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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

Describe the appearance of psoriasis

A

Chronic, immune mediated disease

Sharply demarcated erythematous plaque with micaceous (silver) scales

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2
Q

How does psoriasis develop?

A

Polygenic predisposition + AI + environmental triggers

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3
Q

What genetic factor causes early onset psoriasis?

A

HLA-Cw6 (Chromosome 6)

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4
Q

What % of psoriasis suffers have a family history of both parents having psoriasis?

A

41%

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5
Q

What % of psoriasis suffers have a family history of psoriasis?

A

35-90%

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6
Q

What % of psoriasis suffers have a family history of one parent having psoriasis?

A

14%

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7
Q

What is the psoriasis susceptibility regions?

A

Psoriasis susceptibility regions PSORS1-9

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8
Q

What genetic factors are involved in psoriasis?

A

Hereditary
Psoriasis susceptibility regions PSORS1-9
HLA-Cw6 (Chromosome 6)

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9
Q

What environmental factors are known to trigger psoriasis?

A 
–	Infection
–	Drugs e.g. beta blockers
–	Trauma – scratching can induce excoriation and lesions
–	Sunlight
 - stress
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10
Q

Describe the histology of psoriasis

A

Hyperkeratosis (thickening of stratum corneum)

Neutrophils in stratum corneum (munro’s microabcesses)

Psoriasiform hyperplasia: Acanthosis (thickening of squamous cell layer) with elongated rete ridges

Dilated dermal capillaries

T cell infiltration

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11
Q

What are munro’s microabcesses?

A

Neutrophils in stratum corneum (munro’s microabcesses) seen in psoriasis

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12
Q

What medications are linked to causing psoriasis?

A

beta blockers, Ca channel blockers

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13
Q

What are 2 emergency forms of psoriasis?

A

– Erythroderma (>80% BSA covered) – emergency situation

– Pustular psoriasis – another emergency form

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14
Q

What is seen on the skin when you examine a psoriasis patient?

A

– Sharply demarcated, erythematous, papulosquamous (elevated squamous) plaques
– Numerous small, widely disseminated papules and plaques

If >80 BSA covered or pustular, clinical emergency

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15
Q

What is seen on the nails when you examine a psoriasis patient?

A

onycholysis (separation of nail from nail bed)
pitting (most common)
oil spots

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16
Q

Describe Koebner phenomenon

A

Koebner phenomenon - appearance of lesions along a site of injury

17
Q

What is Woronoff’s ring?

A

Woronoff’s ring - blanched halo of approximately uniform width surrounding psoriatic lesions after phototherapy or topical treatments

18
Q

What type of psoriasis is often seen acutely following an infection, particularly strep infection?

A

Guttate psoriasis

19
Q

Describe chronic plaque psoriasis

A

Chronic Plaque Psoriasis: symmetrical, extensor surfaces
• Plaque psoriasis is the most common form of the disease and appears as raised, red patches covered with a silvery white buildup of dead skin cells.
• These patches or plaques most often show up on the scalp, knees, elbows and lower back. They are often itchy and painful, and they can crack and bleed.

20
Q

Describe the appearance of Guttate psoriasis

A

Small (<5mm), salmon-pink (or red) spots usually appear suddenly on the skin two to three weeks after a streptococcal infection, such as strep throat or tonsillitis. The drop-like lesions are usually itchy.

21
Q

What type of psoriasis affects the skin on the palms and soles, making them appear thick, scaly and red with yellowish brown lesions at the edges?

A

Palmo-plantar Psoriasis/pustulosis

22
Q

What type of psoriasis is often associated with smoking and sterile inflammatory bone lesions?

A

Palmo-plantar Psoriasis/pustulosis

23
Q

Describe Flexural/Inverse Psoriasis

A

o Less scaly – flexures cause constant friction so appear smoother
o Can be triggered or superinfected by localised dermatophyte, candidal or bacterial infection – these are also differential diagnoses. Makes it often confused with infections
o Sometimes called inverse psoriasis and describes psoriasis localised to the skin folds and genitals.

