease
depression
what is the bimodal age of onset associated with psoriasis ?
type I - youth
Type II - adult
what are the triggering factors associated with psoriasis ?
infections ( post streptococcal infection , HIV )
psychogenic stress
weather ( worse in winter )
Drugs ( BASL )
Trauma - koebnerisation
Endocrine - hypocalcaemia
alcohol and smoking
beta blocker
anti malarial
steroid with drawal
lithium
what are the types of psoriasis ?
2 PIGE
plaque - vulgaris
guttate
inverse
erythrodermic
pustular ( generalised , localised )
what is the distribution of plaque psoriasis ?
extensor surface of the knee and the elbow
scalp
lumbosacral areas
intergluteal clefts
glans penis
what are the features of chronic plaque psoriasis ?
chronic well demarcated red/pink plaques
copious silver-white scaling
Koebner’s phenomenon ass itching
Single or multiple lesions
symmetrical on extensor surfaces
what is the presentation of inverse psoriasis ?
occurring in skin folds
doesn’t show the scales seen
shiny pink to red sharply demarcated thin plaques
what are the nail signs associated with psoriasis ?
pits
onycholysis
subungal hyperkeratosis
what are the types of psoriatic arthropathy ?
DIPS
Asymmetrical ( most common )
Axial
Symmetric
Destructive
what does guttate mean in latin ?
drop
what is the presentation of guttate psoriasis ?
post streptococcal throat infection
young adults
shower of scattered discrete lesions
3mm to 1cm lesions , round or slight oval
what are the types of pustular psoriasis ?
localised - palmoplantar
generalized - life threatning
what is the presentation of localised pustular psoriasis ?
palmo-plantar
studded with sterile pustules on erythematous base
what is the presentation of generalised pustular psoriasis ?
life threatening condition
abrupt onset
fever and tender skin lesions
studded sterile pustules on an erythematous base
what is the treatment generalised pustular psoriasis ?
treatment :
admit - ICU if necessary
greasy emollient
IV support
Systemic therapy
Avoid or treat concurrent infection
what is the presentation of eryhthrodermic psoriasis ?
generalized erythema and scaling affecting more than 80-90%
systemic affection :
peripheral oedema
tachycardia
fluid and protein loss
hypothermia
what are the common causes associated with erythrodermic psoriasis ?
psoriasis
atopic dermatitis
mycosis fungoids
drug reaction
what are the dermatological emergencies associated with psoriasis ?
erythroderma psoriasis
generalized pustular psoriasis
what is the psoriasis treatment strategy ?
1st line - emollients
2nd line - topical agents
steroids , vitamin D, topical retinoids
3rd line- phototherapy
4th line- systemic agents
5th line- biological agents
what are the systemic treatments in psoriasis ?
immunosuppression ( methotrexate, ciclosprine)
retinoids
biologic therapies
what are the biological agents ?
monoclonal antibody therapy
Anti-TNF : infliximab , adalimumab
Anti p40 subunit IL-12/23
IL-17
IL-23
what drug is contraindicated in psoriasis ?
oral corticosteroids
