Psoriasis Flashcards
Appearance of psoriasis
sharply demarcated erythematous plaque with micaceous scale
How is psoriasis a systemic disease?
psoriatic arthritis
psychosocial
metabolic syndrome - CVS
Cause of psoriasis
polygenic - HLA
environmental triggers
Environmental triggers for psoriasis
infections
drugs
trauma
sunlight
How are dermal dendritic cells activated?
interleukins, TNF alpha
stressed keratinocytes
Pathogenesis of psoriasis
DDC present to naïve T cells
Th cells –> plaque formation
What happens to the cell cycle in psoriasis?
decreased from 28 days to 3-5 days
When are neutrophils found in psoriasis?
active, pustular disease
Histology of psoriasis
hyperkeratosis
neutrophils in corneum
dilated capillaries
T cell infiltration
Things to ask in history
Age and nature of onset distribution medication history family history effective treatments QOL
Skin examination
distribution - symmetrical, extensor sharply demarcated plaques erythematous papulosquamous papules and pustules
Nails examination
onycholosis
pitting
oil spots
Name 8 types of psoriasis
erythematous palmo-plantar chronic plaque guttate scalp nail flexural/inverse pustular
Guttate psoriasis - who is effected and triggers
children, young
viral/bacterial infection
Differential diagnoses for inverse psoriasis
dermatophye, candida or bacterial infection
Causes of pustular psoriasis
pregnancy, rapid stop steroids, hypocalcaemia, infection
2 possible ways to diagnose psoriasis
clinical findings
biopsy if atypical
3 differential diagnoses for psoriasis
seborrheic dermatitis
lichen planus
mycosis fungoides
What is mycosis fungoides?
cutaneous lymphoma
Treatment of psoriasis in GP
coal tar cream emollient soap substitute vitamin D3 analogues salicylic acid topical steroids
Treating psoriasis in secondary care
Crude coal tar dithranol UVB phototherapy retinoid immunosuppression biologic therapy
Future therapies for psoriasis
targeted biologics
IL -17,20,22
kinase inhibitors
Treatment of erythodermic psoriasis
IV/blood access emollient recognise admit fluid balance systemic or biologic treatment thick greasy emollient
2 index to monitor progress
psoriasis area severity
dermatology life quality
Psoriasis area severity index factors
surface area
plaque colour
thickness
scale
Dermatology life quality index factors
QOL in last week
psoriasis prognosis
3/4 year life reduction
linked to CVD, skin cancer, depression, suicide, smoking, alcohol
