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Dermatology Crash Course > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What is Psoriasis?

A

Chronic inflammtory condition which presents as sharply demarcated red plaques with scale.

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2
Q

What HLA is associated with psoriasis?

A

HLA-Cw6 (Chromosome 6)

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3
Q

What are the complications of Psoriasis?

A

Psoriatic Arthritis

Psychosocial problems

Metabolic Syndrome

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4
Q

What causes Psoriasis?

A

Genetics and environmental factors

Majority have FH

Infection

Drugs

Trauma

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5
Q

Which chromosome is linked to Psoriasis?

A

Chromosome 6

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6
Q

What are examples of environmental triggers?

A

Infection

Drugs

Trauma

Sunlight

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7
Q

What is the involvement of the immune system in psoriasis?

A

Stressed T cells and Keratinocytes present to Dermal Dentritic Cells which are antigen presenting. These then go to LNs and present to naive T cells which mature to become T helper cells.

From here these T helpers enhance Keratinocyte overproliferation and so skin develops Psoriasis - red scaly plaques.

Skin regenration process goes from 25-30 days to 2-3.

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8
Q

What is the histology of psoriasis?

A
  • Hyperkeratosis (thickening of stratum corneum)
  • Neutrophils in stratum corneum (munro’s microabcesses)
  • Psoriasiform hyperplasia: Acanthosis (thickening of squamous cell layer) with elongated rete ridges
  • Dilated dermal capillaries
  • T cell infiltration
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9
Q

Describe the skin in psoriasis

A

–Sharply demarcated, erythematous, papulosquamous plaques

–Numerous small, widely disseminated papules & plaques

Pustules

Erythroderma (>90% body covered)

Red/pink due to increased angiogenesis so increased bvs.

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10
Q

Name some types of Psoriasis?

A

Plaque (Extensor surfaces)

Pustular (yellow pustules)

Erythrodermic (Red Man Syndrome >80% skin)

Guttate (Kids)

Palmo-Plantar (Palms & Soles of feet)

Scalp/Nail Psoriasis

Flexural

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11
Q

Describe the nails in psoriasis

A

–Onycholysis, pitting, oil spots

Onchylosis: is a common medical condition characterized by the painless detachment of the nail from the nail bed, usually starting at the tip and/or sides.

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12
Q

What is chronic plaque psoriasis?

A

Chronic

Salmon coloured plaques

Found on extensor surfaces and is extensive

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13
Q

What is Guttate psoriasis?

A

Acute onset generalised rash

Papules

Affects children and adolescents

Papules worse on trunk and proximal extremities

Check ASO titre

Can be triggered by viral or bacterial infections

It may resolve or it may even trigger chronic psoriasis

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14
Q

What form of psoriasis is associated with skin on the palms and soles appears thick, scaly and red with yellowish brown lesions at the edges?

A

Palmo-plantar Psoriasis

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15
Q

What type of psoriasis is associated with severe dandruff - pink hyperkeratotic plaques at her scalp

A

Scalp psoriasis

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16
Q

What type of psoriasis causes pitting in the nails?

A

Nail psoriasis

17
Q

What type of psoriasis is likely to occur bilaterally in the axilla?

With NO scale

A

Flexural / inverse psoriasis

18
Q

What can trigger or even superinfect flexural psoriasis?

A

Can be triggered or superinfected by localised dermatophyte, candidal or bacterial infection – these are also differential diagnoses

19
Q

What type of psoriasis has generalised red tender patches with multiple yellow pustules?

A

Pustular psoriasis

Pustules are sterile - sometimes features systemic symptoms

20
Q

What causes pustular psoriasis?

A

Pregnancy

Rapid taper / stoppping steroids

Hypocalcaemia

Infection

21
Q

Erythrodemic psoriasis is often a complication of psoriasis - what is the differential?

A

Red man syndrome - drug reaction to vancomycin

22
Q

What is the diagnosis of psoriasis?

A

Skin biopsy

23
Q

What are the differential diagnosis’ for psoriasis?

A
  • Seborrhoeic dermatitis
  • Lichen planus
  • Mycosis fungoides
24
Q

What is the treatment of psoriasis?

A

Most treated in primary care - less than 30 % are referred to dermatology

Emollients (creams vs ointments)

Soap substitutes

Vitamin D3 anologues - these inhibit epidermal proliferation

Coal tar creams

Topical steroid

Salycilic acid (keratolytic) - this is a descaling agent

25
Q

What are the available treatments in dermatology?

A
  • Crude Coal Tar (inpatient or day treatment)
  • Dithranol: since 1916. Can burn.
  • UVB Phototherapy (not the same as sunbed)

–Guttate

26
Q

What systemic disease is associated with psoriasis?

A

–5-30% develop psoriatic arthritis

–Psychosocial implications

–Metabolic syndrome – more susceptible to having cardiovscular complications

27
Q

What are the systemic treatments of psoriasis?

A

•Retinoid - Acitretin

–Teratogenic, LFTs, lipids

•Immunosuppression

–Methotrexate

  • Can treat PsArthritis
  • Max improvement 8-12 weeks

–Ciclosporin

•Renal, cancer risk

•Biologic Therapies

–Qualifying criteria, cost

–Anti-TNF: Etanercept, infliximab, adalimumab

–IL-12,23: Ustekinumab

–Patient can form antibodies to biologic

28
Q

Future treatments

A
  • Targeted biologics
  • IL-17,20,22
  • Kinase inhibitors
  • Ethical / cost dilemmas

–Adalimumab ~£9000 per year (£225000 for 25 years)

–Methotrexate ~£12.50 per year

29
Q

What is the treatment of Erythrodermic Psoriasis?

A
  • Admit
  • FLUID BALANCE
  • Bloods / IV access
  • Thick greasy ointment emollients
  • ?Systemic or biologic treatment
  • ?Trigger

Treat underlying infection, stop causative drugs

30
Q

What can be used to monitor the progress of psoriasis?

A

•Psoriasis Area Severity Index (PASI)

–Surface area, plaque colour, thickness, scale

•Dermatology Life Quality Index (DLQI)

–QOL in last 1 week

31
Q

What 2 age peaks see Psoriasis most commonly?

A

20-30 years

50-60 years

Most people see it by age of 40

Dermatology Crash Course (11 decks)

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