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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is psoriasis?

A

an inflammatory skin disorder

where you get an increased turnover of the skin

due to an increase in keratinocyte proliferation

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2
Q

What is the classical morphology in psoriasis?

A

Red scaly plaques

on extensor surfaces and scalp

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3
Q

How long does psoriasis usually last?

A

It has chronic relapsing course that usually lasts the lifetime of the pt

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4
Q

Is psoriasis normally biopsied?

A

No as the Dx is normally clinically evident

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5
Q

What are the 6 types of psoriasis?

A

Chronic plaque psoriasis (most common)

Palmo-plantar psoriasis

Flexural psoriasis

Guttate psoriasis

Erythrodermic psoriasis

Pustular psoriasis subtypes:

1) Palmoplantar
2) Generalised

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6
Q

What nail changes are associated with psoriasis?

A

Pitting

Onycholysis

Subungal hyperkeratosis

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7
Q

What is onycholysis?

A

When the distal end of the nail seems to be lifting up from the nail bed

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8
Q

What is subungal hyperkeratosis?

A

when there is a lot of keratin debris underneath the distal end of the nail

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9
Q

In which age groups is guttate psoriasis more common?

A

Children and adolescents

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10
Q

What is the course of guttate psoriasis?

A

tends to resolve by itself

over several months but

sometimes can persist for much longer

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11
Q

What are the common causes of erythroderma?

A

eczema

drug reactions

(erythroderma caused by psoriasis is fairly rare + will usually precede the erythroderma)

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12
Q

Why can erythrodermic psoriasis be hard to diagnose?

A

As it may not have the red scalyness of the plaques.

It is unlikely however to present as the pts first experience of psoriasis

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13
Q

What other symptoms is a pt likely to have with erythrodermic psoriasis and why?

A

Systemically unwell as the inflamed skin causes loss of:

heat,

protein and

fluid

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14
Q

What is the commoner variety of pustular psoriasis?

A

Palmoplantar pustular psoriasis

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15
Q

Who does palmoplantar pustular psoriasis occur more in, M or F?

A

females more often get palmoplantar pustular psoriasis

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16
Q

What risk factor is palmoplantar pustular psoriasis associated with?

A

Smoking

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17
Q

What normally precedes generalized pustular psoriasis?

A

Chronic plaque psoriasis

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18
Q

Which two types of psoriasis are commonly associated with being systemically unwell?

A

erythrodermic psoriasis

and

generalized pustular psoriasis

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19
Q

What are the systemic complications of severe psoriasis?

A

psoriatic arthritis (10%)

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20
Q

What age group is psoriatic arthritis most common in?

A

40-60 yr olds

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21
Q

What are the types of psoriatic arthritis?

A

mono-articular -> affects 1 or 2 large joints

the distal interphalangeal joints

arthritis mutilans -> all the small joints of the hands affected

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22
Q

Give some aggravating factors for psoriasis?

A

Streptococcal throat infections

beta blockers

lithium

antimalarials

stress

alcohol + smoking

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23
Q

What usually makes psoriasis better?

A

Sunlight

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24
Q

What are the four steps of psoriasis management?

A

1st line - education

1st line - topical treatment

2nd line - phototherapy

3rd line - systemic treatment

(4th line - biological agents)

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25
Q

Can psoriasis be “cured”?

A

No

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26
Q

What are the first line topical therapies for psoriasis? (with examples)

A

Emollients (E45)

Vitamin D3 analogues (Calcipotriol)

Topical corticosteroids (Eumovate)

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27
Q

For thicker plaques in psoriasis what topical treatments can be used? (with examples)

A

Keratolytics (5% Salicylic acid, similar in structure to aspirin)

Dithranol (dithrocream)

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28
Q

What is the downside to dithranol (dithrocream)?

A

Tends to leave a brown staining of the skin

29
Q

What type of topical treatment is first line for treating widespread psoriasis? (with examples)

A

Coal tar (Carbo-Dome)

30
Q

What type of topical treatment is first line for guttate psoriasis? (with examples)

A

Coal tar (Carbo-Dome)

31
Q

Which topical treatments can cause local irritation?

A

vitamin D derivatives

coal-tar

keratolytics (Salicylic Acid)

32
Q

What are the side-effects with coal-tar topical treatment?

A

It can cause local irritation

Can cause occlusion folliculitis

33
Q

How should topical treatment to the face be altered?

