PT8: POM Eczema & Psoriasis Treatment

Question 1

what is psoriasis

Answer 1

chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations

Question 2

what are the characteristics of psoriasis

Answer 2

scaly, itchy lesions, which can be inthe form of patches, papules or plaques

Question 3

what are the skin lesions of psoriasis

Answer 3

hyperproliferation of the epidermis, abnormal keratinocyte differentiation
dilation and proliferation of blood vessels in the dermis
accumulation of inflammatory cells, particularly neutrophils and T-lymphocytes
when the number of neutrophils in the stratum corneum is sufficient to be clinically obvious, the condition is termed pustular psoriasis

Question 4

what are the less common types of psoriasis

Answer 4

nail psoriasis, guttate psoriasis, erythrodermic psoriasis, generalised pustular psoriasis

Question 5

what can trigger an episode of psoriasis

Answer 5

streptococcal infection, drugs, sunlight, trauma, stress, alcohol, smoking, climate change, hormone changes, HIV/AIDS

Question 6

what are the complications of psoriasis

Answer 6

psychological and social, physical, pregnancy

Question 7

what is the treatment for plaque psoriasis

Answer 7

emollient, potent topical corticosteroid applied once daily and a vitamin D analogue applied once daily

Question 8

how is scalp psoriasis treated

Answer 8

potent topical corticosteroid
possibly combined with vitamin D analogue applied to scalp
coal tar treatments can be considered if treatment failure still occurs

Question 9

what treatment is used for face/flexural/genital psoriasis

Answer 9

emollient and short-term mild or moderate topical corticosteroid for up to two weeks

Question 10

what treatment is used for guttate psoriasis

Answer 10

resolves within 3-4 months
topical treatments can be used if patient is still concerned
if lesions are widespread, pt should be referred to dermatologist

Question 11

what is pustular psoriasis

Answer 11

should be referred to dermatologist

Question 12

what advice is given to a patient with nail psoriasis

Answer 12

keep nails short to avoid the nail detaching
avoid manicures that can cause infection
refer if severe but nails are poorly treated

Question 13

why are vitamin D preparations used in psoriasis

Answer 13

bind to vitamin D receptors which inhibits keratinocyte proliferation and enhance keratinocyte differentiation

Question 14

how are coal tar treatments used in psoriasis

Answer 14

coal tar is a distillation product of coal and has anti-inflammatory and anti-scaling properties
can be applied long term

Question 15

what is dithranol

Answer 15

prevents T-lymphocyte activation and normalises keratinocyte differentiation
should not be used in people with acute or pustular or inflamed psoriasis

Question 16

how is UV light therapy used to treat psoriasis

Answer 16

reduces inflammation in the skin

narrowband UVB is often used to treat guttate or chronic plaque psoriasis

Question 17

what is PUVA

Answer 17

combination of UVA and psoralen

can be used if UVB has not worked

Question 18

what are psoralens

Answer 18

drugs activated by long wave UV light

they interfere with DNA synthesis hence reduce epidermal cell turnover, enhancing the effect of irradiation

Question 19

how is methotrexate used to treat psoriasis

Answer 19

folic acid antagonist used for severe psoriasis affecting high impact sites, when phototherapy has failed
causes bone marrow suppression and should be taken weekly

Question 20

what happens to the skin in atopic eczema

Answer 20

reduction in lipid barrier of the skin, leading to an increase in water loss and a tendency towards dry skin

Question 21

what causes atopic eczema

Answer 21

in genetically susceptible individuals when exposed to environmental irritants or allergens
can be exacerbated by stress or hormones

Question 22

what happens when eczema becomes infected

Answer 22

bacterial infection with staphylococcus aureus, which may present as typical impetigo or as worsening of eczema with increased redness, oozing, and crusting
risk of herpes simplex and fungal infections

Question 23

what are the psychosocial affects of eczema

Answer 23

distress, missed school, self image, sleep disturbances

Question 24

what happens in erythroderma

Answer 24

generalised redness of the skin

severe skin condition that can result in complications such as dehydration, heart failure, infection and death

Question 25

what infection is common in patients with eczema

Answer 25

conjunctivitis

Question 26

what treatment is used for mild eczema

Answer 26

use of emollients, mild corticosteroid for short term use

Question 27

what treatment is used for moderate eczema

Answer 27

emollient use, intensive treatments of moderately potent corticosteroids
topical antibiotics used if infected

Question 28

how is moderate eczema controlled

Answer 28

avoid triggers, frequent and liberal emollient use, topical corticosteroids for flare prone areas,, topical calcineurin inhibitors

Question 29

what treatment is used for severe eczema

Answer 29

intensive treatment until flare is controlled
use of emollients, potent steroid, moderate potency steroid for delicate areas, occlusive bandage may be beneficial
oral corticosteroids used in really severe cases

Question 30

how are topical calcineurin inhibitors used

Answer 30

immunomodulating drugs, inhibit calcineurin production which is responsible for inflammation in the skin

Question 31

how is tacrolimus used

Answer 31

can treat moderate or severe atopic eczema

used if the most potent corticosteroid has not been effective

Question 32

how is pimecrolimus used

Answer 32

considered to treat moderate atopic eczema on the face and neck if the maximum strength corticosteroid has not been effective

Question 33

what is recommended to treat severe hand eczema

Answer 33

alitretinoin

should be stopped as soon as eczema is almost or completely cleared