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Year 3 > Psoriasis (DERM) > Flashcards

Psoriasis (DERM) Flashcards

1
Q

Define psoriasis.

A

Chronic inflammatory skin disease characterised by erythematous circumscribed scale papules and plaques

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2
Q

Describe the pathophysiology of psoriasis.

A

Abnormal T cell activity stimulates keratinocyte hyperproliferation –> plaques

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3
Q

Which age groups does psoriasis happen commonly in?

A

20-40 years old

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4
Q

What are some causes of psoriasis? (4)

A
  • genetic predisposition (60-90% heritability)
  • immunology
  • infection
  • mechanical irritation
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5
Q

What are some triggers for psoriasis / what can exacerbate it? (5)

A
  • trauma
  • infection
  • medications - BBs, lithium, anti-malarials (chloroquine, hydroxychloroquine), NSAIDs, ACEi, infliximab
  • withdrawal of systemic steroids
  • alcohol
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6
Q

Describe the clinical course of psoriasis.

A

Relapsing with symptom-free intervals

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7
Q

What are some different types of psoriasis? (7)

A
  • plaque psoriasis (most common)
  • flexural psoriasis AKA inverse psoriasis
  • guttate psoriasis
  • psoriatic arthritis (30% with psoriasis also have psoriatic arthritis)
  • pustular psoriasis (linked to hypoparathyroidism)
  • erythrodermic psoriasis
  • nail psoriasis
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8
Q

Describe plaque psoriasis (most common).

A

Raised inflamed plaques with a superficial slivery-white scale eruption

Scale may be scraped away to reveal inflamed and sometimes friable skin

(Auspitz sign - small pinpoint bleeding when scales are scraped off)

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9
Q

What drugs make plaque psoriasis worse? (4)

A
  • beta blockers
  • lithium
  • NSAIDs
  • ACEi
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10
Q

What makes plaque psoriasis better?

A

Exposure to sun

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11
Q

Describe flexural psoriasis.

A

Skin is smooth (red) and it occurs on skin creases/flexures (groin, armpits, umbilicus)

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12
Q

Describe guttate psoriasis.

A

Widespread erythematous fine scaly papules (water-drop appearance) on trunk, arms and legs

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13
Q

When does guttate psoriasis often erupt?

A

After upper respiratory tract infections - commonly Streptococcal

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14
Q

How do we treat guttate psoriasis?

A

Phototherapy (topical treatment if lesions are symptomatic)

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15
Q

Describe psoriatic arthritis.

A

Inflammatory damage and deformity to joints - often proceeds development of skin lesions

30% of patients with psoriasis also have psoriatic arthritis

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16
Q

Which gene is psoriatic arthritis linked to?

A

HLA-B27

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17
Q

What do we see clinically in psoriatic arthritis?

A
  • asymmetrical polyarthritis of hands and feet
  • DIP swelling and dactylitis (sausage fingers)
  • pencil-in-cup deformity of DIP joints on XR
18
Q

How do we treat psoriatic arthritis?

A

NSAIDs and DMARDs (methotrexate) - avoid oral steroids as it can cause a flare-up of skin lesions

19
Q

What are two types of pustular psoriasis?

A
  • acute generalised pustular psoriasis (von Zumbusch) is rare, severe and urgent
  • palmoplantar pustulosis affects palms and soles and is chronic
20
Q

Describe erythrodermic psoriasis.

A

Generalised erythema with fine scaling

Pain, irritation and severe itching

21
Q

What are some signs of nail psoriasis? (3)

A
  • pitting
  • onycholysis (split from nail bed)
  • subungual hyperkeratosis
22
Q

What are some general clinical features of psoriasis?

A
  • skin lesions - erythematous, well-demarcated scaly papules and plaques (purple/silver) on scalp and extensor surfaces of knees and elbows
  • joint swelling or pain (psoriatic arthritis in 30%)
  • nail changes - pitting, onycholysis, subungual hyperkeratosis
23
Q

What joint changes are seen in psoriatic arthritis / psoriasis?