24
Q

What would you suspect if a patient presents with an acute onset of generalised red, tender patches, which on closer inspection of the patches multiple yellow pustules are seen?

A

Pustular Psoriasis - clinical emergency

o Sterile pustules, sometimes systemic symptoms
o Generalized so not limited to palms and soles of feet
o Linked to pregnancy, rapid taper/stop steroids, hypocalcaemia, infections
o Overlap with acute generalized exanthematous pustulosis (AGEP; pustular drug eruption reaction)

25
Q

What can trigger pustular psoriasis?

A

Linked to pregnancy, rapid taper/stop steroids, hypocalcaemia, infections

26
Q

What condition overlaps with pustular psoriasis?

A

Overlaps with acute generalized exanthematous pustulosis (AGEP; pustular drug eruption reaction)

27
Q

Describe the features of Erythrodermic psoriasis

A

Patient presents feeling shivery and generally unwell.
O/E More than 80% of his body surface area is erythematous, with fine scale.
Pyrexial and has a low blood pressure.

28
Q

What are some differential diagnoses for psoriasis?

A
  • Seborrhoeic dermatitis – chronic form of eczema; red itchy skin over sebaceous glands, scaly but appear more greasy (except sebopsoriasis!)
  • Lichen planus - small, flat-topped, polygonal bumps that may coalesce into rough, scaly plaques on the skin. Very itchy
  • Mycosis fungoides - common form of cutaneous T-cell lymphoma; non-resolving psoriasis like presentation
  • Bowens disease – early sign of skin cancer, red scaly patch
  • Drug eruption – squamous rash
  • Infection
  • Secondary syphilis – small painless sores, not scaly
  • Contact dermatitis – inflammation caused by irritants
  • Extramammary pagets – adenocarcinomas secondary to primary tumours, rare
29
Q

What does a drug eruption look like?

A

Squamous rash

30
Q

What treatments for psoriasis are given from your GP?

A

o Emollients (standard) - creams or ointment
o Soap substitutes
o Vitamin D3 analogues: inhibit epidermal proliferation
o Coal Tar creams
o Topical Steroid
o Salicylic acid (keratolytic, descaling agent) – special cases with severe scaling. Used alongside other treatments

31
Q

What treatments for psoriasis are given from dermatologists?

A

o Crude Coal Tar - inpatient or day treatment; do patch test first and work up from 1-25% concentration if safe
o Dithranol: since 1916. Can burn.
o UVB Phototherapy (not the same as sunbed) – Guttate psoriasis

32
Q

What systemic treatments can be given for psoriasis?

A

• Retinoid – Acitretin: not immunosuppressive
• Immunosuppression: Methotrexate or Ciclosporin
• Biologic Therapies:
– Anti-TNF: Etanercept, infliximab, adalimumab
– IL-12, 23: Ustekinumab
– IL-17: Secukinumab

33
Q

Who is offered UVB phototherapy?

A

Guttate psoriasis

34
Q

What psoriasis drug is teratogenic, with these effects persisting for years after cessation of treatment?

A

retinoids e.g. acitretin

35
Q

What psoriasis treatment needs to be monitored as it can cause bone marrow suppression?

A

Methotrexate (immunomodulator)

36
Q

Name some anti-TNF biologics

A

Etanercept, infliximab, adalimumab

37
Q

What can be used to monitor progress of psoriasis treatment?

A

Psoriasis Area Severity Index (PASI) - most widely used tool for the measurement of severity of psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 (no disease) to 72 (maximal disease).
– Surface area, plaque colour, thickness, scale

Dermatology Life Quality Index (DLQI) – questionnaire with score out of 30, with higher score meaning the bigger the effect on QOL

38
Q

What diseases are associated with psoriasis?

A

Associated with cardiovascular disease, smoking, alcohol, the metabolic syndrome, depression, suicide, potentially harmful drug and light therapies, possibly melanoma and non-melanoma skin cancers.

Dermatology (12 decks)

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