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Year 6 Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What is the most common form of psoriasis in clinical practice?

A

Chronic plaque psoriasis, accounting for around 80% of presentations.

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2
Q

What are the features of chronic plaque psoriasis?

A

Erythematous plaques covered with a silvery-white scale.

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3
Q

Where are chronic plaque psoriasis plaques typically located?

A

On extensor surfaces such as the elbows and knees, as well as the scalp, trunk, buttocks, and periumbilical area.

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4
Q

How is the boundary between normal and affected skin in chronic plaque psoriasis?

A

There is a clear delineation between normal and affected skin.

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5
Q

What is the typical size range of plaques in chronic plaque psoriasis?

A

Plaques typically range from 1 to 10 cm in size.

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6
Q

What sign may be observed if the scale of a plaque is removed?

A

A red membrane with pinpoint bleeding points may be seen (Auspitz’s sign).

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7
Q

What is guttate psoriasis?

A

Guttate psoriasis is a type of psoriasis more common in children and adolescents, often precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.

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8
Q

What are the features of guttate psoriasis?

A

Features include tear drop papules on the trunk and limbs, pink scaly patches or plaques of psoriasis, and tends to have an acute onset over days.

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9
Q

What is the typical resolution time for guttate psoriasis?

A

Most cases resolve spontaneously within 2-3 months.

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10
Q

Is there evidence supporting the use of antibiotics for guttate psoriasis?

A

There is no firm evidence to support the use of antibiotics to eradicate streptococcal infection.

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11
Q

What are some management options for guttate psoriasis?

A

Management options include topical agents as per psoriasis, UVB phototherapy, and tonsillectomy may be necessary with recurrent episodes.

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12
Q

What is a key differentiating factor between guttate psoriasis and pityriasis rosea?

A

Guttate psoriasis is classically preceded by a streptococcal sore throat 2-4 weeks, while pityriasis rosea may follow recent respiratory tract infections, which is not common in questions.

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13
Q

How do the appearances of guttate psoriasis and pityriasis rosea differ?

A

Guttate psoriasis presents as ‘tear drop’, scaly papules on the trunk and limbs, while pityriasis rosea features a herald patch followed by multiple erythematous, slightly raised oval lesions.

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14
Q

What is the treatment and natural history of pityriasis rosea?

A

Pityriasis rosea is self-limiting and resolves after around 6 weeks.

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15
Q

What is psoriasis?

A

Psoriasis is a common (prevalence around 2%) and chronic skin disorder that generally presents with red, scaly patches on the skin.

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16
Q

What are the associated risks for patients with psoriasis?

A

Patients with psoriasis are at increased risk of arthritis and cardiovascular disease.

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17
Q

What is the pathophysiology of psoriasis?

A

The pathophysiology of psoriasis is multifactorial and not yet fully understood.

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18
Q

What genetic factors are associated with psoriasis?

A

Psoriasis is associated with HLA-B13, -B17, and -Cw6, with a strong concordance (70%) in identical twins.

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19
Q

What immunological factors contribute to psoriasis?

A

Abnormal T cell activity stimulates keratinocyte proliferation, potentially mediated by Th17 cells producing IL-17.

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20
Q

What environmental factors can affect psoriasis?

A

Psoriasis may be worsened (e.g., skin trauma, stress), triggered (e.g., streptococcal infection), or improved (e.g., sunlight) by environmental factors.

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21
Q

What is plaque psoriasis?

A

Plaque psoriasis is the most common subtype resulting in well-demarcated red, scaly patches affecting the extensor surfaces, sacrum, and scalp.

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22
Q

What is flexural psoriasis?

A

Flexural psoriasis presents with smooth skin, in contrast to the scaly patches of plaque psoriasis.

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23
Q

What is guttate psoriasis?

A

Guttate psoriasis is a transient psoriatic rash frequently triggered by a streptococcal infection, characterized by multiple red, teardrop lesions.

