psoriasis (see DM)

Question 1

what areas are most commonly affected by chronic plaque psoriasis

Answer 1

extensors, scalp

Question 2

what are the 5 main types of psoriasis

Answer 2

1. chronic plaque
2. guttate
3. pustular - generalised and palmoplantae
4. localised (scalp, nails, flexures, oral mucosa)
5. psoriatic arthritis

Question 3

what psoriasis can be life threatening and why

Answer 3

generalised pustular psoriasis - if it becomes erythrodermic then thermoregulation is affected as lots of blood is diverted to the skin resulting in lack of blood to other organs -> cardiac failure

Question 4

2 differentials for palmoplantar pustulosis

Answer 4

tinea manus/pedis (usually asymmetrical); infected eczema (larger pustules usually)

Question 5

what is Acrodermatitis continua of Hallopeau

Answer 5

a rare inflammatory disease characterised by pustular eruptions beginning in the tips of fingers and toes, nail shedding can occur

Question 6

what is flexural psoriasis

Answer 6

psoriasis that occurs in locations inverse to traditional psoriasis i.e. flexures, gentials

Question 7

what should not be given to treat flexural psoriasis (3)

Answer 7

dithranol, salicylic acid and coal tar - they are too harsh for skin-skin areas

Question 8

differentials for flexural psoriasis

Answer 8

seborrhoeic dermatitis; contact dermatitis

Question 9

what is the koebner phenomenon in psoriasis

Answer 9

the emergence of new psoriatic lesions in the healthy skin regions following an injury/trauma to psoriatic patients (can occur non-psoriatically as well)

Question 10

risk of what conditions is increased with psoriasis` (2)

Answer 10

MI; metabolic syndrome

Question 11

psoriasis histology

Answer 11

1. parakeratosis (cell nuclei within stratum corneum)
2. thickened projections of the prickle cell layer of keratinocytes (psoriasiform hyperplasia)
3. no granular layer
4. Polymorphonuclear leukocytes and lymphocytes infiltrate dermis (CD8+) and epidermis (CD4+)
5. enlarged looped blood vessels

Question 12

what are the 4 main steps to psoriasis treatment

Answer 12

1. topical treatment;
2. phototherapy;
3. oral treatments;
4. injected (biologic treatments)

Question 13

5 types of topical treatments for psoriasis

Answer 13

1. D3 analogues;
2. corticosteroids;
3. coal tar/wood tar;
4. keratolytics (salicylic acid)
5. dithranol

Question 14

what phototherapy treatments are used for psoriasis

Answer 14

PUVA; UVB

Question 15

what oral treatments are used for psoriasis

Answer 15

Methotrexate; ciclosporin; retinoids; fumeric acid

Question 16

what scoring systems can be used to determine psoriasis severity

Answer 16

psoriasis area severity index (PASI); dermatology life quality index (DLQI)

Question 17

PASI scoring

Answer 17

1. four body areas (head, upper limbs, lower limbs, trunk);
2. range 0-72 for different ategories e.g. erythema, induration
3. physicial performed assessment

> 10 is severe

Question 18

DLQI scoring

Answer 18

pt focused technique -> 10 question validated questionnaire -> assess impact of skin disease on pt

Question 19

what is parakeratosis

Answer 19

incomplete maturation of epidermal keratinocytes, resulting in abnormal retention of nuclei in the stratum corneum