Psoriasis Flashcards Preview

B - Dermatology > Psoriasis > Flashcards

Flashcards in Psoriasis Deck (73):
1

What is psoriasis? 

A long-lasting autoimmune disease characterised by abnormal patches of skin that are typically red, itchy, and scaly

2

How severe is psoriasis? 

It varies in severity, from small localised patches, to complete body coverage which can have a major impact on quality of life 

3

Describe the course of psoriasis? 

The disease involves periods of improvement and then flare ups 

4

At what age can people develop psoriasis? 

It can affect anyone, but most commonly affects adults under 35 years old 

5

What is psoriasis characterised by? 

Abnormally excessive and rapid growth of the epidermal skin layer

6

What does the abnormally excessive and rapid growth of the epidermal basal layer cause in psoriasis? 

Gross thickening of the prickle-cell layer and production of excessive stratum corneum

7

How quickly are skin cells replaced in psoriasis? 

Every 3-5 days, compared to the normal 28-30 days

8

What is the mechanism of disease in psoriasis? 

The exact mechanism is unknown, however these changes are belived to stem from premature maturation of keratinocytes induced by an inflammatory cascade the dermis

9

What is the role of genetics in psoriasis? 

Psoriasis runs in families, with 1 in 3 people with psoriasis having a close relative with the condition, however the exact role genetics plays is unclear. It is likely that a combination of genes contributes to an increased vulnerability to the condition 

10

How are triggers important to psoriasis? 

Most people's psoriasis symptoms start or become worse because of a trigger 

11

Why is it important that patients know their triggers? 

As this can help prevent a flare up 

12

What are the common triggers of psoriasis? 

Injury to the skin
Excessive alcohol intake
Smoking
Stress
Hormonal changes, particularly during puberty or menopause
Certain medications
Throat infections
Other immune disorders, such as HIV

13

What is psoriasis developing as a result of injury to the skin known as? 

Koebner response 

14

What medications can trigger psoriasis?

Lithium
Some anti-malarials
NSAIDs
ACE inhibitors
Beta blockers

15

What are the main types of psoriasis? 

Plaque psoriasis (Psoriasis vulgaris)
Pustular psoriasis
Guttate psoriasis
Erythrodermic psoriasis
 

16

Can different forms of psoriasis co-exist? 

Yes 

17

What is the most common form of psoriasis? 

Plaque psoriasis 

18

What % of cases of psoriasis are plaque psoriasis? 

About 80%

19

Describe the 'plaques' in plaque psoriasis

They are dry, red skin lesions, which are covered in silver scales. They can be itchy and/or sore 

20

Where do the plaques in plaque psoriasis appear? 

They normally appear on the elbows, knees, scalp, and lower back, however can be anywhere on the body They usually do not appear on the face 

21

What might happen in severe plaque psoriasis? 

The skin around the joints may crack and bleed 

22

On what basis does the extent of the rash vary in plaque psoriasis? 

Varies between different people, and can vary from time to time in the same person 

23

How severe is plaque psoriasis? 

It varies - some people may have just a few small plaques of a cm or so, but some people have a more widespread rash with large plaques 

24

What are the variations of plaque psoriasis? 

Scalp psoriasis
Flexural psoriasis

25

Where does flexural psoriasis occur?

In the creases of the skin, such as the armpit, groin, under breasts, and in skin folds

26

Describe the affected skin appear in flexural psoriasis

Looks red and inflamed, but is smooth and does not have rough scaling

27

What makes flexural psoriasis worse?

Friction and sweating, so can be particularly uncomfortable in hot weather

28

What is pustular psoriasis?

A rarer type of plaque psoriasis that causes pus-filled blisters to appear on the skin

29

Does the pus indicate infection in pustular psoriasis?

No, it is not infectious

30

Describe the skin around the pustules in pustular psoriasis?

It is usually red and tender

31

What are the different types of pustular psoriasis?

Generalised pustular psoriasis
Palmar pustular psoriasis
Acropustulosis
 

32

What does generalised pustular psoriasis cause? 

Pustules to develop on a wide area of skin

33

Describe the course of pustular psoriasis

It can develop very quickly, and may reappear every few days or weeks in a cycle

34

What can generalised pustular psoriasis cause during the start of the cycle? 

Fever
Chills
Weight loss
Fatigue
 

35

What does palmar pustular psoriasis cause? 

