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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

Presentation of psoriasis

A 
Sharpley demarcated erythematous plaque with micaceous scale (red scaley patches)
Numerous small, widely disseminated papules and plaques 
Erythroderma (>80% BSA)
Pustules 
Nails 
- onycholysis 
- pitting
- oil spots 
Scalp 
Koehner phenomenon 
Woronoffs ring
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2
Q

Who gets psoriasis?

A

M = F
20 - 30yrs and 50 - 60 yrs
75% before 40 years

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3
Q

What % develops psoriatic arthritis?

A

5 - 30%

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4
Q

Types of psoriasis

A 
Chronic plaque psoriasis
Guttate psoriasis
Palmo-plantar psoriasis / pustulosis
Scalp psoriasis
Nail psoriasis
Flexural / inverse psoriasis 
Pustular psoriasis
Erythrodermic psoriasis
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5
Q

What can guttate psoriasis be trigged by?

A

Viral or bacterial infections (commonly strep)

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6
Q

Who gets guttate psoriasis?

A

Children

Adolescents

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7
Q

What may happen as a consequence of guttate psoriasis?

A

May resolve or may trigger chronic psoriasis in susceptible individuals

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8
Q

What is palmo plantar psoriasis associated with?

A

Smoking

Sterile inflammatory bone lesions

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9
Q

Presentation of scalp psoriasis

A

Severe dandruff
Spreading onto face
Hyperkeratotic plaques on scalp, extending just beyond hairline onto neck and forehead
Nail pitting

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10
Q

What can scalp psoriasis lead to on the affected areas?

A

Alopecia

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11
Q

What is a key feature of flexural/inverse psoriasis?

A

No/less scale

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12
Q

What can trigger flexural/inverse psoriasis?

A

Localised dermatophyte, candida or bacterial infection

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13
Q

Differential diagnosis of flexural/inverse psoriasis

A

Localised dermatophyte infection
Candida infection
Bacterial infection

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14
Q

Presentation of pustular psoriasis

A

Sterile pustules

Systemic symptoms

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15
Q

Causes of pustular psoriasis

A

Pregnancy
Rapid taper/stop steroids
Hypocalcaemia
Infection

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16
Q

What does pustular psoriasis overlap with?

A

AGEP (pustular drug eruption)

17
Q

What is erythrodermic psoriasis?

A

History of psoriasis - flare up

> 80% of body surface erythematous with fine scale

18
Q

What is another name for erythrodermic psoriasis?

A

Red man syndrome

19
Q

Investigations for psoriasis

A

Clinical

Skin biopsy if atypical

20
Q

Differential diagnosis of psoriasis

A 
Seborrheic dermatitis
Lichen planus
Mycosis fungoides 
Bowens disease
Drug eruption 
Infection 
Secondary syphilis 
Contact dermatitis 
Extramammary pagets
21
Q

What % of psoriasis have FH?

A

35-90%

22
Q

What genetic mutation can be found in psoriasis?

A

HLA-Cw6 (chromosome 6)

23
Q

Causes of psoriasis

A 
Genetic
Infection 
Drug
Trauma
Sunlight
24
Q

Pathology of psoriasis

A

T cells (epidermal CD8, dermal CD4 + CD8)
Stressed keratinocytes
Activation of dermal dendritic cells by interleukins and TNF alpha
dDCs -> lymph nodes, present uncertain antigen to naïve T cells
Differentiation into T helper 1, 17 and 22 -> psoriasis -> plaque formation
Interleukins and TNF alpha amplify the inflammatory cascade, stimulate keratinocyte proliferation
VEGF -> angiogenesis
Neutrophils in acute, active, pustular disease
Cell cycle reduced

25
Q

What is the cell cycle change in psoriasis?

A

Reduced from 28 days to 3-5

26
Q

Histology of psoriasis

A

Hyperkeratosis (thickening of strateum corneum)
Neutrophils in the strateum corneum
Psoriasiform hyperplasia; acanthosis (thickening of squamous cell layer) with elongated rete ridges
Dilated dermal capillaries
T cell infiltration

27
Q

Treatment of psoriasis

A 
Regular Emollients 
Soap substitutes 
1. Vitamin D3 analogues (inhibit epidermal proliferation) + potent corticosterioid once daily 1st line 
Coal tar creams / crude coal tar
Topical steroid (flexures, genitalia)
Salicylic acid (keratolytic)
Dithranol 
UVB phototherapy (guttate)
Retinoids - Acitretin 
Methotrexate
Ciclosporin 
Biologic therapies (Anti-TNF etc)
28
Q

Treatment of erythrodermic psoriasis

A 
Admit
Fluid balance
Bloods/IV access
Thick greasy ointment emollients 
Possible systemic or biologic treatment
29
Q

How is psoriasis progress monitored?

A

Psoriasis Area Severity Index (PASI)

Dermatology Life Quality Index (DLQI)

30
Q

What does PASI look at?

A

Surface area
Plaque colour
Thickness
Scale

31
Q

What does DLQI look at?

A

QOL in last 1 week

32
Q

What prognostic outcomes is psoriasis related to?

A 
CVS disease
Smoking 
Metabolic syndrome
Alcohol 
Depression 
Suicide 
Melanoma and non melanoma skin cancers 
Harmful drug and light therapies
33
Q

Patients with psoriasis are at increased risk of what?

A

Arthritis

Cardiovascular disease

34
Q

Complications of psoriasis

A

Psoriatic arthropathy (10%)
Increased incidence of metabolic syndrome
Increased incidence of cardiovascular disease
Increased incidence of VTE
Psychological distress

35
Q

Exacerbating factors of psoriasis

A 
Trauma
Alcohol 
Drugs
- beta blockers
- lithium 
- antimalarials 
- NSAIDs
- ACE Is 
- infliximab 
Withdrawal of systemic steroids
36
Q

What drug can make psoriasis worse?

A

NSAIDs

37
Q

The 5Ps of lichen planus

A 
Polygonal 
Pruritic
Planar (flat-topped)
Papular lesions
Purple

Dermatology (11 decks)

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