Psoriasis

Question 1

What is psoriasis

Answer 1

Chronic inflammatory skin condition.
Immune mediated w/ genetic predisposition.
Not an infection or contagious.
No cure.
Peaks at 15-25 and 50-60 yrs.

Question 2

Pathophysiology of psoriasis

Answer 2

Immune-mediated
Genetic (1/3 have family members w/ psoriasis)
Inflammatory cytokines responsible for redness, inflammation, skin thickening.
Environment - stress, alcohol, smoking, trauma.
Medications - ACEi, Beta blockers.

Dilated bv, inflammatory cell invasion, chemical signals released, too much cell division, abnormal maturation, delayed shedding of cells.

Question 3

Signs and symptoms

Answer 3

Well defined, raised red patches
Plaques w/ thick silvery scale.
Redness may be more subtle in skin colour.

Question 4

Describe plaque psoriasis

Answer 4

Most common
Well demarcated, pink plaque w/ silver scale
Elbows, knees, sacrum, lower back.
Lesion may be single or numerous.
May be itchy, but commonly asymptomatic.
Pustular psoriasis is a rare condition and medical abortion.

Question 5

Describe scalp psoriasis

Answer 5

Thick patches that cover the entire scalp and extend beyond hairline
Temporary, mild hair loss
Can co-exist w/ other forms of psoriasis

Question 6

Describe nail psoriasis

Answer 6

Pitting, yellow, ridging
Onycholysis (separation of nail from nail bed)
Chronic plaque psoriasis
Psoriatic athritis
Arises from within nail matrix
Affect one or more nails
Usually other psoriasis
Course of the condition varies over time

Question 7

Describe psoriatic arthritis

Answer 7

Painful, inflammatory condition of the joints.
Pain and swelling can reduce mobility and function.
Severe joint damage.
Can be as severe as rheumatoid arthritis.

Question 8

Describe guttate psoriasis

Answer 8

Gutta is latin for drop
Looks like a shower of red, scaly tear drops.
On trunk, upper arms, and thighs.
Pink lesions but scaling less noticeable.
Most common in teenagers and young adults.
Triggered by strep throat
Spontaneous resolution.

Question 9

Describe flexural psoriasis

Answer 9

Localised to body folds and genitals
Appear slightly different due to moist nature of skin
AKA - inverse psoriasis
Well defined patch, little scale, shiny.
Can be from candida species.

Question 10

Psoriasis treatment

Answer 10

Aims to induce remission, reduce severity and extent, relieve symptoms

Emollients -
Keratolytics - salicylic acid
Coal tar
Topical corticosteroids
Dithranol - on plaques only
Vitamin D analogues- calciprotol

Question 11

Psoriasis refererral

Answer 11

• Correct diagnosing
• Systemic therapy
• Manage CVD risks and smoking cessation

Question 12

Lifestyle changes

Answer 12

• Skin trauma can worsen
• Smoking
• Excessive alcohol
• Stress
• Strep throat
• Obesity
• Sun exposure
• Medcications (lithium, beta blockers, antimalarials, NSAIDs)