Psoriasis

Question 1

what is it?

Answer 1

a very common immune-mediated disease which is chronic - no cure, severity varies between patients

Question 2

what causes it?

Answer 2

multifactorial

genetic and environmental (stress/drugs/infection)

Question 3

what are the types?

Answer 3

chronic plaque psoriasis (most common)
guttate
palmoplantar pustular
erythrodermic/widespread pustular (rare)

Question 4

what is the prognosis?

Answer 4

life expectancy reduced by 4 years in patients with severe psoriasis
mainly due to increased CV risk (3x increased risk of MI)

Question 5

how does chronic plaque psoriasis present?

Answer 5

symmetrical 
sharply demarcated (well-defined)
scaly 
erythematous plaques
common sites are extensors (elbow/ knee)
scalp 
sacrum 
hands 
feet 
trunk 
nails

Question 6

how does psoriartic nail disease present?

Answer 6

oncholysis
nail pitting
dystrophy
subungual hyperkeratosis

Question 7

what is the koebner phenomenon?

Answer 7

psoriasis develops in area of skin trauma e.g. stretch mark or scar

Question 8

what is the auspitz sign?

Answer 8

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

Question 9

Potential comorbidities

Answer 9

psoriatic arthritis 
metabolic syndrome (obesity, hbp, diabetes, lipid abnormalities)
crohn's disease 
cancer 
depression 
uveitis

Question 10

what is the aim in psoriasis treatment?

Answer 10

to control chronic disease and manage flares

1st line is dependent on the type and severity of the psoriasis

Question 11

GP treatment of psoiasis - topical therapies

Answer 11

Emollients: given to everyone
Vitamin D analogues: for localised plaques (rather than flexures as for this it can be a little irritating) e.g. calcipotriol [Dovonex], calcitriol [Silkis] - this one is less irritating so is better for flexures
Coal tar: anywhere, no limit to amount (messy and smelly)
Dithranol: if few localised plaques and patient complies/short contact (effective but can be irritant - burn, and stains normal skin)
Steroid ointment: usually in combination, there is a risk of rebound with potent steroid ointment

Question 12

specialist supervision therapies

Answer 12

Phototherapy: narrowband UVB and PUVA
Systemic treatments: immunosuppression e.g. methotrexate
Immune modulation: e.g. targeted biological agents