Psoriasis Flashcards
What is psoriasis?
Chronic
Genetically determined
Immune mediated
Inflammatory skin condition
How is psoriasis characterised?
Well defined scaly plaques
Who is typically affected by psoriasis?
<20, 50s
White
M=F
Family history
5% of psoriasis patients have a chance of developing what?
Psoriatic arthritis
Psoriasis is associated with what?
Metabolic syndrome
Systemic disease
How does psoriasis typically appear?
Red scaly plaques
Symmetrical distribution
Chronic plaque
What causes psoriasis?
Genetics Overactive immune system Excess TH1 cytokines Vascular proliferation Increased cell turnover
What causes erythema?
Vascular proliferation
What causes plaques/scaling?
Increased cell turnover
Which infections are associated with psoriasis?
Strep
Candida
Which drugs are associated with psoriasis?
Lithium
Beta blockers
NSAIDs
Steroid withdrawal
What is the Koebner phenomenon?
Skin lesions in response to trauma
What is the parent association with psoriasis?
1 parent - 14%
2 parents - 41%
How does psoriasis appear histologically?
Hyperkeratosis
Neutrophils in stratum corneum
Hypogranulosis
Psoriasisiform hyperplasia
How does Chronic plaque psoriasis typically present?
Scaly plaque on elbows and large areas of body
Associated with stress
How does Guttate psoriasis present?
Post-viral
Self-limiting
Salmon coloured papules with fine scale worse on trunk
How does palmo-plantar psoriasis present?
Psoriasis on palms and soles
Massive psychosocial impact
How does nail psoriasis present?
Pitting and Onycholysis of nails
How does flexural/inverse psoriasis present?
Armpits/flexures
Lack of scale
How does pustular psoriasis present?
Red tender patches with yellow pustules
How does erythrodermic psoriasis present?
‘Red man’ syndrome
>90% body
Generalised erythema
Systemic unwellness
How do you diagnose psoriasis?
Clinical presentation
Atypical - biopsy
How does Lichen planus present?
Forearm
Oral mucosa
How does mycosis fungoides present?
Older Pt
Sudden onset of plaques
Treatment resistant plaques
How is psoriasis treated?
Vitamin D3 analogues never with steroids
Salicylic acid
How are scales treated in psoriasis?
Salicylic acid (keratolytic)
What are the second line therapies for psoriasis?
Immunotherapies Methotrexate Cyclosporin Inpatient tar Biologics
What must be considered with cyclosporin?
Risk:
Renal impairment
Cancer
How is erythrodermic psoriasis treated?
Admission
Fluids
Bloods/IV access
Thick ointments
What prognosis is associated with psoriasis?
Men -3.5y
Women -4.5y
Progression → arthritis
CVD, metabolic Sx, lymphoma
How is psoriasis monitored?
PASI (Psoriasis Area Severity Index)
DLQI (Dermatology Life Quality Index)
Name all 6 of psoriasis
Guttate Flexural Pustular Palmo-plantar Erythrodermic Chronic plaque