Pustules to appear on the palms of the hands and soles of the feet

36

Describe the course of palmar pustular psoriasis

The pustules gradually develop into circular brown, scaly spots, which then peel off. They may reappear every few days or weeks 

37

What does acropustulosis cause? 

Pustules to appear on the fingers and toes 

38

What happens after the development of pustules in acropustulosis? 

They burst, leaving bright red areas that may ooze or become scaly 

39

Other than pustules, what can acropustulosis cause? 

Painful nail deformities 

40

What happens in guttate psoriasis? 

Small (less than 1cm) round/oval plaques of psorasis develop over many areas of the body

41

What does guttate psoriasis normally occur following? 

An infectious sore throat

42

How long does guttate psoriasis last? 

It usually lasts a few weeks, however can last up to 3-4 months 

43

What does guttate psoriasis sometimes develop into? 

Plaque psoriasis 

44

What proportion of people with any type of psoriasis will also have fingernail symptoms? 

About half 

45

What is affected in addition to the fingernails in some people? 

Toenails 

46

Can nail psoriasis occur alone, without the skin rash? 

Yes 

47

What can nail psoriasis cause? 

Development of tiny dents/pits
Discolouration 
Abnormal growth 
Nail to become loose and seperate from the nail bed 
Crumbling of nails in severe cases
 

48

What is erythrodermic psoriasis? 

A rare form that affects nearly all of the skin of the body, which can cause intense itching or burning 

49

What management does erythrodermic psoriasis require? 

Urgent hospital treatment 

50

Why does erythrodermic psoriasis require urgent hospital admission? 

Because it can cause the loss of proteins and fluid, causing further problems such as infection, dehydration, heart failure, hypothermia, and malnutrition 

51

How is a diagnosis of psoriasis made? 

Psoriasis is usually a clinical diagnosis, and no tests are needed
Occassionally, a biopsy can be taken when there is doubt about the diagnosis

52

What does assessment need to be made regarding in any patient with any type of psorasis? 

Disease severity 
Impact of the disease on physical, psychological, and social wellbeing
The potential presence of psoriatic arthritis
Presence of co-morbidities 
 

53

How often should assessment for psoriatic arthritis be made? 

Annually, especially within the first 10 years of diagnosis 

54

What should be identified and managed in adults with severe psoriasis? 

Cardiovascular risk factors

55

What is the management of psoriasis determined by? 

The type and severity, as well as the area of skin affected 

56

What are the categories of treatment in psoriasis? 

Topical  Phototherapy Systemic
 

57

What is the first line treatment for mild to moderate psoriasis? 

Topical treatments 

58

How effective are topical treatments for mild to moderate psoriasis? 

Some people find they are sufficient for control 

59

How long might topical treatments take to work in psoriasis? 

Up to 6 weeks 

60

What should be done if topical therapy alone is unlikely to control the psoriasis? 

You should offer second- or third-line treatment options at the same time as topical therapy

61

What are the second- and third-line treatment options after topical treatments? 

Phototherapy or systemic therapy

62

Give two examples of why topical therapy alone is unlikely to control the disease? 

If there is extensive disease If topical therapy is known to be ineffective in that part of the body, e.g. nail disease 
 

63

What are the topical treatments that can be used in psoriasis? 

Emollients Topical corticosteroids Vitamin D analogues Calcineurin inhibitors 
 

64

What are emollients? 

Moisturising treatments applied directly to the skin 

65

What is the point in emollients? 

To reduce water loss and cover the skin with a protective film

66

What are the main benefits of emollients? 

Reduction in itching and scaling Some topical treatments are thought to work better on moisturised skin 
 

67

What are topical corticosteroids commonly used for in psoriasis? 

To treat mild to moderate psoriasis in most areas of the body 

68

How do topical corticosteroids work in psoriasis? 

They reduce inflammation, which slows the production of skin cells and reduces itching

69

What might continuous use of potent corticosteroids cause in psoriasis? 

Irreversible skin atrophy and striae Psoriasis to become unstable Systemic side effects 
 

70

When might potent topical corticosteroids cause systemic side effects? 

If applied continuously to extensive psoriasis

71

What should patients be made aware of when starting topical corticosteroids? 

The risk and benefits

72

How long can very potent corticosteroids be used for at any site? 

No longer than 4 weeks 

73

How long can potent corticosteroids be used for at any site? 

No longer than 8 weeks