Psoriasis

Question 1

How does psoriasis affect nails?

Answer 1

Onycholysis - distal nail is lifted up

Nail pitting

Subungal hyerpkeratosis

Ridges

Question 2

Where do psoriasis plaques typically occur?

Answer 2

Extensors e.g. backs of elbows
Sacrum
Back of neck

Question 3

Auspitz sign

Answer 3

If scratch off scale get little bleeding spots

Question 4

How to manage psoriasis on trunk?

Answer 4

Education - avoid smoking, reduce alcohol and maintain a healthy weight

1. Once daily topical corticosteroid and topical Vit D or Vit D analogue - once in the morning and once in evening for 4wks - 8 max
2. Just vit D or vit D analogue 2D - 8-12wks
3. Potent topical steroid 2D FOR UP TO 4WKS OR coal tar preparation
4. Refer to derm - phototherapy

Question 5

What are severe psoriasis patients at a 3x increased risk of?

Answer 5

MI

Question 6

Name 4 types of psoriasis and their appearance

Answer 6

Guttate psoriasis - spotty

Chronic plaque psoriasis - plaques on extensors

Erythroderma - 95% cover - v rare

Pustular - pustules

Question 7

How does psoriasis present histologically?

Answer 7

Parakeratosis - nuclei present in the keratin layer

Question 8

How is mod-severe psoriasis managed?

Answer 8

Phototherapy

Immunosuppress - methotrexate

Question 9

What is the pathophysiology behind psoriasis?

Answer 9

Loss of control of epidermal turnover

Question 10

What is the point that a small plaque becomes a large plaque?

Answer 10

3cm

Question 11

Guttate psoriasis is most common in teenagers following what?

Answer 11

URTI/strep infection

Question 12

What is Koebener phenonenum?

Answer 12

When skin gets cut etc. and linear skin condition follows the healing

Occurs in psoriasis and vitiligo

Question 13

What drug can precipitate psoriasis outbreaks?

Answer 13

Beta blockers

Question 14

What is the final step in treatment after phototherapy and methotrexate?

Answer 14

Infliximab