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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is psoriasis?

A

This is a common, chronic inflammatory dermatosis of the psoriatic form

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2
Q

What ages are most commonly affected by psoriasis?

A

There are 2 main peaks of onset, 2nd and 5th decade

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3
Q

What is thought to be a possible cause of psoriasis?

A

There is thought to be a genetic element, with multiple genes being found to be linked to psoriasis (PSORS1 is a major locus)

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4
Q

Describe the disease course of psoriasis?

A

It follows a chronic relapsing and remitting course

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5
Q

What are some precipitating factors of psoriasis?

A
  • Emotional stress
  • Infection
  • Drugs (E.g. ß-Blockers, lithium, anti-malarials, withdrawal of steroids)
  • Alcohol
  • Trauma (Koebner phenomenon)
  • Smoking
  • HIV/AIDS
  • UV radiation
  • Metabolic syndromes
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6
Q

Describe the pathophysiology of psoriasis

A

Psoriasis involves hyperproliferation of the epidermal cells, causing an increase in number of cells entering the cell cycle from the basal layer

This also causes a complement mediated attack on keratin layer

The complement system attracts neutrophils and leukocytes

Munro micro-abscesses can therefore form, which is a useful diagnostic clue

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7
Q

What are some examples of psoriasis subtypes? (10)

A

Chronic plaque psoriasis
Guttate psoriasis
Scalp psoriasis
Flexural psoriasis
Palmoplantar psoriasis
Palmoplantar pustulosis
Erythrodermic psoriasis
Pustular psoriasis
Nail psoriasis
Psoriatic arthritis

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8
Q

What is chronic plaque psoriasis?

A

This is a form of psoriasis in which there is formation of erythematous scaly plaques

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9
Q

Where does chronic plaque psoriasis usually affect?

A

Extensor aspects on the knees, elbows, sacrum and scalp and is often symmetrical

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10
Q

How will chronic plaque psoriasis usually present?

A

Plaques are palpable and raised, with a silver scale

Auspitz’ sign will be positive (Removing scale reveals pin-point bleeding)

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11
Q

What is the koehler phenomenon?

A

This is a phenomenon in which psoriasis may develop in sites of trauma, 2-6 weeks after it is sustained

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12
Q

What are some causes of trauma that can lead to the koehler phenomenon?

A
  • Scratching
  • Burns
  • Other dermatoses (E.g. contact dermatitis)
  • Surgical trauma
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13
Q

What are some other conditions that can be caused by the koehler phenomenon?

A

Lichen planus, vitiligo and some rarer conditions

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14
Q

Who is most commonly affected by guttate psoriasis?

A

Younger patients between 15 and 25

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15
Q

How will guttate psoriasis usually present?

A

This will usually for 7-10 days after a streptococcal sore throat, causing multiple small psoriatic lesions (Raindrops) on the trunk

The patients may only have one episode

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16
Q

How is guttate psoriasis managed?

A

Treatment involves nothing, emollients, topical tar of phototherapy if required

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17
Q

What is a possible complication of scalp psoriasis?

A

Permanent alopecia

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18
Q

What is flexural psoriasis?

A

This is psoriasis that affects flexoral surfaces such as the groin, axillae or inframammary areas (Below breasts)

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19
Q

How will flexural psoriasis present?

A

This will cause formation of shiny, red, well-demarcated plaques with little scale

This can be confused with fungal infection of intertrigo

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20
Q

How is flexural psoriasis managed?

A

Treatment involves a mild topical steroid and antifungal preperation such as Canesten HC or Trimovate cream

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21
Q

What is palmoplantar psoriasis ?

A

This is a very painful and possibly disabling form of psoriasis affecting the palms of the hands and soles of the feet, often causing very thick hyperkeratosis

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22
Q

How is palmoplantar psoriasis managed?

A
  • Topical tar preparations
  • Salicylic acid
  • Topical steroids
  • Phototherapy
  • Systemic immunosuppressants
23
Q

What is palmoplantar pustulosis?

A

This is a possible form of psoriasis or a psoriasis related disorder affecting the hands and feet

24
Q

How will palmoplantar pustulosis present?

