Psoriasis

Question 1

What is psoriasis caused by? (2)

Give examples of each.

Answer 1

Genetics, e.g.

• PSORS 1-19 (chromosome 6)
• HLA genes

Environmental factors, e.g.

• Stress
• Trauma
• Current infection
• Drugs

Question 2

List 3 examples of drugs that might provoke psoriasis.

Answer 2

Beta blockers
Antimalarials
Lithium

Question 3

Describe the clinical features of psoriasis. (4)

Answer 3

Salmon pink plaques with silvery scale (hyperkeratosis)

Nail changes, e.g.

• Onycholysis
• Nail pitting
• Subungual hyperkeratosis

Question 4

Describe the distribution of skin plaques in psoriasis. (4)

Answer 4

Scalp (including ears)
Extensor surfaces (e.g. elbows)
Axillary area
Genital area

Question 5

Describe the pathophysiology of psoriasis. (3)

Answer 5

1. T cell mediated autoimmune disease
2. Psoriasis results in abnormal infiltration of T cells in the skin, causing:
   a. Release of inflammatory cytokines (e.g. IFN, IL, TNF)
3. This causes proliferation of keratinocytes (hyperkeratosis)

Question 6

List 5 types of psoriasis.

Briefly describe what each one looks like.

Answer 6

Plaque psoriasis
Guttate psoriasis (tear drop)
Pustular psoriasis
Erythrodermic psoriasis (inflam and erythema on 90+% body surface)
Palmar/plantar pustulosis

Question 7

Which 2 types of psoriasis may present with an acutely unwell patient?

Which type is technically not psoriasis? Why is it grouped with the others anyway?

Answer 7

ACUTELY UNWELL PATIENTS:
Pustular psoriasis
Erythrodermic psoriasis

NOT PSORIASIS:
Palmar/plantar pustulosis (BUT acts like psoriasis/responds to psoriasis treatment)

Question 8

List 4 conditions which are associated with psoriasis.

Answer 8

Psoriatic arthritis
Metabolic syndrome
Liver disease/alcohol misuse
Depression

Question 9

List 5 possible types of psoriatic arthritis.

Answer 9

Asymmetrical inflammatory arthritis
Symmetrical polyarthritis
Predominant distal interphalangeal joint arthritis
Psoriatic spondylitis
Arthritis mutilans

Question 10

List 3 conditions included in the metabolic syndrome.

Answer 10

Cardiovascular disease
Hypercholesterolaemia
Diabetes

Question 11

How would you manage psoriasis? (3)

Answer 11

Assessment of severity
Topical treatments
Systemic treatments

Question 12

List 6 types of topical treatment for psoriasis.

Answer 12

Moisturisers
Topical steroids
Vitamin D analogues (e.g. calcitriol, calcipotriole)
Coal tar
Topical retinoids (e.g. acitretin, tazarotene)
Phototherapy light treatment

Question 13

List 5 types of systemic treatment for psoriasis.

Answer 13

Immunosuppression (e.g. methotrexate, cyclosporine)
Oral retinoids (e.g. acitretin)
Hydroxycarbamide
Fumaric acid esters
Biologic therapy (e.g. infliximab, etanercept, adalumimab)

Question 14

List 4 methods of assessing severity of psoriasis.

Answer 14

% body area affected
DQLI (dermatology quality of life index)
PASI (psoriasis area severity index)
PEST (psoriasis epidemiology screening tool)

Question 15

Describe the classification of severity of psoriasis according to % body area affected.

Answer 15

Mild: <3%
Moderate: 3-10%
Severe: 10+%