Psoriasis Flashcards
What is psoriasis?
Inflammatory skin disorder
Increased turnover of skin
Red clay plaques
Chronic, relapsing
Where is psoriasis most common?
most commonly extensor surfaces and scalp
How common is psoriasis?
2% of population radical variation affects men and women equally
What are the two age groups of onset?
late teens to early 20s, earlier in females 50s
Describe the histology of psoriasis?
Acanthosis - thickening of epidermis Munro micro abscesses Elongation of retention ridges Suprapapillary thinning Dilated papillary blood vessels
What are the causes of psoriasis?
Genetic and environmental
FH
HLA-CW6
What are the aggravating factors for psoriasis?
streptococcal throat infection medications - beta blockers, lithium, antimalarials stress alcohol and cigarettes trauma, friction (sunlight)
What are the different types/presentations of psoriasis?
Chronic plaque psorasis Palmoplantar psoriasis Flexural psoriasis Guttate psoriasis Erythrodermic psoriasis Pustular psoriasis
Describe chronic plaque psoriasis
salmon pink patches and plaques well demarcated silverly scales extensor surfaces symmetrical
What nail changes are seen in chronic plaque psoriasis?
Pitting
Onycholysis
Subungal hyperkeratosis
What is Koebner phenomenon?
Tendancy for a skin condition to occur within scars or sites of trauma
What is palmoplantar psoriasis?
Psoriasis of the hands and feet
What is flexural psoriasis?
Psoriasis affecting flexed areas
What is guttate psoriasis?
more common in children/adolescents raindrop lesions on skin with acute streptococcal infection
How long does guttate psoriasis take to resolve?
Self-resolving (months)
May precede chronic plaque psorasis
What is erythodermic psoriasis?
more that 90% body surface area affected
Uncommon
How does erythodermic psoriasis present?
Most likely to have preceding history of psoriasis
May not have other features of psoriasis
May be systemically ill
What is pustular psoriasis - palmoplantar?
Common in females / adults
associated with smoking
symmetrical pattern
Describe acute generalised pustular psoriasis?
Rare
patient may be systemically unwell sheets of pustules with background erythema
What precipitates generalised pustular psoriasis?
steroid withdrawal
What other condition is associated with psoriasis?
10% have arthritis
Arthritis can be with psoriasis or preceding/succeeding it
What is the peak age of psoriatic arthropathy onset?
40-60 years
What are the other systemic problems associated with arthritis?
CV RFs
Metabolic syndrome
Psychological
Joint disease
What are the symptoms patients experience with psoriasis?
pain
itch
bleed
What is the emotional effect of having psoriasis?
self confidence
feelings of shame and uncleanliness
What are the different ways to manage psoriasis?
Education
topical treatment
Photo therapy
Systemic treatment
What is the first line in managing psoriasis?
Topical treatment
What are the various topical treatments available?
Emollients e.g. E45 Vitamin D3 analogues Topical corticosteroids e.g. Eumovate Keratolytics e.g. Salicylic acid Coal tarDithranol
What is the best topical treatment for thick plaques?
salicylic acid or dithranol
What is the best topical treatment for face?
mild to mod topical steroids
What is the best topical treatment for flexures?
mild to moderate topical steroids or calcitriol
What is the best treatment for guttate psoriasis?
Coal tar preparations
Also: emollients, calcitroil dovonex and hard to treat cases can be given TL01 narrowband UVB treatment
What is the second line of treatment for psoriasis?
Phototherapy UVB/TL01/UVA
What are the side effects of phototherapy?
Erythema/pruritus
Nausea (PUVA)L/T - Skin cancer
How should erythrodermic psoriasis generalised pustular psoriasis be treated?
Admission
Supportive treatment with careful monitoring of BP, temp,
Use Liberal emollients and topical steroids
Consider systemic treatment
What are the 3rd line systemic treatment?
3 main ones
Methotrexate
Ciclopsporin
Acitretin
When should methotrexate be used?
Psoriasis and psoriatic arthropathy
What are the cons of using methotrexate?
long term effects on the liver do not take if high alcohol intake
When is ciclosporin be used?
short term control
What are the cautions when using ciclosporin?
hypertension
nephrotoxicity
carcinogenesis
care in HTN or past phototherapy
What are the cautions when using acitretin?
Teratogenic (2 years)
Not in young women who want to start a family
What are the side effects of methotrexate?
Teratogenicity, nausea and GI upset
Liver fibrosis, marrow suppression
What should be monitored when taking methotrexate?
LFT
FBC
What are the SEs of ciclosporin?
Hypertrichosis Gym hypertrophy Tingling peripheries Carcinogenesis Hypertension Nephrotoxicity
What should be monitored when taking ciclosporin?
BP
U&E
What are the SEs of Acitretin?
Teratogenic, dry skin and lips
Hyperlipidaemia, hepatotoxicity
What should be monitored when taking acitretin?
fasting lipids LFTs
What treatment can be used when systemic treatment fails?
Biological treatment
When do patients qualify for biological treatment?
- PASI - must score above 10 - DLQI - must score above 10 - patients must have failed on two of the systemic treatments with severe psoriasis
What are some examples of systemic treatments?
Adelimumab Ustekinumab Etanercept Secukinumab Infliximab
