Psoriasis

Question 1

What are the ages of the peak incidences of psoriasis?

Answer 1

20s and 50s

Question 2

Is psoriasis more common in males or females?

Answer 2

Males -=females

Question 3

What is the aetiology of psoriasis?

Answer 3

polygenic redistribution + environmental triggers

genetics
infection
drugs
trauma
sunlight

Question 4

What are the systemic diseases associated with psoriasis?

Answer 4

Psoriatic arthritis
Physio social complications
Metabolic syndrome

Question 5

what drugs can cause psoriasis?

Answer 5

NSAIDS
lithium
beta blockers
steroid withdrawal

Question 6

what is the pathogenesis of psoriasis?

Answer 6

overactivity of the immune system
excessive production of Th1 cytokines including TNF alpha
increased epidermal cell proliferation and turnover
capillary angiogenesis

Question 7

describe some of the features in the histology of psoriasis.

Answer 7

hyperkeratosis (thickening of stratum coreneum)
parakeratosis (keratinocytes with nuclei in stratum corneum)
neutrophils in stratum corneum
hypogranulosis
psorasiform hyperplasia: acanthuses (with elongated retentions ridges)
T cell infiltration
dilated dermal capillaries

Question 8

what does psoriasis plaques look like?

Answer 8

red and scaly
well defined edges
often symmetrical distribution

Question 9

what are the different subtypes of psoriasis?

Answer 9

chronic plaque 
flexural / inverse psoriasis 
scalp 
nails 
guttate 
palmo-plantar/ pustulosis 
erythrodermic psoriasis

Question 10

what can trigger guttate psoriasis and what age is it commonly found?

Answer 10

viral or bacterial infection

children/adolescence

Question 11

what treatment does guttate psoriasis respond well to?

Answer 11

phototherapy

Question 12

what is a differential diagnosis of scalp psoriasis and how would you differentiate the two?

Answer 12

seborrhoeic dermatitis

scalp psoriasis extends below the hairline

Question 13

what 2 features are found in nail psoriasis?

Answer 13

pitting onycholysis

Question 14

what can trigger flexural / inverse psoriasis?

Answer 14

localised dermatophyte (fungal)
candida
bacterial infection

Question 15

what is erythrodermic psoriasis?

Answer 15

red man syndrome

> 80% of body is involved

Question 16

what are differential diagnoses of psoriasis?

Answer 16

seborrhoeic dermatitis
lichen plants
mycosis fungicides
bowens disease

Question 17

what is the initial treatments for psoriasis?

Answer 17

emollients
vitamin D3 analogue 
tar creams
topical steroids
salicylic acid

Question 18

what are the 2nd line treatments for psoriasis?

Answer 18

UVB phototherapy
retinoids i.e. Acitretin
methotrexate
cyclosporin biologics i.e. infliximab, adalimuab

Question 19

what is the teatment for erythrodermic psoriasis?

Answer 19

fluid balance
blood / IV access
thick greasy ointment emollients

Question 20

how do you monitor progress of psoriasis ?

Answer 20

PASI -Psoriasis area severity index

dermatology life quality index (DLQI)

Question 21

what complications is psoriasis associated with?

Answer 21

CV disease
arthritis 
metabolic syndrome 
depression 
possibly melanoma and non melanoma skin cancers