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10. Year 2: Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What is psoriasis?

A

Chronic, genetically, immune-mediated inflammatory skin condition

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2
Q

What kind of lesions is psoriasis usually characterised by?

A

Usually characterised by typically well-defined, scaly plaques

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3
Q

What is the prevalence of psoriasis?

A

3% of UK population

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4
Q

How does the prevalence of psoriasis compare between males and females?

A

M:F is equal

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5
Q

In what age group is the peak incidence of psoriasis?

A

20s and 50s

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6
Q

Is there any genetic factor to psoriasis?

A

>1/3 have family history

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7
Q

As well as the physical implications of psoriasis, what else must be considered?

A

Psychological implications

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8
Q

What other diseases is psoriasis linked to?

A

Is a systemic disease, linked to metabolic syndrome and cardiovascular disease

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9
Q

Describe the appearance of psorasis lesions?

A

Red scaly plaques, often symmetrical distribution

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10
Q

What causes psoriasis?

A

Overactivity of the immune system, excessive production of TH1 cytokines including TNF-alpha:

  • Vascular proliferation (erythema), increased cell turnover (plaques and scaling)
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11
Q

Excessive production of what causes psoriasis?

A

TH1 cytokines including TNF-alpha

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12
Q

What is the aetiology of psoriasis?

A
  • Genetics
  • Environment
  • Infection
    • Strep, candida
  • Drugs
    • Lithium, beta blockers, NSAIDs, steroid withdrawal
  • Trauma
  • Sunlight
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13
Q

What infections can cause psoriasis?

A

Strep

Candida

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14
Q

What drugs can cause psoriasis?

A

Lithium

Beta blockers

NSAIDs

Steroid withdrawal

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15
Q

Explain the pathogenesis of psoriasis?

A

Epidermal infiltration by activated T cells:

  • Increased epidermal cell proliferation and turnover
  • Cell cycle reduced from 28 days to 3-5 days
  • Capillary angiogenesis
  • Excessive production of TH1 cytokines, especially TNF-alpha, which is linked to flares

Often family history, so genetic link

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16
Q

What are some precipitants to psoriasis?

A
  • Trauma
  • Infection
  • Drugs
  • Sunlight
  • Stress
  • Smoking
  • Alcohol
  • HIV
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17
Q

What is A?

A

Epidermis

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18
Q

What is B?

A

Dermis

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19
Q

What is this histology of?

A

Skin

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20
Q

Explain the histology of psoriasis?

A
  • Hyperkeratosis (thickening of stratum corneum) with parakeratosis (keratinocytes with nuclei in statum corneum)
  • Neutrophils in stratum corneum (munro’s microabscesses)
  • Hypogranulosis, no granular layer (needed for barrier function)
  • Psoriasiform hyperplasia: acanthosis (thickening of squamous cell layer) with elongated rete ridges
  • Dilated dermal capillaries
  • Perivascular lymphohistiocystic infiltrate, T cell infiltration
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21
Q

What is hyperkeratosis?

A

Thickening of stratum corneum

22
Q

What is parakeratosis?

A

Keratinocytes with nuclei in stratum corneum

23
Q

What is Munro’s microabscesses?

A

Neutrophils in stratum corneum

24
Q

What layer of the skin is needed for barrier function?

A

Granular layer

25
Q

What is acanthosis?

A

Thickening of squamous cell layer

26
Q

What are some different subtypes of psoriasis?

A
  • Chronic plaque psoriasis
    • Accounts for 90% of psoriasis cases
    • Commonly managed with topical treatments in primary care
  • Guttate psoriasis
    • Commonly post-viral
    • Usually self-limiting
    • Responds well to phototherapy
  • Palm-plantar psoriasis
    • Have greatest impact on quality of life
  • Scalp psoriasis
    • Differential diagnosis of seborhoeic dermatitis
  • Nail psoriasis
    • Pathognomonic features include pitting and onycholysis
  • Flexural/inverse psoriasis
    • Lack of scale
  • Pustular psoriasis
  • Erythrodermic psoriasis
    • “Red man” syndrome
    • >90% of body surface involved
    • Needs in-patient treatment
27
Q

What is the most common subtype of psoriasis?

