psoriasis

Question 1

psoriasis - which types need hospital management

Answer 1

generalised pustular psoriasis
erythrodermic psoriasis
generalised pustular psoriasis of pregnancy

Question 2

generalised pustular psoriasis - non derm symptoms

Answer 2

fever and systemic symptoms

Question 3

erythrodermic psoriasis

• non derm symptoms (2)
• complications (4)

Answer 3

non derm
- fever,
- systemic symptoms
complications 
- heart failure
- infection
- malabsorption
- anaemia

Question 4

psoriatic arthritis - different manifestations of it (5)

Answer 4

distal interphalangeal arthritis
dactylitis

spondyloarthritis
oligoarthritis

enthesopathy

Question 5

nail changes in psoriasis

Answer 5

pitting
onycholysis
subungual hyperkeratosis

Question 6

define onycholysis

Answer 6

nail plate lifts off nail bed

Question 7

define subungual hyperkeratosis

Answer 7

the bit under the nail is hyperkeratosed, leading to athick gross looking nail

Question 8

psoriasis - ddx to consider

Answer 8

eczema
fungal infection
skin cancer - ? SCC
seborrhoeic dermatitis

Question 9

psoriasis - nonmedical management

Answer 9

have quick showers
oatmeal or bath oil
emollient - sorbolene + 10% glycerine in the morning

Question 10

topical treatments of psoriasis - duration of treatment before response can be observed

Answer 10

most treatments take 2-4 weeks to be effective

calcipotriol can take 6 weeks

Question 11

topical treatments of psoriasis - what are the broad classes of treatment available

Answer 11

corticosteroids
coal tar
calcipotriol

Question 12

topical treatments of psoriasis - to cover whole body, how many grams are needed for

• creams
• ointments

Answer 12

cream = 30g
ointment = 20g

Question 13

topical treatment of psoriasis - what is the role of salicylic acid in LPC/Sal combination

Answer 13

salicylic acid is keratolytic, helps to break down excess plaque

Question 14

topical treatment of psoriasis - what is calcipotriol, how does it work

Answer 14

vitamin d analogue, modulates keratinocyte activity

Question 15

topical treatment of psoriasis for
- trunk and limbs, palmoplantar pustular, or guttate
1st - 4th line

Answer 15

1st line
coal tar solution 1% emulsion nocte for 4 weeks \/ LPC + sal 6%/3% BD for 4 weeks
2nd line
add mometasone furoate 0.1% OD \/ methylprednisolone aceponate 0.1% OD
3rd line
change steroid to betamethasone dipropionate 0.05% OD
4th line -
calcipotriol+betamethasone dipropionate 50+500 micrograms/g gel topically, once daily for 6 weeks

Question 16

topical treatment of psoriasis for scalp

Answer 16

methylprednisolone aceponate 0.1% topically OD for 2-6 weeks

next, add betamethasone dipropionate 0.05% OD

once symptoms controlled, use a coal-tar shampoo
- use LPC 6%/Sal 3% if it thickens or gets scaly

Question 17

topical treatment of palmoplantar hyperkeratotic psoriasis

Answer 17

salicylic acid - LPC + sal 6/6 BD for 1 month, then

calcipotriol+betamethasone dipropionate 50+500 micrograms/g gel topically, once daily

Question 18

topical treatment of nail psoriasis

Answer 18

calcipotriol+betamethasone dipropionate 50+500 micrograms/g gel topically, once daily for 3 months
consider oral therapy early, as topical doesn’t work

Question 19

topical treatment of flexural and genital psoriasis

Answer 19

methylprednisolone aceponate 0.1%

once controlled, add LPC 2% emulsion ointment or ichthammol 1%

Question 20

topical treatment of face psoriasis (2), what not to use (1)

Answer 20

start with steroids - methylprednisolone aceponate 0.1%, or hydrocortisone 1% if its a child, for 2-4 weeks
when symptoms are controlled, add
LPC 2% + sal 2% OD

don’t use calcipotriol

Question 21

what topical agent should you avoid in facial psoriasis

Answer 21

calcipotriol

Question 22

triggers for guttate psoriasis

Answer 22

group A step pyogenes infection in throat or perianal area

Question 23

guttate psoriasis triggered by group A strep - how long does it take for psoriasis to manifest once infection occurs

Answer 23

psoriasis occurs 2-3 weeks after infection