Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

SPM- Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

What is psoriasis?

A

A chronic inflammatory skin disease due to hyper-proliferation of keratinocytes and inflammatory cell infiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the features of psoriasis

A

Scaled
Erythematous plaques
Silvery appearance
Lesions may be itchy, burning or painful
Common on the extensor surfaces and over the scalp
Auspitz sign- scratch and gentle removal of scales causes capillary bleeding
50% also have nail changes- Pitting or onycholysis
5-8% suffer associated psoriatic arthropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is auspitz sign?

A

Gentle scratching away of scales causes capillary bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What nail changes are seen in psoriasis?

A

Pitting

Onycholysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common type of psoriasis?

A

Chronic plaque psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is post-streptococcal guttate psoriasis?

A

Derived from gutter meaning droplet- Raindrop lesions
Truncal distribution of widespread small plaques
Commonest in children
Occurs 2 weeks post group A beta haemolytic strep infection (pharyngitis/tonsillitis)
Usually self limiting
Around 40% develop chronic plaque psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is palmar-plantar pustular psoriasis?

A

Affects the palmar and plantar surfaces (palms and soles)

Majority of patients are women (9:1) and around 25% also have chronic plaque psoriasis. It is associated with thyroid disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What systemic issues can also occur with psoriasis?

A

Seronegative spondyloarthropathy- psoriatic arthritis
Nail psoriasis
Associated with anterior uveitis and episcleritis
Associated with Crohn’s Disease and Ulcerative Colitis
Psychological impact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Roughly what percentage of patients have nail changes in psoriasis?

A

Around 50%

Features are pitting and onycholysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of psoriatic arthritis? What percentage of patients are affected?

A

Inflammatory arthritis
Classically involves DIPS
End stage is Arthritis Mutilans- Severe flexion deformity of DIP
Symmetrical polyarthritis, asymmetrical oligomonoarthritis, psoriatic spondylosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What makes patients with psoriasis more at risk of CVD?

A 
They are at increased risk of metabolic syndrome:
Hyperglycaemia
Hyperlipidaemia
Central obesity
Insulin resistance
Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the features of type I psoriasis?

A

Generally age of onset <40

HLA-Cw6 65% (association)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the features of type II psoriasis?

A

Generally age of onset >40

HLA-Cw6 15% (no association)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is thought to cause psoriasis?

A

Complex interaction between genetic, immunological and environmental factors.

Disease is now thought to be due to immune dysfunction and be T-Cell mediated.

Precipitating factors include trauma (may produce Koebner phenomenon), infection (e.g post-streptococcal guttate psoriasis), drugs, stress, alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some known triggers for psoriasis?

A

Streptococcus Infection- Guttate Psoriasis, and patients with chronic plaque psoriasis can get flares with infection
HIV
Trauma- Koebner Phenomenon
Drugs- Beta blockers, NSAIDs, Lithium, Anti-Malarials

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the differential diagnoses for scaly skin lesions?

A 
Psoriasis
Eczema
Fungal infection
Cutaneous T-Cell Lymphoma/Mycosis Fungoides can appear like psoriasis, asymmetrical- do a biopsy 
Wide spread SCC
Actinic Keratosis
17
Q

What should you explain to patients recently diagnosed with psoriasis?

A

What is known about the disease
It is not contagious
Can come and go
Treatment is suppressive

18
Q

What scoring system is used to gauge the severity of psoriasis?

A

PASI- Psoriasis Area and Severity Index

19
Q

What are some of the features of mild psoriasis?

A

Disease is limited- less than 10% of BSA
May remit spontaneously
Stable disease
Rarely requires continuous therapy

Most commonly managed in primary care.

20
Q

What are the first line measures for the management for psoriasis? (For mild and localised psoriasis)

A

General Measures- Avoid known precipitating factors, emollients to reduce scales.

Topical Therapies- Coal tar preparations, Dithranol (inhibits keratinocyte proliferation). Vitamin D Analogues, Topical corticosteroids, topical retinoids, keratolytics and scalp preparations

21
Q

How does dithranol work?

A

This is a topical treatment for psoriasis that reduces keratinocyte proliferation

Side effects- skin irritation (burning), stains skin and clothes

22
Q

How are vitamin D analogues used in the management of psoriasis?

A

Topical treatment that stabilises keratinocyte proliferation

Given as creams or ointments e.g:
Calcipotriol, Tacalcitol, Calcitriol

Side effects- skin irritation, hypercalcaemia if widely used..

May be combined with corticosteroids

23
Q

What are some side effects of topical corticosteroids given for the management of psoriasis?

A

Skin atrophy
Cushing’s Syndrome if used widely
Unstable psoriasis - pustular

May be used as creams, ointments, lotion. Often combined with vitamin D analogues to reduce the side effects.

24
Q

What are some features of severe psoriasis?

A

Greater than 10% of BSA affected
Persistent with frequent plares
Unresponsive to initial topical therapies (coal tar, dithranol, corticosteroids, vit D)
Often requires life long treatment

25
Q

What are the second line measures for the treatment of psoriasis? (For extensive disease)

A

Phototherapy - UVB light
Photo-chemotherapy- Psoralen and UVA light called PUVA
Systemic Immunosuppression:
- Methotrexate
- Retinoids (Acitretin, Vitamin A)
- Mycophenolate Mofetil
- Biologic Therapies (e.g. Infliximab (Anti-TNF), entarcept (Anti TNF))

26
Q

What are some side effects of methotrexate?

A

Hepatotoxicity
Marrow suppression- Neutropenia
Nausea

27
Q

What are some risk factors of PUVA?

A

Increased risk of skin malignancies- especially SCC

28
Q

What disease course does psoriasis usually take?

A

Relapsing remitting

29
Q

What medical emergency can develop in psoriasis?

A

Eryhtromderma/Erythrodermic Psoriasis or Generalised Psoriasis

This can cause severe systemic upset including raised WCC, Hypotension, Increased HR, Fever and dehydration

30
Q

What can trigger generalised psoriasis/erythrodermic psoriasis?

A

Rapid withdrawal of steroids for psoriasis

31
Q

When should phototherapy be considered for psoriasis?

A

Failure of topical treatments and for wide-spread psoriasis

32
Q

What is the biggest risk of PUVA?

A

SCC

33
Q

What monitoring needs to be done for patients taking methotrexate?

A

LFTs- can cause hepatotoxicity

FBC- Can cause bone marrow suppression

34
Q

How does ciclosporin work? What is a side effect?

A

It is a calcineurin inhibitor (so it tacrolimus used for post renal transplant immunosuppression). Prevents T cell proliferation.

Calcineurin inhibitors are nephrotoxic

35
Q

What must me checked for women considering acitretin as a treatment for psoriasis?

A

Acitretin and other retinoids are teratogenic

Women therefore need to be using at least one and preferable two contraceptive methods. Pregnancy tests should be done at the start of treatment and every months throughout. Pregnancy should be avoided until at least 3 years after the last dose.

Because of all this it is rarely given to women of childbearing age.

SPM- Dermatology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions