Psoriasis Flashcards
Definition
A chronic autoimmune disease characterised by erythematous, scaly plaques
Name the 5 types of psoriasis
- chronic plaque psoriasis (common type, symettrical plaques on extensor surfaces)
- flexural (smooth, erythematous plaques on flexor regions)
- guttate psoriasis (tear drop shaped plaques appear after a strep infection)
- pustular
- generalised/erythrogermic
Risk Factors
- Drugs (BALI)
Beta blockers, Anti-malarials, Lithium and Indomethacin/NSAIDs - Skin trauma
- infection
- FH
- Steroid withdrawal
Presentation of chronic plaque psoriasis
S - extensor surfaces and scalp
C - bright red/pink
A - nail changes e.g. pitting, onycholysis, hyperkeratosis.
M - circular/oval elevated plaques, often have overlying white scale
differentials for a scaly rash
scabies
discoid eczema
Pathophysiology and its relation to treatment
The autoimmune reaction causes inflammation and hyperproliferation of keratinocytes.
Corticosteroids reduce inflammation
Vitamin B reduced keratinocyte proliferation
Name 4 methods of management
Topical treatment
Phototherapy
Systemic treatment
Biologics e.g. infliximab
Name the 4 topical treatments in the order of their stepwise approach
All pts must use emollients all the time
1st line - potent topical steroid e.g. Betnovate AND topical vitamin B e.g. Dovonex (apply at diff times)
2nd line - stop topical steroid and apply vitamin D twice daily
3rd line - stop topical vitamin D and apply steroid twice daily
Describe the 3 lines of systemic treatment
1st line - Methotrexate
2nd line - Ciclosporin
3rd line - Acitretin