Psoriasis

Question 1

What is psoriasis?

Answer 1

Chronic
Genetically determined
Immune mediated
Inflammatory skin condition

Question 2

How is psoriasis characterised?

Answer 2

Well defined scaly plaques

Question 3

Who is typically affected by psoriasis?

Answer 3

<20, 50s
White
M=F
Family history

Question 4

5% of psoriasis patients have a chance of developing what?

Answer 4

Psoriatic arthritis

Question 5

Psoriasis is associated with what?

Answer 5

Metabolic syndrome

Systemic disease

Question 6

How does psoriasis typically appear?

Answer 6

Red scaly plaques
Symmetrical distribution
Chronic plaque

Question 7

What causes psoriasis?

Answer 7

Genetics
Overactive immune system 
Excess TH1 cytokines
Vascular proliferation
Increased cell turnover

Question 8

What causes erythema?

Answer 8

Vascular proliferation

Question 9

What causes plaques/scaling?

Answer 9

Increased cell turnover

Question 10

Which infections are associated with psoriasis?

Answer 10

Strep

Candida

Question 11

Which drugs are associated with psoriasis?

Answer 11

Lithium
Beta blockers
NSAIDs
Steroid withdrawal

Question 12

What is the Koebner phenomenon?

Answer 12

Skin lesions in response to trauma

Question 13

What is the parent association with psoriasis?

Answer 13

1 parent - 14%

2 parents - 41%

Question 14

How does psoriasis appear histologically?

Answer 14

Hyperkeratosis
Neutrophils in stratum corneum
Hypogranulosis
Psoriasisiform hyperplasia

Question 15

How does Chronic plaque psoriasis typically present?

Answer 15

Scaly plaque on elbows and large areas of body

Associated with stress

Question 16

How does Guttate psoriasis present?

Answer 16

Post-viral
Self-limiting
Salmon coloured papules with fine scale worse on trunk

Question 17

How does palmo-plantar psoriasis present?

Answer 17

Psoriasis on palms and soles

Massive psychosocial impact

Question 18

How does nail psoriasis present?

Answer 18

Pitting and Onycholysis of nails

Question 19

How does flexural/inverse psoriasis present?

Answer 19

Armpits/flexures

Lack of scale

Question 20

How does pustular psoriasis present?

Answer 20

Red tender patches with yellow pustules

Question 21

How does erythrodermic psoriasis present?

Answer 21

‘Red man’ syndrome
>90% body
Generalised erythema
Systemic unwellness

Question 22

How do you diagnose psoriasis?

Answer 22

Clinical presentation

Atypical - biopsy

Question 23

How does Lichen planus present?

Answer 23

Forearm

Oral mucosa

Question 24

How does mycosis fungoides present?

Answer 24

Older Pt
Sudden onset of plaques
Treatment resistant plaques

Question 25

How is psoriasis treated?

Answer 25

Vitamin D3 analogues never with steroids

Salicylic acid

Question 26

How are scales treated in psoriasis?

Answer 26

Salicylic acid (keratolytic)

Question 27

What are the second line therapies for psoriasis?

Answer 27

Immunotherapies 
Methotrexate
Cyclosporin
Inpatient tar
Biologics

Question 28

What must be considered with cyclosporin?

Answer 28

Risk:
Renal impairment
Cancer

Question 29

How is erythrodermic psoriasis treated?

Answer 29

Admission
Fluids
Bloods/IV access
Thick ointments

Question 30

What prognosis is associated with psoriasis?

Answer 30

Men -3.5y
Women -4.5y
Progression → arthritis
CVD, metabolic Sx, lymphoma

Question 31

How is psoriasis monitored?

Answer 31

PASI (Psoriasis Area Severity Index)

DLQI (Dermatology Life Quality Index)

Question 32

Name all 6 of psoriasis

Answer 32

Guttate
Flexural
Pustular
Palmo-plantar
Erythrodermic 
Chronic plaque