Psoriasis

Question 1

Area where psoriasis is common

Answer 1

Extensor srufaces - Scalp, elbows, gluteal cleft + genitals, umbilicus, knees, nails, ears

Question 2

Signs of psoriasis

Answer 2

Well demarcated plaques
Silvery adherent scale
Onycholysis
Subungal hyperkeratosis
Pitting

Question 3

First line steroids for psoriasis

Answer 3

Hydrocortisone
Bethamethasone

Question 4

What is guttate psoraiasis?

Answer 4

Psoriasis in demarcated ciricles - small scattered round or oval - water drop appearance, red, scaly papules
Occur over body 1-7 dyas esp trunk + proximal limbs
mOSTLY IN YOUNGER people

Question 5

What is psoriasis?

Answer 5

Psoriasis is a systemic, immune-mediated, inflammatory skin disease which typically has a chronic relapsing-remitting course, and may have nail and joint involvement

Question 6

What causes lesions to occur in psoriasis?

Answer 6

Epidermal hyperproliferation - cells multiplying wuickly
Abnormal keratinocyte differentiation

Question 6

What causes lesions to occur in psoriasis?

Answer 6

Epidermal hyperproliferation - cells multiplying wuickly
Abnormal keratinocyte differentiation - cells not maturing
lymphocyte inflammatory infiltrate - cells which cause inflammation

Question 7

What is pustular psoraiasis?

Answer 7

Rapidly developing widespread erythema followed by eruption of white, sterile non follicular pustules - coalesce -> large areas pus
Ass with fever, malaise, tachycardia, weight loss, arthralgia

Question 8

Which psoriasis is ass with generalised systemic illness?

Answer 8

Pustular psoriasis
Usually in [people with existing or prev psoriasis, can occur with no history

Question 9

What is erythrodermic psoriasis?

Answer 9

Diffuse, widespread severe psoriasis - 90% of body surface area
Gradual or abrupt development

Question 10

Factors precipitating erythrodermic psoriasis

Answer 10

Systemic infection
Irritnats - coal tar, ciclosporin, phototherapy, sudden withdrawal of corticosteroids

Question 11

What can erythrodermic psoraisis be ass with>

Answer 11

Warm lesions
Systemic illness eg fever, malaise, tachy, lymphadenopathy, peripheral oedema

Question 12

What is lamotrigine used for?

Answer 12

Epilepsy and bipolar

Question 13

What is auspitz sign?

Answer 13

When a plaque of psoriasis is gently removed -> glossy red membrane with pinpoint bleeding points

Question 14

What is Woronoffs sign and what causes it?

Answer 14

Halo like effect around a plaque due to vasoconstriction

Question 15

What can mid scaling around eyebrows and nasolabial folds be due to?

Answer 15

Co-exisitng facial psoriasis and seborrhoeic dermatitis

Question 16

What form of psoraisis is itchy?

Answer 16

Flexural

Question 17

Who are at an increased risk of flexural psoriasis?

Answer 17

Elderly, immobile, overweight or obese

Question 18

What is flexural psoriasis + where?

Answer 18

Itchy psoriasis lesions well defined, may be little or no scaling due to friction in these area. Red and glazed, fissure in skin crease
Groin, genital area, axillae, inframmary folds, abdominal folds, sacral + gluteal cleft

Question 19

When does guttate psoriasis often show up for the first time?

Answer 19

Acute strep URTI
Acute exacerbation of plaque psoriasis

Question 20

How does nail psoriasis present?

Answer 20

Nial pitting
Discolouration orange yellow nail bed
Subungal hyperkeratosis - hyperproliferation of naul bed w accumulation of keratinocytes under nail
Oncholysis - detachment of nail from under bed
Complete nail dystrophy

Question 21

Differentials for guttate psoriasis

Answer 21

Viral exanthems
Pityriasis rosea
Drug eruptions

Question 22

Oustular psoriasis differnetials

Answer 22

Pyogenic infections.
Vasculitis.
Drug eruptions

Question 23

Lifestyle advice psoriasis

Answer 23

Smoking cessation
Alcohol within limits
Weight loss
Manage stress, anxiety, depression etc
Exercise for above

Question 24

Type of emollient for hairy areas

Answer 24

Lotions, solutions, gels

Question 25

Type of emollient for widespread psoraisis

Answer 25

Creams, lotions, gels

Question 26

What emollient use for thick scale psoriasis?

