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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is the genetic factor linked to psoriasis?

A

HLA - Cw6

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2
Q

What are the pathological features in psoriasis?

A

Increases turnover of keratinocytes in epidermis
Thickened, parakeratotic (no nuclei) stratum corneum
Munro micro abscesses
Absence of granular layer
Expanded stratum spinosum
Large capillary vessels in dermis

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3
Q

Give some examples of precipitating factors for a flare up of psoriasis?

A 
Emotional stress
Infection e.g. strep throat --> guttate psoriasis
Drugs
Alcohol, smoking
Trauma --> Koebner phenomenon 
HIV/AIDS
UV radiation (10% worsen, 90% improve)
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4
Q

Which drugs might trigger psoriasis?

A

Beta blockers
Lithium
Antimalarials
Withdrawal of steroids

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5
Q

Describe the morphology and distribution of chronic plaque psoriasis?

A

Erythematous, scaly, raised plaques
On extensor aspects of knees, elbows, sacrum and scalp
Often symmetrical

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6
Q

What is the Auspitz sign seen in psoriasis?

A

removing scale reveals pin-point bleeding

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7
Q

What is the Koebner phenomenon?

A

Development of psoriasis as a site of trauma (2-6 weeks post trauma)

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8
Q

What is the treatment for scalp psoriasis?

A 
Olive oil (softens plaques)
Tar shampoo
Tar/salicylic acid ointment
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9
Q

How does guttate psoriasis present?

A

guttate = raindrop appearance
–> multiple small psoriatic lesions on trunk
7-10 days post strep throat

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10
Q

What is flexural psoriasis?

A

Shiny red well-demarcated plaques in groin, axilla or inframammary (under boobs)
Scale not prominent as moist areas

Can be confused with fungal infection or intertrigo

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11
Q

What is the treatment for flexural psoriasis?

A

Mild TCS/antifungal preparation

e.g. Trimovate cream or Canesten HC cream

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12
Q

What is palmoplantar psoriasis?

A

Very painful/disabling psoriasis on palms and soles –> fissures
Very thick hyperkeratosis

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13
Q

What is palmoplantar pustulosis?

A

Not psoriasis, related disorder
Sterile yellow pustules fading to brown macules on palms/soles –> scaling
Strong association with smoking

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14
Q

What is erythrodermic psoriasis?

A

Erythroderma = > 90% of skin surface red

Uncommon complication, usually in patients with known/deteriorating psoriasis

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15
Q

What are some causes of erythrodermic psoriasis?

A

Withdrawal of potent steroids
Drug reactions
UV burns

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16
Q

What are the complications of erythrodermic psoriasis?

A 
Hypothermia
Cardiogenic shock
Dehydration
Anaemia
Hypoalbuminaemia
17
Q

What is the treatment for erythrodermic psoriasis?

A

Fluids
Emollients
Immunosuppressants

18
Q

What is generalised pustular psoriasis and what are the features?

A

Sterile pustules within areas of psoriasis
Painful, fever, malaise
Hypoalbuminaemia, hypocalcaemia, leukocytosis

19
Q

What are some causes of generalised pustular psoriasis?

A

Withdrawal of steroids
Infection
Pregnancy
Hypocalcaemia

20
Q

What is the management for generalised pustular psoriasis?

A

Same as erythrodermic psoriasis

21
Q

What are some of the nail changes seen in psoriasis?

A 
Nail pitting
Onycholysis
Oil drop lesions (orange/brown area)
Subungual hyperkeratosis
Nail deformity
22
Q

What is onycholysis?

A

Separation of nail from bed - white at tip

23
Q

Which conditions are associated with severe psoriasis?

A

Higher incidence of obesity, DM, metabolic syndrome, CVD and stroke

24
Q

What are the 3 steps in treatment of psoriasis?

A
  1. topical agents
  2. phototherapy
  3. oral treatments
25
Q

Which topical therapies are used in psoriasis?

A 
Regular emollients
Coal tar (effective but messy)
Dithranol (burns normal skin and stains clothes)
Vitamin D analogues
Salicylic acid (removes hyperkeratosis)
TCS
26
Q

Which topical therapy is first line for mild psoriasis and give an example?

A

Vitamin D analogues e.g. Calcipotriol (dovonex)

27
Q

How/when should TCSs be used in psoriasis?

A

Mild TCS can be used, often in combination with dovonex e.g. Dovobet
Avoid potent TCS –> risk of rebound flare (erythroderma, pustular psoriasis)
Also remember risk of flare if taking oral steroids for another condition

28
Q

What are the options for phototherapy in psoriasis?

A

UVB 3x per week for 6-8 weeks

PUVA (psoralen + UVA)

29
Q

What are the acute side effects of phototherapy?

A

Erythema/blistering (sunburn)
Photoconjunctivitis
Exacerbation of herpes simplex

30
Q

What are the chronic effects of phototherapy?

A

Photoageing

Photocarcinogenesis

31
Q

What are the systemic treatments available for severe psoriasis?

A

Methotrexate (good if psoriatic arthritis)
Ciclosporin
Retinoids
Biologics

Dermatology (18 decks)

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