Psoriasis

Question 1

Percentage population affected by psoriasis?

Answer 1

3%

Question 2

Gender spread psoriasis

Answer 2

M=F

Question 3

Peak age onset psoriasis

Answer 3

Bimodal: 20s and 50s

Question 4

Condition associated with increased prevalence of psoriasis?

Answer 4

Crohn’s

Question 5

Pathophysiology psoriasis?

Answer 5

-inflammatory infiltrate
-epidermal hyperproliferation
-vascular proliferation
usually skin cell turnover =20d but in psoriasis = 4-7d so basically have sensitive, friable baby skin cells at surface

Question 6

What is the most common type of psoriasis?

Answer 6

Chronic plaque psoriais: red, raised heavily scaled symmetric plaques.

• salmon pink classic
• extensors (sacrum, behind ears and scalp etc, nails)
• if flexural, no scaling
• koebnerisation

Question 7

What are the types of psoriasis?

Answer 7

• Chronic plaque
• Palmoplantar
• Guttate
• Erythrodermic
• Generalised pustular
• Nail psoriasis

Question 8

What is pustular psoriasis?

Answer 8

• Usually soles of feet
• Sterile pustules
• More common in female smokers
• Quitting smoking doesn’t change incidence

Question 9

What is guttate psoriasis?

Answer 9

• Younger
• Usu. follows strep infection
• Small spots
• Self resolving
• Not predisposing to later psoriasis

Question 10

What erythrodermic psoriasis?

Answer 10

• Up to 90% body affected
• In old or young can cause haemodynamic compromise (as so much going to skin)
• Can require urgent medical admission

Question 11

What are the features of psoriatic nails?

Answer 11

• Pitting
• Onycholysis (plate separating from bed)
• Oil spots (yellowy stains)

Question 12

Why are oral steroids a poor treatment choice?

Answer 12

Work well but flare when PO steroids ceased

Question 13

Management of psoriasis?

Answer 13

• Identify triggers (EtOH, smoking, strep throat, drugs)
• Pt education (genetic, lifelong)
• Emollients
• Keratolytics (e.g. salicylic acid)
• Sedating antihistamines for night
• Ointments > creams

Question 14

Which drugs are ass

Answer 14

• NSAIDs
• Lithium
• CCBs
• Steroid withdrawal

Question 15

Why are ointments stronger than cream?

Answer 15

Stronger emollient effect allowing greater penetration of active ingredient, despite same concentration of active ingredient

Question 16

What are the topical treatments for psoriasis?

Answer 16

• Coal tar: cruder the better but smells and stains
• Dithranol: great with UVB, most effective and safest but unattractive
• Vit D analogues: clears in 4-8 weeks
• Topical steroids: high compliance, reserve for local areas
• Retinoids: irritant
• Pimecrolimus: for sensitive areas

Question 17

What are the systemic treat

Answer 17

• Phototherapy (PUVA)
• Methotrexate / cyclosporin
• Systemic retinoids