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Dermatology > psoriasis > Flashcards

psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

definition of psoriasis?

A

Chronic, genetically determined, immune-mediated, inflammatory skin condition, usually characterized by typical well defined, scaly, plaques

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2
Q

other areas affected by psoriasis?

A

hair
nails
joints

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3
Q

M:F ratio?

A

M=F

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4
Q

FH?

A

1/3 cases have a family history

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5
Q

distribution of psoriasis?

A

symmetrical

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6
Q

what is the cause of psoriasis?

A

excessive production of TH1 cytokines (TNF-a)

i.e. overactivity of immune system

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7
Q

infective causes of psoriasis?

A

strep

candida

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8
Q

drug related causes of psoriasis?

A

lithium
beta-blockers
NSAIDs
steroid withdrawal

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9
Q

what is Koebner phenomenon?

A

the characteristic spread related to trauma

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10
Q

other causes of psoriasis?

A

trauma
sunlight
environmental

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11
Q

what is increased TNF-a linked to?

A

likelihood of flares

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12
Q

risk if 1 parent has psoriasis?

A

14%

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13
Q

risk if both parents have psoriasis?

A

41%

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14
Q

further precipitants to psoriasis?

A

stress
cigarettes
alcohol
HIV

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15
Q

name 6 histological features present in psoriasis?

A

thickening of stratum corneum

keratinocytes with nuclei in stratum corneum

munro’s microabscesses

no granular layer

thickening of squamous cell layer

dilated dermal capillaries

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16
Q

describe chronic plaque psoriasis?

A

~90% cases

great impact on CVS and psycho-social health

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17
Q

presentation?

A

large areas of body affected by rash

CVS complication

pink plaques with thick scale

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18
Q

treatment for chronic plaque psoriasis?

A

topical treatments in 1y care setting

19
Q

describe guttate psoriasis?

A

post-viral
self-limiting
commonly reoccurs

20
Q

treatment for guttate psoriasis?

A

phototherapy

21
Q

describe palmo-plantar psoriasis?

A

several months history of rash on hands and feet

thickened skin on palms and soles

scaly and red with yellowish brown lesions at edges

22
Q

common consequence of palmo-plantar psoriasis?

A

greater impact on patients quality of life than other types of psoriasis

23
Q

describe a case of scalp psoriasis?

A

severe and persistent dandruff which has spread to face

examination -
thick hyperkeratotic plaques in scalp
nail pitting
plaques spread to face

24
Q

differential diagnosis for scalp psoriasis?

A

seborhoeic dermatitis

25
Q

2 features of nail psoriasis?

A

pitting

oncholysis

26
Q

what is oncholysis?

A

loosening or separation of a fingernail or toenail from its nail bed
usually starts at the tip of the nail and progresses back

27
Q

presentation of flexural/inverse psoriasis?

A

lack of scale

rash in flexural areas for months

topical & anti-fungal meds have been ineffective

no growth showing in skin scrapings

28
Q

examination findings for flexural/inverse psoriasis?

A

shiny pink-red sharply demarcated plaque with no scaling

29
Q

case for pustular psoriasis?

A

acute onset

generalised red, tender patches with lots of yellow pustules

30
Q

‘red man ‘syndrome is associated with which type of psoriasis?

A

erythrodermic psoriasis

31
Q

common case of erythrodermic psoriasis?

A

history of other type of psoriasis

presents after weeks of other flare

> 90% surface involvement

examination-
erythema 
fine scale 
pyrexia
hypotension
32
Q

clinical diagnosis for psoriasis?

A

based on TYPICAL presentation

33
Q

what is used for diagnosis if presentation is atypical?

A

skin biopsy

34
Q

name 3 differential diagnosis for psoriasis?

A

seborrhoeic dermatitis (esp scalp and face)

lichen planus (forearm, oral mucosa)

mycosis fungoides (older yrs, plaques & treatment resistant plaques)

35
Q

initial treatments for psoriasis?

A 
emollients 
vitamin D analogues (+/- topical steroids)
tar creams 
topical steroids 
salicylic acid
36
Q

name a vitamin D analogue

A

Calcipotriol

37
Q

when are topical steroids typically used?

A

used in flexural/ genital areas

in combination with vit D analogues

38
Q

what id the function of vit D analogues?

A

inhibits epidermal proliferation

39
Q

second line treatments for psoriasis?

A 
UVB phototherapy 
acitretin 
methotrexate 
cyclosporin 
inpatient tar 
biologics
40
Q

risk of using cyclosporin?

A

renal impairment/cancer

41
Q

Treatment of Erythrodermic Psoriasis?

A

Admit
FLUID BALANCE
Bloods / IV access
Thick greasy ointment emollients

42
Q

3 methods of monitoring while on treatment?

A

PASI
DLQI
bloods if on systemic treatment

43
Q

name 5 associations of psoriasis?

A 
arthritis 
metabolic sydromes
CVD
smoking
skin cancer
44
Q

name 3 systemic treatments of psoriasis?

A

phototherapy
oral retinoids/ immunosuppressants
biologics

Dermatology (8 decks)

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