Psoriasis Flashcards
What is it?
Chronic inflammatory skin disease due to hyperproliferation of the keratinocytes and inflammatory cell infiltration
Types
What is the most common type?
Guttate - raindrop lesions Seborrhoeic - naso-labial and retro-auricular Flexural - body folds Pustular - palmar-plantar Erythrodermic - total body redness
Plaque psoriasis
What triggers flare-ups?
Alcohol and smoking
Stress
UV light - though sunlight might improve symptoms
Medication - lithium, beta blockers, ACE inhibitors, NSAID’s, steroid withdrawal
Presentation:
What the lesions look like?
S - —
C - red with white plaques
A - itchy - though varies
M - plaques, well demarcated
Presentation:
Areas affected
Where else should be checked on examination?
Symmetrical
Limbs - extensor surfaces of knees and elbows
Trunk
Palms and soles
Behind ears
In scalp
Umbilicus
Presentation:
Nail signs seen in 50% - 3
P
O
O
Pitting - small indentations
Onycholysis - plate seperation due to subungual hyperkeratosis
Oil drop sign - yellow-red discoloration
Other manifestations of psoriasis?
Psoriatic arthritis
Ddx
Eczema
Lichen plants
Discoid lupus
Tinea corporis
Management:
General measures
Avoid known precipitating, emollients to reduce scales
Management:
Topical therapy
Regular emollients plus 1 or more of the following:
- steroids
- Vit A or D analogies
- Coal tar
Management - 1st line
Topical therapy:
Emollients options
Diprobase
Epaderm
E45
Ointments are better than creams for dry scalp lesions.
Management - 1st line
Topical therapy:
When are corticosteroids used?
Where is betnovate used?
Where is hydrocortisone or eumovate?
Trunk and limb
Face, flexures and genitals
Management - 1st line
Topical therapy:
What are calcipotriol and tacalcitol and how long are they used for?
What are dithranol and tazarotene?
Vitamin D analogues
Long-term treatment
Vitamin A analogues
Management - 1st line
Scalp psoriasis
What is used if mild?
What is used if severe flare up?
Coal tar-based shampoo
Potent corticosteroid
Then scale removal agent - salicylic acid, emollients
Then vit D analogues
Management - 2nd line
Phototherapy
What type is used first and second?
UVB
PUVA
Management - 3rd line
Systemic therapy
What immunosuppressor can be used?
What biologics can be used? - 2
Methotrexate 1st line
Ciclosporin for flares
Infliximab
Adalimumab
Flexural Psoriasis:
Where is it found?
Appearance
Groin
Armpits
Umbilicus
Natal cleft
Red, shiny and smooth
Less scaly
Guttate Psoriasis
What is it?
Where?
What does it happen after?
Who is it commoner in?
Small drop-like papules on trunk
2 weeks after streptococcal pharyngitis
Younger people
Generalised pustular psoriasis
Erythrodermic psoriasis
Sterile pustules (neutrophils) in skin
Uncommon, aggressive, inflammatory form of psoriasis. Symptoms include a peeling rash across the entire surface of the body. The rash can itch or burn intensely, and it spreads quickly.
Calcipotriol
Mechnanism
Use
Side effects
Vit D analogues which alters T-cell transcription
Used in primary care
Hypercalcaemia
Dithranol
Mechnaism
What it comes like?
Side effects
Vit A analogue which disrupts mitochondria so lowers hyperkeratosis
Comes as a paste
Stains clothes and skin
Chemical burn
Coal tar
Mechanism
Contraindications
Side effects
Keratolytic therefore skin peels
Broken skin
Irritant
Stain
Desquamation
