Psoriasis Flashcards
(26 cards)
What is Psoriasis?
An immune mediated inflammatory disease
What are the types of psoriasis?
Guttate
Chronic Plaque
Scalp
Palmo-plantar
Flexural (reverse)
General Pustular
Why does Psoriasis happen?
There is immune interaction of Th1/ Th17 cells with dendritic cells and keratinocytes.
There is increased keratinocyte shedding.
There is formation of inflamed plaques.
Who is affected by psoriasis?
2-4% of males and females
age 15-25 or 50-60
What is associated with psoriasis?
Smoking and alcohol
Psoriatic arthritis
Metabolic syndrome/ NAFLD
Depression
CVS disease
What are the clinical features of plaque psoriasis?
Well demarcated
Silvery- white scales
Erythmatous
Plaques
Extensor surfaces affected (also can be scalp, nails, hands, feet and trunk)
What scoring system helps to decide whether to use biologics?
PASI (if >10 and 2 systemics tried)
How is psoriasis diagnosed?
Clinical
Use PASI/ DLQI/ BSA/ PEST to determine pathway
What is the management of Chronic Plaque psoriasis?
Lifestyle changes (smoking/ alcohol cessation)
Topical steroids (stronger for palmoplantar)
Topical tacrolimus/ ciclosporin
Vit D analogues, emollients
Narrowband UVB
PUVA (Psoralen + UVA)
Systemic treatments
Biologics
Which biologics can be used?
Infliximab (anti TNF alpha)
Ustekinumab (Anti IL-12 and Il-23)
Secukinumab (anti IL17A)
What is the best treatment of Guttate psoriasis?
Pen V if strep throat related
Phototherapy
Which forms of psoriasis cannot be treated with phototherapy?
Genital
Flexural
What do you tell someone who has psoralen?
Cover up due to increased sunburn risk
How do you treat erythrodermic psoriasis?
Admit patient
2 hourly paraffin to re establish barrier
Moderate steroids BD/ ciclosporin
Fluids
Septic screen
What systemic treatments can be used and what are their main side effects?
Methotrexate (liver/ lung fibrosis)
Ciclosporin (kidney damage, gum hyperplasia, neuropathy)
Acitretinin (LFT dysfunction and dyslipidaemia)
Need blood test monitoring
How do you treat generalised pustular psoriasis?
Stop phototherapy/ steroids if that is the cause
Use infliximab (IV every 6-8wks)
Ciclosporin
What is the inherited form of pustular psoriasis?
Monogenic IL36R mutation treated with anakinra (IL-1 antagonist)
How do nails get affected?
Onycholysis
Pitting
Subungual hyperkeratosis
What is koebners phenomenon?
Psoriasis at site of injury
Describe and diagnose this lesion
A shower of small, pink-red, scaly ‘raindrops’
Psoriasis
Describe and diagnose this lesion
Small to large, well-demarcated, red, scaly and thickened areas of skin. It most likely to affect elbows, knees, and lower back but may arise on any part of the body.
Plaque psoriasis
Desceribe and diagnose this lesion
red scaly thickened patches (plaques) affecting the scalp.
Describe and diagnose this lesion
Generalised redness of the skin with sloughing
Erythrodermic psoriasis
Describe and diagnose this lesion
Well-circumscribed, red, scaly, plaques
Patchy or generalised thickening and scaling of the entire surface of palms and/or soles without redness (an acquired keratoderma)
Palmoplantar psoriasis
