Psoriasis

Question 1

What is the pathophysiology of psoriasis?

Answer 1

• Acute, intermittent of chronic skin disease
• multifactoral: genetic, immune and environment
• Abnormal T cell activity stimulates keratinocyte proliferation

Question 2

What are recognised subtypes of psoriasis?

Answer 2

• Plaque psoriasis (most common)
• Flexural psoriasis
• Guttate psoriasis
• Pustular psoriasis

Question 3

What are the features of plaque psoriasis?

Answer 3

*Well demarcated red, scaly patches affecting extensor surfaces, sacrum and scalp

Question 4

What nail features can be seen in psoriasis?

Answer 4

• Pitting

* oncholysis

Question 5

What following factors can exacerbate psoriasis?

Answer 5

• Trauma
• Alcohol
• Drugs: lithium, beta blockers, antimalarials, NSAIDs, ACEi
• Withdrawal of systemic steroids

Question 6

What is the management of chronic plaque psoriasis?

Answer 6

1a. Regular emollients help to reduce scale loss and reduce pruritus
1b. Potent topical steroid + vit D analogue OD
2. No improvement after 8 weeks offer vit D analogue BD
3. No improvement after 8-12wks then potent sterid BD
4. Short acting dithranol can be used

Secondary Care:
5. Phototherapy

6. Immunosuppresants: methotrexate, ciclosporine, acitretin, biological therapy

Question 7

How do vit D analogues work?

Answer 7

Reduce cell division and differentiation