Psoriasis Flashcards

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1
Q

What is psoriasis?

A

Psoriasis is a chronic inflammatory skin condition characterised by clearly defined, red and scaly plaques.

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2
Q

What is the aetiology of psoriasis?

A

Psoriasis affects 2–4% of males and females
peaks at 15–25 years and 50–60 years.

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3
Q

How long does it last?

A

It tends to persist lifelong, fluctuating in extent and severity.

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4
Q

What type of condition is psoriasis classed as?

A

Immune-medicated genetic skin condition

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5
Q

Where are psoriasis lesions most commonly found? (2)

A

1) extensor surfaces of knees and elbows
2) scalp

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6
Q

Summarise the pathophysiology of psoriasis:

A

hyperproliferation of keratinocytes and inflammatory cell infiltration

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7
Q

What is the name of the phenomenon where psoriasis lesions form in regions recently injured by trauma?

A

Koebner phenomenon

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8
Q

Name 5 triggers of psoriasis:

A

1) trauma
2) infection
3) stress
4) alcohol
5) drugs

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9
Q

Name the four types of psoriasis:

A

1) plaque
2) guttate
3) pustular
4) erythrodermic

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10
Q

What is the most common type of psoriasis?

A

plaque psoriasis

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11
Q

What is the second most common type of psoriasis?

A

guttate psoriasis

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12
Q

How does plaque psoriasis present?

A

thickened erythematous plaques with silver scales, commonly seen on extensor surfaces and the scalp

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13
Q

Give the approx. size range of psoriasis plaques:

A

1-10cm

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14
Q

What would be defined as plaque psoriasis?

A

Persistent and treatment-resistant
Plaques >3 cm
Most often affects elbows, knees, and lower back
Ranges from mild to very extensive

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15
Q

In which patient group is guttate psoriasis most common?

A

Children

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16
Q

Describe how guttate psoriasis presents:

A

small raised papules across the trunk and limbs which are mildly erythematous and slightly scaly

17
Q

What is the most common identified trigger of guttate psoriasis?

A

Streptococcal throat infection

18
Q

How can psoriasis be classified?

A

Early age of onset <35 years (75%) vs late age of onset >50 years
Acute eg guttate psoriasis vs chronic plaque psoriasis
Localised eg, scalp, palmoplantar psoriasis vs generalised psoriasis
Small plaques (<3 cm) vs large plaques (>3 cm)
Thin plaques vs thick plaques
Nail involvement vs no nail involvement

19
Q

Describe how pustular psoriasis presents:

A

pustules form under areas of erythematous skin, often making patients systemically unwell

20
Q

What two types of psoriasis are considered medical emergencies?

A

1) pustular psoriasis
2) erythrodermic psoriasis

21
Q

How does erythrodermic psoriasis present?

A

extensive erythematous inflamed areas covering most of the skin which come away in large patches, resulting in raw, exposed areas

22
Q

How do psoriasis plaques present in darker skin?

A

lesions can appear dark brown, grey or purple

23
Q

Give two nail changes associated with approx. 50% of psoriasis cases:

A

1) pitting nails
2) oncolysis

24
Q

What is oncolysis?

A

detachment of the nail from the nail bed

25
Q

What joint pathology is seen in 5-8% of psoriasis cases?

A

psoriatic arthritis

26
Q

What is Ausptiz sign?

A

pinpoint bleeding when psoriatic scales removed

27
Q

Give 4 medications used to treat localised and mild psoriasis:

A

1) topical corticosteroids
2) topical vitamin D analogues
3) topical dithrand
4) topical retinoids

28
Q

Give an example of a topical vitamin D analogue:

A

calcipotriol

29
Q

Give 5 treatments used for extensive and severe psoriasis:

A

1) phototherapy (UVB and photochemotherapy)
2) methotrexate
3) retinoids
4) mycophenolate mofetil
5) ciclosporin

29
Q

Give 2 examples of combined steroid and vitamin D analogue drugs:

A

1) dovobet
2) enstilar

30
Q

What is sebopsoriasis?

A

Overlap of seborrhoeic dermatitis and psoriasis
Affects the scalp, face, ears and chest
Colonised by malassezia

31
Q

What aggravates psoriasis?

A
  1. Streptococcal tonsilitis
  2. Injuries
  3. Sun exposure
  4. Dry skin
  5. Obesity, smoking or excessive alcohol
  6. Medications
  7. Stopping oral steroids/ topical corticosteroids
  8. Stress
32
Q

Name 6 health conditions associated with psoriasis?

A
  1. psoriatic arthritis
  2. IBS
  3. Uveitis (A form of inflammation of the eye)
  4. Coeliac disease
  5. Localised palmoplantar pustulosis, generalised pustulosis, and acute generalised exanthematous pustulosis.
  6. Non-alcoholic fatty liver disease
33
Q

How is psoriasis diagnosed?

A

Psoriasis is diagnosed by its clinical features. If necessary, diagnosis is supported by typical skin biopsy findings.

34
Q

What is recommended as general advice for patients with psoriasis?

A

Smoking cessation
Safe limits for alcohol consumption
Maintaining optimal weight.