Psoriasis

Question 1

What are the complications of psoriasis?

Answer 1

Nail changes
Psoriatic arthropathy (5%) - including arthritis mutilans
Psychological and social effects
Erythroderma

Question 2

What is meant by guttate psoriasis?

Answer 2

Presents with salmon pink drop shaped scaly plaques 2-3 weeks after a strep throat infection/ URTI
Typically on the trunk and limbs
Usually resolves after a few months

Question 3

What are the key descriptive features of chronic plaque psoriasis?

Answer 3

Well demarcated silver scaled plaques on an erythematous background
Bilateral symmetrical pattern
Common on the scalp and extensor surfaces
Plaques are typically >3cm

Question 4

What nail changes can be seen with psoriasis?

Answer 4

Nail pitting
Loss of the nail
Discolouration
Onycholysis (separation of the nail from the nail bed)

Question 5

What is the most common type of psoriasis?

Answer 5

Chronic plaque psoriasis

Question 6

Which drugs exacerbate psoriasis?

Answer 6

Alcohol
B-blockers
ACE inhibitors
NSAIDs
Lithium
Anti-malarials

Question 7

What is the NICE management of psoriasis?

Answer 7

Reduce exacerbations (e.g reduce alcohol)
Emollients (reduce scale and relieve itch)
Topical steroids (potent TCS - do not use for more than 8 weeks at a time)
Topical vitamin D preparation - can be used for long term management
Review response to treatment after 4 weeks

Question 8

What are the features of psoriatic arthritis?

Answer 8

Dactylitis (sausage-like swelling of fingers)
Enthesis (inflammation of Achilles tendon)
Involvement of DIPJs

Question 9

What strength of steroids to use in psoriasis?

Answer 9

Scalp + body = potent
Facial psoriasis = mild potency

Question 10

What are the side effects of topical steroids?

Answer 10

• Skin atrophy
• Skin depigmentation
• Increased hair growth