Psoriasis Flashcards
What is it?
A chronic autoimmune inflammatory rash characterised by well defined red patches with adherent thick silvery scale.
Typically the patch is symmetrical.
It’s not contagious
Reference: AFP article Psoriasis
How common is it?
When can it present?
1-4% of the population
15-20 year age group and 55-60 year age group (Ref: How to Treat MCQ:Psoriasis)
What % have a comorbidity and what are these?
73%
Metabolic syndrome HTN T2DM inflammatory bowel (crohn's not UC) Arthritis Lymphoma Depression
What are drugs causing worsening of psoriasis?
Beta Blocker
NSAIDS
Lithium
What is a life threatening but less common ddx for psoriasis?
What’s another ddx of psoriasis that does not heal?
T cell tumour of the skin -
if psoriasis worsens or is isolated
Bowen’s disease
What are some nail changes which occur with Psoriasis?
Onycholysis (lifting of the nail, pitting)
Subungal hyperkeratosis
Which factors can exacerbate psoriasis?
smoking
poor diet
lack of exercise
certain meds
What is onycholysis?
lifting of the nail plate from the nail bed
1/What’s Guttate Psoriasis?
2/ Mx?
(Ref AFP)
1/ Typically this presents in the teens or early 20s a
week or so after a streptococcal sore throat.
There may be a florid outbreak of small plaques, especially on the trunk and proximallimbs
2/ refer early for UV treatment as it responds quickly (ref. Dr Koh, itches and stitches workshop)
Management of Psoriasis
Non pharmacological
Try not to itch/scratch
Have quick showers that are not too hot
Weekly or more regularly bath with bath oil or oatmeal
Use soap free body was
Regular Moisturiser
Pharmacological
Topical steroids (for 3-4 weeks)
betamethasone 0.05% or mometasone 0.1% ointment at
night OR betamethasone + Calcipotriol combination
(Daivobet) For one month
If the response is partial, add another agent.
Calcipotriol 0.05% cream BD (Daivonex) Upto 100g can
be used/day without affecting serum calcium levels)
Diathranol 1% + Salicylic acid 1%
Tar Creams - smelly and messy
Prompts for referral.
1/ extensive psoriasis
2/psoriasis not responding to treatment
3/psoriasis causing impairment in function or severe distress
4/diagnostic uncertainty
5/associated arthropathy
6/ rapidly progressive/erythrodermic psoriasis.
What is Calcipotriol?
What’s the treatment value in psoriasis?
Calcipotriol is a vitamin-D derivative, about 1% as powerful as the natural hormone calcitriol (also known as 1,25 dihydroxycholecalciferol).
Decreases the thick scaly nature, but psoriasis can often remain red
% of patients with psoriasis have arthritis?
40% (ref: how to treat quizz)
Medications that exacerbate psoriasis?
Lithium Indomethacin Chloroquine NSAIDs, and Beta-blockers. (ref: bmj on examination)
