Psoriasis

Question 1

Presentation and pathophysiology mnemonic

Answer 1

PSORIASIS: Presentation and
Pathophysiology
Pink papules/Plaques/Pinpoint bleeding
(Auspitz sign)/Physical injury (Koebner
phenomenon)
Silver scale/Sharp margins
Onycholysis/Oil spots
Rete Ridges with Regular elongation
Itching
Arthritis/Abscess (Munro)/Autoimmune
Stratum corneum with nuclei
Immunologic
Stratum granulosum absent

Question 2

Exacerbating factors

Answer 2

Lithium
Ethanol
Chloroquine
Beta blockers
Stress

Question 3

Most common sites

Answer 3

1. Scalp
2. Extensors
3. Trunk
4. Nails
5. Pressure areas

Question 4

Pathophysiology

Answer 4

1. Decreased epidermal transit time
2. Shortened cell cycle compared to normal skin
3. Th1 mediated inflammatory response

Question 5

Classification

Answer 5

1. Plaque psoriasis
2. Guttate
3. Erythrodermic
4. Pustular
5. Psoriatic arthritis

Question 6

Triggers

Answer 6

1. Physical trauma
2. Infections
3. Stress
4. Drugs
5. Alcohol

Question 7

Management of psoriasis

Answer 7

1. Benign, rare serious association. Recurrent and chronic
2. Stress can aggrevate->stress management
3. Smoking cessation
4. Alcohol reduction
5. Weight loss
6. Topical
   a. Emolients
   b. Keratolytics: salicylic acid 2-10% in sorbolene
   c. Corticosteroids
   d. LPC 2% BD (tars)
   e. Calcipotriol (regulates proloferation/differentiation of keratinocytes, 6 weeks to see results)
   f. Dithranol w/ salicylic (prevent oxidation and remove scale). Stains clothes permanently and skin transiently
7. Systemic when severe/debilitating
   Methotrexate + folic acid->widespread, disabling
   Acitretin
   Cyclosporin
   Efalizumab
8. Phototherapy

Question 8

First line therapy in guttate psoriasis

Answer 8

1. Phototherapy