Psoriasis (2)

Question 1

What is this?

What is the most common type in adults?
→ What does it look like?

What is the most common type in children?
→ What does it look like?
→ How does it often present?

What are the other 2 rare, severe types?

Answer 1

➊ Chronic autoimmune condition characterised by well-demarcated, erythematous, scaly plaques

➋ Plaque
→ Thickened erythematous plaques with silver scales, commonly seen on extensors and scalp

➌ Guttate
→ Many small, raised papules across trunk and limbs, which can become scaly over time. Over time, the papules turn into plaques,
→ Often triggered by step throat infection, stress or medications, and resolves spontaneously within 3-4 months

➍ • Pustular – Rare, severe form – Pustules form under areas of erythematous skin and pt becomes systemically unwell
• Erythrodermic – Rare, severe form – Extensive erythematous inflamed areas covering most of skin. Skin comes away in large parches, leaving raw exposed areas.

Question 2

What is it often triggered by in children?

What are the specific signs suggestive of psoraisis?

What are the nail changes that occur?

What are other associations with this condition?

Answer 2

➊ Strep throat infection

➋ • Residual pigmentation – Of skin after lesions resolve
• Auspitz sign – Small points of bleeding when plaques are scraped off
• Koebner phenomenon – Development of psoriatic lesions to areas that have been affected by trauma

➌ Pitting, thickening, discolouration, ridging, onycholysis

➍ • Psoriatic arthritis – Occurs in 10-20% of pts
• Anxiety and Depression

Question 3

Management:
What are the aims of management?

What are the options?

Answer 3

➊ Chronic plaque type is characterised by inflammation and hyperproliferation of keratinocytes (scales), therefore treated with steroids and vit D (reduce keratinocyte proliferation)

➋ • Topical steroids
• Topical Vit D analogues (calcipotriol)
• Topical Dithranol
• Topical Calcineurin inhibitors (Tacrolimus)
• Phototherapy with narrow band UVB light