Psoriasis 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?

19
Q

What percentage of cases of psoriasis is chronic plaque?

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
Which type of psoriasis has been shown to have the greatest effect on patients quality of life?
Palmo-plantar
26
What is a differential diagnosis for scalp psoriasis?
Seborrheic dermatitis | Psoriasis scales are usually thicker/drier and tend to extend more beyond the scalp
27
Give the 2 pathognomic features of nail psoriasis?
1. Pitting | 2. Oncholysis
28
What is a distinctive feature of flexural/inverse psoriasis?
Lack of scales - just red, sharply demarcated plaque often at skin folds e.g. armpits
29
Describe the appearance of pustular psoriasis
Generalised red, tender patches with multiple small yellow pustules
30
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?
Erythrodermic psoriasis
31
What is erythrodermic psoriasis also known as?
'Red Man Syndrome' - >90% body surface involved
32
Where should erythrodermic psoriasis be managed?
Hospital
33
Give 3 differentials for psoriasis
``` Seborrhoeic dermatitis (esp scalp, face) Lichen planus (check forearm, oral mucosa) Mycosis fungoides (older PT, sudden onset - biopsy) ```
34
Give the first line treatment plan for psoriasis
``` Topical steroids (flexural/genital area) Vit D3 analogues (calcioptriol) +/- steroids Tar creams + Emollients (to smooth skin) + Salicylic acid (to remove plaques) ```
35
Give the 2nd line treatment for psoriasis
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
Give some 3rd line options for psoriasis treatment
- 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
What is the treatment plan for ERYTHRODERMIC psoriasis
ADMIT Fluid balance Bloods/IV access Thick greasy ointment emollients
38
What are the 2 criteria for monitoring of psoriasis
PASI (psoriasis area severity index) | DMQI (dermatology life quality index) - more general
39
In what percent of psoriasis patients does it progress to arthritis?
5-10%