Psoriasis Flashcards
Who normally gets guttate psoriasis?
Children and adolescents.
What normally precedes a guttate psoriasis?
streptococcal infection 2-4 weeks prior to the lesions appearing
(e.g. strep throat)
Features of guttate psoriasis
- tear drop papules on the trunk and limbs
- tends to be acute onset over days
Management of guttate psoriasis
- most resolve within 2-3 months
- topical agents as per psoriasis
- UVB phototherapy
- tonsillectomy if recurrent strep infections
Pathophysiology of psoriasis
Genetic: associated:
HLA-B13, HLA-B17, HLA-Cw6.
Immunological:
abnormal T-cell activity stimulates keratinocyte proliferation
What can worsen psoriasis?
- Skin trauma
- stress
- Streptococcal infection
- alcohol
- Drugs: beta blockers, lithium, antimalarials, NSAIDs and ACEi, infliximab
- Withdrawal of systemic steroids
Types of psoriasis
plaque psoriasis
- scaly plaques affecting extensor surfaces and scalp
flexural psoriasis
- skin is smooth
guttate psoriasis
- triggered by a streptococcal infection
- red teardrop papules
pustular psoriasis
- on palms and soles
Whaat nail signs can be seen in psoriasis
pitting,
onycholysis
What is the first line treatment of chronic plaque psoriasis
potent corticosteroid OD + vitamin D analogue OD
one applied in the morning and the other in the evening
for up to 4 weeks
If a potent corticosteroid and vitamin D analogue do not work as first line treatment in psoriasis, what can be tried?
second-line: vit D analogue BD
third-line:
- potent corticosteroid BD for up to 4 weeks
- or a coal tar preparation OD/BD
What treatments can be offered for psoriasis in Secondary Care?
Phototherapy
- narrowband UVB
- 3 times a week
Photochemotherapy
- psoralen + UVA (PUVA)
S/E: skin ageing, SCC
Systemic therapy:
- MTX
- Ciclosporin
- Systemic retinoids
- Biologics
Management of scalp psoriasis
Use topical agent to remove adherent scale (eg. containing salicylic acid/oils
then apply topical potent steroid
What is the maximum length of time topical steroids can be used on the face?
2 weeks/ 1 month
high risk of skin atrophy and side effects
Systemic side-effects may be seen when potent corticosteroids are used on what percentage of the body area?
> 10% of the body surface area
How long should you leave between courses of topical steroids?
4-week break