psoriasis 🐍

Question 1

what is psoriasis

Answer 1

immune mediated
chronic
inflammatory (t lymphocytes)
well demarcated
erythematous
silver scaly plaques (hyperproliferation of epidermis)
+ fmh
bimodal age distribution (16-22/55-60)

Question 2

types of psoriasis (ive seen in clinic)

Answer 2

1. chronic plaque psoriasis (persistent & treatment resistent, can be very extensive, on extensor surface, ears, scalp & even beyonf hairline)
2. flexural psoriasis (affects the body folds, colonised by candida)- ddx: eczema
3. scalp psoriasis (first site usually!!)
4. nail psoriasis (nail pitting! onycholysis, a/w inflammatory athritis)

Question 3

aggravating factors of psoriasis

Answer 3

1. strep tonsilitis
2. injuries such as cuts or sunburn
3. obesity
4. stress
5. alcohol & smoking
6. drugs: anti malarial, NSAIDs, beta blocker, lithium
7. stopping oral steroids

Question 4

associated comorbidities of psoriasis (not sure i understand what this means )

Answer 4

1. arthropathy
2. IBD
3. uveitis
4. metabolic syndrome & CVD
5. lung fibrosis

Question 5

how to diagnose psoriasis

Answer 5

it is a clinical diagnosis!!!

Question 6

how to asssess psoriasis severity?

Answer 6

• What are the assessment tools that are used to assess severity?
  
  1. Psoriasis Area and Severity Index (PASI)
  2. Dermatology Life Quality Index (DLQI)
  3. Body Surface Area as percentage of total (BSA)
• How is psoriasis severity classified? (everything less than 10%)
  
  • Mild psoriasis: PASI ≤10 and DLQI ≤10 or <10% BSA.
  • Moderate psoriasis: (10-30% BSA) to severe psoriasis (>30% BSA): PASI >10 and DLQI >10; involvement of visible areas such as face, palms, soles and/or genitals; severe pruritus and significant nail disease.

Question 7

non pharmaco tx of psoriasis

Answer 7

1. education- dss natural history, tx, ae, cx of psoriasis
2. lifestyle modifications: no smoking, no excessive alcohol, BMI
3. review effects of medications esp methotrexate

Question 8

pharmaco for psoriasis

Answer 8

1. emollient
2. topical steroids- dont exceed >4 weeks
3. vit D & retinoid
4. purified coal tar for scalp psoriasis
5. phototherapy
6. (best to avoid) systemic therapy: methotrexate
7. for tx resistant severe psoriasis: biologics (adalimumab)

Question 9

criteria for psoriatic arthropathy

Answer 9

CASPAR
• CASPAR criteria - A patient with an inflammatory musculoskeletal disease (peripheral arthritis, spondylitis, or enthesitis) can be classified as having PsA if a total of at least 3 points is accumulated from the presence of the following list of features (each of which is assigned a certain number of points):
•Skin psoriasis that is:
• -Present - 2 points, OR
• -Previously present by history - I point, OR
• -A family history of psoriasis, if the patient is not affected - one point
•Nail lesions (onycholysis, pitting) - I point
•Dactylitis (present or past, documented by a rheumatologist) - I point
•Negative rheumatoid factor (RF) - I point
•Juxtaarticular bone formation on radiographs (distinct from osteophytes) - I point
• Sensitivity and specificity in four studies, ranging from 9 to 100 percent and 97 to 99 percent, respectively.

Question 10

PsA

Answer 10

affects DIP
oligoarthritis
symetrical
nail pitting
onycholysis
pitting edema