Psoriasis

Question 1

Psoriasis presentation

Answer 1

• symmetrical scaly patches
• clearly demarcated and red with overlying silver scale
• nail signs - pitting, onycholysis, subungual hyperkeratosis
• Koebner phenomenon - rash colonises trauma sites
• psoriatic arthritis

Question 2

Psoriasis differentials

Answer 2

• eczema (ill-defined, finer scale)
• seborrheic dermatitis on scalp
• dermatitis herpetiformis (itchy, blistering skin lesions on extensor surfaces, coeliac association, gluten free diet and dapsone)

Question 3

Psoriasis management

Answer 3

• patient education - treatment aims to control, not cure
• avoid triggers
• use of emollients
• treated with corticosteroid + vitamin D analogue (calcitriol)
• can increase analogue to BD then steroid to BD
• other options - phototherapy, systemic drugs (retinoids, immunosuppressants or anti-TNFα agents)

Question 4

Psoriasis complications

Answer 4

• psoriatic arthropathy
• increased risk of metabolic syndrome, cardiovascular disease, venous thromboembolism
• psychological distress