Psoriasis

Question 1

Psoriasis is defined as a chronic, immune-mediated skin disease with markedly increased _______ cellular turnover

Answer 1

epidermal

Question 2

What is the most common subtype of psoriasis ?

Answer 2

Plaque psoriasis (about 90% of cases)
- flexural
- nail
- scalp
- palmoplantar
- sebopsoriasis

Question 3

Most common features of plaque psoriases:
1.
2.
3. sharp borders

Answer 3

1. Red plaques
2. silver scales

Question 4

Non-plaque psoriases subtypes:
1.
2. Pustular
3. Erythrodermic

Answer 4

1. guttate

Question 5

Non-drug measures for psoriasis include:
1.
2.
3.
4. occlusive dressings

Answer 5

1. avoid triggers
2. moisturizer
3. humidifier

Question 6

One of the biggest non-modifiable risk factors for psoriasis is:

Answer 6

Genetics, almost 50% of patients report a family history

Smoking, excessive alcohol

Question 7

This type of non-plaque psoriasis is characterized by small papules triggered by respiratory infection and appears on trunk, limbs and face

Answer 7

Gutatte

Question 8

This type of non-plaque psoriasis can cover up to 90% of the BSA and is associated with complications

Answer 8

Erythroderma

Question 9

First line for MILD plaque psoriasis?

Answer 9

Non-Rx self care
1. Topical steroid mild-medium potency <7 days

adjuncts:
- Petrolatum: to reduce irritation and tachyphylaxis + can allow someone to taper of steroid
- Salicyclic acid: Increases topical steroid penetration
- Lactic acid: 2nd line to SA, safe on large BSA

Question 10

Common side effects of topical steroids?
1.
2.

Answer 10

1. Skin atrophy
2. Thinning of skin

Tachyphylaxis, contact dermatitis

Question 11

Initial options for mild-moderate plaque psoriasis?
1.
2.

Answer 11

1. topical steroids
2. vitamin D analogues

Question 12

What is the next option for mild-moderate plaque psoriasis when topical therapy doesn’t work?

Answer 12

Topical + Photo TX

Question 13

If topical + photo therapy fail for mild-moderate plaque psoriasis, the next step should be?

Answer 13

Topical + systemic agents

Question 14

First line for moderate to severe psoriasis?
1.

Answer 14

1. Systemic agents
   +/- topical agent or photo therapy

if those fail, then biologics

Question 15

Topical retinoid Tazarotene is contraindicated in:

Answer 15

Pregnancy

also avoid on face/folds

Question 16

This topical drug class is approved for atopic dermatitis but not psoriasis:

Answer 16

Topical calcineurin inhibitors tacrolimus and pimecrolimus

2nd line

Question 17

This agent used in moderate-severe psoriasis can be useful in psoriatic arthritis:

Answer 17

MTX, also first line of plaque psoriases moderate to severe

Question 18

Methotrexate is contraindicated in:
1.
2.

Answer 18

Liver Dx
Pregnancy

Contraception for both men and women is required during/3 months post treatment

Question 19

Cyclosporin is used orally for moderate to severe psoriasis first line for severe pustular or ________

Answer 19

erythrodermic

Question 20

Cyclosporin for psoriasis should be used for a max of ____ weeks

Answer 20

12

Question 21

Cyclosporin can cause many side effects:
1.
2.
3. HTN
4. higher risk for squamous and basal cell carcinomas

Answer 21

1. Renal Toxicity
2. Hypertriglyceridemia

Question 22

Acitretin (retinoid) is used orally for moderate to severe psoriasis first line for pustular psoriasis or _______

Answer 22

chronic palmoplantar

Question 23

Acitretinin is contraindicated in:
1.

Answer 23

Pregnancy

Question 24

In patients of childbearing potential, effective contraception must begin 1 month before beginning therapy with _________ and continue for at least 3 y after discontinuation

Answer 24

acitretinin

Question 25

Rare side effect with acitretinin:
1.

Answer 25

Pseudotumor cerebri

Others: Arthralgia, myalgia, alopecia, dry lips, hyperlipidemia, hepatotoxicity

Question 26

Apremilast (PDE-4 inhibitor ) can be used for ___ - ____ plaque psoriasis

Answer 26

moderate to severe

Question 27

If oral therapy for moderate to severe psoriasis does not work the next step would be?

Answer 27

Biologics

Question 28

For plaque psoriasis of the NAIL, topical therapy is tried first. However if this does not work, one can try:

Answer 28

Intralesional steroid injections (Triamcinolone) for resistant plaque/nail psoriasis

Question 29

The three psoriasis treatment options safe in pregnancy are:
1.
2.
3.

Answer 29

1. Topical steroids
   (FIRST)
2. UVB
3. Cyclosporine (only Severe)

Question 30

Ethanol increases the risk of conversion of acitretin to etretinate, which is also a major teratogen and can remain in the body for years. Therefore no alcohol _____ / _____ months post treatment

Answer 30

during / 2 months post

Question 31

This type of phototherapy should be avoided in pregnancy:

Answer 31

PUVA

Question 32

First line treatment for non-plaque psoriasis: Gutatte =

Answer 32

Photo TX UVB

Question 33

MEDICATION triggers of psoriasis include:
1.
2. lithium
3. antimalaria drugs
4. oral steroids
5. nsaids

Answer 33

1. beta blockers