Psoriasis

Question 1

Psoriasis - triggers

Answer 1

smoking + alcohol
stress
beta blockers, NSAIDs + ACEis
antimalarials, lithium

Question 2

Fitzpatrick skin types

Answer 2

1 - always burns, never tans, red hair

6 - black skin

Question 3

Psoriasis - nail changes

Answer 3

Subungual keratosis - buildup of yellow keratin in the onycholysis space
Onycholysis - separation from bed
Periungual oedema
Pitting
Yellowing

Question 4

Psoriasis or eczema?

Answer 4

Eczema usually flexural

Psoriasis usually extensor

Question 5

Sunlight and psoriasis

Answer 5

Helps some, triggers others

Question 6

psoriasis - complications

Answer 6

Arthropathy
Blepharitis
Conjunctivitis
Depression
Extra lifestyle precautions - CVD + DM risk

Question 7

psoriasis - common areas for disease

Answer 7

extensor surfaces
ears + scalp
umbilicus
bum crack + genitals
toenails

Question 8

what is guttate psoriasis? any link to chronic plaque ps?

Answer 8

small pink raindrop plaques on trunk
often after strep throat
1/3 get chronic plaque ps

Question 9

what is flexural psoriasis?

Answer 9

on genitals/axillae

Question 10

what is a complication of psoriasis that requires admission?

Answer 10

erythroderma:
90% body surface, flare up
inflamed - red, hot, painful
unwell + hypotensive

Question 11

what is a psoriatic emergency? what causes it?

Answer 11

generalised pustular psoriasis

flare, red, hot, painful
pustules within the plaques
triggered by withdrawal of superpotent steroids (topical systemic)

Question 12

chronic plaque psoriasis - management

Answer 12

4wk trial:
topical corticosteroid - od
emollients - bd, diff ones for diff body parts
vitamin D analogue eg calcitrol - od
soap substitute
± shower cap, plastic occlusion overnight

review at 4wk - if improvement:
break from steroids
review 4-weekly

Question 13

topical corticosteroids - SEs + how long + often to use for

Answer 13

thinning + stretch marks, systemic if potent + on >10% body
rebound symptoms

scalp, face and flexures - max 1-4wk
v potent - max 4wk
potent - max 8wk at a time

try to have 4wk breaks

Question 14

what scoring systems can be used for assessing severity of psoriasis?

Answer 14

PASI - psoriasis area severity index (disease severity)
DLQI - dermatology life quality index (impact on QOL)
PEST - psoriatic arthritis screen

Question 15

psoriasis - extra treatments

Answer 15

step up existing treatment
coal tar
short term dithranol

phototherapy (PUVA + UVB)
methotrexate - esp good for joints
ciclosporin, systemic retinoids
biologics - etanercept, adalimumab, infliximab

Question 16

psoriasis - what are the lesions like?

Answer 16

well-dermarcated salmon pink plaques with silvery scales

Question 17

psoriasis - what is it?

Answer 17

hyperproliferation + inflammation of epidermis

inflammation of dermis

Question 18

what topical therapies are there for psoriasis?

Answer 18

emollients
keratolytic agents
coal tar + UVB
dithranol - short contact therapy
topical steroids - betamethasone ointment, calcipotriol +- betamethasone

Question 19

psoriasis - diagnosis on examination

Answer 19

extensor surfaces, scalp, navel
well-demarcated salmon pink plaques with silvery white scales
white blanching ring around plaque
nail changes

Question 20

role of vitamin D analogues eg calcitrol in psoriasis? any CIs?

Answer 20

reduce cell division - reduce scale + thickness of plaques
avoid in pregnancy
adverse effects uncommon, can be used long term, no smell/stain

Question 21

explain psoriasis

Answer 21

skin normally made + replaced every 3 to 4 weeks
in psoriasis it’s 3-7 days → build-up of skin cells → psoriatic patches
not fully understood but thought to be immune system attacking healthy skin cells