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Psoriasis Flashcards

(68 cards)

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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
Can psoriasis be "cured"?
No
26
What are the first line topical therapies for psoriasis? (with examples)
Emollients (E45) Vitamin D3 analogues (Calcipotriol) Topical corticosteroids (Eumovate)
27
For thicker plaques in psoriasis what topical treatments can be used? (with examples)
Keratolytics (5% Salicylic acid, similar in structure to aspirin) Dithranol (dithrocream)
28
What is the downside to dithranol (dithrocream)?
Tends to leave a brown staining of the skin
29
What type of topical treatment is first line for treating widespread psoriasis? (with examples)
Coal tar (Carbo-Dome)
30
What type of topical treatment is first line for guttate psoriasis? (with examples)
Coal tar (Carbo-Dome)
31
Which topical treatments can cause local irritation?
vitamin D derivatives coal-tar keratolytics (Salicylic Acid)
32
What are the side-effects with coal-tar topical treatment?
It can cause local irritation Can cause occlusion folliculitis
33
How should topical treatment to the face be altered?
DO NOT use strong steroids, use: mild (1% Hydrocortisone) to Moderate steroids (Eumovate)
34
How long can mild to moderate steroids be used on the face?
Up to several weeks
35
What topical treatments can be used for scalp psoriasis?
Coal Tar shampoo Vitamin D analogues in the form of scalp applications or Topical steroids in the form of scalp applications
36
What treatment strategy can be used for psoriasis in the flexures?
Same as for the face: DO NOT use strong steroids, use: mild (1% Hydrocortisone) to moderate steroids (Eumovate)
37
What are the two main types of phototherapy?
UVB PUVA (psoralen UVA)
38
How long does UVB phototherapy last?
3 times a week for about 7 weeks
39
What is UVB phototherapy particularly useful for?
Guttate psoriasis
40
What is the procedure for PUVA light therapy?
The skin is sensitised with psoralens either tablets or in a solution (for bathing) this occurs 2 hours before exposure to UVA
41
What are the side-effects of phototherapy?
Erythema (like sunburn) Pruritus (nausea from psoralen tablets)
42
Which type of phototherapy has a higher risk of skin cancer?
PUVA (but only after multiple courses)
43
What are the main systemic treatments for psoriasis?
1) Methotrexate 2) Cyclosporin 3) Acitretin (4) Biological agents)
44
How often is methotrexate taken?
once per week
45
What is methotrexate good for?
Joints and the skin
46
What is methotrexate bad for? (who can it not be used in)
The liver (thus cannot be used in alcoholics)
47
What monitoring should be done with methotrexate?
FBC LFT's
48
For how long can cyclosporin be used and why?
1-2 years as it has long-term side-effects
49
What are the side effects of cyclosporin?
HTN Nephrotoxicity Increased risk of skin cancers
50
When should cyclosporin be used with caution?
If pt has HTN, as it can cause this If pt has had previous phototherapy as both increase the risk of skin cancer
51
What should the pt have monitored if they are on cyclosporin?
BP U+E's
52
What are the side-effects of acitretin? (who tolerates it better)
dry skin and dry lips (elderly tolerate it better) teratogenicity (effects last for max 2 years after stopping drug)
53
What should be monitored in acitretin?
Fasting lipids LFTs
54
When should biological agents be used in psoriasis?
In severe cases where all other treatments have failed
55
What are the biological agents available? (what are they)
Infliximab (TNF-α antagonists) Etanercept (TNF-α antagonists) Efalizumab (a humanized monoclonal antibody)
56
Which biological agents are given I.V.?
Infliximab
57
Which biological agents are given subcutaneously?
Etanercept + Efalizumab
58
How does Efalizumab work?
It is a humanized monoclonal antibody which by blocks T-cell activation and migration
59
What do erythrodermic psoriasis and generalized pustular psoriasis have in common?
They both often cause systemic symptoms and need admitting for these.
60
What is often the treatment for erythrodermic psoriasis and generalized pustular psoriasis?
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
How common is psoriasis?
2% of the population have it
62
Which gender is more commonly affected by psoriasis?
M=F
63
What are the two age groups who commonly get psoriasis?
early 20's and 50's
64
What phenomena can psoriasis exhibit?
Kõebner phenomena
65
What normally precedes guttate psoriasis?
Acute streptococcal infection
66
What proportion of the body is covered in erythrodermic psoriasis?
more than 90%
67
What can precipitate generalised pustular psoriasis?
Steroid withdrawal
68
What does the rash in generalised pustular psoriasis look like?
Background of erythema with sheets of pustules

Dermatology (11 decks)

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