Psoriasis

Question 1

What is psoriasis?

Answer 1

Chronic, immune mediated disease

Question 2

What are the 2 classes of psoriasis?

Answer 2

Type 1- runs in families and is early onset

Type 2- related to autoimmune conditions and environmental triggers and an older population

Question 3

What causes psoriasis?

Answer 3

Polygenic predisposition and environmental truggers

Question 4

What are the environmental triggers of psoriasis?

Answer 4

Infection
Drugs
Trauma
Sunlight

Question 5

What is the appearance of psoriasis?

Answer 5

Sharply demarcated erythematous plaque with micaceous scale

Question 6

What part pf the immune system os psoriasis associated with?

Answer 6

Adaptive immune system

Question 7

What is the pathogenesis of psoriasis?

Answer 7

Stressed keratinocytes cause activation of dermal dendritic cells (dDC) via interleukins and TNFa
dDC= travel to lymph nodes and activate naive T cells to T helper cells that target skin and cause psoriatic dermic and plaque formation
IL and TNFa= amplify inflammatory cascade and stimulate keratinocyte proliferation
High serum VEGF caused angiogenesis
Cell cycle is reduced from 28 to 3-5 days

Question 8

What is the histology of psoriasis?

Answer 8

Hyperkeratosis
Neutrophils in stratum corneum
Psoriasform hyperplasia
Dilated dermal capillaries
T cel infiltration

Question 9

What i hyperkeratosis seen as histologically?

Answer 9

Thickening of stratum corneum

Question 10

What is psoriasform hyperplasia seen as histologic;ly?

Answer 10

Thickening of squamous cell layer

Question 11

What history should be taken for psoriasis?

Answer 11

Age and nature of onset
Distrubution
Effective treatments
Medical history
Family history
Medications
Quality of life

Question 12

What are the signs and symptoms of psoriasis?

Answer 12

Sharply demarcated, erythematous plaques
Numerous small, widely disseminated papule ad plaques
Erythroderma
Nail pitting and oil spots, onycholysis
Koebner phenomenon
Woronoff's ring

Question 13

What is Koebner phenomenon?

Answer 13

Lesions along area of injury

Question 14

What is Woronoff’s ring?

Answer 14

Blanched halo around lesions after phototherapy

Question 15

What are the types of psoriasis?

Answer 15

Chronic plaque psoriasis
Guttate psoriasis
Palmo-plantar psoriasis
Scalp psoriasis
Nail psoriasis
Plexural/inverse psoriasis
Pustular psoriasis
Erythrodermic psoriasis

Question 16

What is the appearance oc chronic plaque psoriasis?

Answer 16

Large salmon coloured plaques with thick scale

Symetric, extensor surfaces

Question 17

What is the trigger of guttate psoriasis?

Answer 17

Viral or bacterial infection

Question 18

Who is guttate psoriasis seen in?

Answer 18

Children and adolescents

Question 19

Wha is the appearance of guttate psoriasis?

Answer 19

Multiple pink papule with fine scale

Question 20

What are the possible outcomes of guttate psoriasis?

Answer 20

REsolve

Trigger chronic psoriasis

Question 21

What is palm-plantar psoriasis associated with?

Answer 21

SMoking

Question 22

What is the appearance of palmo-plantar psoriasis?

Answer 22

Thick, scaly and red with yellow/brown lesions at the edges

Question 23

What is the appearance of scalp psoriasis?

Answer 23

Alopecia at affected areas
Pink hyperkeratotic plaques
Severe dandruff

Question 24

What is the appearance of nail psoriasis?

Answer 24

Pitting or oil spots on nails

Question 25

What is the issue with nail psoriasis?

Answer 25

Difficult to treat

Question 26

What is the appearance of flexural psoriasis?

Answer 26

Skin pink or red sharply demarcated plaques | Less scaly

Question 27

What triggers flexural psoriasis?

Answer 27

Localised dermaphyte, candida or bacterial infection

Question 28

What is th appearance of pustular psoriasis?

Answer 28

Sterile pustules and generalised red tender patches | Sometimes systemic symptoms

Question 29

What are the triggers of pustular psoriasis?

Answer 29

Pregnancy Rapid tapering or stopping steroids Hypoglycaemia Infection

Question 30

What is the appearance of erythrodermic psoriasis?

Answer 30

Red man syndrome >80% body surface involved- erythematous with fine scale Hypotensive and pyrexial

Question 31

What is the differential diagnosis for psoriasis?

Answer 31

Seborrhoeic dermatitis Lichen planus Mycosis fungoides

Question 32

What is the treatment of psoriasis in primary care?

Answer 32

``` Emollients Soap substitutes Vit D analogues Coal tar creams Topica steroid Salicylic acid ```

Question 33

What is the treatment of psoriasis in dermatology?

Answer 33

Crude coal tar Dithranol UVB phototherapy

Question 34

What is the systemic treatment of psoriasis?

Answer 34

Retinoid Immunosuppression Biologics

Question 35

What immunosuppressants are used in psoriasis?

Answer 35

Methotrexate | Ciclosporin

Question 36

What is the treatment of erythrodermic psoriasis?

Answer 36

``` Admit FLuid balance Bloods Thick greasy ointment/emollient Systemic treatment ```