Psoriasis

Question 1

What is psoriasis

Answer 1

Chronic, immune mediated disease

Question 2

What is the pathogenesis of psoriasis

Answer 2

Polygenic predisposition + environmental triggers

Question 3

What is the clinical presentation of psoriasis on skin

Answer 3

Sharply demarcated, erythematous, papulosquamous plaques, pustules

Pink or purple in light skin, dark brown/hyperpigmented in dark skin

Question 4

What is the clinical presentation of psoriasis on nails

Answer 4

Onycholysis (nail separates from its bed), pitting, oil spots

Question 5

What is the treatment of psoriasis in primary care (6)

Answer 5

Emollients (creams or ointments)
Soap substitutes
Vitamin D3 analogues
Coal tar creams
Topical steroids (with care)
Salicylic acid

Question 6

What is the treatment of psoriasis in secondary care (7)

Answer 6

Optimise topical therapy
Crude coal tar (inpatient or day treatment)
Dithranol
UVB phototherapy
Oral retinoids
Immunosuppression
Biologic therapies

Question 7

How is psoriasis monitored

Answer 7

Psoriasis area severity index (PASI) - surface area, plaque colour, thickness, scalE

Dermatology life quality index (DLQI)

Question 8

What are seborrhoeic keratoses

Answer 8

Benign warty growths with “stuck on appearance”
Patients often have multiple +/- cherry angiomas

Generally untreated (cryotherapy/curettage if troublesome)

Question 9

What is cryotherapy (pros and cons)

Answer 9

Liquid nitrogen

Pros: cheap, easy to perform
Cons: can scar, failure/recurrence, no pathology result

Question 10

What virus causes viral warts? How do we treat

Answer 10

Due to human papilloma virus

Treatment:
Dont really need to treat will clear when immunity develops to virus
Cryotherapy or wart paint can stimulate immune system, curette in severe cases

Question 11

What are cysts

Answer 11

Encapsulated lesion containing fluid or semi-fluid material

Question 12

How are cysts treated

Answer 12

Excision
If inflamed/infected:
- antibiotics
- intralesional steroid
- incision and drainage

Question 13

What are dermatofibroma

Answer 13

Benign fibrous nodules, often on limbs - tethered to skin but mobile over fat
Cause is unknown
Dimple sign positive

Question 14

What is lipoma

Answer 14

Benign tumour consisting of fat cells with an unknown cause
Smooth and rubbery subcutaneous mass

Question 15

2 examples of vascular lesions

Answer 15

Angioma + pyogenic granuloma

Question 16

What is an angioma

Answer 16

Overgrowth in blood vessels in the skin due to proliferating endothelial cells
Generally asymptomatic, can bleed
Excised or lasered

Question 17

What are pyogenic granulomas

Answer 17

Rapidly enlarging red/raw growth, often found at sight of trauma
Bleed easily
Cause unknown
Common on head and hands, remove by curettage and cautery

Question 18

Exam question: Gardner pricks his finger and develops a pyogenic granuloma on his finger. What should you do

Answer 18

Benign but treat quickly as its hard to tell if this is a melanoma