Psoriasis + Acne + Rosacea Flashcards
Name some histological features of psoriasis
Parakeratosis (retained nuclei in the keratin layer) Acanthoses (thick epidermis) Absent granular layer Lengthened rete ridges Dilated, tortuous capillaries Munro's microabscess T cells in upper epidermis
What is Auspitzs sign?
Scratching psoriatic plaques causes scale removal and bleeding
What age group is affected in guttate psoriasis?
Young
What often precedes guttate psoriasis?
Streptococcal tonsilitis
Flexoral psoriasis
- What do the plaques look like?
- Distribution?
- Who is commonly affected?
Erythematous but not scaly
Summammary, axillary, anogenital, umbilical
Women, elderly, HIV +ve
Acute onset of erythroderma + pustular plaques = ?
Management?
Erythrodermic/generalized pustular psoriasis
Methotrexate
Give four nail changes associated with psoriasis
- Pitting
- Oncholysis - lifting off bed
- Subungual hyperkeratosis
- Beaus lines
Treatment of psoriatic arthritis?
NSAIDs, DMARDs, anti-TNF
How do vitamin D analogues treat psoriasis?
Drug name?
Decrease cell proliferation
Calcipotriol
Why should you not use corticosteroids alone to treat psoriasis?
May cause brittle psoriasis on rebound
Which phototherapy can be used for psoriasis?
UVB for classic/plaque and guttate
PUVA for palmoplantar
What is the stepwise treatment for psoriasis?
1st - dithranol
2nd - vit D analogues or topical steroids or tar or salicylic acid
3rd - UVB
4th - retinoids, PUVA, immunosuppressants
What are the Goekerman and Ingram regimes for treating psoriasis?
Goekerman = tar + UVB Ingram = tar + UVB + dithranol
What are the five pillars of acne?
- Basal keratinocyte proliferation in pilosebaceous follicles (androgen and corticotropin releasing hormone driven)
- ↑sebum production
- Propionibacterium acnes colonization of blocked duct
- Dermal inflammation
- Comedones (white and black head) blocking secretions, hence nodules, cysts, papules, and scars
What are androgen levels like in those with acne?
Most don’t have increased androgen, but their sebaceous glands are more sensitive to androgens
