PSORIASIS

Question 1

what is psoriasis?

Answer 1

a chronic,non infectious, inflammatory dermatosis characterised by well demarcated erythematous plaques topped by silvery scales

Question 2

causes of psoriasis

Answer 2

genetic
trauma and excessive itching. koebner phenomenon
post infection such as streptococcal infection
stress
drugs
cigarettes and alcohol

Question 3

what types of drugs cause psoriasis

Answer 3

b blockers, lithlium, antimalarials

Question 4

pathophysiology of psoriasis

Answer 4

• decreased epidermal transit time from stratum basale to stratum corneum • shortened cell cycle of psoriatic compared to normal skin • Th1-mediated inflammatory response

Question 5

ddx of psoriasis

Answer 5

• atopic dermatitis, mycosis fungoides (cutaneous T-cell lymphoma), seborrheic dermatitis, tinea

Question 6

types of psoriasis

Answer 6

plaque, gluttate, erythrodermic, pustularm, locialised, flexural

Question 7

Psoriasis and severity index

Answer 7

score is based on: percentage of surface area involved and the severity of symptoms (erythema, infiltration, desquamation)

Question 8

drugs that cause psoriasis

Answer 8

b blockersm lithlium, corticosteriod rebound phenonmenon

Question 9

site of plaque psoriasis

Answer 9

scalp, extensor surfaces of elbows and knees, trunk (especially buttocks), nails, pressure areas

Question 10

treatment

Answer 10

If 10% total body surface area involved - Topical medications + phototherapy or systemic drugs

Question 11

topical tx of psoriasis

Answer 11

• Lubricants
• Salicylic acid 1-12%
• Tar (LCD: Liquor carbonis detergens) Calcipotriene /calitriol (Dovonex®, Vectical®)
• Betamethasone + calciprotriene (Dovobet®, Taclonex®) See above Sold as Dovobet® in Canada and Europe, sold as Taclonex® in US Corticosteroid Tazarotene (Tazorac®) (gel/cream) Retinoid derivative, decreased scaling Use on nails

Question 12

systemic tx of psoriasis

Answer 12

methotrexate
PUVA
acitretin
cyclosporine
UVB and barrow band

Question 13

Guttatte aka

Answer 13

drop like

Question 14

clinical presentation of gluttate

Answer 14

discretem scattered salmon pink scaling papules, sites: generalised, sparing palms and soles

Question 15

which type of psoriasis is usually followed after strep infections

Answer 15

gluttate

Question 16

ERYTHRODERMIC PSORIASIS

Answer 16

generalized erythema with fine desquamative scale on surface • associated symptoms: arthralgia, severe pruritus • may present in patient with previous mild plaque psoriasis • aggravating factors: lithium, β-blockers, NSAIDs, antimalarials, phototoxic reaction, infection

Question 17

management of erythrodermic psoriasis

Answer 17

hospitalization, bed rest, IV fluids, monitor fluid and electrolytes • treat underlying aggravating condition, sun avoidance • methotrexate, cyclosporine, UV, oral retinoids, biologics

Question 18

pustular psoriasis

Answer 18

sudden onset of erythematous macules and papules which evolve rapidly into pustules, very painful • can be generalized or localized to palms/soles • patient usually has history of psoriasis; may occur with sudden withdrawal from steroid therapy