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24
Q

What is pustular psoriasis?

A

Pustular psoriasis commonly occurs on the palms and soles.

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25
Q

What are some nail signs associated with psoriasis?

A

Nail signs include pitting and onycholysis.

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26
Q

What are the complications of psoriasis?

A

Complications include psoriatic arthropathy (around 10%), increased incidence of metabolic syndrome, cardiovascular disease, venous thromboembolism, and psychological distress.

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27
Q

What factors may exacerbate psoriasis?

A

The following factors may exacerbate psoriasis: trauma, alcohol, drugs (beta blockers, lithium, antimalarials such as chloroquine and hydroxychloroquine, NSAIDs, ACE inhibitors, infliximab), and withdrawal of systemic steroids.

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28
Q

What type of infection may trigger guttate psoriasis?

A

Streptococcal infection may trigger guttate psoriasis.

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29
Q
A
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30
Q

What guidelines were released for psoriasis management?

A

NICE released guidelines in 2012 on the management of psoriasis and psoriatic arthropathy.

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31
Q

What is the recommended approach for chronic plaque psoriasis management?

A

NICE recommends a step-wise approach for chronic plaque psoriasis.

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32
Q

What is the first-line treatment for chronic plaque psoriasis?

A

A potent corticosteroid applied once daily plus a vitamin D analogue applied once daily for up to 4 weeks.

33
Q

What should be done if there is no improvement after 8 weeks of first-line treatment?

A

Offer a vitamin D analogue twice daily.

34
Q

What are the options if there is no improvement after 8-12 weeks of treatment?

A

Either a potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily.

35
Q

What is the treatment of choice for phototherapy in psoriasis?

A

Narrowband ultraviolet B light, given 3 times a week.

36
Q

What is the first-line systemic therapy for psoriasis?

A

Oral methotrexate, particularly useful if there is associated joint disease.

37
Q

What are examples of biological agents used in psoriasis treatment?

A

Infliximab, etanercept, adalimumab, and ustekinumab (IL-12 and IL-23 blocker).

38
Q

What is the recommended management for scalp psoriasis?

A

Potent topical corticosteroids used once daily for 4 weeks.

39
Q

What should be done if there is no improvement in scalp psoriasis after 4 weeks?

A

Use a different formulation of the potent corticosteroid or topical agents to remove adherent scale.

40
Q

What is the management recommendation for face, flexural, and genital psoriasis?

A

Offer a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks.

41
Q

What are the risks of using topical corticosteroids in psoriasis?

A

May lead to skin atrophy, striae, and rebound symptoms.

42
Q

What is the maximum duration for using potent corticosteroids?

A

No longer than 8 weeks at a time and very potent corticosteroids for no longer than 4 weeks at a time.

43
Q

What are examples of vitamin D analogues used in psoriasis?

A

Calcipotriol (Dovonex), calcitriol, and tacalcitol.

44
Q

How do vitamin D analogues work in psoriasis treatment?

A

They decrease cell division and differentiation, leading to reduced epidermal proliferation.

45
Q

What are the adverse effects of vitamin D analogues?

A

Adverse effects are uncommon.

46
Q

What is the mechanism of action of dithranol?

A

Inhibits DNA synthesis.

47
Q

What are the adverse effects of dithranol?

A

Burning and staining.

48
Q

What is the mechanism of action of coal tar?

A

Not fully understood, probably inhibits DNA synthesis.

49
Q

What guidelines were released for psoriasis management?

A

NICE released guidelines in 2012 on the management of psoriasis and psoriatic arthropathy.

50
Q

What is the recommended approach for chronic plaque psoriasis management?

A

NICE recommends a step-wise approach for chronic plaque psoriasis.

51
Q

What is the first-line treatment for chronic plaque psoriasis?

A

A potent corticosteroid applied once daily plus a vitamin D analogue applied once daily for up to 4 weeks.

52
Q

What should be done if there is no improvement after 8 weeks of first-line treatment?

