Psoriasis Flashcards
What is Psoriasis?
Chronic, immune mediated disease
What does psoriasis look like?
Sharply demarcated erythematous plaques with micaceous scale
Which age ranges are peaks for psoriasis?
20-30
50-60
->75% of cases occur before 40yrs so more common in young adults
Psoriasis is a systemic disease. What other issues can occur in patients?
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
Is psoriasis associated with family history?
Yes, 35-90% have a family history
What factors contribute to the pathogenesis of psoriasis?
Polygenetic predisposition and environmental triggers e.g. infection, drugs, trauma and sunlight
Which chromosome is associated with psoriasis?
Chromosome HLA-Cw6
What happens in the immune system in psoriasis?
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
Describe what is seen microscopically in psoriasis.
Hyperkeratosis- thickening of stratum corneum
Neutrophils in stratum corneum
Psoriasiform hyperplasia- thickening of sqaumous cell layer
Dilated dermal capillaries
T cell infiltration
What is seen in the skin in patients with psoriasis?
Sharply demarcated, erythematous papulosquamous plaques
Numerous small papules and plaques
Pustules
Erthroderma
What is seen in the nails in patients with psoriasis?
Onycholysis (where nail separates from nail bed)
Pitting
Oil spots
Which type of psoriasis is triggered by streptococcal infection e.g. pharyngitis ?
Guttate psoriasis
Who is more at risk of Guttate psoriasis?
Children and adolescents
Guttate psoriasis can resolve but what could also happen?
Could trigger into chronic psoriasis in susceptible individuals
Palmo-plantar Psoriasis?
Chronic type of psoriasis which characteristically affects the skin of the palms and soles
What is Palmo-plantar Psoriasis associated with?
Smoking
->however, stopping smoking won’t make it go away
What can can scalp psoriasis lead to?
Alopecia of affected areas
What is the treatment for nail psoriasis?
Difficult to treat…
Which type of psoriasis can be triggered by localised dermatophyte, candidal or bacterial infection?
Flexural/inverse psoriasis
What are the symptoms of pustular psoriasis?
Sterile pustules
Sometimes systemic symptoms
What are some triggers for pustular psoriasis?
Pregnancy
Hypocalcaemia
Infection
Steroids
->important to taper steroids off and not just stop them abruptly
Erythrodermic psoriasis?
Known as ‘red man syndrome’
>80% of body area involved and bright red
How is a diagnosis of psoriasis made?
Often made clinically
Skin biopsy can be done if atypical
What are some of the differential diagnoses for psoriasis?
Seborrhoeic dermatitis
Lichen planus
Mycosis fungoides
What can be done in primary care for patients with psoriasis?
Emollients, creams vs ointments
Soap substitutes
Vitamin D3 analgoues
Coal tar creams
What is purpose of Vitamin D3 analogues in the treatment of psoriasis?
Inhibit and slow down rate of keratinocyte proliferation
Topical steroids may be given with care for psoriasis affecting which parts of the body?
Flexures
Genitailia
What can be done in secondary care for patients with psoriasis?
Optimise topical therapy
Crude coal tar treatment
Dithranol
UVB phototherapy
Oral retinoids e.g. acitretin
Immunosuppression
Biologics
What can be used to monitor progress in the treatment of psoriasis?
Psoriasis Area Severity Index
Dermatology Life Quality Index
->PASI looks at surface area, plaque colour, thickness and scale
What is the treatment for erythrodermic psoriasis specifically?
Admission
Fluid balance
Bloods/IV access
Thick greasy ointment emollients
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?
Chronic Plaque Psoriasis
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?
Palmo-plantar Psoriasis, or pustulosis.
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?
Flexural / Inverse Psoriasis
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?
Erythrodermic psoriasis
aka red man syndrome
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?
Guttate psoriasis
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?
Scalp psoriasis
and
Nail psoriasis
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?
Pustular psoriasis
