Psoriasis

Question 1

Definition

Answer 1

A chronic autoimmune disease characterised by erythematous, scaly plaques

Question 2

Name the 5 types of psoriasis

Answer 2

• chronic plaque psoriasis (common type, symettrical plaques on extensor surfaces)
• flexural (smooth, erythematous plaques on flexor regions)
• guttate psoriasis (tear drop shaped plaques appear after a strep infection)
• pustular
• generalised/erythrogermic

Question 3

Risk Factors

Answer 3

• Drugs (BALI)
  Beta blockers, Anti-malarials, Lithium and Indomethacin/NSAIDs
• Skin trauma
• infection
• FH
• Steroid withdrawal

Question 4

Presentation of chronic plaque psoriasis

Answer 4

S - extensor surfaces and scalp
C - bright red/pink
A - nail changes e.g. pitting, onycholysis, hyperkeratosis.
M - circular/oval elevated plaques, often have overlying white scale

Question 5

differentials for a scaly rash

Answer 5

scabies
discoid eczema

Question 6

Pathophysiology and its relation to treatment

Answer 6

The autoimmune reaction causes inflammation and hyperproliferation of keratinocytes.

Corticosteroids reduce inflammation
Vitamin B reduced keratinocyte proliferation

Question 7

Name 4 methods of management

Answer 7

Topical treatment
Phototherapy
Systemic treatment
Biologics e.g. infliximab

Question 8

Name the 4 topical treatments in the order of their stepwise approach

Answer 8

All pts must use emollients all the time

1st line - potent topical steroid e.g. Betnovate AND topical vitamin B e.g. Dovonex (apply at diff times)

2nd line - stop topical steroid and apply vitamin D twice daily

3rd line - stop topical vitamin D and apply steroid twice daily

Question 9

Describe the 3 lines of systemic treatment

Answer 9

1st line - Methotrexate
2nd line - Ciclosporin
3rd line - Acitretin