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Dermatology for MCCQE1 (class #1) > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

Psoriasis.

Classification

A
  1. plaque psoriasis 2. guttate psoriasis 3. erythrodermic psoriasis
  2. pustular psoriasis 5. inverse psoriasis
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2
Q

Psoriasis

Pathophysiology

A
  • not fully understood, genetic and immunologic factors

* shortened keratinocyte cell cycle leads to th1- and Th17-mediated inflammatory response

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3
Q

Psoriasis

Epidemiology

A

1.5-2%, M=F
• all ages: peaks of onset: 20-30 yr old and 50-60 yr old
• polygenic inheritance: 8% with 1 aected parent, 41% with both parents aected

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4
Q

Psoriasis

Differential Diagnosis

A

AD, mycosis fungoides (cutaneous T-cell lymphoma), seborrheic dermatitis, tinea, nummular
dermatitis, lichen planus

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5
Q

Psoriasis

Investigations

A

• biopsy (if atypical presentation, rarely needed)

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6
Q

psoriasis

• risk factors:

A

smoking, obesity, alcohol, drugs, infections, physical trauma (Koebner phenomenon)

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7
Q

PLAQUE PSORIASIS

Clinical Feature. Worsing. Auspitz sign. common site

A

• chronic and recurrent disease characterized by well-circumscribed erythematous papules/plaques with
silvery-white scales
• often worse in winter (lack of sun)
• Auspitz sign: bleeds from minute points when scale is removed
• common sites: scalp, extensor surfaces of elbows and knees, trunk (especially buttocks), nails, pressure
areas

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8
Q

PLAQUE PSORIASIS

Management depends on

A

severity of disease, as defined by BSA afected or less commonly PASI
• mild (<3% BSA).
- moderate (3-10% BSA) to severe (>10% BSA)

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9
Q

PLAQUE PSORIASIS
Management.
mild (<3% BSA)

A

topical steroids, topical vitamin D3 analogues, or a combination of the two are first line
topical retinoid ± topical steroid combination, anthralin, and tar are also effective but tend to be less
tolerated than first line therapies
emollients
phototherapy or systemic treatment may be necessary if the lesions are scattered or if it involves sites
that are dicult to treat such as palms, soles, scalp, genitals

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10
Q

PLAQUE PSORIASIS
Management.
moderate (3-10% BSA) to severe (>10% BSA). Goal

A

goal of treatment is to attain symptom control that is adequate from patient’s perspective
phototherapy if accessible
systemic or biological therapy based on patient’s treatment history and comorbidities
topical steroid ± topical vitamin D3 analogue as adjunct therapy

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11
Q

Topical Treatment of Psoriasis. Mechanism

Emollients

A

Reduce fissure formation

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12
Q

Topical Treatment of Psoriasis. Mechanism.

Salicylic acid 1-12%

A

Remove scales

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13
Q

Topical Treatment of Psoriasis. Mechanism of Tar (LCD: liquor carbonis detergens)

A

Inhibits DNA synthesis, increases cell

turnover. Poor long-term compliance

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14
Q

Topical Treatment of Psoriasis. Mechanism of Topical Corticosteroids

A

Reduce scaling, redness and thickness.
Use appropriate potency steroid in
different areas for degree of psoriasis

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15
Q

Topical Treatment of Psoriasis. Mechanism of Vitamin D3 analogues: Calcipotriene /
calcipotriol (Dovonex®, Silkis®)

A

Reduces keratinocyte hyperproliferation

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16
Q

Topical Treatment of Psoriasis. Warning of Betamethasone + calciprotriene
(Dovobet®)

A

Not to be used on face and folds

17
Q

Topical Treatment of Psoriasis. Mechanism of Tazarotene (Tazorac®) (gel/cream)

A

Retinoid derivative, decreased scaling. Irritating

18
Q

Systemic Treatment of Psoriasis. Considerations and SE

Acitretin

A

More effective when used in combination
with phototherapy.
Alopecia, cheilitis, teratogenicity, hepatotoxicity,
photosensitivity, epistaxis, xerosis, hypertriglyceridemia

19
Q

Systemic Treatment of Psoriasis. Considerations and SE. Cyclosporine

A

Used for intermittent control rather than
continuously
Avoid using for >1 yr.
Renal toxicity, hypertension, hypertriglyceridemia,
immunosuppression, lymphoma

20
Q

Systemic Treatment of Psoriasis. Considerations and SE Methotrexate

A

Has been used for over 50 yr.

