psoriasis

Question 1

in what age groups does psoriasis present?

Answer 1

2nd/3rd decade and the 6th decade of life

Question 2

what are some precipitating factors of psoriasis

Answer 2

trauma (koebner phenomena)
infection (tonsilitis)
drugs (beta blockers, lithium)
stress & alcohol

Question 3

describe the presentation of plaque psoriasis

Answer 3

• well demarcated erythematous scaly plaques
• lesions can be itchy, burning or painful
• common on extensor surfaces and scalp

Question 4

what is ausptiz sign?

Answer 4

scratch and gentle removal of scales cause capillary bleeding

Question 5

what non-skin clinical features may present?

Answer 5

• nail changes (pitting, onycholysis)

- psoriatic arthropathy

Question 6

how might guttate psoriasis present?

Answer 6

raindrop lesions on torso and limbs, usually self- limiting

Question 7

how does flexural psoriasis present?

Answer 7

well demaracted shiny red lesions in flexures- often mistaken for fungal infections but symmetrical and self-limiting

Question 8

how does sebopsoriasis present?

Answer 8

• red lesion with silver scale in naso-labial distribution or retro auricular

Question 9

NICE guidelines first line management (aside from emollient and soap substitutes)

Answer 9

1. potent corticosteroid and vitamin D analogue applied once daily 4/52

Question 10

second and third line treatment for psoriasis

Answer 10

if no improvement in 8 weeks offer vitamin D analogue BD

if no further improvement in 8-12wks offer potent corticosteroid BD for 4/52

Question 11

what is secondary care management of psoriasis

Answer 11

1. systemic therapy- methotrexate, ciclosporin, oral retinoids, biological agents
2. phototherapy (UVA, UVB)

Question 12

what are side effects of phototherapy

Answer 12

redness itching and initial worsening of psoriasis

hyperpigmentation scars

Question 13

when to refer to secondary care?

Answer 13

diagnostic uncertainty
patient request
failure to respond/adverse reaction after 3/12 of topical therapy
acute unstable psoriasis
generalised pustular psoriasis