Psoriasis Flashcards
What is psoriasis
Hyperproliferation of keratinocytes
A chronic immune mediated disease
causes red flaky crusty patches of skin covered in silvery scales
Where is psoriasis usually found
On the extensors (blows, knees, arms, legs)
Causes of psoriasis
35-90% have a family history
Autoimmune condition
Cell cycle time
Usually 28 days, in psoriasis it renews every 3-5 days
What causes the red skin appearance
VEGF is secreted - causing new blood vessel formation to the skin
Skin presentation
Sharply demarcated plaques
Light skin - pink or purple
dark skin - dark brown or hyper pigmented
Comes with sterile pustules
What is koebner phenomenon
Psoriasis forming at the site of a scratch/injury (in a place that it wouldn’t usually form)
Types of psoriasis
Plaque psoriasis Guttate psoriasis Palmo-plantar psoriasis Flexural/inverse psoriasis Pustular psoriasis erythrodermic psoriasis
What is the management of Psoriasis
thick skin moisturisers vitamin D3 - slow keratinocyte proliferation topical steroids coal tar cream salicylic acid (to remove scale)
Care of psoriasis in secondary care
Oral retinoids - these are teratogenic
crude coal tar
What are triggers of psoriasis?
Family history Cold/Dry weather Infection (strep throat or HIV) Beta blockers Steroid withdrawal Anti malarial Lithium NSAIDs Stress Alcohol smoking
What is plaque psoriasis?
The most common type. Plaques form, usually on the extensor surfaces. Usually involves the scalp too. Symmetrical. Mostly in adults and chronic.
What is flexure psoriasis?
Plaques form on the flexors of the skin, they usually appear erythrodermic but have no scales (usually rubbed off).
Which other parts of the body are affected along with the skin?
Scalp
Nails
What is erythrodermic psoriasis?
AKA Skin failure
>80% of the skin is involved
Usually has systemic involvement
Medical emergency
What is Guttae psoriasis?
Psoriatic papules seen on the trunk and limbs.
Usually in children, brought on by strep throat, medication or stress.
Lasts for 3-4 months.
What is pustular psoriasis?
A severe form of psoriasis here the patient can be systemically unwell, patient should be admitted as a medical emergency.
what type of psoriasis is. more common in children?
Guttae psoriasis
What is auspitz sign?
When there are patches of bleeding where the scales have been removed.
What is the treatment for plaque psoriasis?
1st line:
Topical corticosteroid + Vitamin D analogue 1x daily.
2nd line:
Increase vit D to 2x daily.
3rd line:
Increase Vitamin D to 3x daily
Coal tar 1/2x daily
short acting dithranol
Secondary care:
UV B light phototherapy 3x weekly.
Systemic:
1st line - oral methotrexate.
What should be known about psoriatic treatment?
vitamin D analogues can be used long term whereas corticosteroids can’t.
Often the erythematous part of the skin remains even after the plaque has improved.
