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Flashcards in Psoriasis Deck (35)
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1
Q

What is psoriasis?

A

A common papulo-squamous disorder affecting 2% of the population and is characterized by well-demarcated, red scaly plaques. The skin becomes inflamed and hyperproliferates at about ten times the normal rate

2
Q

What immune cell is implicated in psoriasis?

A

T-lymphocyte

3
Q

What are thought to be trigger factors for the development of psoriasis?

A
  • Infections
  • Drugs
  • Trauma
  • Smoking
  • Alcohol
  • UV light
  • Genotype
4
Q

What are pathological features of psoriasis?

A
  • Increased skin turnover
    • Epidermal acanthosis
    • Epidermal parakeratosis
  • Absent granular layer
  • Polymorphonuclear abscesses in upper dermis
  • Capillary dilatatio in dermis
5
Q

What is the most important cytokine implicated in someone with psoriasis?

A

TNF-alpha - bases of some therapeutic interventions

6
Q

What proportion of those with psoriasis have family members with the disease?

A

30%

7
Q

What drugs can trigger psoriasis?

A
  • Lithium
  • NSAIDs
  • B-blockers
  • Antimalarials
8
Q

What are typical features of psoriatic plaques?

A
  • Symmetrical, well defined, with silvery scales
  • Found on extensors surfaces
  • Flexures can be affected, but plaques are less scaley
9
Q

What are signs of psoriasis?

A
  • Symmetrical, sclaey plaques on flexures
  • Specific types of psoriasis - guttate, pustular, generalised
  • Nail changes
  • Arthritis
10
Q

What is the comonest type of psoriasis?

A

Chronic plaque psoriasis - pinkish red sclay plaques, especially on extensor surfaces such as knees and elbows. Can be present on lower back, ears and scalp as well.

11
Q

In chronic plaque psoriasis, what is the term used to describe new pllaques which have formed at sites of trauma?

A

Kobner phenomena

12
Q

What are features of flexural psoriasis?

A

Well-demarcated, red glazed plaques confined to flexures such as the groin, natal cleft and sub mammary area. These are rarely scaly lesions

13
Q

What are features of guttate psoriasis?

A

‘Raindrop-like’ psoriasis is a variant most commonly seen in children and young adults. An explosive eruption of very small circular or oval plaques appears over the trunk about 2 weeks after a streptococcal sore throat.

14
Q

Where is guttate psoriasis most commonly found?

A

Over the trunk

15
Q

What can cause guttate psoriasis?

A

Strep throat infection - occurs approximately 2 weeks post infection

16
Q

What are features of erythrodermic psoriasis?

A

Usually occurs in the setting of known worsening or unstable psoriasis but may uncommonly be the first presentation of psoriasis - Acute onset of erythroderma and pustular plaques

17
Q

Is erythrodermic psoriasis an emergency?

A

Yes

18
Q

What systemic features can appear in erythrodermic psoriasis?

A
  • Malaise
  • Pyrexia
  • Circulatory disturbance
19
Q

What are the main types of psoriasis?

A
  • Chronic plaque psoriasis - extensors
  • Flexure psoriasis
  • Guttate psoriasis
  • Palmo-plantar psoriasis
  • Erythrodermic psoriasis
20
Q

What are features of palmo-plantar psoriasis?

A

Plaques: Yellow-brown pustules on palms and soles

21
Q

What are nail changes seen in psoriasis?

A
  1. Pitting of the nail plate
  2. Distal separation of the nail plate (onycholysis)
  3. Yellow-brown discoloration
  4. Subungual hyperkeratosis
  5. Damaged nail matrix and lost nail plate - Rare
22
Q

What proportion of those with psoriasis develop a seronegative arthritis?

A

5-10%

23
Q

What would your differential diagnosis be for a suspected psoriatic plaque?

A
  • Dermatitis/eczema: discoid or seborrhoeic
  • Lichen planus
  • Pityriasis rosea [esp. guttate psoriasis]
  • 2o stage of syphilis
  • Reiter’s syndrome [Esp. palmoplanar psoriasis]
  • Discoid lupus
24
Q

What are the general principles to managent of someone with psoriasis?

A
  • Education
  • Remove triggers
  • Topical therapies
  • Systemic therapies
25
Q

What topical therapies might you use in someone with psoriasis?

A

CREVAS CKD

  • Coal tar preparations - Inhibit DNA synthesis
  • Retinoids - Tazarotene
  • Emollients
  • Vit. D analogues (Calcipotriol, tacalcitol and calcitriol) - decrease cell proliferation
  • Anthralin - ↓ cell proliferation
  • Salicylic acid
  • Corticosteroids
  • Keratolytics
  • Dithranol
26
Q

What systemic therapies might you use for someone with psoriasis?

A
  • Immunosuppressants - Methotrexate, ciclosporin, azathioprine, and hydroxyurea
  • Retinoids - Acitretin
  • Photochemotherpy
    • UVB for classic/plaque and guttate types
    • PUVA [psoralen] for palmoplanar type
27
Q

What is the goeckerman regimen?

A

Treatment of tar and UVB light

28
Q

How would you treat erythrodermic psoriasis?

A

Methotrexate

29
Q

How would you treat guttate psoriasis?

A

Topical therapies and/or UVB

30
Q

How would you treat palmo-plantar psoriasis?

A
  • Potent topical steroids
  • Coal tar paste
  • Local hand and foot PUVA
31
Q

How would you manage someone with flexural psoriasis?

A
  • Mild steroid and/or tar topical creams
  • Calcitriol and 0.1% tacrolimus ointment
32
Q

What does the ingram regimen consist of?

A

Dithranol and UVB

33
Q

What can be used in those with severe psoriatic disease?

A

Cytokine modulators - Anti-TNFalpha

34
Q

What age group does guttate psoriasis most commonly occur in?

A

Children/teenagers

35
Q

What is PUVA?

A

PUVA is a combination treatment which consists of Psoralens (P) and then exposing the skin to UVA (long wave ultraviolet radiation).