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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What is psoriasis and what causes

A

Chronic autoimmune disease due to hyper proliferation epidermis - keratinocytes and inflammatory cell infiltration
Genetic - HLA B13/17 / FH
Immune
Environment

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2
Q

What are environmental relations of psoriasis

A

Improved sunlight

Worsened
Infection - strep throat
Trauma  - Koebner phenomena 
Stress
Withdrawal steroid - can cause pustular 
IBD 
HIV 
Alcohol
BB
Lithium
NSAID
ACEI
Quinine
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3
Q

What is the pathophysiology of psoriasis

A

Hyperproliferative epidermis causing abnormal build up and thickening
Stressed keratinocytes (due to trigger) + lymphocytes interact
Activation of dendritic cells by IL + TNF-A
Cause proliferation of keratinocyte + inflammation
Dendritic cells present antigen to T cell
VEGF = Angiogenesis and neovascularisation
T cells and neutrophils infiltrate
Cell cycle reduced from 28 days to 5

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4
Q

What is needed to diagnose psoriasis

A

Neutrophils

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5
Q

What does the histology show

A 
Thick stratum corneum = hyperkeratosis 
Neutrophils in stratum
Dilated capillaries
T cell infiltration 
Psoriasiform hyperplasia
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6
Q

What are the 3 types of psoriasis

A

Type 1 = early onset - 20-30 (most common)
Type 2 = elderly
Type 3 = systemic

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7
Q

What is systemic associated with

A 
Psoriatic arthritis = 30% - screen using PEST 
CVS disease
VTE
Increased risk of metabolic syndromes
Psychosocial implications
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8
Q

What are S+S of psoriasis

A 
Symmetrical
Favour extensor - elbows, knee, scalp 
Sharp demarcated erythematous plaque
Silvery scale
Dry 
Well defined edge 
Raised and rough plaques 
Numerous widely disseminated papule and plaque
Can have itch + pain 
Nail changes
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9
Q

What happens if psoriasis on skin folds e.g. anal area / breast

A

No scale forms

Can be misDx as yeast infection

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10
Q

What are the types of psoriasis

A 
Chronic plaque = most common 
Guttate = 
Flexural (inverse) 
Pustular (palmo-plantar) 
Scalp
Nail
Arthritic
Erythrogermic
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11
Q

What is chronic plaque psoriasis

A

Symmetric well demarcated plaques
Silvery scale
Affects extensor surfaces

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12
Q

Who is guttate psoriasis common in and what triggers

A

Children
Viral or bacterial
Typically strep throat 2-4 weeks prior
Raindrop lesions

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13
Q

What should you do

A

Check ASO titre - usually high
Treat if symptmati
No routine use of Ax

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14
Q

How does it present and what is outcome

A

Numerous small psoriatic tear drop lesions / papules
May resolve within 3-4 months
May trigger chronic and turn into plaques

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15
Q

How do you Rx

A

Most resolve
Topical Rx as per psoriasis
YVB

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16
Q

How does flexural present

A

Non scaly and smooth
Often confused with fungal as affects moist areas
Systemic fever

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17
Q

What triggers flexural

A 
Dermatophyte / candida
Bacterial 
Pregnancy
Withdrawal of steroids
Hypocalcaemia
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18
Q

How do you Rx

A

Combined steroid + anti-fungal to cover

19
Q

How does pustular present

A 
Thick scaly skin on palms and soles
Pustules on hands and feet under skin 
Rapid erythema
Systemically unwell - fever / elevated WCC 
Koebner
20
Q

How do you Rx

A

Very resistant
Need to act quickly with systemic Rx
Medical emergency so admit to hospital

21
Q

How does scalp psoriasis present

A

Pink hyperkeratotoic plaque

Thick adherent scales

22
Q

What can it cause

A

Alopecia

23
Q

What are nail signs in psoriasis

A

Pitting = most common
Onycholysis - separation from nail bed
Luekonychia
Oil spots

24
Q

How do you Dx

A

Clinical or take culture to exclude fungal

Rarely present without psoriasis or arthritis (suggest fungal)

25
Q

What is Koebner phenomenon

A

Skin lesions / conditions which appear at site of injury or trauma

26
Q

What causes

A 
Psoriasis
Vitiligo 
Warts
Lichen sclerosus
Molluscum contagiosa
27
Q

What should you avoid in erthyrodermic psoriasis

A

Medical emergency = admit
Extensive erythematous area leading to exfoliation
Topical steroid
Can make it turn pustular

28
Q

What is main DDX

A

Red man syndrome - drug reaction to vancomycin

29
Q

How do you Dx psoriasis

A

Clinical

Skin biopsy if atypical

30
Q

What are differentials of psoriasis

A 
Seborrheic dermatitis
Lichen planus
Mycosis fungiodes
Bowen's 
Drug eruption
Paget's
Contact dermatitis
Secondary syphillis
31
Q

What is 1st line management in primary care

A

Avoid precipitating
Emollinets + soap substitute = always prescribe to reduce scale and itch
Coal tar cream
Vit D3 anaolgue + topical steroid once daily = 1st line
- Calcitriol
Increase 2x daily
Can add coal tar cream if no response
Topical dithranol if no response
Topical calcineurin inhibitor (tacrolimus) - only in adults
Salicyclic acid

32
Q

What is 2nd line management in dermatology

A

Phototherapy
UVB = 1st line and very useful in guttate
PUVA

33
Q

What is risk of UVB / PUVA

A

Skin ageing

SCC

34
Q

What is 3rd step if all else fails / pustular / systemic involvement

A

Systemic retinoid
Immunosuppression - methotrexate / ciclosporin
Biologics = final step
If children must be guided by a specialist

35
Q

What is 1st line immunosuppression

A

Methotrexate = 1st line
Ciclosporin
More helpful if arthritis

36
Q

How do you Rx erythrodermic

A 
Admit
Fluid balance
Bloods + IV access
Thick greasy ointment / emollinet
Systemic or biologics
37
Q

What scales to measure severity

A

Psoriasis Area Severity Index

Dermatology Life Quality Index

38
Q

What do they look at

A

SA
Plaque colour
Thickness
Scale

39
Q

What is psoriasis associated with

A 
CVD
- Obesity
- Hyperlipidaemia 
- Type II DM
- Hypertension 
Smoking
Alcohol
Metabolic syndrome
Depression
Suicde
40
Q

What drugs worsen

A 
BB
Lithium
NSAID
ACEI
TNF-a
Anti-malarial
41
Q

What other factors worsen

A

Trauma
Alcohol
Withdrawal of systemic steroids

42
Q

What are SE of methotrexate

A

Pulmonary and hepatic fibrosis
Myelosuppressio
Microcytic anaemia

43
Q

What must be taken with it

A

Folic acid different day

Dermatology (12 decks)

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