A

Offer a vitamin D analogue twice daily.

53
Q

What are the options if there is no improvement after 8-12 weeks of treatment?

A

Either a potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily.

54
Q

What is the treatment of choice for phototherapy in psoriasis?

A

Narrowband ultraviolet B light, given 3 times a week.

55
Q

What is the first-line systemic therapy for psoriasis?

A

Oral methotrexate, particularly useful if there is associated joint disease.

56
Q

What are examples of biological agents used in psoriasis treatment?

A

Infliximab, etanercept, adalimumab, and ustekinumab (IL-12 and IL-23 blocker).

57
Q

What is the recommended management for scalp psoriasis?

A

Potent topical corticosteroids used once daily for 4 weeks.

58
Q

What should be done if there is no improvement in scalp psoriasis after 4 weeks?

A

Use a different formulation of the potent corticosteroid or topical agents to remove adherent scale.

59
Q

What is the management recommendation for face, flexural, and genital psoriasis?

A

Offer a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks.

60
Q

What are the risks of using topical corticosteroids in psoriasis?

A

May lead to skin atrophy, striae, and rebound symptoms.

61
Q

What is the maximum duration for using potent corticosteroids?

A

No longer than 8 weeks at a time and very potent corticosteroids for no longer than 4 weeks at a time.

62
Q

What are examples of vitamin D analogues used in psoriasis?

A

Calcipotriol (Dovonex), calcitriol, and tacalcitol.

63
Q

How do vitamin D analogues work in psoriasis treatment?

A

They decrease cell division and differentiation, leading to reduced epidermal proliferation.

64
Q

What are the adverse effects of vitamin D analogues?

A

Adverse effects are uncommon.

65
Q

What is the mechanism of action of dithranol?

A

Inhibits DNA synthesis.

66
Q

What are the adverse effects of dithranol?

A

Burning and staining.

67
Q

What is the mechanism of action of coal tar?

A

Not fully understood, probably inhibits DNA synthesis.

68
Q

What percentage of psoriasis patients may require referral to secondary care?

A

Around 60% of patients with psoriasis will require referral to secondary care at some point.

69
Q

What are some reasons for referral to secondary care according to NICE guidance?

A

Reasons include diagnostic uncertainty, severe or extensive psoriasis, uncontrolled psoriasis with topical therapy, major impact on wellbeing, and referral of children and young people at presentation.

70
Q

What defines severe or extensive psoriasis?

A

Severe or extensive psoriasis is defined as affecting more than 10% of the body surface area.

71
Q

When should children and young people with psoriasis be referred?

A

Children and young people with any type of psoriasis should be referred to a specialist at presentation.

72
Q

When should patients with erythroderma or generalized pustular psoriasis be referred?

A

Patients with erythroderma or generalized pustular psoriasis should be referred for same day.

73
Q

What is erythroderma sometimes referred to as?

A

Erythroderma is sometimes referred to as ‘red man syndrome’.

74
Q

What is a notable symptom of erythroderma?

A

A generalised erythematous rash is a notable symptom of erythroderma.

75
Q

What is observed in patients with extensive exfoliation?

A

Extensive exfoliation is seen in patients with certain severe forms of psoriasis.

76
Q

What are the physical complications associated with psoriasis?

A

Patients with psoriasis are at an increased risk of cardiovascular disease, hypertension, venous thromboembolism, and non-melanoma skin cancer.

77
Q

What psychological complications can arise in patients with psoriasis?

A

Patients with psoriasis are at an increased risk of depression.

78
Q

What gastrointestinal diseases are associated with psoriasis?

A

Patients with psoriasis are at an increased risk of ulcerative colitis and Crohn’s disease.

79
Q

What types of cancers are patients with psoriasis at risk for?

A

Patients with psoriasis are at an increased risk of other cancers including liver, lung, and upper gastrointestinal tract cancers.

Year 6 Dermatology (16 decks)

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