psoriasis

Question 1

what is the most commonest type of psoriasis ?

Answer 1

chronic plaque psoriasis

presents with:
symmetrical erythematous scaly plaques usually between extensor surfaces of the limbs (knees and elbows), scalp and lower back

well demarcated and coin shape and is associated with nail changes

Question 2

what is Auspit sign

Answer 2

pinpoint bleeding on removal of a layer of scale

Question 3

what is psoriasis

Answer 3

chronic autoimmune disease characterised by well-demarcated, erythematous scaly plaques

Question 4

what are the 5 types of psoriasis

Answer 4

1. chronic plaque (most common)
2. flexural/inverse: smooth, erythematous plaques without scale in flexures and skin folds
3. guttate: multiple small, tear drop shaped erythematous plaques occur on the trunk after a Strep infection in young people
4. pustular: multiple petechiae and pustules on the past and soles
5. generalised: rare but serious characterised by erythroderma and systemic illness

Question 5

what type of psoriasis is this ?

Answer 5

inverse / flexural

Question 6

what type of psoriasis is this ?

Answer 6

chronic plaque

Question 7

what type of psoriasis is this?

Answer 7

guttate

Question 8

what type of psoriasis is this

Answer 8

pustular

Question 9

what are some of the nail changes that can occur with psoriasis

Answer 9

nailbed pitting
onycholysis - separation of nail plate from nailbed
subungual hyperkeratosis

Question 10

risk factors/triggers for psoriasis

Answer 10

skin trauma (Koebner)
infection
drugs - Bbs, lithium, anti-malarials
withdrawal of steroids
stress
alcohol and smoking
cold/dry weather
family history
HIV infection
obesity

Question 11

what is the Koeber phenomenon

Answer 11

when skin lesions only develop at site of skin injury in otherwise healthy skin

ie vitiligo and lichen planus

Question 12

management

Answer 12

topical:
emollient to reduce scale and itch >
1st - potent topical corticosteroid OD + vitamin D OD applied at different times
2nd - stop the topical CTC, apply Vit D TD
3rd - stop topical Vit D and apply potent CTC td
*dithranol + tar are alternatives

phototherapy:
1st narrowband UVB phototherapy
2nd psoralen + UVA

systemic treatment:
1st -methotrexate
2nd - ciclosporin
3rd - acitretin

biologics:
infliximab
etanercept
adalimumab

Question 13

mnemonic for remembering topical steroid potencies

Answer 13

Help Every Budding Dermatologist

Hydrocortisone (mild)
Eumovate
Betnovate
Dermovate (very potent)

Question 14

what are the common nail changes for chronic plaque psoriasis

Answer 14

nail pitting
leukonychia
onycholysis

Question 15

TF is lithium a common trigger for psoriasis

Answer 15

T

Question 16

what type of drug is methotrexate

Answer 16

an anti-folate

it inhibits the synthesis of DNA and inducing immunosuppression

Question 17

TF eczema occurs on the flexor surfaces

Answer 17

T

Question 18

what are the 5Hs of side effects of ciclosporin use

Answer 18

Hypertrophy of the gums
Hypertrichosis
Hypertension
Hyperkalaemia
Hyperglycaemia

*ciclosporin is a commonly used drug for management of psoriasis