Psoriasis

Question 1

define parakeratosis

Answer 1

inc in number of nuclei in keratin layer of epidermis (stratum corneum)

Question 2

define papillomatosis

Answer 2

irregular epithelial thickening

Question 3

what is the most common form of psoriasis

Answer 3

psoriasis vulgaris (chronic plaque psoriasis)

Question 4

define psoriasis

Answer 4

chronic inflammatory dermatosis thought to be autoimmune mediated

characterised by well demarcated red, scaly plaques. The skin becomes inflamed and hyperproliferates at about ten times the normal rate

Question 5

age of onset

Answer 5

two peaks

• younger is more common, and is usually associated with a psoriatic family history
• older peaks at around around 55-60

Question 6

aetiology

Answer 6

regulation of epidermal turnover lost - hyperplasia . T cell driven inflammatory infiltration of dermis and epidermis

there is a genetic predisposition but it is also dependent on environmental factors

Question 7

which T cells is psoriasis associated with

Answer 7

Th1 and Th17

Question 8

is there epidermal or dermal involvement?

Answer 8

T lymphocyte driven inflammatory infiltration of dermis and epidermis

Question 9

pathophysiology

Answer 9

polymorphs attracted to stratum corneum creating munro micro abscesses.

parakeratosis, acanthosis and thick keratin scale

epidermal rete ridges are elongated and clubbed

Question 10

where are munro micro abscesses found

Answer 10

in the epidermis

Question 11

what happens to the dermis

Answer 11

there is oedema and inflammation

Question 12

what does the thick keratin scale indicate

Answer 12

epidermal involvement

Question 13

what happens to the keratinocyte turnover time

Answer 13

normally 28 days, reduced to 7 days

Question 14

what are munro micro abscesses

Answer 14

collection of neutrophils in the stratum corneum

Question 15

what happens to the blood vessels

Answer 15

thick and tortuous

Question 16

describe the plaques

Answer 16

thick, scaly, sharply demarcated erythematous plaques

Question 17

symmetrical?

Answer 17

yes

Question 18

what is the koebner phenomenon

• what diseases is it also seen in

Answer 18

new lesions at site of trauma

• lichen planus and vitiligo

Question 19

what is Auspitz sign

Answer 19

removal of surface scale reveals tiny bleeding point due to dilated capillaries in elongated dermal papillae

Question 20

what does sun do to lesions

Answer 20

improve them

Question 21

itchy?

Answer 21

mildy

Question 22

guttate

Answer 22

widespread small plaques on trunk and limbs

Question 23

what is guttate preceded by

Answer 23

sore throat with group B haemolytic streptococcus

Question 24

time of onset of guttate psoriasis

Answer 24

• Rash comes on very quickly, use in a couple of days

Question 25

what shape can the guttate plaques be described as

Answer 25

tear drop

Question 26

Answer 26

palmoplantar pustular chronic condition with multiple sterile pustules on the palms and soles of feet

Question 27

what does palmoplantar pustular first appear as

Answer 27

monomorphic yellow lesions

Question 28

what is a serious life threatening form

Answer 28

erythrodermic or widespread pustular - RARE

Question 29

features of erythrodermic

Answer 29

* Features are those of any form of erythroderma (red dry skin all over the body)

Question 30

aetiology of erythrodermic

Answer 30

* Usually occurs in the setting of known worsening or unstable psoriasis, uncommonly is the first presentation of psoriasis * May be precipitated by e.g. infection, withdrawal of steroids

Question 31

psoriatic nail disease CF

Answer 31

oncholysis, nail pitting, dystrophy, subungal hyperkeratosis

Question 32

subungal hyperkeratosis

Answer 32

excessive reproduction of skin cells that accumulate between the nail and the nail bed

Question 33

oncholysis

Answer 33

pulling away of nail from bed due to abnormal cell adhesion

Question 34

what is nail pitting due to

Answer 34

parakeratotic cells being los from surface

Question 35

what are the treatment choices

Answer 35

vitamin D analogues tar dithranol steroid ointments emollients phototherapy IS immune modulation

Question 36

IS drug

Answer 36

methrotrexate

Question 37

vitaminD analogues

Answer 37

calcipotriol (Dovonex) and calcitriol (silkis) ointment

Question 38

what effect can emollients have if used regularly

Answer 38

anti inflammatory

Question 39

what is this histological feature

Answer 39

spongiosis - oedema between keratoinocytes

Question 40

what is this histological feature

Answer 40

papillomatosis - irregual epithelial thickening

Question 41

name 3 drugs which aggravate psoriasis

Answer 41

* **Beta blockers** * anti-malarials (hydroxychloroquine) * lithium * interferons

Question 42

what adverse effect on the skin can steroids cause

Answer 42

skin atrophy

Question 43

what adverse effect can dithranol cause

Answer 43

skin irritation, particularly of genitalia and eyes

Question 44

which treatment is preferred by patients as it is the cleanest

Answer 44

vitamin D analogues