diagnosis, ddx & prognosis of psoriases

Question 1

what is the diagnosis of psoriases based off of?

Answer 1

• clinical- based on typical p[resentaion

- skin biopsy if atypical

Question 2

ddx of psoriases if its in scalp and face?

Answer 2

Seborrhoeic dermatitis

Question 3

ddx of psoriases if on forearm and oral mucosa?

Answer 3

Lichen planus

Question 4

ddx of psoriases if (older Pt, Sudden onset of plaques or treatment resistant plaques – Think of biopsy)

Answer 4

Mycosis fungoides

Question 5

what is the initial treatment of psoriases?

Answer 5

Emollients
Creams vs. Ointments
Vitamin D3 analogues (calcipotriol) +/- Top steroids
- Inhibits epidermal proliferation
Tar creams
Topical steroids – fleuxural / genital area
Salicylic acid ( Keratolytic)

Dithranol
Anthralin

Question 6

if initial treatment fails…

Answer 6

UVB Phototherapy
Acitretin ( Teratogenic, Impairment of LFTs/ Lipids)
Methotrexate ( Also for Joint/ Nail involvement, Improvement within 2- 3 months)
Cyclosporin (Risk of renal impairement/ Cancer)

Inpatient Tar : Crude coal tar in zinc ointment

Biologics - Qualifying criteria, cost
Anti-TNF: Etanercept, Infliximab, Adalimumab
IL-12,23 inhib: Ustekinumab
IL 17 inhib : Ixekizumab, Secukinumab
Pt can form antibodies to biologics

Question 7

future prescriptions

Answer 7

kinase inhibitors

ethical/cost dilemmas

Question 8

what is the treatment of erythrodrmic psoriases?

Answer 8

admit
FLUID BALANCE
Bloods/IV access
thick greasy ointment emollients

Question 9

how to vomiter psoriases?

Answer 9

Psoriasis Area Severity Index (PASI)
(Body area, redness, thickness, scaliness)
Dermatology Life Quality Index (DLQI)

Bloods etc if on systemic treatment

Question 10

prognosis of psoriases?

Answer 10

Exacerbations & remissions, can be difficult to treat

Progression to arthritis in 5-10%

Men with severe psoriasis died 3.5 years earlier compared with controls. Women with severe psoriasis died 4.4 years earlier compared with controls.

Associated with cardiovascular disease, smoking, alcohol, the metabolic syndrome, lymphoma, depression, suicide, potentially harmful drug and light therapies, and possibly melanoma and non-melanoma skin cancers.