Psoriasis Flashcards
Psoriasis is a chronic inflammatory skin disease. What is the world wide prevalence of psoriasis?
1 - 1-3%
2 - 10-13%
3 - 20-30%
4 - 30-40%
1 - 1-3%
- in the UK this is 2.8%
Psoriasis has a bimodal peak in age, with type 1 occurring <40 = early onset and type 2 = late onset occurring >40 years. Is this more common in men or women?
- equal in both
What % of patients with psoriasis have some form of family history of Psoriasis?
1 - 6-9%
2 - 16-19%
3 - 46-49%
4 - 60-90%
4 - 60-90%
The pathogenesis of psoriasis is factorial. Which of the following has not typically been associated with Psoriasis?
1 - Environmental factors
2 - Infection strep, HIV
3 - Drugs
4 - Obesity
5 - Alcohol and smoking
6 - Psychological (stress, anxiety and depression)
7 - Skin trauma- Isomorphic phenomenon, sunlight
4 - Obesity
- drugs such can cause psoriasis/drug induced psoriasis caused by anti-malarial and anti TNFs in susceptible people
Although the cause of Psoriasis is likely to be multifactorial, one theory is that the skin can become irritated by environmental or microorganisms that act as a trigger. This trigger causes which cell to then initiate an immune response?
1 - neutrophils
2 - macrophages
3 - dendritic cells
4 - eosinophils
3 - dendritic cells
Once the dendritic cells in the skin have been triggered they will elicit an immune response by activating T cells that release cytokines and cause inflammation. What then happens to the keratinocyte in the area?
1 - cells in the area die due to inflammation
2 - tissue scars causing abscess formation
3 - keratinocyte proliferation
4 - all of the above
3 - keratinocyte proliferation
- this is what causes plaques on the skin
- typically once the trigger is removed the inflammation subsides, BUT in Psoriasis, this inflammation becomes chronic
Which of the following can be used to describe the most common clinical feature in a caucasian with Psoriasis?
1 - plaques
2 - pink or red underlying skin
3 - white scaly appearance on top
4 - rough to touch
5 - all of the above
5 - all of the above
8-9 / 10 will have these forms of plaques if they have Psoriasis
- typically can be very itchy
Are the plaques that are the most common feature of psoriases as evident in pigmented skin?
- no
- it is more difficult to identify the erythema
Where are plaques most commonly found on the body?
1 - face and head
2 - torso and extensor surface of limbs
3 - all over limbs
4 - torso only
2 - torso and extensor surface of limbs
Are psoriatic plaques present in the flexor regions of joints?
- typically no
There are different body area specific forms of psoriases. What is a key feature of flexural psoriasis?
1 - skin has a darker form of erythema
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - rough scaling is not present and skin is smooth
4 - rough scaling is not present and skin is smooth
- occurs in the creases of the skin (flexures) such as in the armpit, in the groin, under breasts and in skin folds.
There are different body area specific forms of psoriases. What is a key feature of scalp psoriasis?
1 - skin has a darker form of erythema
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - rough scaling is not present and skin is smooth
2 - dandruff appearance and/or hair loss
There are different body area specific forms of psoriases. What is a key feature of pustular psoriasis?
1 - skin has a darker form of erythema
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - rough scaling is not present and skin is smooth
3 - crops of pustules on surface of hands
- pustule = fluid filled lesion
- 2nd most common form of psoriasis
- pustules can also be present all over the body
There are different body area specific forms of psoriases. What is a key feature of guttate (drop) psoriasis?
1 - typically cause by a germ following a sore throat
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - rough scaling is not present and skin is smooth
1 - typically cause by a germ following a sore throat
- small scaly widespread plaques
- can also be associated with hypopigmentation
There are different body area specific forms of psoriases. What is a key feature of erythrodermic psoriasis?
1 - typically cause by a germ following a sore throat
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - systemic erythema and plaques often merge together
4 - systemic erythema and plaques often merge together
There are different body area specific forms of psoriases. What is a key feature of nail psoriasis?
1 - pitting of nail with onycholysis
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - systemic erythema and plaques often merge together
1 - pitting of nail with onycholysis
- can be in isolation or with skin psoriases
The severity of psoriasis can be screened using which of the following scales?
1 - Dermatology Life Quality Index (DLQI)
2 - Psoriasis Area and Severity Index (PASI)
3 - Nail Psoriasis Severity Index (NAPSI)
4 - Palmoplantar pustulosis Psoriasis severity index (PPPASI)
5 - all of the above
5 - all of the above
- the index used depends on the form of psoriasis the patient has
- DLQI and PASi are the most common
Using the Dermatology Life Quality Index (DLQI) or Psoriasis Area and Severity Index (PASI), what score would indicate severe psoriasis?
