psoriasis

Question 1

what is psoriasis vulgaris

Answer 1

chronic plaque

Question 2

what age is it most common

Answer 2

15-25 then 55-60

Question 3

definition of psoriasis

Answer 3

chronic inflammatory disorder of skin and joints. relapsing and remitting.

Question 4

pathophysiology

Answer 4

inflammatory cells in all layers of psoriatic skin, leading to epidermal hyper proliferation

Question 5

risk factors

Answer 5

stress, genetics, obesity, smoking, alcohol, medications, skin injury, infection

Question 6

symptoms

Answer 6

red plaques with overlying white scale, thick, may bleed if scales are scraped off

Question 7

commonly affected areas

Answer 7

buttocks, lower back, scalp, elbows, knees and nails

Question 8

complications

Answer 8

psoriatic arthritis, depression and anxiety, metabolic syndrome, CVD

Question 9

treatment regimen

Answer 9

4 week blocks with regular reviews

Question 10

MILD treatment

Answer 10

• emollients
• topical corticosteroid +/- topical vit D analogue e.g. calcitriol
• calcineurin inhibitor - tacrolimus
• coal tar / dithranol

Question 11

MODERATE treatment

Answer 11

topical therapy +
1st line = oral methotrexate / ciclosporin

• oral ACITRETIN (synthetic) –> moa decreases hyper keratinisation, risks ; hyperlipidaemia, hepatotoxic, teratogenic (longer t1/2)

-PHOTOTHERAPY - narrowband UVB 2-3/7, psoralen + UVA 3/7. disrupts DNA synthesis slowing basal cell to normal growth.
risks = teratogenic, premature skin ageing and pigmentation.

Question 12

SEVERE treatment

Answer 12

add a biological agent
e.g. INFLIXIMAB - anti TNF
risks : cancer and CVD, infection and neurological risk

Question 13

what kind of treatment is used on the face, flexures and genitals

Answer 13

MILD-MOD steroid start term treatment

long term treatment may be needed with calcineurin inhibitor

Question 14

application of emollients

Answer 14

apply daily in the direction hair growth before other topical applications to improve absorption

Question 15

side effect of vit d analogues

Answer 15

skin irritation + photosensitivity

Question 16

what symptoms should be reported immediately

Answer 16

joint symptoms

Question 17

methotrexate moa risks and interactions

Answer 17

folic acid antagonist 
inhibits dihydrofolate reductase 
blocks dna synthesis 
slows basal cell proliferation 
risks: teratogenic, hair loss, gi symptoms, liver cirrhosis 
interactions; nsaids trimethoprim

Question 18

ciclosporin moa and risks and interactions

Answer 18

blocks calcineurin dependent factor

risks: teratogenic, nephrotoxic, hypertension
interactions: grapefruit