A

It results in the formation of sterile yellow pustules on the hands and feet which fade down to brown macules

25
Q

What are some risk factors for palmoplantar pustulosis?

A

Over 50
Female
Cigarette smoking

26
Q

What is erythrodermic psoriasis?

A

This is a very uncommon form of psoriasis, which involves full skin involvement and plaque formation, with >90% of the skin being red

27
Q

What are some causes of erythrodermic psoriasis?

A

This usually occurs in patients with known or deteriorating psoriasis, but can also occur de-novo

This can be caused by withdrawal of potent topical or systemic steroids, drug reactions of UV burns

28
Q

What are some risks of erythrodermic psoriasis?

A

This increases risk of dehydration, electrolyte deficiency, hypothermia, cardiogenic shock, anaemia and hypoproteinaemia

29
Q

How is erythrodermic psoriasis managed?

A

Treatment involves fluid balance, bed rest, emollients and systemic immunosuppression

30
Q

What is pustular psoriasis?

A

This is a generalised condition resulting in painful skin, fever, malaise and formation of sterile pustules

31
Q

What are some causes of pustular psoriasis?

A

Withdrawal of steroids, infection, pregnancy or hypocalcaemia

32
Q

What will blood testing show in pustular psoriasis?

A

Hypoalbuminaemia, hypocalcaemia and leucocytosis

33
Q

How is pustular psoriasis managed?

A

Treatment involves bed rest, emollients, infection monitoring, fluid balance, protein monitoring and systemic immunosuppression

34
Q

What are some common nail changes in nail psoriasis?

A
  • Nail pitting
  • Onycholysis
  • Oil-drop lesions
  • Sub-ungual hyperkeratosis
  • Nail deformity
35
Q

What are the 5 main patterns of psoriatic arthritis?

A
  • Asymmetric oligoarthritis (60-70%)
  • Symmetrical polyarthritis (15%)
  • Distal phalangeal joint disease (5%)
  • Destructive arthritis (Arthritis mutilans - 5%)
  • Axial arthritis (5%) (Spondylitis/Sacroiliitis)
36
Q

What pattern of psoriasis is shown?

A

Chronic plaque

37
Q

What pattern of psoriasis is shown?

A

Guttate

38
Q

What pattern of psoriasis is shown?

A

Scalp

39
Q

What pattern of psoriasis is shown?

A

Flexural

40
Q

What pattern of psoriasis is shown?

A

Palmoplantar psoriasis

41
Q

What pattern of psoriasis is shown?

A

Palmoplantar pustulosis

42
Q

What pattern of psoriasis is shown?

A

Erythrodermic

43
Q

What pattern of psoriasis is shown?

A

Pustular

44
Q

What psoriatic nail change is shown?

A

Onycholysis

45
Q

What psoriatic nail change is shown?

A

Nail pitting

46
Q

What are some histological features of psoriasis?

A
  • Parakeratotic stratum corneum (Contains nuclei)
  • Absence of granular layer
  • Expanded prickle cell layer
  • Large capillary vessels in papillary dermis
  • Leucocytes (Munro microabscesses in stratum corneum)
47
Q

What are some treatment options in psoriasis?

A
  • Topical treatment
  • Phototherapy
  • Oral treatments
  • Biologic therapy
48
Q

Why should topical steroids never be used in generalised psoriasis?

A

It can cause rebound flare-ups

49
Q

What are some acute side effects of phototherapy ?

A
  • Erythema
  • Blistering
  • Photoconjunctivitis
  • Exacerbation of Herpes simplex
50
Q

What are some chronic side effects of phototherapy?

A

Photoaging
Photocarcinogenesis

51
Q

What are some forms of photo treatment?

A

Phototherapy (UVB) and photochemotherapy (UVA + Psoralen)

52
Q

How often is phototherapy given?

A

3 times per week for 3 weeks

53
Q

How often is photochemotherapy given?

A

2 times per week

54
Q

What are some targets for biologic therapy in psoriasis?

A
  • TNF-alpha (Mediates T-cell to macrophage communication)
  • IL17 (Activates keratinocytes and fibroblasts)
  • IL23 (Triggers differentiation and growth of Th17 cells)

Dermatology (38 decks)

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