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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is Psorasis?

A
  • A chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration
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2
Q

What are the risk factors for Psorasis?

A
  • Genetics
  • Streptococcal infection ( related to Guttate psorasis)
  • Trauma ( Koebner Phenomenon - new lesions of a pre-existing dermatosis occur at sites of skin trauma - red line joining the dots)
  • Hormones (worse in puberty, menopause and postpartum period)
  • Drugs (Beta-blockers, Lithium, Chloroquine and Ace-inhibitors and NSAIDs)
  • HIV
  • Smoking
  • Alcohol
  • Stress
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3
Q

What is the Pathophysiology of Psorasis?

A
  • Psoriasis is an immune- mediated disease featuring hyperproliferation of the epidermis
  • There is release of inflammatory mediators and dendtritic cells are activated producing IL-23 triggering T cell involvement.
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4
Q

What are the Associated Conditions with Psorasis?

A
  • Psoriatic Arthritis
  • Psoriatic Nails
  • Other Conditions - more liked to have Inflammatory Bowel Disease, Metabolic Syndrome, CVS disease
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5
Q

What are the Types of Psoriasis?

A
  • Chronic Plaque Psoriasis
  • Guttate Psoriasis - raindrop psoriasis, occurs after a streptococcal sore throat infection, self-limiting within 3/4 weeks
  • Erythrodermic Psoriasis - widespread erythema and psoriasis, triggers: recent illness, medications and emotional stress. Can be life-threatening. Immunosuppressive agents and biologics should be used.
  • Localised Pustular Psoriasis - Affects hands and feet, pustules and plaques, associated with smoking
  • Generalised Pustular Psoriasis - rapidly developing, widespread erythema and pustules. Pustules coming together and form lakes of pus, resolve over days leaving erythema and scaring - dermatological emergency
  • Seborrhoeic Psoriasis
  • Flexural Psoriasis
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6
Q

How would you describe Psoriasis?

A
  • A well-demarcated erythematous scaly plaques
  • Lesions can be itchy, burning or painful
  • Common on extensor surfaces of the body and over the scalp
  • Auspitz Sign
  • Nail Changes
  • Psoriatic Arthropathy
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7
Q

What is Auspitz Sign?

A
  • When the patient scratches and gently removes the scales this causes capillary bleeding
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8
Q

What are the nail changes in Psoriasis?

A
  • Pitting
  • Onycholysis (lifting of the nail bed)
  • Leukonychia (white discolouration)
  • Subungual hyperkeratosis
  • Splinter Haemorrhages
  • Oil Drop Discolouration (yellow/pink patches)
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9
Q

What is Psoriatic Arthropathy?

A
  • Symmetrical Polyarthritis
  • Asymmetrical oligomonoarthritis
  • lone distal interphalangeal disease
  • Psoriatic Spondylosis
  • Arthritis Mutilans ( flexion deformity of distal interphalangeal joints
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10
Q

What is the Managment for Psoriasis?

A
  • General Measures
  • Topical Therapies
  • Phototherapy
  • Oral Therapies
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11
Q

What are some of the General Measures in the Managment of Psoriasis?

A
  • Avoid Known precipitating factors
  • Emollients - reduce scale
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12
Q

What are some of the Topical Therapies in the Managment of Psoriasis?

A
  • Emollients - moisturising agents that reduce itching and remove scaling
  • Topical Steroids - beclometasone - have an anti-inflammatory effect and used for a limited defined courses.
  • Vit D analogues - Calcipotriol, modulates the immune system and reduces hyperkeratosis. Can be used as a long-term treatment option. Care to avoid hypercalcaemia, pregnancy and breast-feeding
  • Vit A analogues - Tazarotene - used sparingly, causes irritation. Contraindicated in pregnancy and breast-feeding.
  • Tar preparations - reduce scaling and slow plaque formation down, comes in shampoo, creams and ointments
  • Short contact dithranol - used for short periods of times before being rinsed off (10-30mins), applied to chronic extensor plaque lesions only
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13
Q

What is Phototherapy in the Managment of Psoriasis?

A
  • UVB: Narrow-band ultraviolet B therapy may be used in patients with plaque psoriasis that has not adequately responded to topical therapy
  • PUVA: Form of Photochemotherapy which uses a combination of a photosensitising drug and UV therapy (Psoralen and UV therapy)
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14
Q

What are some of the Systemic Treatments for Psoriasis?

A
  • Methotrextate
  • Ciclosporin
  • Acitretin
  • Biologics
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15
Q

How does Methotrexate work?

A
  • Antifolate immunosuppresent
  • Reduces the hyperproliferation of keratinocytes
  • Tetraogenic - not for pregnancy or breastfeeding
  • Contraception advised
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16
Q

How does Ciclosporin work?

A
  • Calcineurin inhibitor with immunosuppressant action
  • Used in an acute flare
  • In palmoplantar pustulosis
  • When patients are considering pregnancy
17
Q

How does Acitretin work?

A
  • It is a retinoid
  • for when other options have failed
18
Q

How does Biologics work?

A
  • Infliximab
  • Monoclonal Antibodies that modulate the immune system
  • Administered as IV injections and generally reserved for severe and treatment-resistant disease
19
Q

What are some of the Complications of Psoriasis?

A
  • Psychological - affect confidence and induce mental illness
  • Systemic Upset - erythrodermic psoriasis and generalised pustular psoriasis can lead to significant systemic upset
  • Medication-Related - skin irritation, teratogenicity and malignancies
20
Q

What is the step-wise managment for Chronic plaque psoriasis?

A

1st line:
- potent corticosteroid applied once daily + Vitamin D analogue
- one in the morning and one in the evening
- 4 weeks initial treatment
2nd line:
- if no treatment after 8 weeks
- a Vit D analogue twice daily
3rd line:
- if no improvement after 8-12 weeks then offer:
- a potent corticosteroid applied twice daily for 4 weeks
- a coal tar preparation applied once or twice daily
- a short-acting dithranol

21
Q

What is the managment for Scalp Psoriasis?

A
  • Potent topical corticosteroids used once daily for 4 weeks
22
Q

What is the managment for Face, Flexural and Genital Psoriasis?

A
  • Mild to moderate potency corticosteroid applied once/ twice daily for max 2 weeks
23
Q

How does Vit D analogue work?

A
  • They decrease cell division and differentiation and therefore decrease epidermal proliferation
  • May be used long term
  • They reduce the scale and thickness of the plaques but not the er

Dermatology (32 decks)

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