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YR6 DERM > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is psoriasis?

A

systemic, immune-mediated, inflammatory skin disease
Typically has a chronic relapsing-remitting course
May have nail + joint (psoriatic arthritis) involvement

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2
Q

Describe the aetiology of psoriasis

A

Multifactoral
Genetic predisposition
Trigger of inflammatory response (infection, irritation, drugs)

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3
Q

4 subtypes of psoriasis

A

Plaque (most common)
Pustular (2nd most common)
Guttate
Erythrodermic

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4
Q

List 5 conditions associated with psoriasis

A

Psoriatic arthropathy
Metabolic syndrome
Cardiovascular disease
VTE
Psychological distress

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5
Q

4 features of plaque psoriasis

A

Well demarcated red, scaly patches
Symmetrical distribution, extensor surfaces
Psoriatic nail changes
Koebner phenomenon

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6
Q

Give 5 features of psoriatic nail changes

A

Affect fingers + toes
Pitting
Onycholysis
Subungal hyperkeratosis
Loss of nail

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7
Q

4 features of guttate psoriasis

A

Transient (often resolves after several months)
Widespread, erythematous, fine, scaly papules (water drop appearance)
Scattered on trunk + limbs
Often triggered by Streptococcal infection

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8
Q

4 features of erythrodermic psoriasis

A

Diffuse, widespread severe psoriasis affecting >90% of body surface area
Pain, irritation, + severe itching
Malaise , fever + dehydration
Skin feels hot + uncomfortable

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9
Q

Describe development of erythrodermic psoriasis

A

Can develop gradually from chronic plaque psoriasis or appear abruptly, (even in mild psoriasis)
May be precipitated by systemic infection, irritants, phototherapy

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10
Q

3 features of localised pustular psoriasis

A

aka. Palmo-plantar pustulosis
Crops of sterile pustules on hand(s)/ feet
A/w thickened, scaly, red skin that easily develops painful fissures

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11
Q

3 features of generalised pustular psoriasis

A

RARE + SEVERE form of pustular psoriasis
Reccurent flares of widespread sterile pustules with erythematous painful skin
Involvement of mucosa + systemic features

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12
Q

What is koebner phenomenon?

A

New skin lesions of pre-existing dermatosis in areas of cutaneous injury in otherwise healthy skin

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13
Q

List 4 exacerbating factors of psoriasis

A

Trauma
Alcohol
Drugs
Withdrawal of systemic steroids

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14
Q

List 6 drugs that may exacerbate psoriasis

A

B-blockers
Lithium
Antimalarials: Chloroquine + hydroxychloroquine
NSAIDs
ACEi
Infliximab

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15
Q

Dx of psoriasis

A

Clinical
Biopsy if unsure

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16
Q

Which forms of psoriasis are potentially life-threatening medical emergencies?

A

Generalised pustular psoriasis
Erythrodermic psoriasis

17
Q

Describe the step-wise management for plaque psoriasis

A
  1. Potent CS OD plus vitamin D analogue OD, applied separately (1 AM, 1 PM) for up to 4w
  2. If no improvement after 8w offer: vitamin D analogue BD
  3. If no improvement after 8-12w offer either:
    a potent CS applied BD for up to 4w, or
    a coal tar preparation applied OD-BD

Short-acting dithranol can also be used
Regular emollients may help reduce scale loss + reduce pruritus

18
Q

Give an example of a potent corticosteroid and vitamin D analogue to use in plaque psoriasis

A

Hydrocortisone
Calcipotriol, calcitriol + tacalcitol

19
Q

When should a patient with psoriasis seek urgent medical advice?

A

If they experience unexplained joint pain or swelling: may be a sign of psoriatic arthritis; requires specialist referral.

20
Q

What treatment options may be offered in secondary care management of plaque psoriasis?

A

Phototherapy
Oral Methotrexate / Ciclosporin/ Biologics

21
Q

What type of phototherapy is used in treatment of plaque psoriasis?

A

Narrowband ultraviolet B light
3x per week

22
Q

Describe management for scalp psoriasis

A

Potent topical CS OD for 4w

If no improvement after 4w; either use a different formulation of the potent CS (e.g. a shampoo or mousse) +/or a topical agent to remove adherent scale (e.g. agents containing salicylic acid, emollients + oils) before applying CS

23
Q

Describe management of face, flexural and genital psoriasis

A

Mild-mod potency CS applied OD-BD for max 2w

24
Q

Why should steroids only be used on the scalp, face and flexures for limited periods?

A

Particularly prone to steroid atrophy

25
Q

When are systemic side effects of steroids seen in psoriasis?

A

When potent CS are used on large areas: >10% surface area

26
Q

What is the recommended duration of break between topical steroids?

A

4w

27
Q

What is the recommended maximum duration of potent and very potent topical CS?

A

Potent: 8w at a time
V potent: 4w at a time

28
Q

What is the MOA of vitamin D analogues?

A

Reducing cell division + differentiation
Leads to reduced epidermal proliferation

29
Q

Give 3 benefits of using vitamin D analogues

A

SE’s uncommon
May be used long term (unlike CS)
Don’t smell/ stain (unlike coal tar + dithranol)

30
Q

What is the MOA of Dithranol? How should it be used?

A

Inhibits DNA synthesis
Wash off after 30 mins

31
Q

Give 2 adverse effects of dithranol

A

Burning
Staining

32
Q

Tx for erythemodermic psoriasis

A

Admit: IV fluids + temperature regulation
Oral Ciclosporin

33
Q

Tx for guttate psoriasis

A

Self limting, often resolves within 3-4 months
May consider TOP CS + VIt D analogue
If widespread: Phototherapy

34
Q

Tx for generalised pustular psoriasis

A

Admit: IV fluids
Ciclosporin/ Methotrexate

35
Q

5 patterns of psoriatic arthropathy

A

Asymmetrical Mono- or oligoarticular
Symmetric polyarthropathy
DIP arthritis
Arthritis mutilans
Spondylitis with sacroiliac + spinal involvement

36
Q

Tx of psoriatic arthropathy

A

NSAIDs
DMARDs e.g. Methotrexate if progressive

37
Q

What % of patients with psoriatic arthropathy have nail changes?

A

80-90%

YR6 DERM (15 decks)

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