Psoriasis

Question 1

Hallmark of skin lesions in psoriasis

Answer 1

Inflammation

Question 2

What triggers psoriasis?

Answer 2

Environmental factors in genetically susceptible individual studies

Question 3

What is released when the keratinocyte is under stress in the immunopathogenesis of psoriasis?

Answer 3

Factors that stimulate plasmacytoid dendritic cells to produce IFN alpha
IL1-beta/IL-6 and TNF are also released

Question 4

In the immunopathogenesis of psoriasis, what do T cells secrete after they are attracted to the dermis?

Answer 4

IL-17A, IL-17F, IL-22

Question 5

In the immunopathogenesis of psoriasis, what do IL-17A, IL-17F, IL-22 do?

Answer 5

Stimulate keratinocyte proliferation, anti-microbial peptide release and neutrophil-attracting chemokines

Question 6

Munro microabscess

Answer 6

Collection of neutrophils in the stratum corneum of the epidermis which is a useful diagnostic clue for psoriasis

Question 7

Pathogenesis of psoriasis

Answer 7

Epidermal hyperplasia leads to increased epidermal turnover

New lesions can arise form site of trauma

Question 8

Peak incidence of psoriasis

Answer 8

Bimodal peak incidence. 15-25 years old, 50-60 years old

Question 9

Environmental factors that can lead to psoriasis

Answer 9

Stress
Drugs
Infection

Question 10

Commonest form of psoriasis

Answer 10

Chronic plaque psoriasis (psoriasis vulgaris)

Question 11

Describe chronic plague psoriasis

Answer 11

Symmetrical, sharply demarcated, scaly, erythematous plaques

Question 12

Common sites involved in chronic plaque psoriasis

Answer 12

Extensors, scalp, sacrum, hands, feet, trunk, nails

Question 13

Psoriasis in darker skin

Answer 13

Same distribution as in paler skin but may appear white/pink instead of red

Question 14

2 main psoriasis signs

Answer 14

Koebner phenomenon

Auspitz sign

Question 15

Koebner phenomenon

Answer 15

Psoriasis develops in areas of skin trauma e.g. stretch marks or scars

Question 16

Auspitz sign

Answer 16

Removal of surface scale reveals tiny bleeding points (dilated capillaries in elongated dermal papillae)

Question 17

Types of psoriasis

Answer 17

Chronic plaque psoriasis (main type)
Guttate psoriasis
Palmoplantar pustular psoriasis
Erythrodermic or widespread pustular psoriasis (rare)

Question 18

Describe guttate psoriasis

Answer 18

More acute type of psoriasis. Presents as more spotty areas

Question 19

Describe palmoplantar psoriasis

Answer 19

Large pustules caused by massive collection of lymphocytes

Question 20

Psoriatic nail disease

Answer 20

Dystrophy
Oncholysis
Nail pitting
Subungal hyperkeratosis

Question 21

Oncholysis

Answer 21

When the distal nail lifts up off the nail bed

Question 22

Subungal hyperkeratosis

Answer 22

Heaped up keratin layer under the nail

Question 23

True or false: biomarkers of inflammation are raised in psoriasis

Answer 23

True

Question 24

Comorbidities in psoriasis

Answer 24

Psoriatic arthritis
Metabolic syndrome
Crohn's disease
Cancer
Depression
Uveitis

Question 25

Life expectancy in patients with psoriasis

Answer 25

Reduced by about 4 years for severe psoriasis, primarily owning to their increased cardiovascular risk

Question 26

Lifestyle factors that can exacerbate psoriasis

Answer 26

Alcohol and smoking

Question 27

Topical therapies for psoriasis

Answer 27

Vitamin D analogues
Coal tar
Dithranol
Steroid ointments
Emollients

Question 28

When is calcipotriol used and when is calcitriol used in the treatment of psoriasis

Answer 28

Calcipotriol - localised plaques rather than flexures

Calcitriol - less irritating and better for flexures

Question 29

Treatments other than topical therapies for psoriasis

Answer 29

Phototherapy - narrow band UVB and PUVA

Systemic treatments - immunosuppression, immune modulation