A

DO NOT use strong steroids, use:

mild (1% Hydrocortisone)

to

Moderate steroids (Eumovate)

34
Q

How long can mild to moderate steroids be used on the face?

A

Up to several weeks

35
Q

What topical treatments can be used for scalp psoriasis?

A

Coal Tar shampoo

Vitamin D analogues in the form of scalp applications

or

Topical steroids in the form of scalp applications

36
Q

What treatment strategy can be used for psoriasis in the flexures?

A

Same as for the face:

DO NOT use strong steroids, use:

mild (1% Hydrocortisone)

to

moderate steroids (Eumovate)

37
Q

What are the two main types of phototherapy?

A

UVB

PUVA (psoralen UVA)

38
Q

How long does UVB phototherapy last?

A

3 times a week

for about 7 weeks

39
Q

What is UVB phototherapy particularly useful for?

A

Guttate psoriasis

40
Q

What is the procedure for PUVA light therapy?

A

The skin is sensitised with psoralens either

tablets or in a solution (for bathing)

this occurs 2 hours before exposure to

UVA

41
Q

What are the side-effects of phototherapy?

A

Erythema (like sunburn)

Pruritus

(nausea from psoralen tablets)

42
Q

Which type of phototherapy has a higher risk of skin cancer?

A

PUVA (but only after multiple courses)

43
Q

What are the main systemic treatments for psoriasis?

A

1) Methotrexate
2) Cyclosporin
3) Acitretin
(4) Biological agents)

44
Q

How often is methotrexate taken?

A

once per week

45
Q

What is methotrexate good for?

A

Joints and the skin

46
Q

What is methotrexate bad for? (who can it not be used in)

A

The liver (thus cannot be used in alcoholics)

47
Q

What monitoring should be done with methotrexate?

A

FBC

LFT’s

48
Q

For how long can cyclosporin be used and why?

A

1-2 years as it has long-term side-effects

49
Q

What are the side effects of cyclosporin?

A

HTN

Nephrotoxicity

Increased risk of skin cancers

50
Q

When should cyclosporin be used with caution?

A

If pt has HTN, as it can cause this

If pt has had previous phototherapy as both increase the risk of skin cancer

51
Q

What should the pt have monitored if they are on cyclosporin?

A

BP

U+E’s

52
Q

What are the side-effects of acitretin? (who tolerates it better)

A

dry skin and dry lips (elderly tolerate it better)

teratogenicity (effects last for max 2 years after stopping drug)

53
Q

What should be monitored in acitretin?

A

Fasting lipids

LFTs

54
Q

When should biological agents be used in psoriasis?

A

In severe cases where all other treatments have failed

55
Q

What are the biological agents available? (what are they)

A

Infliximab (TNF-α antagonists)

Etanercept (TNF-α antagonists)

Efalizumab (a humanized monoclonal antibody)

56
Q

Which biological agents are given I.V.?

A

Infliximab

57
Q

Which biological agents are given subcutaneously?

A

Etanercept +

Efalizumab

58
Q

How does Efalizumab work?

A

It is a humanized monoclonal antibody

which by blocks

T-cell activation

and migration

59
Q

What do erythrodermic psoriasis and generalized pustular psoriasis have in common?

A

They both often cause systemic symptoms and need admitting for these.

60
Q

What is often the treatment for erythrodermic psoriasis and generalized pustular psoriasis?

A

Supportive treatment:

1) BP monitoring
2) Temp monitoring
3) Urine output monitoring

For the skin:

1) Greasy emolients
2) Potent topical steroids

(3) Systemic steroids if severe enough)

61
Q

How common is psoriasis?

A

2% of the population have it

62
Q

Which gender is more commonly affected by psoriasis?

A

M=F

63
Q

What are the two age groups who commonly get psoriasis?

A

early 20’s and 50’s

64
Q

What phenomena can psoriasis exhibit?

A

Kõebner phenomena

65
Q

What normally precedes guttate psoriasis?

A

Acute streptococcal infection

66
Q

What proportion of the body is covered in erythrodermic psoriasis?

A

more than 90%

67
Q

What can precipitate generalised pustular psoriasis?

A

Steroid withdrawal

68
Q

What does the rash in generalised pustular psoriasis look like?

A

Background of erythema with sheets of pustules

Dermatology (11 decks)

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