Psoriasis Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

x

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ETIOLOGY OF PSORIASIS ?

A

multifactorial and not yet fully understood
genetic: associated HLA-B13, -B17, and -Cw6. Strong concordance (70%) in identical twins

abnormal T cell activity stimulates keratinocyte proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

it is recognised that psoriasis may be worsened by ?

A

Skin trauma

stress

Streptococcal infection - glutamate psoriasis

trauma

alcohol

drugs: beta blockers,
lithium,
antimalarials (chloroquine and hydroxychloroquine),
NSAIDs and
ACE inhibitors,
infliximab
withdrawal of systemic steroids

flexural - sweat , friction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

it is recognized that may be improved by ?

A

(e.g. Sunlight) by environmental factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the recognised subtype of psoriasis ?

A

plaque psoriasis: the most common
well-demarcated red, silver scaly patches affecting the extensor surfaces, sacrum and scalp

flexural psoriasis: in contrast to plaque psoriasis the skin is smooth
occurs commonly in skin folds - armpit , groin

guttate psoriasis: transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body

pustular psoriasis = commonly occurs on the palms and soles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is Auspitz’s sign

A

he appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are some of the major complications of psoriasis ?

A

psoriasis is more related to arthropathy and cardiovascular diseases
increased incidence of venous thromboembolism
psychological distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Chronic plaque psoriasis management ?

A

first-line: NICE recommend:
potent corticosteroid applied once daily + vitamin D analogue applied once daily

should be applied separately, one in the morning and the other in the evening)

for up to 4 weeks as initial treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

if no improvement after how many weeks do we start second line treatment for Chronic plaque psoriasis

A

8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

if no improvement after 8 weeks, what do we start as second line treatment for Chronic plaque psoriasis?

A

a vitamin D analogue applied twice daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when do we start third line treatment for chronic plaque psoriasis ?

A

if no improvement after 8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

third line treatment for chronic plaque psoriasis ?

A

potent corticosteroid applied twice daily for up to 4 weeks,

a coal tar preparation applied once or twice daily

short-acting dithranol can also be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what secondary therapy can be given in chronic plaque psoriasis ?

A

narrowband ultraviolet B , 3 times a week

photochemotherapy is also used - psoralen + ultraviolet A light (PUVA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

if chronic plaque psoriasis affects systematically such as joint - psoriatic arthritis ?

A

mild peripheral arthritis/mild axial disease may be treated with ‘just’ an NSAID

if more moderate/severe disease then methotrexate is typically used as in RA

=====
ciclosporin

systemic retinoids

biological agents: infliximab, etanercept and adalimumab
( TNF alpha is a pro-inflammatory cytokine )

ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials

apremilast: phosphodiesterase type-4 (PDE4) inhibitor → suppression of pro-inflammatory mediator synthesis and promotion of anti-inflammatory mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Scalp psoriasis management

A

potent topical corticosteroids used once daily for 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

if no improvement of scalp psoriasis after 4 weeks what is given

A

use a different formulation of the potent corticosteroid (for example, a shampoo or mousse)

and/or a topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid

17
Q

management of face / flexural or genital psoriasis management ?

A

mild or moderate potency corticosteroid applied once or twice daily for a MAXIMUM OF 2 WEEKS

18
Q

what re some of the side effects of topical steroids ?

A

skin atrophy,
striae
and rebound symptoms

19
Q

which type of psoriasis are most affected by topical steroid side effect ?

A

the scalp, face and flexures are particularly prone to steroid atrophy so topical steroids should not be used for more than 1-2 weeks/month

20
Q

systemic side-effects may be seen when potent corticosteroids are used how ?

A

> 10% of the body surface area

21
Q

NICE recommends using potent corticosteroids for no longer than

A

8 weeks at a time and very potent corticosteroids for no longer than 4 weeks at a time

22
Q

what are examples of fit D analogues ?

A

Dovonex

23
Q

how does fit d analogue help psoriasis ?

A

↓ cell division and differentiation → ↓ epidermal proliferation

24
Q

coal tar and dithranol they do not smell or stain
they tend to reduce the scale and thickness of plaques but not the ?

A

erythema

25
Q

vit d analogues and coal should be avoided in ?

A

pregnancy -
Dithranol
inhibits DNA synthesis
wash off after 30 mins

Coal tar - inhibit DNA synthesis

26
Q

puva in psoriasis increase risk for ?

A

squamous cell carcinoma