A

Chronic plaque psoriasis (accounts for 90% of cases_

28
Q

How is chronic plaque psoriasis commonly managed?

A

With topical steroids in primary care

29
Q

When does guttate psoriasis commonly occur?

A

Post-viral

30
Q

What treatment does guttate psorasis respond well to?

A

Phototherapy

31
Q

What kind of psoriasis has the greatest impact on quality of life?

A

Palm-plantar psoriasis

32
Q

What is a differential diagnosis for scalp psoriasis?

A

Seborrhoeic dermatitis

33
Q

What is erythrodermic psorasis also known as?

A

“Red man” syndrome

34
Q

How much of the body is involved in erythrodermic psorasis?

A

>90% of body surface

35
Q

How is psorasis diagnosed?

A

Can be clinical based on typical presentation or skin biopsy if atypical

36
Q

What are some differential diagnosis for psoriasis?

A
  • Seborrhoeic dermatitis
    • Especially scalp, face
  • Lichen planus
    • Check forearm, oral mucosa
  • Mycosis fungoides
    • Older patient, sudden onset of plaques or treatment resistant plaques
37
Q

What is the initial treatment for psoriasis?

A

Emollients:

  • Creams vs ointments

Vitamin D3 analogues with or without topical steroids

Tar creams

Topical steroids:

  • Fleuxural/genital area

Salicyclic acid (keratolytic)

Dithranol

Anthralin

38
Q

What are emollients?

A

Cosmetic preparations used for protecting, moisturizing, and lubricating the skin

39
Q

What is the treatment for psoriasis if initial treatment fails?

A
  • UVB phototherapy
  • Acitretin
    • Teratogenic, impairment of LFTs/lipids
  • Methotrexate
  • Cyclosporin
    • Risk of renal impairment/cancer
  • Inpatinet tar
  • Biologics
    • Qualifying criteria, costly
      • Anti-TNF (etanercept, infliximab, adalimbumab)
      • IL-12, 23 inhibitor (ustekinumab)
      • IL 17 inhibitor (ixekizumab, secukinumab)
40
Q

What are some biologics for the treatment of psoriasis if initial treatment fails?

A
  • Anti-TNF (etanercept, infliximab, adalimbumab)
  • IL-12, 23 inhibitor (ustekinumab)
  • IL 17 inhibitor (ixekizumab, secukinumab)
41
Q

What is a possible future medicine for psoriasis?

A

Future medicine is kinase inhibitors:

  • Ethical/cost dilemmas
    • Examples are adalimumab and methotrexate
42
Q

What is the treatment of erythrodermic psoriasis?

A
  • Admit
  • Fluid balance
  • Bloods/IV access
  • Thick greasy ointment emollients
43
Q

How is psoriasis monitred?

A
  • Psoriasis Area Severity Index (PASI)
    • Body area, redness, thickness, scaliness)
  • Dermatology Life Quality Index (DLQI)
    • Bloods etc if on systemic treatment
44
Q

What does PASI stand for?

A

Psoriasis area severity index

45
Q

What does PASI consider?

A

Body area, redness, thickness, scaliness

46
Q

What does DLQI stand for?

A

Dermatology life quality index

47
Q

What is the prognosis of psoriasis?

A

Exacerbations and remissions occur, can be difficult to treat

May progress to arthritis in 5-10%

Die earlier than controls on average

Associated with other co-morbidities:

  • Cardiovascular disease, smoking, alcohol, metabolic syndrome, lymphoma, depression, suicide
48
Q

What other co-morbidities is psoriasis associated with?

A
  • Cardiovascular disease, smoking, alcohol, metabolic syndrome, lymphoma, depression, suicide
49
Q

How is psorasis usually managed?

A

Usually managed in primary care with topical treatment and addressing risk factors:

  • Smoking, alcohol, stress, drugs
50
Q

What are some systemic treatments for psoriasis?

A
  • Phototherapy, oral (retinoids, immunosuppresants), biologics

10. Year 2: Dermatology (11 decks)

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