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*Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

Describe psoriasis

A

Chronic, genetically determined, immune-mediated, inflammatory skin condition

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2
Q

What is psoriasis usually characterised by?

A

Well-defined, red, scaly plaques

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3
Q

Name the 8 types of psoriasis

A 
Chronic plaque
Flexural
Acute guttate
Scalp
Palmoplantar
Nail
Pustular
Erythrodermic
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4
Q

What is the most common type of psoriasis?

A

Chronic plaque

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5
Q

What are the 2 unstable forms of psoriasis?

A

Pustular

Erythrodermic

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6
Q

What is psoriasis caused by (pathophysiology)?

A

Overactivity of the immune system

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7
Q

Epidermal infiltration by activated T cells and excessive production of what leads to psoriasis?

A

TH1 cytokines (esp TNF-alpha - linked to flares)

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8
Q

Give the pathophysiological causes each for the erythema, and the plaques + scaling?

A

Erythema = vascular proliferation; capillary angiogenesis

Plaques + scaling = increased cell turnover

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9
Q

What are the categories for causes/triggers of psoriasis?

A 
Genetics
Environmental (stress)
Infection 
Drugs
Trauma
Sunlight (~10% it worsens; rest it helps)
Cigs/alcohol
HIV
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10
Q

What types of infection can trigger psoriasis?

A

Strep

Candida

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11
Q

What drugs can trigger psoriasis?

A 
Lithium
ACEI
Beta-blockers
NSAIDs
Steroid withdrawal
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12
Q

What is the koebner phenomenon?

A

Development/spread of patches of psoriasis as triggered by trauma (cut, bruise, burn etc)

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13
Q

What is the usual rate of skin cell turnover vs rate in psoriasis?

A

4-5 weeks

3-5 days

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14
Q

Is there a familial component to the development of psoriasis?

A

Yeah

1 parent = 14%; both parents = 41%

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15
Q

Name some of the genes (3) thought to be associated with psoriasis?

A

HLA (human leukocyte antigens) Cw6, B13, B17

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16
Q

What are 4 terms that describe the basic histology of psoriasis? Define them?

A
  • Hyperkeratosis = thickening of stratum corneum
  • Parakeratosis = keratinocytes with nuclei in stratum corneum
  • Hypogranulosis = nogranular layer
  • Psoriasiform hyperplasia = acanthosis (thickening of squamous cell) with elongated rete ridges
17
Q

What are the neutrophils in stratum corneum in psoriasis histology called?

A

Munro’s microabscesses

18
Q

What is the appearance of capillaries in psoriasis histology?

A

Dilated

19
Q

What percentage of cases of psoriasis is chronic plaque?

A

90%

20
Q

What complications can occur in severe chronic plaque psoriasis?

A

Cardiovascular health impacts; psycho-social impacts

21
Q

How is chronic plaque commonly managed?

A

Topical treatments in primary care setting

22
Q

How is guttate psoriasis usually developed?

A

Post-viral; usually self-limiting

23
Q

What does guttate respond well to?

A

Phototherapy

24
Q

What can guttate develop into?

A

Chronic plaque

25
Q

Which type of psoriasis has been shown to have the greatest effect on patients quality of life?

A

Palmo-plantar

26
Q

What is a differential diagnosis for scalp psoriasis?

A

Seborrheic dermatitis

Psoriasis scales are usually thicker/drier and tend to extend more beyond the scalp

27
Q

Give the 2 pathognomic features of nail psoriasis?

A
  1. Pitting

2. Oncholysis

28
Q

What is a distinctive feature of flexural/inverse psoriasis?

A

Lack of scales - just red, sharply demarcated plaque often at skin folds e.g. armpits

29
Q

Describe the appearance of pustular psoriasis

A

Generalised red, tender patches with multiple small yellow pustules

30
Q

How would you describe a patient who presented with a long history of chronic plaque, with a recent flareup and generalised erythema of the skin with fine scale along with pyrexia and low BP?

A

Erythrodermic psoriasis

31
Q

What is erythrodermic psoriasis also known as?

A

‘Red Man Syndrome’ - >90% body surface involved

32
Q

Where should erythrodermic psoriasis be managed?

A

Hospital

33
Q

Give 3 differentials for psoriasis

A 
Seborrhoeic dermatitis (esp scalp, face)
Lichen planus (check forearm, oral mucosa)
Mycosis fungoides (older PT, sudden onset - biopsy)
34
Q

Give the first line treatment plan for psoriasis

A 
Topical steroids (flexural/genital area)
Vit D3 analogues (calcioptriol) +/- steroids
Tar creams
\+ Emollients (to smooth skin)
\+ Salicylic acid (to remove plaques)
35
Q

Give the 2nd line treatment for psoriasis

A

Dithranol/Anthralin - slower onset of action and has various side effects e.g. staining of skin/clothes and cant be applied to face/genitals

36
Q

Give some 3rd line options for psoriasis treatment

A
  • UVB Phototherapy
  • Acitretin (teratogenic, impairment of LFTs/lipids)
  • Methotrexate (also for joint/nail involvement, improvement in 2-3 months)
  • Cyclosporin
  • Inpatient Tar (crude coal tar in zinc ointment)
  • Biologics - qualifying criteria, cost
  • Retinoids, immunosuppressants
37
Q

What is the treatment plan for ERYTHRODERMIC psoriasis

A

ADMIT
Fluid balance
Bloods/IV access
Thick greasy ointment emollients

38
Q

What are the 2 criteria for monitoring of psoriasis

A

PASI (psoriasis area severity index)

DMQI (dermatology life quality index) - more general

39
Q

In what percent of psoriasis patients does it progress to arthritis?

A

5-10%

*Dermatology (11 decks)

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