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Year 2 - Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is psoriasis

A

Chronic, genetically determined, immune-mediated, inflammatory skin condition, usually characterised by well defined, scaly, plaques

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2
Q

Clinical features of psoriasis (describe the characteristics)

A

Lesions are red, inflamed, silvery-white scaly, and circumscribed papules and plaques;

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3
Q

Causative factors of psoriasis (7)

A

Genetics - strong predisposition

Immunology - overactive immune system, excessive production of cytokines

Infection - strep, candida

Environmental trigger

Drug induced - lithium, beta blockers

Trauma

Sunlight

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4
Q

Pathophysiology of psoriasis

A

hyperproliferation involving a complex cascade of inflammatory mediators (excessive production of TH1 cytokines)
-causing basal and suprabasal cells to excessively divide and migrate from the basal layer to the stratum corneum in just a few days compared to normal turnover of 28 days

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5
Q

What cytokines are involved mediating psoriasis

A

TH1 cytokines, esp TNF-alpha

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6
Q

Histological features of psoriasis

A

Hyperkeratosis (thickened stratum corneum)

Parakeratosis (keratinocytes with nuclei in stratum corneum)

Neutrophils in stratum corneum

Hypogranulosis - no granular layer (needed as a physical barrier)

Acanthosis (thickening of squamous cell layer)

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7
Q

What infiltrating cells can be seen on histology of psoriasis

A

T cells

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8
Q

Subtypes of psoriasis

A 
Chronic plaque - commonest
Flexural
Acute Guttate
Scalp
Palmoplantar
Nail
Pustular
Erythrodermic
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9
Q

Clinical features of chronic plaque psoriasis

  • characteristics of plaque
  • where it’s found
A

Raised inflamed thick plaque lesions with a superficial silvery-white scaly eruption

Legs/back/knee/elbow/foot/scalp

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10
Q

Commonest subtype of psoriasis

A

chronic plaque

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11
Q

Psoriasis can have implications on what organ system

A

Cardio

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12
Q

Clinical features of guttate psoriasis

  • characteristics of lesions
  • where the lesions are found
A

Widespread, erythematous, fine, scaly papules (water drop appearance)
-on trunk, arms, and legs

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13
Q

Guttate psoriasis onset is usually acute or chronic

A

Acute

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14
Q

Lesions due to guttate psoriasis often erupt following a period of what

A

upper resp infection, e.g. throat infection

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15
Q

1st line treatment of guttate psoriasis

A

phototherapy

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16
Q

Several months’ history of a rash on her hands and feet, she works as a masseuse.
Examination - skin on pass and soles appear thick, scaly, red with yellowish brown lesions at the edges

What’s the diagnosis

A

Palmo-plantar psoriasis

17
Q

A 14 year old boy presents with an acute onset of a generalized eruption.
O/E he has 2-5 mm multiple salmon colour papules with a fine scale worse on the trunk and proximal extremities.
On direct questioning his mother says that he has had a throat infection 2-3 weeks prior to the rash

Diagnosis?

A

Guttate psoriasis

18
Q

54 year old male presents with a 15 year history of scaly plaques on both elbows. Over the last few months the rash has spread to involve large areas of his body

O/E he has large salmon coloured plaques on his arms, legs and back with thick scale

Diagnosis?

A

Chronic plaque psoriasis

19
Q

27 year old lady presents to your clinic complaining of severe dandruff; starting to spread to face as well.

O/E you note thick hyperkeratotic plaques in the scalp with some pitting of the nails. She also has 2 small plaques of scaly rash on the cheeks

Diagnosis

A

Scalp psoriasis

20
Q

Scalp psoriasis can be confused with what other condition which commonly causes dandruff as well

A

Seborhoeic dermatitis

21
Q

Clinical features of nail psoriasis (2)

A
  1. Pitting

2. Onycholysis

22
Q

36 year old patients presents to you complaining of several months history of RASH IN ARMPITS. He has been treated with topical and oral anti-fungal agents in the past with out any benefit

O/E you note shiny pink to red sharply demarcated plaque with NO SCALING

Diagnosis?

A

Flexural/inverse psoriasis

23
Q

Flexural psoriasis lacks what feature most forms of psoriasis have

A

scaling

24
Q

50 year old lady presents with an ACUTE onset of generalised red, tender patches.

On closer inspection of the patches multiple yellow PUSTULES are seen

Diagnosis?

A

Pustular psoriasis (unstable acute emergency)

25
Q

67 year old patient with 35 years history of chronic plaque psoriasis.

Psoriasis started to flare up he was prescribed 2 weeks course of oral prednisolone.

He presents 4 weeks after that feeling generally unwell.

O/E He has generalized erythema of the skin with fine scale. He is pyrexial and has low blood pressure

Diagnosis?

A

Erythrodermic psoriasis (red man syndrome)

26
Q

Diagnosis of the different subtypes of psoriasis is based on just what

A

‘typical’ presentation

27
Q

INITIAL treatment of psoriasis/ treatment of mild psoriasis (7)

A

Emollients

Topical vitamin D3 analogues (calcipotriol) - inhibits epidermal proliferation - IMPORTANT

Topical steroids - IMPORTANT

Tar creams

Salicyclic acid

Dithranol ointment - slows down the process of skin cell production; applied only to the psoriasis plaques and not to normal healthy skin
-inhibits DNA replication in these cells

Anthralin ointment - slows down growth of skin cells

28
Q

If initial treatment (emollients, vitamin D3 analogues, topical steroids etc) of psoriasis fails, then what options are considered next (5)

A

UVB phototherapy
Oral retinoid - acitretin
Methotrexate - immunosuppressant
Biologics - e.g. adalimumab

29
Q

1st line treatment of pustular psoriasis

A

Oral retinoid

30
Q

1st line treatment of erythrodermic psoriasis

A

Ciclosporin (immunosuppressant) or biologics (inflixmab, adalimumab)

31
Q

Emergency treatment of erythrodermic psoriasis (3) then 1st line treatment after that

A

IV fluids - electrolyte and fluid balance
IV access
Emollient - ointment

1st line - immunosuppressant (cyclosporine) or biologic

32
Q

What monitoring systems can be used to monitor severity of psoriasis (2)

A

Psoriasis Area Severity Index (PASI)

Dermatology life quality index (DLQI)

33
Q

Psoriasis Area Severity Index (PASI) can be used to monitor severity of psoriasis - what 4 characteristics of the condition does it consider

A

Body area, redness, thickness, scaling

Year 2 - Dermatology (10 decks)

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