Psoriasis

Question 1

drugs that worsen psoriassi

Answer 1

lithium
antimalarials
beta blockers
withdrawal of systemic steroids
NSAIDs
ACEi

Question 2

aetiology

Answer 2

t-cell mediated autoimmune disorder. cytokines stimulate keratinocyte proliferation

Question 3

associated with what diseases

Answer 3

• psoriatic arthritis
• IBD
• metabolic syndrome: obesity, hypertension, insulin resistance, dyslipidaemia

Question 4

environmental triggers

Answer 4

lack of sunlight (i.e. worse in winter)
strep
psychological distress
postpartum hormonal changes
smoking/alco

Question 5

is psoriatic arthritis seronegative or positive? what does this mean?

Answer 5

negative (negative for rheumatoid factor and anti-CCP)

Question 6

describe the lesions

Answer 6

itchy
well demarcated
circular
bright red/pink
elevated (plaques)
silvery scale
extensor surfaces and scalp

Question 7

what is auspitz’ sign

Answer 7

vigorous scraping of plaques causes pin point bleed

Question 8

what is Kobner’s reaction

Answer 8

new lesions often appear at sites of skin injury 2 weeks after injury

Question 9

where can psoriasis occur in children

Answer 9

nappy region
flexural areas
face

Question 10

nail changes

Answer 10

• pitting
• onycholysis (nail separates from skin)
• subungual hyperkeratosis (scaling under the nail due to excessive proliferation of keratinocytes)
• oil-drop sign (yellow/red discolouration of nail bed looking like oil drop beneath nail)

Question 11

what needs to be assessed five-yearly

Answer 11

CVS risk!! (link between psoriasis and CVS disease)

Question 12

initial rx for trunk/limb psoriasis

Answer 12

• potent steroid + vit d (aka calcipotriol) e.g. dovobet for up to 2 weeks
• calcipotriol can be used longer term
• regular emolient

Question 13

e.g. of brand name of calcipotriol

Answer 13

dovonex

Question 14

what may happen if take too much vit d analogue

Answer 14

hypercalc, parathyroid hormone suppression

Question 15

alternatives to vit D if ineffective

Answer 15

coal tar
vit A analgoue (tazarotene)
short contact dithranol

Question 16

what can be given for scalp psoriasis

Answer 16

overnight salicyclic acid, tar, or oil

Question 17

secondary care rx?

Answer 17

• phototherapy (UV)
• photochemotherpay (uses a photosensitising drug e.g. PUVA)
• systemic non-biologics
• systemic biologics

Question 18

when to refer?

Answer 18

dx uncertainty
severe/extensive (>10% body covered)
uncontrolled
major impact on life

Question 19

SEs of photochemo

Answer 19

nausea
pruritus
skin damage
skin cancer

Question 20

what non-biologics may be used in 2ndry care?

Answer 20

• methotrexate (1st line),
• ciclosporin
• acitretin (oral retinoid)
• 2nd tier agents: sulfasalazine, hydroxcarbamide, azanthioprine

Question 21

examples of biologics?

Answer 21

etanercept, infliximab, adalimumab

Question 22

SEs of methotrexate

Answer 22

N+V+D
SOB
mouth ulcers.
minor hair loss and hair thinning.
rashes
HEPATIC FIBROSIS!