Bone marrow toxicity, hepatic cirrhosis, teratogenicity

21
Q

Systemic Treatment of Psoriasis. Considerations and SE. Apremilast (Otezla®)

A

Extremely safe.

GI upset, headache, loose stool, weight loss

22
Q

Systemic Treatment of Psoriasis. Considerations and SE. PUVA

A

Highly effective in achieving remission
Avoid >200 sessions in lifetime.
Pruritus, burning, skin cancer

23
Q

Systemic Treatment of Psoriasis. Considerations and SE of UVB and “Narrow band”
UVB (311-312 nm)

A

UVB much less carcinogenic than PUVA
Narrowband has not been shown to
increase the risk of skin cancer.
Rare burning

24
Q

Biologics Approved in Canada

A 
Etanercept.
Adalimumab.
Infliximab. (IV)
Ustekinumab.
Ixekizumab.
Guselkumab.
Broadalumab.
All of them are SC
25
Q
  1. GUTTATE PSORIASIS (“DROP-LIKE”)

Clinical Feature. Smp. St. comorbt.

A
  • discrete, scattered salmon-pink small scaling papules
  • sites: diffuse, usually on trunk and legs, sparing palms and soles
  • often antecedent streptococcal pharyngitis
26
Q
  1. GUTTATE PSORIASIS (“DROP-LIKE”)

Management.

A
  • UVB phototherapy, sunlight, lubricants, topical steroids

* penicillin V or erythromycin if Group A beta-hemolytic Streptococcus on throat culture

27
Q
  1. ERYTHRODERMIC PSORIASIS . Clinical Feature. associated signs and symptoms.
A
  • generalized erythema (>90% of BSA) with ne desquamative scale on surface
  • associated signs and symptoms: arthralgia, pruritus, dehydration, electrolyte imbalance
28
Q
  1. ERYTHRODERMIC PSORIASIS . • aggravating factors:
A

lithium, beta-blockers, NSAIDs, antimalarials, phototoxic reaction, infection

29
Q
  1. ERYTHRODERMIC PSORIASIS . • Management. Avoid.
A
  • IV fluids, monitor fluids and electrolytes, may require hospitalization
  • treat underlying aggravating condition, sun avoidance
  • cyclosporine, acitretin, methotrexate, UV, biologics
30
Q
  1. PUSTULAR PSORIASIS Clinical Feature. Variations. comorbidities
A
  • sudden onset of erythematous macules and papules which evolve rapidly into pustules, can be painful
  • may be generalized or localized
  • patient usually has a history of psoriasis; may occur with sudden withdrawal from steroid therapy
31
Q
  1. PUSTULAR PSORIASIS

Management

A

methotrexate, cyclosporine, acitretin, UV, biologics

32
Q
  1. INVERSE PSORIASIS

Clinical Feature

A
  • erythematous plaques on flexural surfaces such as axillae, inframammary folds, gluteal fold, inguinal folds
  • lesions may be macerated
33
Q
  1. INVERSE PSORIASIS

Management

A
  • low potency topical corticosteroids
  • topical vitamin D derivatives (e.g. calcipotriene, calcitriol)
  • topical calcineurin inhibitors (e.g. tacrolimus, pimecrolimus)
34
Q
  1. PSORIATIC ARTHRITIS
A

20-30% of patients with psoriasis also suffer from psoriatic arthritis
• psoriatic patients with nail or scalp involvement are at a higher risk for developing psoriatic arthritis

Dermatology for MCCQE1 (class #1) (35 decks)

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