Psoriasis

Question 1

aetiology

Answer 1

family hx present in 40-50% cases

Question 2

pathophysiology

Answer 2

• epidermal hyperplasia
• T cell infiltration: CD4 + CD8
• inflam cascade involving TNF alpha

Question 3

features of psoriatic nails

Answer 3

• periungal erythema
• pitting
• subungal hyperkeratosis
• onycholysis

Question 4

triggers (7)

Answer 4

• smoking
• alcohol
• stress
• infection
• trauma
• drugs
• post partum pregnancy

Question 5

which drugs can trigger psoriasis

Answer 5

• some anti malarials
• lithium
• beta blockers

Question 6

description of psoriatic lesions

Answer 6

• pink/red
• silvery/scale appearance
• well defined edges
• symmetrical
• extensor surfaces

Question 7

appearance of guttate psoriasis

Answer 7

multiple small tear drop pink lesions affecting large area of body

Question 8

cause of guttate psoriasis

Answer 8

comes on quickly following streptococcal sore throat

Question 9

name a trigger for erythrodermis psoriasis

Answer 9

withdrawal of systemic steroids

Question 10

presentation of erythrodermis psoriasis

Answer 10

skin: hot, red, painful
unwell + hypotensive
no longer have clear defined plaques

Question 11

flare up of psoriasis that becomes red, hot, painful + development of pustules within plaques?

+ whats a trigger?

Answer 11

Generalised pustular psoriasis

Trigger = withdrawal of inappropriate superpotent steroid use

Question 12

having psoriasis increases your risk of ?

Answer 12

• MI
• T2DM
• hyperlipidaemia
• metabolic syndrome

Question 13

Psoriatic arthritis affects … (joints)

Answer 13

• DIPs

- spares MCPs

Question 14

more likely for psoriatic arthritis to occur before or after psoriasis of skin

Answer 14

before

Question 15

validated screening tool for psoriatic arthritis?

Answer 15

PEST = psoriatic epidemiology screening tool

Question 16

75% patients have a genetic link with…

Answer 16

HLA-CW6

Psons 1 gene

Question 17

indexes to assess severity of disease

Answer 17

1) PASI - psoriasis area severity index

2) DLQI - dermatology life quality index

Question 18

treatment to reduce pruritus + scale loss

Answer 18

regular emollients

Question 19

topical treatments

Answer 19

application of a potent corticosteroid OD
+
Vitamin D analogue applied OD

for up to 4 weeks as initial treatment

Question 20

2nd line topical treatment if no improvement with topical corticosteroid for 8 weeks…

Answer 20

Vitamin D analogue BD

Question 21

3rd line topic trx

Answer 21

potent corticosteroid applied BD for up to 4 weeks
OR
coal tar preparation BD

Question 22

examples of Vitamin D analogues + their benefits

Answer 22

• Calcitriol
• Calcipotriol

Reduce cell division + differentiation –> reduce scale + thickness of plaques (but not erythema

Question 23

name 4 secondary care treatments

Answer 23

• phototherapy
• ciclosporin
• methotrexate
• acitretin

Question 24

2 types of phototherapy

Answer 24

1) Narrow band UVB

2) PUVA = Psoralen + UVA (photochemotherapy)

Question 25

adverse effects of phototherapy

Answer 25

- skin ageing | - squamous cell carcinoma

Question 26

1st line choice for systemic therapy

Answer 26

methotrexate

Question 27

when to offer systemic non biological therapies? (such as ciclosporin + methotrexate)

Answer 27

- cannot be controlled with topical therapy - sig impact on physical, psychological, social welbeing - extensive psoriasis (>10% body SA) - phototherapy has been in effective

Question 28

e.g. of systemic biological therapy and mechanism

Answer 28

- adalimumab - etanercept - infliximab TNF blockers

Question 29

describe the psoriatic patches:

Answer 29

dry, flaky, scaly & erythematous | raised & rough

Question 30

location of psoriatic plaques

Answer 30

extensor surfaces e.g. of knees and elbows

Question 31

which type of psoriaiss is more common in children

Answer 31

guttate

Question 32

what is guttate psoriasis triggered by

Answer 32

strep throat

Question 33

widespread smal pink plaques - what psoriasis

Answer 33

guttate

Question 34

skin comes away in large patches - exposing raw areas, skin feels hot what psorisais?

Answer 34

erythrodermic

Question 35

what is auspitz sign

Answer 35

small points of bleeding when plaques are scraped off

Question 36

koebrer phenomena

Answer 36

development of psoriatic lesions to areas of skin affected by trauma

Question 37

how does Narrow b & UVB or PUVA help psoriasis

Answer 37

by slowing down keritonocyte proliferation

Question 38

initial treatment for psoriasis & duration

Answer 38

potent corticosteroids OD & Vit D analogue OD for up to 4 weeks

Question 39

2nd and 3rd line for psoriasis

Answer 39

2nd: increase Vit D analogue to BD 3rd line: potent corticosteroid BD for 4 weeks or coal tar preparation BD

Question 40

example of 2 vit D analogues

Answer 40

Calcitriol & calcipotriol

Question 41

mechanism of vit D analogs

Answer 41

reduce cell division & differentiation to reduce scale & thickness of plaques

Question 42

1st line choice of systemic treatment for psoriasis

Answer 42

methotrexate