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Derm > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is psoriasis?

A

Inflammatory skin disorder
Increased turnover of skin
Red clay plaques
Chronic, relapsing

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2
Q

Where is psoriasis most common?

A

most commonly extensor surfaces and scalp

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3
Q

How common is psoriasis?

A

2% of population radical variation affects men and women equally

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4
Q

What are the two age groups of onset?

A

late teens to early 20s, earlier in females 50s

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5
Q

Describe the histology of psoriasis?

A 
Acanthosis - thickening of epidermis 
Munro micro abscesses 
Elongation of retention ridges 
Suprapapillary thinning 
Dilated papillary blood vessels
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6
Q

What are the causes of psoriasis?

A

Genetic and environmental
FH
HLA-CW6

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7
Q

What are the aggravating factors for psoriasis?

A 
streptococcal throat infection 
medications - beta blockers, lithium, antimalarials 
stress
alcohol and cigarettes 
trauma, friction (sunlight)
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8
Q

What are the different types/presentations of psoriasis?

A 
Chronic plaque psorasis 
Palmoplantar psoriasis 
Flexural psoriasis 
Guttate psoriasis 
Erythrodermic psoriasis 
Pustular psoriasis
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9
Q

Describe chronic plaque psoriasis

A 
salmon pink patches and plaques 
well demarcated 
silverly scales 
extensor surfaces 
symmetrical
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10
Q

What nail changes are seen in chronic plaque psoriasis?

A

Pitting
Onycholysis
Subungal hyperkeratosis

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11
Q

What is Koebner phenomenon?

A

Tendancy for a skin condition to occur within scars or sites of trauma

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12
Q

What is palmoplantar psoriasis?

A

Psoriasis of the hands and feet

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13
Q

What is flexural psoriasis?

A

Psoriasis affecting flexed areas

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14
Q

What is guttate psoriasis?

A

more common in children/adolescents raindrop lesions on skin with acute streptococcal infection

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15
Q

How long does guttate psoriasis take to resolve?

A

Self-resolving (months)

May precede chronic plaque psorasis

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16
Q

What is erythodermic psoriasis?

A

more that 90% body surface area affected

Uncommon

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17
Q

How does erythodermic psoriasis present?

A

Most likely to have preceding history of psoriasis
May not have other features of psoriasis
May be systemically ill

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18
Q

What is pustular psoriasis - palmoplantar?

A

Common in females / adults
associated with smoking
symmetrical pattern

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19
Q

Describe acute generalised pustular psoriasis?

A

Rare

patient may be systemically unwell sheets of pustules with background erythema

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20
Q

What precipitates generalised pustular psoriasis?

A

steroid withdrawal

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21
Q

What other condition is associated with psoriasis?

A

10% have arthritis

Arthritis can be with psoriasis or preceding/succeeding it

22
Q

What is the peak age of psoriatic arthropathy onset?

A

40-60 years

23
Q

What are the other systemic problems associated with arthritis?

A

CV RFs
Metabolic syndrome
Psychological
Joint disease

24
Q

What are the symptoms patients experience with psoriasis?

A

pain
itch
bleed

25
Q

What is the emotional effect of having psoriasis?

A

self confidence

feelings of shame and uncleanliness

26
Q

What are the different ways to manage psoriasis?

A

Education
topical treatment
Photo therapy
Systemic treatment

27
Q

What is the first line in managing psoriasis?

A

Topical treatment

28
Q

What are the various topical treatments available?

A

Emollients e.g. E45 Vitamin D3 analogues Topical corticosteroids e.g. Eumovate Keratolytics e.g. Salicylic acid Coal tarDithranol

29
Q

What is the best topical treatment for thick plaques?

A

salicylic acid or dithranol

30
Q

What is the best topical treatment for face?

A

mild to mod topical steroids

31
Q

What is the best topical treatment for flexures?

A

mild to moderate topical steroids or calcitriol

32
Q

What is the best treatment for guttate psoriasis?

A

Coal tar preparations

Also: emollients, calcitroil dovonex and hard to treat cases can be given TL01 narrowband UVB treatment

33
Q

What is the second line of treatment for psoriasis?

A

Phototherapy UVB/TL01/UVA

34
Q

What are the side effects of phototherapy?

A

Erythema/pruritus

Nausea (PUVA)L/T - Skin cancer

35
Q

How should erythrodermic psoriasis generalised pustular psoriasis be treated?

A

Admission
Supportive treatment with careful monitoring of BP, temp,
Use Liberal emollients and topical steroids
Consider systemic treatment

36
Q

What are the 3rd line systemic treatment?

3 main ones

A

Methotrexate
Ciclopsporin
Acitretin

37
Q

When should methotrexate be used?

A

Psoriasis and psoriatic arthropathy

38
Q

What are the cons of using methotrexate?

A

long term effects on the liver do not take if high alcohol intake

39
Q

When is ciclosporin be used?

A

short term control

40
Q

What are the cautions when using ciclosporin?

A

hypertension
nephrotoxicity
carcinogenesis
care in HTN or past phototherapy

41
Q

What are the cautions when using acitretin?

A

Teratogenic (2 years)

Not in young women who want to start a family

42
Q

What are the side effects of methotrexate?

A

Teratogenicity, nausea and GI upset

Liver fibrosis, marrow suppression

43
Q

What should be monitored when taking methotrexate?

A

LFT

FBC

44
Q

What are the SEs of ciclosporin?

A 
Hypertrichosis 
Gym hypertrophy 
Tingling peripheries 
Carcinogenesis 
Hypertension 
Nephrotoxicity
45
Q

What should be monitored when taking ciclosporin?

A

BP

U&E

46
Q

What are the SEs of Acitretin?

A

Teratogenic, dry skin and lips

Hyperlipidaemia, hepatotoxicity

47
Q

What should be monitored when taking acitretin?

A

fasting lipids LFTs

48
Q

What treatment can be used when systemic treatment fails?

A

Biological treatment

49
Q

When do patients qualify for biological treatment?

A
  • PASI - must score above 10 - DLQI - must score above 10 - patients must have failed on two of the systemic treatments with severe psoriasis
50
Q

What are some examples of systemic treatments?

A 
Adelimumab
Ustekinumab 
Etanercept 
Secukinumab 
Infliximab

Derm (10 decks)

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