Psoriasis

Question 1

What is psoriasis?

Answer 1

Chronic inflammatory, hyperproliferative skin disease

Question 2

Explain the pathophysiology of psoriasis?

Answer 2

• Caused by a combination of genetic and environmental factors - associated with specific HLA genes & occurs at sites of trauma, anxiety and stress makes symptoms worse
• results in increased epidermal turnover which creates psoriatic plaque

Question 3

What histological changes can be seen in psoriasis?

Answer 3

• hyperproliferation of keratinocytes
• inflammation - T cells and release of cytokines
• vascular changes - capillary loops

Question 4

How does plaque psoriasis present?

Answer 4

• erythematous plaques on extensor surfaces & scalp

- nails: pitting & onycholysis

Question 5

What is 1st line management for plaque psoriasis?

Answer 5

topical corticosteroid (hydrocortisone) AND/OR topical vitamin D analogue (calcitriol)

Question 6

What are some treatment options for psoriasis?

Answer 6

Emollient 
Topical corticosteroid (hydrocortisone)
Vit D analogue (calcitriol)
UVB Phototherapy 
Methotrexate 
Coal tar therapy 
Biologicals (infliximab)

Question 7

What is guttate psoriasis?

Answer 7

Drop shaped plaques across trunk following a strep throat infection in teenagers

Question 8

What is given in any type of psoriasis and why?

Answer 8

Emollient - to help with scale and itch

Question 9

What is 1st line management for guttate psoriasis?

Answer 9

UVB phototherapy - it usually only lasts 3-4 months so not everyone will end up getting phototherapy

Question 10

If 1st line management for guttate psoriasis doesn’t work, what are some other treatment options?

Answer 10

Methotrexate

Oral retinoid

Question 11

what is another name for pustular psoriasis?

Answer 11

Erythrodermic psoriasis - it is a medical emergency

Question 12

What can trigger pustular psoriasis?

Answer 12

withdrawal from steroids

Question 13

What is pustular psoriasis?

Answer 13

Medical emergency - sudden onset of sheets of pustules and systemically unwell in a patient who already has plaque psoriasis

Question 14

What is the difference between generalised and localised pustular psoriasis?

Answer 14

Localised: not emergency, yellow/brown pustules on palms and soles in established plaque psoriasis
Generalised: emergency, sheets of pustules covering body and fever

Question 15

How are generalised and localised pustular psoriasis managed?

Answer 15

Localised: oral retinoid
Generalised: urgent referral to dermatology