Psoriasis

Question 1

What are the common examination findings?

Answer 1

Hands - Nail pitting - Nb psoriatic arthritis where they have joint destruction (dactylitis - sausage fingers) and signs of psoriasis and joint deformities

Characterstic psoriasis rash on:

Hairline

elbows and knees

Umbilicus

Palms and soles

Question 2

What is the rash like?

Answer 2

Typically

Plaques - Scaly with a silver white scale on a salmon plaque

Guttate is like teardrops and follows URTI

Question 3

What are the investigations?

Answer 3

To finish the exam i would like to - take a history and expose the whole body for rashes - Perform and MSK examination of any affected joints

Bloods - FBC, ESR (inflammation), ANA and RF

Other - X ray of the joints affected

Question 4

What are the key investigation findings?

Answer 4

Psoriatic joint destruction:

Pencil in cup

Erosions/entethesitis

Periostitis

Subluxations

Question 5

What is the treatment?

Answer 5

Conservative - Explain what it is

Medical -

• Topical emolients
• Vitamin D analogues
• Topical corticosteroids

Can proceed to

• Light therapy
• Systemic therapies eg ciclosporin