Psoriasis

Question 1

What is it?

Answer 1

Chronic inflammatory skin disease due to hyperproliferation of the keratinocytes and inflammatory cell infiltration

Question 2

Types

What is the most common type?

Answer 2

Guttate - raindrop lesions 
Seborrhoeic - naso-labial and retro-auricular 
Flexural - body folds 
Pustular - palmar-plantar
Erythrodermic - total body redness 

Plaque psoriasis

Question 3

What triggers flare-ups?

Answer 3

Alcohol and smoking
Stress
UV light - though sunlight might improve symptoms
Medication - lithium, beta blockers, ACE inhibitors, NSAID’s, steroid withdrawal

Question 4

Presentation:

What the lesions look like?

Answer 4

S - —
C - red with white plaques
A - itchy - though varies
M - plaques, well demarcated

Question 5

Presentation:

Areas affected

Where else should be checked on examination?

Answer 5

Symmetrical
Limbs - extensor surfaces of knees and elbows
Trunk
Palms and soles

Behind ears
In scalp
Umbilicus

Question 6

Presentation:

Nail signs seen in 50% - 3

P
O
O

Answer 6

Pitting - small indentations

Onycholysis - plate seperation due to subungual hyperkeratosis

Oil drop sign - yellow-red discoloration

Question 7

Other manifestations of psoriasis?

Answer 7

Psoriatic arthritis

Question 8

Ddx

Answer 8

Eczema
Lichen plants
Discoid lupus
Tinea corporis

Question 9

Management:

General measures

Answer 9

Avoid known precipitating, emollients to reduce scales

Question 10

Management:

Topical therapy

Answer 10

Regular emollients plus 1 or more of the following:

• steroids
• Vit A or D analogies
• Coal tar

Question 11

Management - 1st line

Topical therapy:

Emollients options

Answer 11

Diprobase
Epaderm
E45

Ointments are better than creams for dry scalp lesions.

Question 12

Management - 1st line

Topical therapy:

When are corticosteroids used?

Where is betnovate used?

Where is hydrocortisone or eumovate?

Answer 12

Trunk and limb

Face, flexures and genitals

Question 13

Management - 1st line

Topical therapy:

What are calcipotriol and tacalcitol and how long are they used for?

What are dithranol and tazarotene?

Answer 13

Vitamin D analogues

Long-term treatment

Vitamin A analogues

Question 14

Management - 1st line

Scalp psoriasis

What is used if mild?
What is used if severe flare up?

Answer 14

Coal tar-based shampoo

Potent corticosteroid

Then scale removal agent - salicylic acid, emollients

Then vit D analogues

Question 15

Management - 2nd line

Phototherapy

What type is used first and second?

Answer 15

UVB

PUVA

Question 16

Management - 3rd line

Systemic therapy

What immunosuppressor can be used?

What biologics can be used? - 2

Answer 16

Methotrexate 1st line

Ciclosporin for flares

Infliximab
Adalimumab

Question 17

Flexural Psoriasis:

Where is it found?

Appearance

Answer 17

Groin
Armpits
Umbilicus
Natal cleft

Red, shiny and smooth
Less scaly

Question 18

Guttate Psoriasis

What is it?

Where?

What does it happen after?

Who is it commoner in?

Answer 18

Small drop-like papules on trunk

2 weeks after streptococcal pharyngitis

Younger people

Question 19

Generalised pustular psoriasis

Erythrodermic psoriasis

Answer 19

Sterile pustules (neutrophils) in skin

Uncommon, aggressive, inflammatory form of psoriasis. Symptoms include a peeling rash across the entire surface of the body. The rash can itch or burn intensely, and it spreads quickly.

Question 20

Calcipotriol

Mechnanism

Use

Side effects

Answer 20

Vit D analogues which alters T-cell transcription

Used in primary care

Hypercalcaemia

Question 21

Dithranol

Mechnaism

What it comes like?

Side effects

Answer 21

Vit A analogue which disrupts mitochondria so lowers hyperkeratosis

Comes as a paste

Stains clothes and skin
Chemical burn

Question 22

Coal tar

Mechanism

Contraindications

Side effects

Answer 22

Keratolytic therefore skin peels

Broken skin

Irritant
Stain
Desquamation