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Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

What is psoriasis

A

widespread inflammatory condition characterised by widespread well-demarcated erythematous plaques covered with a silvery layer on top

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2
Q

what is the histological change in psoriasis

A

thickening of the epidermis with some lymphocytic infiltration

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3
Q

what’s the chance of inheriting psoriasis if one parent has it, or if both have it

A

1 parent 25%

both 60%

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4
Q

what group of genes are responsible for psoriasis

A

HLA

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5
Q

what age does psoriasis commonly present at

A

double peak, so mid teens then again in 50s

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6
Q

what is the difference in presentation of a younger patient from an older one in psoriasis

A

younger tends to be stronger family history with more severe symptoms

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7
Q

what are the types of psoriasis

A 
chronic plaque -  most common 
palmoplantar
flexural
guttate
erythrodermic
pustular
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8
Q

what is the most common type of psoriasis + what proportion of all types does it take up

A

chronic plaque - 60%

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9
Q

what are some features of chronic plaque psoriasis

A

widespread well-demarcated erythematous plaques with overlying scale mainly on scalp sacrum and extensor compartments of limbs

sometimes itchy + bleed when scale removed

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10
Q

what is auspitz sign

A

bleeding on removal of scale for psoriasis - not clinically performed

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11
Q

what can psoriasis sometimes be confused for + how do you tell them apart

A

seborrhoeic dermatitis or dandruff as it it mostly found on scalps

psoriais is thicker, better demarcated and scalier

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12
Q

what proportion of those with chronic plaque psoriasis have the associated nail changes

A

50%

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13
Q

what are the associated nail changes with psoriasi

A

pitting
subungal hyperkeratisation - build up of keratin beneath distal nail edge
onycholysis - separation of nail from bed causing a colour change

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14
Q

what are features of palmoplantar psoriasis

A

psoriasis affecting the soles of the feet and the palms of the hands - usually yellow/brown pustules on hand/feet only

usually less erythema and just thickening

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15
Q

who is more likely to get palmoplantar psoriasis

A

female smokers

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16
Q

what is flexural psoriasis

A

psoriasis affecting the flexural areas of the body - axilla, submammary areas, natal cleft

plaques tend to be smooth and glazed due to friction in flexural areas

may coexist with chronic plaque

17
Q

who is more likely to get flexural psoriasis

A

elderly people

18
Q

what can be associated with flexural psoriasis

A

yeast/bacteria infection on top

19
Q

what is erythrodermic psoriasis

A

confluent psoriasis covering around 90% of the bodys surface - dermatological emergency

20
Q

what may cause erythrodermic psoriasis

A

withdrawal of potent steroids

drug eruptions

21
Q

what is the complications for erythrodermic psoriasis

A 
hypothermia
dehydration 
sepsis
protein loss
high output cardiac failure
22
Q

what is pustular psoriasis

A

rare but life-threatening form with 2 subtypes- generalised and local

generalised: acute onset sheets of pustules on background of erythema, skin is painful, spread is rapid, onset is acute, patients is systemically unwell, required hospital admission
local: Palmoplantar psoriasis, older age of onset, sore pustules but no systemic symptoms – strongly associated with smoking

23
Q

what is acrodermatitis of hallopeau

A

uncommon form of pustular psoriasis affecting fingers and nails

24
Q

what are the systemic complications of psoriasis and what % suffer from them

A

10% have arthritis, 5% have psoriatic arthritis

There is a higher chance of ankylosing spondylitis and sacrolitis

arthritis mutilans

25
Q

what is arthritis mutilans

A

This is the development of small erosions in the small bones of hands, feet and spine, causing progressive deformity due to damage causing things like telescoping of the fingers

26
Q

what are common triggers for psoriasis

A 
streptococcal throat infection 
stress
medication (beta blockers, anti malaria medication, lithium) 
alcohol 
smoking 
trauma
sunlight (but only 10% of patients)
27
Q

what is the general treatment for psoriasis

A

Stepwise

  1. topical treatment + specialist referral
  2. phototherapy
  3. non biological systemic therapy
  4. systemic biological therapy
28
Q

what topical treatments are used for psoriasis treatment

A

Emollient

Vit D3 analogue – may lead to hypercalcaemia, restricted to 100g p/w

Corticosteroid (hydrocortisone, eumovate, betonate, dermovate (in order of strength)) - most commonly used, great for plaque, facial and flexural psoriasis. Only hydrocortisone and eumovate allowed on face in adults, only hydrocortisone in kids unless done by a specialist)

Keratolytic (5% salicylic acid – mainly used against thick plaques)

Coat Tar – mainly used in guttate psoriasis, but messy and restricted to OPC use

Dithranol (short contact time) - messy, causes staining, only used in plaque psoriasis, causes irritation

29
Q

what phototherapy is used in psoriasis

A

PUVA - topical photosensitising agent + UVA

UVB

30
Q

what are the side effects of photosensitising agents

A

erythema
pruitis
nausea
skin cancer

31
Q

what non-biological systemic treatments are used for psoriasis

A

methotrexate
ciclospirin
aceitretin

32
Q

what is methotrexates mechanism of action

A

folic acid antagonist selecting for rapidly dividing cells

33
Q

what are some side effects of methotrexate

A

GI upset
teratogenicity
nausea
liver/lung fibrosis

34
Q

what is the method of action for ciclosporin

A

suppresses T lyphocytes and lymphokine production

35
Q

what are side effects of ciclosporin

A

hypertension
nephrotoxicity
carcinogenesis

36
Q

what is an important counselling point for aceitretin

A

causes teratogenicity for 2 years post treatment - not used in women planning to have a family too

37
Q

what is used for systemic biological therapy for psoriasis

A

infliximab

Dermatology (12 decks)

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