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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

Epidemiology of psoriasis

A

2% of population

Equal sex incidence

2nd-3rd and 6th decade (bimodal peak incidence)

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2
Q

Aetiology of psoriasis

A

Hyperproliferation of keratinocytes and inflammatory cell infiltration

Ppt by trauma (Kobner), infection (esp strep throat), drugs, stress, alcohol

UV light helps but not always (lowest incidence equator)

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3
Q

Types of psoriasis

A

Chronic plaque

Guttate - post-streptococcal

Seborrheic

Flexural

Pustular

Erythrodermic

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4
Q

Features of psoriasis plaques

A

Silvery, rough scale

Clearly demarcated

Erythematous background

Can be itchy, burning, painful

Auspitz sign - pinpoint bleeding when they’re touched

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5
Q

Nail changes in psoriasis

A

Affects 50%

Onycholysis

Pitting

Subungual hyperkeratosis

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6
Q

Koebner phenomenon

A

Rash ‘colonises’ site of recent trauma (e.g. excoriation) - line marking

Esp tattoos

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7
Q

Distribution of psoriasis

A

Extensor surfaces

Scalp

Palmo-plantar

Retro-auricular

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8
Q

Auspitz sign

A

Removal of psoriasis scale results in pinpoint capillary bleeding

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9
Q

Drugs exacerbating psoriasis

A

Antimalarials

Beta blockers

Lithium

Acute steroid withdrawal

Rampant psoriasis

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10
Q

Complications of psoriasis

A

Erythroderma

Social phobia, depression

Vit D deficiency, deconditioning

Skin atrophy from prolonged potent topical steroids

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11
Q

Differential between seb derm and seb psoriasis

A

Psoriasis more sharply demarcated

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12
Q

Differential between psoriasis and eczema

A

Eczema more itchy

Less well demarcated

Flexor > extensor

Less erythematous

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13
Q

Clinical course based on early vs late onset

A

Early onset - 16-22

Irregular course, more severe, increased psych comorbidity, tendency to become generalised

Late onset - 57-62

Milder, more localised

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14
Q

Pathogenesis of psoriasis

A

T-cell driven

Th1: TNF-a, IL-2, IFN-g

Th17: IL-17 for neutrophils, IL-23 for keratinocyte proliferation and keratosis

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15
Q
A

Chronic plaque psoriasis

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16
Q

Management of psoriasis - patient education

A

Control not cure

Avoid known triggers

Emollients to reduce scale (esp for scalp)

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17
Q

Topical treatments for psoriasis

A

Localised, mild disease

Vit D analogues

Coal tar preparations

Topical retinoids/VitA analogues

Topical steroid

Anti-yeast (seborrheic)

alongside emollient

Most topicals may cause irritation

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18
Q
A

Inverse psoriasis

Friction > loss of scale > shiny plaque or fissure

19
Q
A

Guttate psoriasis

Associated with infection (Esp strep throat) in adolescence

Raindrop, ‘spotty’ lesions

20
Q
A

Palmo-plantar pustular psoriasis

Collection of neutrophils

Can result from inappropriate sue of oral steroids

If generalised > skin failure

21
Q

Assessment of psoriasis severity

A

PASI

Looking at thickness, erythema, coverage, scale

In: head + neck, trunk, upper limb, lower limb

22
Q

Patterns of psoriatic arthritis

A

Distal interphalangeal joint

Dactylitis

Arthritis mutilans (DIP flexion deformities, digit shortening)

Symmetrical polyarthritis (RA-like)

Spondyloarthritis

Asymmetrical oligoarthritis

23
Q

Comorbidities with psoriasis

A

Psychiatric - depression/anxiety

Metabolic syndrome and CVD - from inflammation

Smoking/alcohol - cause and effect? worsen illness

24
Q

Name of vitamin d analogue

A

Calcipotriol

May cause hypercalcaemia with prolonged use

25
Q

Name of coal tar analogue

A

exorex

will stain bedsheets! Advise patient

26
Q

Management of scalp psoriasis

A

Coal tar based treatment/emollient overnight to descale

Steroid for inflammation

Anti-yeast

27
Q

Forms of psoriasis phototherapy

A

Narrow band UVB

Psoralen-PUVA (can be hand/feet only)

28
Q

Narrow band UVB therapy

A

311-312nm - most effective w/ least cancer risk

3x per week for 8 weeks

29
Q

UVA therapy

A

Psoralen taken prior to therapy (topical if hands/feet)

Psoralen absorbs UVA light - sensitises skin

Then twice weekly

Caution if prev immunosuppression

30
Q

Systemic management of psoriasis

A

Methotrexate

Acitretin

Ciclosporin

Fumaric acid esterase, mycophenolate mofetil less common

31
Q

Methotrexate monitoring

A

Teratogenic - not pregnancy (but can be given to females)

Limit EtOH

Hepatitis, myelosuppression risk - FBC, LFTs, U&Es

Folate supplementation

32
Q

Methotrexate side effects

A

Nausea + vomiting

Oral ulcers

Myelosuppression, hepatitis

Teratogenic - encourage contraception until 6mo after stopping

Caution if suspecting infection to acute myelosuppression

33
Q

Methotrexate dosing

A

10-25mg

Once-weekly

34
Q

Acitretin side effects

A

Vit A derivative (retinoid)

Mucocutaeneous dryness

Mood disturbance

LFT and lipid profile monitoring

Teratogenic - contraception 1mo before and 3 years after stopping

35
Q

Ciclosporin side effects

A

Renal impairment

Increased blood pressure

Short-term treatment only

36
Q

Acitretin dose

A

25mg daily

37
Q

Ciclosporin ose

A

2.5-5mg/kg daily in two divided doses

38
Q

NICE eligibility criteria for biologics

A

DLQI >10

PASI >10

Failed systemic treatment + phototherapy

39
Q

Biologic targets

A

TNF-a

IL-17

IL-12/23

40
Q

TNF-a biologics

A

Adalimumab

Etanercept

Infliximab

41
Q

IL-17 biologics

A

Secukinumab

Brodalumab (receptor antagonist)

42
Q

IL-12/23 biologics

A

Ustekinumab

Inhibits p40 subunit

43
Q

Differential for nail pitting

A

Eczema

Lichen planus

Psoriasis

Dermatology (10 decks)

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