Psoriasis

Question 1

What is Psoriasis?

Answer 1

Chronic, immune mediated disease

Question 2

What does psoriasis look like?

Answer 2

Sharply demarcated erythematous plaques with micaceous scale

Question 3

Which age ranges are peaks for psoriasis?

Answer 3

20-30
50-60

->75% of cases occur before 40yrs so more common in young adults

Question 4

Psoriasis is a systemic disease. What other issues can occur in patients?

Answer 4

Psoriatic arthritis
Psychosocial implications
Metabolic syndrome

->btw metabolic syndrome is the name for a group of health conditions which increases risks of type 2 diabetes or conditions which affect the heart and blood vessels

Question 5

Is psoriasis associated with family history?

Answer 5

Yes, 35-90% have a family history

Question 6

What factors contribute to the pathogenesis of psoriasis?

Answer 6

Polygenetic predisposition and environmental triggers e.g. infection, drugs, trauma and sunlight

Question 7

Which chromosome is associated with psoriasis?

Answer 7

Chromosome HLA-Cw6

Question 8

What happens in the immune system in psoriasis?

Answer 8

Activation of dermal dendritic cells
Lymph nodes present uncertain antigen to naive T cells
There is differentiation into T helper cells 1, 17 and 22
There is plaque formation

->girl, idk, the recording is impossible to hear hahaha so making these based on the powerpoint, can always look into it more but chances of it coming up probably fairly slim

Question 9

Describe what is seen microscopically in psoriasis.

Answer 9

Hyperkeratosis- thickening of stratum corneum
Neutrophils in stratum corneum
Psoriasiform hyperplasia- thickening of sqaumous cell layer
Dilated dermal capillaries
T cell infiltration

Question 10

What is seen in the skin in patients with psoriasis?

Answer 10

Sharply demarcated, erythematous papulosquamous plaques
Numerous small papules and plaques
Pustules
Erthroderma

Question 11

What is seen in the nails in patients with psoriasis?

Answer 11

Onycholysis (where nail separates from nail bed)
Pitting
Oil spots

Question 12

Which type of psoriasis is triggered by streptococcal infection e.g. pharyngitis ?

Answer 12

Guttate psoriasis

Question 13

Who is more at risk of Guttate psoriasis?

Answer 13

Children and adolescents

Question 14

Guttate psoriasis can resolve but what could also happen?

Answer 14

Could trigger into chronic psoriasis in susceptible individuals

Question 15

Palmo-plantar Psoriasis?

Answer 15

Chronic type of psoriasis which characteristically affects the skin of the palms and soles

Question 16

What is Palmo-plantar Psoriasis associated with?

Answer 16

Smoking

->however, stopping smoking won’t make it go away

Question 17

What can can scalp psoriasis lead to?

Answer 17

Alopecia of affected areas

Question 18

What is the treatment for nail psoriasis?

Answer 18

Difficult to treat…

Question 19

Which type of psoriasis can be triggered by localised dermatophyte, candidal or bacterial infection?

Answer 19

Flexural/inverse psoriasis

Question 20

What are the symptoms of pustular psoriasis?

Answer 20

Sterile pustules
Sometimes systemic symptoms

Question 21

What are some triggers for pustular psoriasis?

Answer 21

Pregnancy
Hypocalcaemia
Infection
Steroids

->important to taper steroids off and not just stop them abruptly

Question 22

Erythrodermic psoriasis?

Answer 22

Known as ‘red man syndrome’
>80% of body area involved and bright red

Question 23

How is a diagnosis of psoriasis made?

Answer 23

Often made clinically
Skin biopsy can be done if atypical

Question 24

What are some of the differential diagnoses for psoriasis?

Answer 24

Seborrhoeic dermatitis
Lichen planus
Mycosis fungoides

Question 25

What can be done in primary care for patients with psoriasis?

Answer 25

Emollients, creams vs ointments Soap substitutes Vitamin D3 analgoues Coal tar creams

Question 26

What is purpose of Vitamin D3 analogues in the treatment of psoriasis?

Answer 26

Inhibit and slow down rate of keratinocyte proliferation

Question 27

Topical steroids may be given with care for psoriasis affecting which parts of the body?

Answer 27

Flexures Genitailia

Question 28

What can be done in secondary care for patients with psoriasis?

Answer 28

Optimise topical therapy Crude coal tar treatment Dithranol UVB phototherapy Oral retinoids e.g. acitretin Immunosuppression Biologics

Question 29

What can be used to monitor progress in the treatment of psoriasis?

Answer 29

Psoriasis Area Severity Index Dermatology Life Quality Index ->PASI looks at surface area, plaque colour, thickness and scale

Question 30

What is the treatment for erythrodermic psoriasis specifically?

Answer 30

Admission Fluid balance Bloods/IV access Thick greasy ointment emollients

Question 31

Okayyyy, now for some cases! 54 year old male presents with a 15 year history of scaly plaques on both elbows. Over the last few months the rash has spread to involve large areas of his body. He has recently lost his job and has been diagnosed with hypertension. O/E he has large salmon coloured plaques on his arms, legs and back with thick scale. Diagnosis?

Answer 31

Chronic Plaque Psoriasis

Question 32

A 32 year old lady presents with several months’ history of a rash on her hands and feet. She works as a beautician / masseuse and wants it to be cured. O/E the skin on the palms and soles appears thick, scaly and red with yellowish brown lesions at the edges. Diagnosis?

Answer 32

Palmo-plantar Psoriasis, or pustulosis.

Question 33

A 36 year old man presents with several months history of a bilateral axillary rash. He has been treated with topical and oral anti-fungal agents recently without any benefit. Skin scrapings show no growth. O/E you see shiny pink to red sharply demarcated plaques with NO scale. Diagnosis?

Answer 33

Flexural / Inverse Psoriasis

Question 34

A 67 year old man arrives with a 35 years history of stable chronic plaque psoriasis. His wife died 8 weeks ago and his psoriasis started to flare. He was prescribed 2 weeks course of oral Prednisolone, which was stopped without tapering. He presents feeling shivery and generally unwell. O/E More than 80% of his body surface area is erythematous, with fine scale. He is pyrexial and has a low blood pressure. Diagnosis?

Answer 34

Erythrodermic psoriasis aka red man syndrome

Question 35

A 14 year old boy presents with an acute onset of a generalized rash. O/E he has multiple 2-5 mm pink papules with a fine scale, worse on the trunk and proximal extremities. His mother says that he had a throat infection 2-3 weeks prior to the rash. Diagnosis?

Answer 35

Guttate psoriasis

Question 36

27 year old lady presents to your clinic complaining of severe dandruff. She has tried various shampoos with out much effect. She has noticed that the dandruff is spreading onto her face as well. O/E you see pink hyperkeratotic plaques at her scalp, extending just beyond the hairline onto her neck and forehead. She has some pitting at her nails. Diagnosis?

Answer 36

Scalp psoriasis and Nail psoriasis

Question 37

A 50 year old lady presents with an acute onset of generalised red, tender patches. On closer inspection of the patches multiple yellow pustules are seen. Diagnosis?

Answer 37

Pustular psoriasis