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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

Describe the appearance of Psoriasis? [4]

A

Numerous small sharply demarcated [1] erythematous papules/plaques [1] with a micaceous scale [1]
On extensor surfaces all over body, scalp

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2
Q

Describe the appearance of Psoriasis in layman terms? [3]

A

Raised
Red clean-edged lesions
Sparkly scale

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3
Q

How does psoriasis affect the nails? [3]

A

Psoriasis of the nails presents with:

  • Onycholysis
  • Pitting
  • Oil spots
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4
Q

What are Koebner’s phenonmenon and Woronoff’s Ring?

What is the Auspitz sign?

A

Koebnor’s Phenomenon - Lesions appear directly at sites of injury on the skin

Woronoff’s Ring - A blanched halo around lesions following topical therapy

Auspitz sign refers to the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques.

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5
Q

Describe how Psoriasis biopsies appear histologically? [5]

A
  • Hyperkeratosis (Thickened stratum corneum)
  • Munro’s Microabscesses (Neutrophils in S. Corneum)
  • Psoriasiform Hyperplasia (Thick squamous cell layer, aka Acanthosis)
  • Dilated dermal capillaries
  • T cell infiltration
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6
Q

Whats the DDX for Psoriasis?

A

Seborrhoeic Dermatitis
Lichen Planus
Mycosis Fungoides

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7
Q

Describe the aetiology of Psoriasis?

A

A mixture of genetic susceptibility and an environmental trigger

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8
Q

What genes determine Psoriasis susceptibility?

A

PSORS1-9 genes

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9
Q

What are the main environmental triggers for Psoriasis? [4]

A

Infection
Drugs
Trauma
Sunlight

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10
Q

Age of onset is determined by a seperate gene?

A

HLA-Cw6

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11
Q

When do most people develop Psoriasis? [2]

A

Peaks at 20-30 and 50-60

But 75% occur before reaching 40

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12
Q

What are the parts of Psoriasis’ pathogenesis? [5]

A

Stressed Keratinocytes –> Th activation

Interleukins/TNF-alpha stimulate keratinocyte proliferation

Excess VEGF –> Angiogenesis

Neutrophils gather in acute disease causing pustules

Cell cycle is reduced from 28-5 days

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13
Q

How is keratinocyte proliferation stimulated? [3]

A

Interleukins and Anti-TNFalpha amplify the inflammatory cascade

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14
Q

What are the risk factors for Psoriasis? [7]

A 
FH
Smoking, Alcohol
CVD
Depression
Drug/Light therapies
Skin cancer
Metabolic syndrome
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15
Q

What are the systemic signs of Psoriasis? [3]

A

Psoriatic Arthritis
Psychosocial problems
Metabolic syndrome

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16
Q

How is Psoriasis diagnosed? [2]

A

Clinical diagnosis

But if atypical take a biopsy and diagnose histologically

17
Q

How would you treat Psoriasis in the GP? [7]

A 
Avoid known ppt factors
Soap Substitutes
Emollients reduce scales
Coal Tar Creams
Vit D3 analogues eg Dovonex
Topical Steroids (Genitals/flexures)
Salicylic acid (keratolytic)
18
Q

How do Vit D3 analogues help Psoriasis? [1]

A

They inhibit epidermal proliferation

19
Q

How would a dermatologist treat Psoriasis? [3]

A

Crude Coal Tar (Day or inpatient treatment)

Dithranol

UVB phototherapy (for Guttate)

20
Q

What are the systemic treatments for Psoriasis? [3]

A

Retinoids
Immunosuppression
Biologics

21
Q

What isoretinoin is used in psoriasis?

What are monitoring requirements for isoretinoin? [2]

A

E.g. Acitretin

You must monitor LFTs, lipids and educate that they’re teratogenic for up to 3 yrs post treatment

22
Q

Describe immunosuppresion use in Psoriasis? [2]

A

Cyclosporin - Fast acting so good for initial treatment (risks renal damage)

Methotrexate - Good for Psoriatic Arthritis but risks marrow suppression and liver damage

23
Q

Describe biologic use in Psoriasis? [3]

A

Anti-TNF e.g. Infliximab
ILK-12, 23 e.g. Ustekinumab

Patients can develop antibodies to these therapies

24
Q

How do we monitor patients with Psoriasis? [2]

A

Psoriasis Area Severity Index (PASI)

Dermatology Life Quality Index (DLQI)

25
Q

List some variations of Psoriasis?

A
  • Chronic plaque psoriasis
  • Guttate Psoriasis
  • Palmo-plantar Psoriasis
  • Scalp Psoriasis
  • Nail Psoriasis
  • Flexure or Inverse Psoriasis
  • Pustular Psoriasis
  • Erythrodermic Psoriasis
26
Q

How does chronic plaque Psoriasis tend to present? [2]

A

Large symmetrical plaques on the extensor surfaces

Silvery well defined red plaques

27
Q

How does guttate Psoriasis occur/present? [3]

A

In kids/adolescents following a viral/bacterial infection

It may develop into chronic plaque Psoriasis

Lasts 3-4m

28
Q

How do we investigate [2] and treat Guttate Psoriasis [1]?

A

ASO titre/History for recent infection

UVB phototherapy if doesn’t resolve on its own

29
Q

How does Palmo-plantar Psoriasis or pustular present? [3]

A

Associated with smoking and sterile inflammatory bone lesions

Large yellow-brown pustules on the palms and soles

30
Q

Why is scalp Psoriasis important?

A

Can lead to alopecia

31
Q

How is flexural or inverse Psoriasis different?

A

Often lacks a scale, colonized with candida

32
Q

Whats particularly bad about Erythrodermic Psoriasis [3]

What is it precipitated by usually?

A

Total body redness +/- pustule clusters
Elevated WCC and dehydration; emergency hospital admission rqd
Can be precipitated by abrupt steroid withdrawal

33
Q

How do you manage Erythrodermic Psoriasis? [8]

A
  • Admit to hospital
  • Bloods (including excluding infection), will show elevated WCC
  • IV access
  • Thick/greasy emollient
  • Correct fluid balance
  • Find the trigger
  • Avoid steroids
  • Systemic or Biologic therapy

Dermatology (11 decks)

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