psoriasis

Question 1

definition of psoriasis?

Answer 1

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

Question 2

other areas affected by psoriasis?

Answer 2

hair
nails
joints

Question 3

M:F ratio?

Answer 3

M=F

Question 4

FH?

Answer 4

1/3 cases have a family history

Question 5

distribution of psoriasis?

Answer 5

symmetrical

Question 6

what is the cause of psoriasis?

Answer 6

excessive production of TH1 cytokines (TNF-a)

i.e. overactivity of immune system

Question 7

infective causes of psoriasis?

Answer 7

strep

candida

Question 8

drug related causes of psoriasis?

Answer 8

lithium
beta-blockers
NSAIDs
steroid withdrawal

Question 9

what is Koebner phenomenon?

Answer 9

the characteristic spread related to trauma

Question 10

other causes of psoriasis?

Answer 10

trauma
sunlight
environmental

Question 11

what is increased TNF-a linked to?

Answer 11

likelihood of flares

Question 12

risk if 1 parent has psoriasis?

Answer 12

14%

Question 13

risk if both parents have psoriasis?

Answer 13

41%

Question 14

further precipitants to psoriasis?

Answer 14

stress
cigarettes
alcohol
HIV

Question 15

name 6 histological features present in psoriasis?

Answer 15

thickening of stratum corneum

keratinocytes with nuclei in stratum corneum

munro’s microabscesses

no granular layer

thickening of squamous cell layer

dilated dermal capillaries

Question 16

describe chronic plaque psoriasis?

Answer 16

~90% cases

great impact on CVS and psycho-social health

Question 17

presentation?

Answer 17

large areas of body affected by rash

CVS complication

pink plaques with thick scale

Question 18

treatment for chronic plaque psoriasis?

Answer 18

topical treatments in 1y care setting

Question 19

describe guttate psoriasis?

Answer 19

post-viral
self-limiting
commonly reoccurs

Question 20

treatment for guttate psoriasis?

Answer 20

phototherapy

Question 21

describe palmo-plantar psoriasis?

Answer 21

several months history of rash on hands and feet

thickened skin on palms and soles

scaly and red with yellowish brown lesions at edges

Question 22

common consequence of palmo-plantar psoriasis?

Answer 22

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

Question 23

describe a case of scalp psoriasis?

Answer 23

severe and persistent dandruff which has spread to face

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

Question 24

differential diagnosis for scalp psoriasis?

Answer 24

seborhoeic dermatitis

Question 25

2 features of nail psoriasis?

Answer 25

pitting | oncholysis

Question 26

what is oncholysis?

Answer 26

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

Question 27

presentation of flexural/inverse psoriasis?

Answer 27

lack of scale rash in flexural areas for months topical & anti-fungal meds have been ineffective no growth showing in skin scrapings

Question 28

examination findings for flexural/inverse psoriasis?

Answer 28

shiny pink-red sharply demarcated plaque with no scaling

Question 29

case for pustular psoriasis?

Answer 29

acute onset generalised red, tender patches with lots of yellow pustules

Question 30

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

Answer 30

erythrodermic psoriasis

Question 31

common case of erythrodermic psoriasis?

Answer 31

history of other type of psoriasis presents after weeks of other flare >90% surface involvement ``` examination- erythema fine scale pyrexia hypotension ```

Question 32

clinical diagnosis for psoriasis?

Answer 32

based on TYPICAL presentation

Question 33

what is used for diagnosis if presentation is atypical?

Answer 33

skin biopsy

Question 34

name 3 differential diagnosis for psoriasis?

Answer 34

seborrhoeic dermatitis (esp scalp and face) lichen planus (forearm, oral mucosa) mycosis fungoides (older yrs, plaques & treatment resistant plaques)

Question 35

initial treatments for psoriasis?

Answer 35

``` emollients vitamin D analogues (+/- topical steroids) tar creams topical steroids salicylic acid ```

Question 36

name a vitamin D analogue

Answer 36

Calcipotriol

Question 37

when are topical steroids typically used?

Answer 37

used in flexural/ genital areas in combination with vit D analogues

Question 38

what id the function of vit D analogues?

Answer 38

inhibits epidermal proliferation

Question 39

second line treatments for psoriasis?

Answer 39

``` UVB phototherapy acitretin methotrexate cyclosporin inpatient tar biologics ```

Question 40

risk of using cyclosporin?

Answer 40

renal impairment/cancer

Question 41

Treatment of Erythrodermic Psoriasis?

Answer 41

Admit FLUID BALANCE Bloods / IV access Thick greasy ointment emollients

Question 42

3 methods of monitoring while on treatment?

Answer 42

PASI DLQI bloods if on systemic treatment

Question 43

name 5 associations of psoriasis?

Answer 43

``` arthritis metabolic sydromes CVD smoking skin cancer ```

Question 44

name 3 systemic treatments of psoriasis?

Answer 44

phototherapy oral retinoids/ immunosuppressants biologics