Psoriasis Flashcards
What is psoriasis?
Sharply demarcated erythematous plaque with micaceous scale
Chronic imune mediated disease
How can psoriasis develop?
Polygenic predisposition + environmental triggers
What genes predispose for psoriasis?
HLA-Cw6 9 (chromosome 6)
What are the environmental triggers of psoriasis?
Infection
Trauma
Drugs
Sunlight
What is the pathogenesis of psoriasis?
Keratinocytes become stressed
Activation of dermal dendritic cells (dDCs)
dDCs travel to lymph nodes and present antigen to naive T cells
Interleukins and TBF alpha amplify inflammatory cascade, stimulate keratinocyte proliferation
Angiogenesis
Cell cycle reduced from 28 to 3-5 days
What is found in the histology of psoriasis
Hyperkeratosis Neutrophils in stratum corneum dilated dermal capillaries T cell infiltration Acanthosis
What examination should be completed for psoriasis?
Skin (Erythroderma, pustules)
Nails (Onocholysis, pitting, oil spots)
Scalp
What is Koebner phenomenon?
Surgery scar line can erupt in patient weeks after procedure who has psoriasis
What is the appearance of chronic plaque psoriasis?
Symmetric
Extensor surfaces
What can trigger guttate psoriasis?
Viral or bacterial infections
Who is commonly affected by guttate psoriasis?
Children and adolescents
What areas of the body does palm-plantar psoriasis affect?
Palms and soles
What can palms-plantar psoriasis be associated with?
Smoking
Sterile inflammatory bone lesions
What is a consequence of scalp psoriasis?
Alopecia
What can trigger flexural/inverse psoriasis?
Localised dermatophyte, candidate or bacterial infection
What is the appearance of pustular psoriasis?
Sterile pustules, sometimes systemic symptoms
What can pustular psoriasis associated with?
Pregnancy
Rapid stop of steroids
Hypocalcaemia
Infection
What is erythrodermic psoriasis also known as?
Red man syndrome
What is the differential diagnosis of psoriasis?
Seborrhagic dermatitis Lichen planus Mycosis fungoides Bowens disease Secondary syphillis Contact dermatitis
What is the treatment for psoriasis by GP?
Emollients Soap substitutes Vitamin D3 analogues Coal tar creams Topical steroid Salicylic acid
What treatments for psoriasis are managed by dermatologists?
Crude coal tar
Dithranol
UVB phototherapy
What are the systemic treatments for psoriasis?
Retinoid (Acitretin)
Immunosuppression (ciclosporin, methotrexate)
Biologic therapies
What is the treatment for eyrthrodermic psoriasis?
Admission
Fluid balance
Bloods/ IV access
Thick greasy ointment emollients
What is used to monitor the progress of psoriasis?
Psoriasis Area Severity Index (PASI)
Dermatology Life Quality Index (DLQI)