A
  • symmetrical polyarthritis (similar to RA)
  • asymmetrical oligoarthritis - typically affecting hands and feet (20-30%)
  • sacroiliitis / psoriatic spondylitis
  • DIP joint disease (10%) e.g. dactylitis (sausage fingers)
  • arthritis mutilans - severe deformity fingers/hand, ‘telescoping fingers’
24
Q

What do the fingers of someone with psoriatic arthritis look like?

A

Dactylitis - sausage fingers

Arthritis mutilans - ‘telescoping fingers’

25
Q

What are some risk factors for psoriasis?

A
  • genetic
  • infection
  • local trauma
  • medications
26
Q

How is psoriasis usually diagnosed?

A

Clinical diagnosis

27
Q

What do we do if clinical diagnosis is in doubt for psoriasis?

A

Skin biopsy:

  • intra-epidermal spongiform pustules
  • Munro neutrophilic microabscess within the stratum corneum
28
Q

What does XR show in psoriatic arthritis? (3)

A
  • pencil-in-cup deformity
  • new bone forming yet also erosive changes
  • periostitis
29
Q

What is the Koebner phenomenon in psoriasis?

A

Skin lesions developing at sites of trauma/scars

30
Q

What is the Auspitz sign (plaque psoriasis)?

A

Small pinpoint bleeding when scales are scraped off

31
Q

What are some differential diagnoses for psoriasis? (12)

A
  • eczema (less well-defined border)
  • pityriasis rosea (Christmas tree-shaped distribution)
  • seborrhoeic dermatitis (scaly eruptions of scalp, eyebrows, paranasal, ears, chest)
  • onychomycosis
  • mycoosis fungoides
  • tinea corporis
  • nappy dermatitis
  • SCC/actinic keratosis
  • lichen planus
  • lichen simplex chronicus
  • subcorneal pustular dermatosis
  • keratoderma blennorrhagicum (reactive arthritis)
32
Q

What is 1st line for mild plaque psoriasis?

A

Topical potent corticosteroid (betamethasone, hydrocortisone) PLUS topical vitamin D analogue (calcipotriol)

  • corticosteroids reduce inflammation
  • vitamin D reduces keratinocyte proliferation
33
Q

Describe the management plan for mild plaque psoriasis.

A
  1. topical potent corticosteroid + topical vitamin D analogue (calcipotriol)
  2. if no improvement after 8 weeks: vitamin D analogue 2x daily
  3. if no improvement after 8-12 weeks: potent corticosteroid 2x daily + coal tar preparation
    - moderate/severe: phototherapy (UVB), photochemotherapy (PUVA)
34
Q

What is the difference in steroid use between plaque and flexural psoriasis?

A

Use milder topical steroids for flexural, because skin is thinner and more sensitive to steroids in flexural regions

35
Q

Why do we avoid steroid use for >8 weeks in psoriasis?

A

Skin atrophy, rebound symptoms and striae (Cushing’s)

36
Q

How do we manage moderate-severe plaque psoriasis?

A

Phototherapy (UVB) - narrowband UVB light

Photochemotherapy (PUVA)

37
Q

How do we manage guttate psoriasis?

A

Phototherapy (topical Rx if lesions are symptomatic)

2nd line - ciclosporin/methotrexate
3rd line - acitretin

38
Q

How do we manage pustular psoriasis?

A

Supportive care, phototherapy, systemic agents

39
Q

What systemic therapy can we give for psoriasis?

A

Oral methotrexate is 1st line - useful in psoriatic arthritis

40
Q

How do we manage psoriatic arthritis?

A

NSAIDs and DMARDs (methotrexate) - avoid oral steroids as it can cause flare-up of skin lesions

41
Q

What are some complications of psoriasis? (5)

A
  • CVD
  • psoriatic arthritis (30%)
  • depression
  • lymphoma
  • secondary infection
42
Q

Describe the prognosis of psoriasis.

A
  • chronic disease with fluctuating course
  • long-term control with topical and/or systemic medications necessary for many patients

Year 3 (205 decks)

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