Psoriasis

Question 1

What is psoriasis?

Answer 1

Inflammatory skin disorder
Increased turnover of skin
Red clay plaques
Chronic, relapsing

Question 2

Where is psoriasis most common?

Answer 2

most commonly extensor surfaces and scalp

Question 3

How common is psoriasis?

Answer 3

2% of population radical variation affects men and women equally

Question 4

What are the two age groups of onset?

Answer 4

late teens to early 20s, earlier in females 50s

Question 5

Describe the histology of psoriasis?

Answer 5

Acanthosis - thickening of epidermis 
Munro micro abscesses 
Elongation of retention ridges 
Suprapapillary thinning 
Dilated papillary blood vessels

Question 6

What are the causes of psoriasis?

Answer 6

Genetic and environmental
FH
HLA-CW6

Question 7

What are the aggravating factors for psoriasis?

Answer 7

streptococcal throat infection 
medications - beta blockers, lithium, antimalarials 
stress
alcohol and cigarettes 
trauma, friction (sunlight)

Question 8

What are the different types/presentations of psoriasis?

Answer 8

Chronic plaque psorasis 
Palmoplantar psoriasis 
Flexural psoriasis 
Guttate psoriasis 
Erythrodermic psoriasis 
Pustular psoriasis

Question 9

Describe chronic plaque psoriasis

Answer 9

salmon pink patches and plaques 
well demarcated 
silverly scales 
extensor surfaces 
symmetrical

Question 10

What nail changes are seen in chronic plaque psoriasis?

Answer 10

Pitting
Onycholysis
Subungal hyperkeratosis

Question 11

What is Koebner phenomenon?

Answer 11

Tendancy for a skin condition to occur within scars or sites of trauma

Question 12

What is palmoplantar psoriasis?

Answer 12

Psoriasis of the hands and feet

Question 13

What is flexural psoriasis?

Answer 13

Psoriasis affecting flexed areas

Question 14

What is guttate psoriasis?

Answer 14

more common in children/adolescents raindrop lesions on skin with acute streptococcal infection

Question 15

How long does guttate psoriasis take to resolve?

Answer 15

Self-resolving (months)

May precede chronic plaque psorasis

Question 16

What is erythodermic psoriasis?

Answer 16

more that 90% body surface area affected

Uncommon

Question 17

How does erythodermic psoriasis present?

Answer 17

Most likely to have preceding history of psoriasis
May not have other features of psoriasis
May be systemically ill

Question 18

What is pustular psoriasis - palmoplantar?

Answer 18

Common in females / adults
associated with smoking
symmetrical pattern

Question 19

Describe acute generalised pustular psoriasis?

Answer 19

Rare

patient may be systemically unwell sheets of pustules with background erythema

Question 20

What precipitates generalised pustular psoriasis?

Answer 20

steroid withdrawal

Question 21

What other condition is associated with psoriasis?

Answer 21

10% have arthritis

Arthritis can be with psoriasis or preceding/succeeding it

Question 22

What is the peak age of psoriatic arthropathy onset?

Answer 22

40-60 years

Question 23

What are the other systemic problems associated with arthritis?

Answer 23

CV RFs
Metabolic syndrome
Psychological
Joint disease

Question 24

What are the symptoms patients experience with psoriasis?

Answer 24

pain
itch
bleed

Question 25

What is the emotional effect of having psoriasis?

Answer 25

self confidence | feelings of shame and uncleanliness

Question 26

What are the different ways to manage psoriasis?

Answer 26

Education topical treatment Photo therapy Systemic treatment

Question 27

What is the first line in managing psoriasis?

Answer 27

Topical treatment

Question 28

What are the various topical treatments available?

Answer 28

Emollients e.g. E45 Vitamin D3 analogues Topical corticosteroids e.g. Eumovate Keratolytics e.g. Salicylic acid Coal tarDithranol

Question 29

What is the best topical treatment for thick plaques?

Answer 29

salicylic acid or dithranol

Question 30

What is the best topical treatment for face?

Answer 30

mild to mod topical steroids

Question 31

What is the best topical treatment for flexures?

Answer 31

mild to moderate topical steroids or calcitriol

Question 32

What is the best treatment for guttate psoriasis?

Answer 32

Coal tar preparations | Also: emollients, calcitroil dovonex and hard to treat cases can be given TL01 narrowband UVB treatment

Question 33

What is the second line of treatment for psoriasis?

Answer 33

Phototherapy UVB/TL01/UVA

Question 34

What are the side effects of phototherapy?

Answer 34

Erythema/pruritus | Nausea (PUVA)L/T - Skin cancer

Question 35

How should erythrodermic psoriasis generalised pustular psoriasis be treated?

Answer 35

Admission Supportive treatment with careful monitoring of BP, temp, Use Liberal emollients and topical steroids Consider systemic treatment

Question 36

What are the 3rd line systemic treatment? | 3 main ones

Answer 36

Methotrexate Ciclopsporin Acitretin

Question 37

When should methotrexate be used?

Answer 37

Psoriasis and psoriatic arthropathy

Question 38

What are the cons of using methotrexate?

Answer 38

long term effects on the liver do not take if high alcohol intake

Question 39

When is ciclosporin be used?

Answer 39

short term control

Question 40

What are the cautions when using ciclosporin?

Answer 40

hypertension nephrotoxicity carcinogenesis care in HTN or past phototherapy

Question 41

What are the cautions when using acitretin?

Answer 41

Teratogenic (2 years) | Not in young women who want to start a family

Question 42

What are the side effects of methotrexate?

Answer 42

Teratogenicity, nausea and GI upset | Liver fibrosis, marrow suppression

Question 43

What should be monitored when taking methotrexate?

Answer 43

LFT | FBC

Question 44

What are the SEs of ciclosporin?

Answer 44

``` Hypertrichosis Gym hypertrophy Tingling peripheries Carcinogenesis Hypertension Nephrotoxicity ```

Question 45

What should be monitored when taking ciclosporin?

Answer 45

BP | U&E

Question 46

What are the SEs of Acitretin?

Answer 46

Teratogenic, dry skin and lips | Hyperlipidaemia, hepatotoxicity

Question 47

What should be monitored when taking acitretin?

Answer 47

fasting lipids LFTs

Question 48

What treatment can be used when systemic treatment fails?

Answer 48

Biological treatment

Question 49

When do patients qualify for biological treatment?

Answer 49

- PASI - must score above 10 - DLQI - must score above 10 - patients must have failed on two of the systemic treatments with severe psoriasis

Question 50

What are some examples of systemic treatments?

Answer 50

``` Adelimumab Ustekinumab Etanercept Secukinumab Infliximab ```