Psoriasis 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
what is arthritis mutilans
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
what are common triggers for psoriasis
``` streptococcal throat infection stress medication (beta blockers, anti malaria medication, lithium) alcohol smoking trauma sunlight (but only 10% of patients) ```
27
what is the general treatment for psoriasis
Stepwise 1. topical treatment + specialist referral 2. phototherapy 3. non biological systemic therapy 4. systemic biological therapy
28
what topical treatments are used for psoriasis treatment
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
what phototherapy is used in psoriasis
PUVA - topical photosensitising agent + UVA UVB
30
what are the side effects of photosensitising agents
erythema pruitis nausea skin cancer
31
what non-biological systemic treatments are used for psoriasis
methotrexate ciclospirin aceitretin
32
what is methotrexates mechanism of action
folic acid antagonist selecting for rapidly dividing cells
33
what are some side effects of methotrexate
GI upset teratogenicity nausea liver/lung fibrosis
34
what is the method of action for ciclosporin
suppresses T lyphocytes and lymphokine production
35
what are side effects of ciclosporin
hypertension nephrotoxicity carcinogenesis
36
what is an important counselling point for aceitretin
causes teratogenicity for 2 years post treatment - not used in women planning to have a family too
37
what is used for systemic biological therapy for psoriasis
infliximab