1 - >5
2 - >10
3 - >15
4 - >20
2 - >10
There are a large number of co-morbidities associated with psoriases. Which of the following is NOT typically associated with psoriases?
1 - Psoriatic arthritis(PsA)
2 - T1DM
3 - Cardiovascular disease
4 - Metabolic syndrome/NAFLD
5 - Obesity
6 - Anxiety and depression
7 - Alcohol abuse
2 - T1DM
- the strongest association appears to be any condition where there are metabolic imbalances
Which of the following but be the most likley differential for a patient with hand and foot psoriases?
1 - hand/foot eczema
2 - psoriasiform drug reaction
3 - pityriasis rubra pilaris
4 - secondary syphilis
5 -pityriasis rosea
1 - hand/foot eczema
Which of the following is the least likley differential for a patient with psoriases?
1 - chronic eczema-Lichen simplex chronicus
2 - psoriasiform drug reaction
3 - pityriasis rubra pilaris
4 - secondary syphilis
5 - squamous cell carcinoma
6 - pityriasis rosea
5 - squamous cell carcinoma
Typically how is psoriasis diagnosed?
1 - skin biopsy
2 - microbiology sample
3 - clinically
4 - imaging
3 - clinically
- skin biopsy can be used to rule out other conditions and if psoriasis presents atypically
Which of the following features would be present if a skin biopsy of a patient with psoriases was taken?
1 - thickened basal cells
2 - dilated tortuous vessels in dermal papillae
3 - less keratinocyte proliferation
4 - all of the above
2 - dilated tortuous vessels in dermal papillae
Patients with psoriases can be graded based on the Psoriasis Epidemiology Screening Tool (PEST). What score using the PEST tool would warrant a referral to a rheumatologist?
1 - >3
2 - >6
3 - >9
4 - >12
1 - >3
- metabolic dysfunction is assessed
- hospital anxiety and depression can also be used to refer to GP for psychiatric support
Which of the following would be the 1st line for mild psoriasis?
1 - systemic therapy
2 - topical therapy
3 - phototherapy-narrow band UVB
4 - systemic immunosuppressants
2 - topical therapy
- Coal tar preparations
- Topical calcineurin inhibitors- 0.1%
- Tacrolimus ointment and 1%
- Pimecrolimus cream
- Topical corticosteroids- note potency in reference to skin site
- Topical vitamin D analogues
- Topical corticosteroid and vitamin D analogue combination
- Topical corticosteroid and salicylic acid combination
In moderate to severe disease, or when topical therapy is not practical or not worked for psoriasis, which of the following are typically used to treat patients?
1 - systemic therapy
2 - topical therapy
3 - phototherapy-narrow band UVB
4 - systemic immunosuppressants
1 - systemic therapy
- Phototherapy- Narrow band UVB, PUVA
- Systemic retinoids such as Acitretin
- Systemic immunosuppressants such as Methotrexate, Ciclosporin,
- Fumaric acid esters such as Dimethyl fumarate
Phosphodiesterase 4 inhibitors such as Apremilast - Injectable biologic therapy such as Anti-TNFs, IL 12/IL23, IL 23, IL 17
- Novel systemic therapy such as Tyrosine kinase 2 inhibitor-Deucravacitinib
Which of the following is NOT a treatment for psoriasis in children?
1 - Topicals - Corticosteroids, Vitamin D analogues, calcineurin inhibitors, Coal tar
2 - Phototherapy- Narrow band UVB
3 - Incision
4 - Systemic retinoids-Acitretin (1month- 17 years)
5 - Systemic immunosuppressants
3 - Incision
Biologics licensed for use in children:
Anti-TNF- Adalimumab(4-17years)
IL12/23-Ustekinumab(6-17years)
IL17A-Secukinumab(6-17years)
IL17A- Ixekizumab(6-17years)
In a pregnant women can psoriasis get better or worse?
- can improve in some patients
- uncontrolled disease can affect pregnancy
In pregnant women which of the following treatments cannot be used at any time during the pregnancy?
1 - Topicals/vitamin D analogues
2 - Phototherapy-Narrow band UVB
3 - Systemic immunosuppressants
4 - Biologic therapy
4 - Biologic therapy
Biologics
- Adalimumab = up to 1st trimester only
- Certolizumab = ok to use during pregnancy and lactation