Answer 26

Ointments

Question 27

What is classified as moderate and above psoriasis?

Answer 27

More than 10% of body covered

Question 28

When are topical corticosteroids suitable for psoriasis?

Answer 28

Localised areas

Question 29

What do you prescribe with topical corticosteroids for psoriasis?

Answer 29

Vitamin D preparations Once a dya, at a different time to the steroid

Question 30

What topical treamtnet can be described specifically for scale?

Answer 30

Salicyclic acid

Question 31

How ling can you apply potent corticosteroids on one site?

Answer 31

8 weeks maximum Stop as soon as skin is clear or nearly

Question 32

What can be tried if non response to treatment agter 4 weeks

Answer 32

Coal tar products

Question 33

How long does it take for guttate psoriasis to resolve?

Answer 33

Self limiting 3-4 months

Question 34

What does dithranolm achieve?

Answer 34

Makes lesions flat

Question 35

What treatments are available for severe psoriasis?

Answer 35

Topical calcineurin inhibtiors Phototherapy - narrow bran ultraviolet - UVB (PUVA for pustular) Systemiv Biologic

Question 36

Medications systemic therapy psoriasis

Answer 36

Methotrexate Ciclosporin Acitretin Apremilast

Question 37

When is immunosupressant therapy used for psoriasis?

Answer 37

When phototherapy ineffective, contraindicated or rapid relapse in 3 months

Question 38

Important info know when taking immunosupression - systemic or biologics for psoriasis

Answer 38

Teratogenic Live vaccines containdicated Increased risk flu and oenumococcal infection

Question 39

Biologic therapy for psoriasis

Answer 39

TNF alpha inhibitors - adalimumab, etanercept, infliximab Interleukin inhibiting monoclonal antibodies

Question 40

Interleukin inhibiting monoclonal antibodies, what ILs do they target

Answer 40

ustekinumab, brodalimumab, guselkumab, ixekizumab, risankizumab, tildrakizumab and secukinumab IL12/23, 17. 23

Question 41

How is infliximab administered vs etanercept. adalimumab?

Answer 41

Infliximba - IV infusion Etanercept, adalimumuab - Injection

Question 42

When are biologics used in psoriasis?

Answer 42

When phototherapy and systemic options dont work, contraindicated or not tolerated

Question 43

Features of psoriatic arthritis

Answer 43

Inflammatory pain or peripheral joint swelling or dactylitis Axial skeletin + tendon insertion pain (enthesitis) esp @ achilles tendon or plantar fascia - inflammatory or night oain Nail changes

Question 44

Ass conditions with psoriasis

Answer 44

Metabolic syndromes - obesity, hyperlipidemia HPTN, T2DM, non alcoholic fatty liver disease IHD IBD anxiety and depression VTE Non melanoma skin cancer Lymphoma Opthalmological conditions Coeliac disease

Question 45

Complications of Erythrodermic psoriasis

Answer 45

Impacts temp regulation, haemodynamics, intestinal absorption, protein and water metabolsim HF Malabsorption hypothermia Dehydration Mild aneamia - skin losses iron deficienct

Question 46

Psoraiss complciations

Answer 46

Becomes erythrodermic Pustular can be life threatening Pregnancy

Question 47

Gene ass with psoriasis

Answer 47

HLA -B27 - psortiatic arthropathies Also HLAC, B13 etc for different types

Question 48

Factors ass with onset or exacerbation of psoriasis

Answer 48

Strep infection - guttate, after URTI Drugs UV exposure Trauma Hormonal changes HICV infection + AIDS Psychological stress Smoking Alcohol Obesity

Question 49

Drugs ass with exaerbation psoriasis

Answer 49

lithium, antimalarial drugs - chloroquine, beta-blockers (NSAIDs), (ACE) inhibitors, trazodone terfenadine, antibiotics - tetracycline + penicillin Sudden or potent topical corticosteroid withdrawal - severe rebound phenomenon