Psoriasis Flashcards
What are the peaks of onset in psoriasis?
2nd and 5th decades
What is the pathogenesis of psoriasis?
Hyperproliferation of epidermal cells
Name some precipitating factors of psoriasis?
Emotional stress
Infection
Drugs
Alcohol
Trauma
Smoking
HIV / AIDS
What are some common histological features of psoriasis?
Parakeratotic stratum corneum
Absence of granular layer
Expanded prickle cell layer
Large capillary vessels in papillary dermis
Leucocytes
What are the most common types of psoriasis?
Chronic plaque
Guttate
Scalp
Flexural
Palmoplantar
What skin surfaces are affected by chronic plaque psoriasis?
Extensor surfaces of the knees, elbows, sacrum and the scalp
Often symmetrically
How do the plaques present in chronic plaque psoriasis?
Palpable and raised
Silvery scale look
What is Auspitz’s sign?
Pin point bleeding caused by removing a scale in chronic plaque psoriasis
What is Koebner phenomenon?
When psoriasis develops in sites of trauma, typically 2 to 6 weeks after the trauma was sustained
What is guttate psoriasis?
‘Raindrop’ psoriasis brought on by a streptococcal sore throat
Multiple small psoriatic lesions on the trunk 7 to 10 days after
What are the common features of scalp psoriasis?
Itchy
May advance past hairline onto the forehead / neck
What is flexural psoriasis?
Psoriasis in the groin, axillae or inframammary areas
What is the typical presentation of flexural psoriasis?
Shiny, red, well-demarcated plaques
Scales are not a prominent feature
What is the treatment for flexural psoriasis?
Mild topical steroid / antifungal preparations
Trimovate cream, Canesten HC cream
What is palmoplantar psoriasis?
A painful / disabling type of psoriasis that results in very thick hyperkeratosis of the hands and feet
How is palmoplantar psoriasis managed?
Topical tar preparations
Salicylic acid
Topical steroids
What is erythrodermic psoriasis?
An uncommon type of psoriasis in which >90% of the skin surface would be red
What are possible causes for erythrodermic psoriasis?
Withdrawal of potent topical / systemic steroids
Drug reactions
UV burns
What are some possible complications of erythrodermic psoriasis?
Hypothermia
Cardiogenic shock
Dehydration
Anaemia
Hypoproteinaemia
What is the treatment of erythrodermic psoriasis?
Fluid balance
Bed rest
Emollients
Systemic immunosuppressants
What are the common nail changes in psoriasis?
Nail pitting
Onycholysis
‘Oil-drop’ lesions
Sub-ungal hyperkeratosis
What can be seen in 5-10% of psoriasis patients?
Psoriatic arthritis
What are the two most common patterns of psoriatic arthritis?
Asymmetric oligoarthritis
Symmetrical polyarthritis
What is the first step of management in psoriasis?
Topical treatment - emollients, tar preparations, vit D analogues etc.
What is the second step in the management of psoriasis?
Phototherapy
What is the third step in the management of psoriasis?
Oral treatments
What is the fourth step in the management of psoriasis?
Biologic therapy
How does coal tar preparations help to treat psoriasis?
Reduces DNA synthesis and epidermal proliferation
Give examples of vitamin D analogues?
Calcipotriol (dovonex)
Calcitriol (silkis)
Why should potent topical steroids be avoided in generalised psoriasis?
Risk of rebound flare-up
What are the acute side effects of phototherapy?
Erythema
Blistering
Photoconjunctivitis
Exacerbation of Herpes Simplex
What are the chronic side effects of phototherapy?
Photoaging
Photocarcinogenesis
What are the four recognised systemic therapies used in psoriasis?
Methotrexate
Ciclosporin
Retinoids
Biologics
