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Ned's Clinical Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

what is the most common cause of psoriasis

A

psoriasis vulgaris

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2
Q

what is the fundamental pathology of psoriasis

A

chronic inflammation

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3
Q

what triggers psoriasis and who is it triggered in

A

triggered by environmental conditions in genetically susceptible individuals

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4
Q

what can psoriasis be accompanied by

A

arthritis

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5
Q

what is the main pathophysiology of psoriasis

A

keratin cell proliferation

acanthosis - thickening of the epidermis
parakeratosis - retention of the nucleated keratinocytes in the stratum corneum

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6
Q

what releases the keratin cell and epidermal growth factors

A

dermal fibroblasts

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7
Q

what is the stratum corneum

A

the outer keratin layer of epidermis

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8
Q

when are the 2 peaks in incidence in psoriasis

A

20’s and 50’s

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9
Q

name some drugs that exacerbate psoriasis

A

B blockers, anti-malarial drugs, swift withdrawal of topical or systemic steroids

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10
Q

what can topical steroids cause when they’re stopped suddenly in psoriasis

A

they cause rebound, then pustular psoriasis

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11
Q

what does psoriasis do to the dermal blood vessels and why is this significant in its pathology

A

causes dilation and proliferation of dermal blood vessels

this makes the vessel walls leaky and allows inflammatory cells to infiltrate the dermis

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12
Q

what specific immune cell inflames and accumulate sin the dermis and epidermis

A

T cell

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13
Q

how is the plaque in psoriasis described

A

itchy, palpable, scaly and erythematous

often described as silvery

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14
Q

what is Auspitz sign

A

removing the scale causes pinpoint bleeding

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15
Q

what percentage of psoriasis patients are depressed

A

60%!

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16
Q

name 7 things that exacerbate psoriasis

A
  1. smoking and alcohol
  2. stress
  3. infections (especially streptococci)
  4. skin trauma (köbner phenomenon)
  5. drugs
  6. obesity
  7. climate
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17
Q

where does psoriasis vulgaris commonly affect

A

scalp
extensor surfaces
genitals
lumbosacral area

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18
Q

how does psoriasis vulgaris present

A

symmetrical, well defined red plaques with silvery scale on extensor surfaces

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19
Q

where does flexural psoriasis present and what is it often misdiagnosed as

A

presents in the flexural surfaces
often misdiagnosed as fungal infection due to being less scaly
however, the symmetry of the rash suggests flexural psoriasis

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20
Q

what does pustular psoriasis look like and where does it affect

A

yellow/brown pustules within plaques

it affects the palms and soles

21
Q

what nail changes are evident in psoriasis

A

pitting

onycholysis (separation from nailbed)

22
Q

what is a psoriatic arthritis and how does it present

A

it is a seronegative arthropathy

presents with swelling of entire digits and toes (dactylics)

23
Q

what genotype is often present in psoriatic arthritis

A

HLA B27

24
Q

define asymmetrical oligoathritis

A

inflammation affecting 1-4 joints in the 1st 6 months

25
Q

does sacroillititis occur in psoriatic arthritis

A

oh yeh baby

26
Q

psoriatic arthritis is rheumatoid factor +ive. yeh?

A

no - psoriatic arthritis is Rh -IVE

27
Q

psoriatic arthritis affects PIP joints. true?

A

false - it affects DIP joints

RA affects PIP joints

28
Q

which psoriasis in particular has a strong association with smoking

A

pustular psoriasis

29
Q

what is the best topical treatment to use for widespread psoriasis

A

cream, lotion or gel

30
Q

what is the best topical treatment for hairy/scalp area

A

lotion, solution or gel

31
Q

when should you use topical ointment

A

when there is thick scale

32
Q

how long after starting a new topical treatment should you arrange a review appointment

A

4 weeks in adults

2 weeks in kids

33
Q

what is 1st line treatment for plaque psoriasis

A 
topical corticosteroid (hydrocortisone) 
and a topical vitamin D (calcipotroil)
34
Q

what is the maximum time a potent corticosteroid should be used for

A

8 weeks!

then have a treatment break of 4 weeks before restarting

35
Q

when do you offer tar treatment

A

if the topical corticosteroid and vit D analogue aren’t effective

36
Q

how to treat psoriasic arthritis

A

NSAIDs
DMARDs (methotrexate) (an immunosuppressant)
anti-TNF agents (Infliximab)

37
Q

when is phototherapy appropriate

A

when topical treatments aren’t working and disease is widespread

38
Q

what phototherapy is most effective for plaque psoriasis

A

narrowband UVB

39
Q

describe guttate psoriasis

A

multiple, small, PEAR SHAPED plaques that affect the whole body

follows 7-10 days after an infection - usually strep throat

40
Q

describe the presentation of erythrodermic psoriasis

A

its a rare condition that causes the skin to shed in large sheets

41
Q

how does severe psoriasis affect life expectancy and why is this?

A

severe psoriasis reduces life expectancy by 4 years due to the risk of MI

42
Q

how much more susceptible are patients with severe psoriasis to an MI compared to general public

what could this link be due to?

A

3x!

due to the vascular inflammation that comes with psoriasis

43
Q

what are the histological changes that occur in psoriasis

A

hyperkeratotic stratum corneum with parakeratosis

absence of granular layer

thickening of prickle cell layer

large dilated, papillary blood vessels

44
Q

what are munro abscesses

A

seen on the histology of psoriasis

neutrophil filled abscesses within stratum corneum

45
Q

what can precipitate the onset of erythrodermic psoriasis

A

the removal of potent steroids

46
Q

which psoriasis causes well demarcated plaques with absent scale and widespread erythema

A

erythrodermic psoriasis

47
Q

which psoriasis comes with associated fever and malaise

A

generalised pustular

48
Q

which psoriasis has a v strong association with smoking

A

palmo-plantar pustulosis

typically develops in women >50

49
Q

describe the lifecycle of palmoplantar pustulosis

A

multiple, sterile yellow pustules that develop into brown macules, then develop scale

Ned's Clinical Dermatology (11 decks)

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