Psoriasis Flashcards

1
Q

what is psoriasis

A

Chronic autoimmune disease characterised by well-demarcated, erythematous, scaly plaques

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2
Q

Psoriasis precipitating factors

A
  • Emotional stress
  • Trauma (koebner phenomenon)
  • Alcohol and smoking
  • Infection - strep throat
  • Drugs - β-blockers, lithium, anti malarial drugs, swift withdrawal of topical or systemic steroids (‘rebound’ psoriasis)
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3
Q

Psoriasis histological features

A

Parakeratotic stratum corneum
Absence of granular layer
Expanded prickle cell layer
Large capillaries in papillary dermis
Munro microabscesses (leukocytes) in stratum corneum

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4
Q

UV light implications in psoriasis

A

Can be used as treatment but can made psoriasis worse in 10% patients

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5
Q

Psoriasis pathophysiology

A
  • Keratinocytes experience stress (environmental factors)
  • They release factors to stimulate plasmacytoid DC (dermis)
    • pDC produce IFN⍺, release cytokines
    • pDC migrate to lymph nodes & activate Th cells
  • Activated Th cells cause an inflammatory cascade in dermis
  • Attraction of neutrophils in the keratin layer
    • forms munro micro abscesses in stratum corneum
  • This results in keratinocyte proliferation
    • hyperkeratosis & parakeratotic stratum corneum
    • expanded prickle cell layer (^ keratinocyte turnover)
    • loss of granular cell layer (loss of normal maturation)
  • Dermal fibroblasts also become involved
    • this contributes to the inflammation
    • this contributes to abnormal keratinocyte proliferation
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6
Q

Describe chronic plaque psoriasis

A

This is the commonest type and causes symmetrical plaques on the extensor surfaces of the limbs (knees + elbows), scalp and lower back

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7
Q

Describe the plaques in psoriasis

A

Plaques are palpable, red & scaly with well defined edges and a raised silvery scale

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8
Q

What is auspitz’s sign

A

removing scale reveals pin-point bleeding

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9
Q

What is koebner phenomenon

A

psoriasis that develops in an area of trauma e.g. scratches, burns, surgical trauma

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10
Q

What is guttate psoriasis - what causes it & how does it present

A

Multiple small, tear-drop shaped, erythematous plaques occur on the trunk after around 7-10 days of Streptococcal infection in young adults

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11
Q

Guttate psoriasis treatment

A

Usually self limiting
If regularly occurring (emollients, topical tar, phototherapy)

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12
Q

Scalp psoriasis treatment

A
  • Olive oil
  • Tar shampoos
  • Coconut oil
  • Dovobet scalp, enstillar foam
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13
Q

Flexural psoriasis - location & appearance

A

•Psoriasis in groin, axillae or inframammary areas
•Shiny, red, well-demarcated plaques
•Scale not a prominent feature
•Is colonised by candida infections

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14
Q

What can flexural psoriasis be misdiagnosed as

A

Can be confused with fungal infection or intertrigo (skin fold dermatitis)

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15
Q

Flexural psoriasis treatment

A

Mild topical steroid / antifungal preparations e.g. Trimovate® cream, Canesten HC® cream

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16
Q

What is palmoplantar psoriasis

A

Psoriasis on palms and/or soles
Presents with very thick hyperkeratosis & painful fissuring

17
Q

Palmoplantar psoriasis treatment

A

– topical tar preparations
–salicylic acid
–topical steroids
–phototherapy
–systemic immunosupressants

18
Q

Palmoplantar pustulosis - clinical features & risk factors

A

Sterile yellow pustules fading to brown macules (palms/ feet)
Strong association with cigarette smoking

19
Q

What is erythrodermic psoriasis

A

Dermatological emergency with >90% of skin surface red & scaly that usually occurs in patients with known or deteriorating psoriasis.

20
Q

Erythrodermic psoriasis aetiology

A

withdrawal of potent topical or systemic steroids, drug reactions, ultraviolet burns

21
Q

Erythrodermic psoriasis presentation

A

> 90% of skin surface red
With systemic symptoms

22
Q

Erythrodermic psoriasis complications

A

hypothermia, cardiogenic shock, dehydration, anaemia, hypoproteinaemia

23
Q

Erythrodermic psoriasis treatment

A

fluid balance, bed rest, emollients, systemic immunosupressants

24
Q

Pustular psoriasis clinical features

A

•Generalised
•Painful skin, fever, malaise
•Sterile pustules

25
What three blood changes are frequently associated with pustular psoriasis
Hypoalbuminaemia, hypocalcaemia and leucocytosis
26
Pustular psoriasis aetiology
withdrawal of steroids, infection, pregnancy, hypocalcaemia
27
Pustular psoriasis treatment
bed rest, emollients, monitor for infection, fluid balance, monitor protein, systemic immunosupressants
28
Name some psoriatic nail changes
–Nail pitting –Onycholysis –“oil-drop” lesions –Sub-ungal hyperkeratosis –Nail deformity
29
Psoriatic arthritis patterns
–Asymmetric oligoarthritis (60-70%) –Symmetrical polyarthritis (15%) –Distal phalangeal joint disease (5%) –Destructive arthritis (arthritis mutilans – 5%) –Axial arthritis (5%) (spondylitis / sacroiliitis)
30
Psoriasis 1st line
Topical treatment! - Emollients (soften plaques) - Tar preparations (reduce cell turnover) - Vitamin D analogues (reduce cell turnover) - Salicylic acid (softens keratin/ removes hyperkeratosis) - Topical steroids (slowly thins down plaques)
31
Why are potent topical steroids not used
risk of rebound flare-up (erythroderma, pustular psoriasis)
32
Psoriasis 2nd line
Phototherapy
33
Phototherapy acute side effects
–Erythema –Blistering –Photoconjunctivitis –Exacerbation of Herpes Simplex
34
Phototherapy chronic side effects
–Photoageing –Photocarcinogenesis
35
Psoriasis last line
Systemic therapies - Methotrexate (immunosuppressant) - Ciclosporin (immunosuppressant, quick but short term) - Retinoids (vitamin A derivative, teratogenic, blood monitor) - Biologics