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pyt-derma > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

Explain 6 ways in which psoriasis affects nails

A

1 m/c nail finding → thimble pitting
2 onycholysis → separation of nail from nail bed
3 salmon patches of nail bed
4 subungual hyperkeratosis → keratinous material under nail plate
5 oil drop sign → staining of nail bed
6 thickening & tunneling of nail plate

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2
Q

Define psoriasis

A

Genetically determined
T cell mediated
Chronic
Relapsing
Skin dis
Unknown etiology

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3
Q

Define lesions?

A

Skin lesions are → erythrosquamous
Means it involves both > vasculature (erythema)
> epidermis ( increased scale formation)
Worsens in winter
+ve family history in > 50%

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4
Q

HLA asso.?

A

HLA CW 6

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5
Q

What is basic underlying pathologic defect ?

A

Increased epidermal proliferation rate
Normal skin →27 days.
Psoriatic skin → 4 days

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6
Q

Aggravating factors?

A

Sepsis
Stress
Cold injury» shivering
Trauma
Drugs → beta blockers
lithium
Antimalarial’s
ibuprofen
stoppage of steroids

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7
Q

Histo features?

A

Munro microabstasses → neutrophils in stratum corneum
Spongiform pustules of kogoj → neutrophils in stratum spinosum
Parakeratosis
Absent granular layer

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8
Q

Lesion looks like?
Does it itch?

A

Silvery mica scales → scales typically absent in groin & flexures
As epidermal mass is increased 3-5 times

Mild / No itching » variably pruritic

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9
Q

Onset?
Gender preponderance?

A

2nd-3rd decade
More common in males

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10
Q

Common sites?

A

Extensor aspects → elbow, knees, trunk » back & lumbo sacral area
scalp, hands

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11
Q

Signs in psoriasis?

A

Auspitz sign
Bulkeley’s membrane
Grattage test
Woronoff’s ring
Köbner / isomorphic phenomenon
Candle grease sign (tache de bougie)

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12
Q

Describe auspitz sign

A

When scales are scrapped → pinpoint bleeding » from dilated superficial capillaries occurs through Bulkeley’s membrane

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13
Q

Describe Bulkeley’s membrane ?

A

Removal of scales reveal a glistening red membrane of bulkeley

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14
Q

Grattage test

A

On scratching the lesion → mila like scales appear

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15
Q

Woronoff’s ring?

A

Whitish halo around the lesion

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16
Q

Koebner /isomorphic phenomenon?

A

Traumatised areas → start developing lesions

17
Q

Candle - grease sign aka Tache de bougie

A

When lesion scratched with point ofdissecting forceps → candle like grease scale can be repeatedly produced even from non scaling lesions

18
Q

Does it involve joints?

A

Yes
30%» pts. Have psoriatic arthritis
90% pts. Of psoriatic arthritis have nail changes

19
Q

Psoriatic arthritis
Doc?
Features?
X-ray signs?

A

Doc → methotrexate
Features: dip involvement
dactylitis » sausage digits
arthritis mutilans
severe destructive arthritis

X-ray signs: opera glass hand, pencil in cup app, whiskering

20
Q

Describe opera glass hand? See img

A

Telescoping of one bone into its neighbour with shortening of digits

21
Q

Pencil in cup app? How it looks? See img

A

Tapering → proximal phalanx
Proliferation → distal terminal phalanx

22
Q

Whiskering is?

A

Marginal erosions with adjacent proliferation

23
Q

Name → types of psoriasis?
See img of lesions? - from AIIMS essence

A

Stable plaque psoriasis
Rupioid psoriasis
Guttate / eruptive/raindrop psoriasis
Inverse / seborrrheic psoriasis
Pustular psoriasis
Erythrodermic psoriasis
General pustular / Von zumbusch psoriasis
Impetigo herpetiformis

24
Q

Stable plaque psoriasis

A

M/C type of psoriasis
Involves → elbows, knees, lower back, scalp, nails, napkin area
Infant may present as » ‘nappy rash”

25
Q

Rupioid psoriasis

A

Limpet - like cone-shaped hyperkeratotic lesions of psoriasis

26
Q

Guttate psoriasis

A

More common in» children & adolescents
Preceded by » tonsillitis, pharyngitis by beta hemolytic streptococci
Rxoc: antibiotics + emollients
PUVA / PUVA Sol

27
Q

Seborrheic psoriasis

A

Very resistant to therapy
Lesions on scalp + less typical moist lesion in body folds
No visible scales

28
Q

Pustular psoriasis

A

Precipitated by steroid use
Sudden onset with small sterile pustules on erythematous base
Palms & soles involved
Acrodermatitis pustulosa » seen in smokers» treated with retinoids

29
Q

Erythrodermic psoriasis

A

Doc - mtx
Skin» becomes universally red & scaly
Precipitated by» irritants like» tar, dithranol, steroids withdrawal

30
Q

Von zumbusch psoriasis

A

Combination of» erythroderma + sterile pustular psoriasis
Rxoc: retinoids » oral acitretin
2nd choice: mtx + emollients ,cyclosporine
oral steroids used only in pregnant women

31
Q

Impetigo herpetiformis

A

Pustular eruption of pregnancy
A/w: hypoparathyroidism, hypocalcemia
Rx: corticosteroids > cyclosporine
As mtx & retinoids - C/I in pregnancy

32
Q

Rx of psoriasis vulgaris?

A

Refer table of aims essence

33
Q

Images → for spotters

A

Refer AIIMS essence

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