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Long Case - Rheumatology > Psoriasis > Flashcards

Flashcards in Psoriasis Deck (6)
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1

What is it?

Chronic inflammatory skin condition
1. Epidermal proliferation
2. Inflammatory infiltration of dermis and epidermis by TNF-alpha, activated T cells, macrophages and dendritic cells

2

Rx Factors/Triggers and Associations

Rx Factors/Triggers:
Family Hx (HLA associations)
Recent strep infection
Stress
Skin Trauma
Drugs (lithium, NSAIDs, BB)
Alcohol + Smoking
Obesity

Associations:
Inflammatory arthritis (30% develop)
IBD
Uveitis
Coeliac disease
Metabolic Syndrome

3

Examination

Symmetrical, well defined red plaques with silvery scale on the extensor surfaces, scalp and sacrum
Flexures also affected by lesions not scaly
Itch generally mild but can be severe
Nail changes - oncholysis, subungual hyperkeratosis
Sterile pustular variants on palms and soles
Systemic upset = fever + dehydration
Pinpoint bleeding on scale removal

4

Sub types

many - dependent upon where their lesions are or how they started
eg. Post-strep, Flexural psoriasis

5

Differential

Eczema
Tinea
Seborrheic dermatitis

6

Management

Non-Pharm:
Education - control is aim, not cure
Encourage a support group
Remove triggers

Pharmacological:
MILD
- Davobet cream
- Emollients
- Tar preparations
- Salicylic acid

MODERATE/SEVERE:
- warrants systemic treatment and/or phototherapy
- methotrexate, ciclosporin, acitretin
- narrowband UVB, broadband UVB, chemophototherapy
- Consider biologics eg etanercept

Psoriatic arthritis
- etanercept, infliximab or methotrexate