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Dermatology Diploma > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

GENETICS

What % of new cases of psoriasis are familial?

A

40%

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2
Q

What the the single Major Histocompatability Complex (MHC) locus is the strongest susceptibility locus for psoriasis?

(Strongest gene)

A

PSORS1

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3
Q

What environmental factors affect the course of Psoratic disease?

A
  • Stress
  • Infection
  • Skin trauma
  • Drugs
  • Alcohol
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4
Q

What drugs are associated with worsening/developing psoriasis?

A
  • Beta Blockers
  • NSAIDs
  • Lithium
  • Anti-Malarials
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5
Q

What form of psoriasis has the strongest link with smoking?

A

Pustular psoriasis

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6
Q

What is the aetiology of psoriasis?

A
  • T-lymphocytes & Dendritic cells produce cytokines
  • These Cytokines stimulate keratinocytes
  • Keratinocytes proliferate and increase inflammatory cells to the skin
    • Epidermal Hyperplasia and inflammation occurs.
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7
Q

What are the peak decades of onset?

A

20-30yrs and 50-60yrs

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8
Q

What are the subtypes of Psoriasis?

A
  • Thin Plaque Psoriasis
  • Flexural Psoriasis
  • Pustular Psoriasis
  • Gutatte Psoriasis
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9
Q

What type of psoriasis is this?

A

Pustular Psoriasis

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10
Q

What type of psoriasis is this?

A

Guttate Psoriasis

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11
Q

What type of psoriasis is this?

A

Thin Plaque Psorasis

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12
Q

What is the commonest form of psorasis?

A

Plaque Psorasis

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13
Q

Where does plaque psoriasis most commonly appear?

A
  • Scalp - 80%
  • Elbows more than knees (75% vs 55%)
  • Legs more than arms (75% vs 55%)
  • Soles of the feet in 13%
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14
Q

If you notice psoriasis, what part of the body should you also examine.

A

The nails.

Look for Subungual Hyperkeratosis, Pitting, onycholysis.

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15
Q

What form of psoriasis is the 2nd most common form of psoriasis in adults & the most common in children?

A

Guttate Psoriasis

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16
Q

What is strongly linked to guttate psoriasis?

A

Streptococcal infection

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17
Q

What investigations should be done if you see guttate psorasis?

A

ASO Titres.

Check for sore throat.

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18
Q

What is the differential diagnosis for guttate psoriasis?

A
  • Pityriasis rosea
  • Secondary syphilis
  • Rarely: pityriasis lichenoides chronica
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19
Q

What is the management of guttate psoriasis?

A

UV light.

Topical therapies don’t really work.

The plaques settle in a few weeks to a few months.

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20
Q

What type of psoriasis is this?

A

Flexural psoriasis

(AKA Inverse Psoriasis)

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21
Q

What type of psoriasis is this and how does it differ from cadidal nappy rash?

A

Napkin psoriasis

(There is clear demarcation here where as in candidal infection there are satellite lesions)

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22
Q

What type of psoriasis is this and what should you do as a GP?

A

Unstable psoriasis

  • Refer as a Dermatological emergency
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23
Q

What type of psoriasis is this?

A

Erythrodermic psoriasis

  • Differentials: Eczema, Drug Rection, Cutaneous T-Cell Lymphoma & Pityriasis rubra pilaris.
  • Dermatological Emergency
  • Biopsies are taken.
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24
Q

What type of psoriasis is this?

When does it develop?

How is it managed?

A

Palmar Pustular psoriasis

  • Middle age
  • Treat with topical therapies & Smoking cessation
  • If these fail consider Acitretin.
25
Q

What type of psoriasis is this?

A

Generalised Pustular Psoriasis

  • Differntial Diagnosis: Acute Generalised Eruptive Pustulosis
  • Pustular psoriasis may arise when patients stop or reduce oral steroids.
  • Dermatological Emergency
26
Q

What form of psoriasis is this?

How is it treated?

A

Acrodermatitis Continua of Hallopeau

Usually treated with methotrexate

27
Q

What other areas of the body should you check in psoriasis?

A
  • Scalp
  • Anogenital area
  • Fingers
  • Joints
28
Q

What percentage of patients have anogenital psoriatic lesions?

How is it treated?

A

30-40%

  • Combination therapy with moderate strength steroids and antifungals. (Trimovate or Lotriderm) for intermittent periods.
29
Q

What % of patients will have scalp psorasis?

A

80%

30
Q

What is this form of psoriasis called?

A

Pityriasis Amianatacea

Large waxy adherent scales infiltrates and surrounds the base of a group of scalp hairs

31
Q

5% of Psoriasis patients will have Psoriatic Arthritis.

What sort of joint disease can occur in psoriatic arthritis?

A
  • Enthesesis - usually of the achilles tendon & thumb tendons.
  • Plantar fasciitis.
  • Monoarthropathies of large joints (Most common joint involvement)
  • Less Common
    • RA of the hands, sacroiliitis, enthesesis, arthritis mutilans
32
Q

Describe the screening tool for arthritis in psoriasis?

A

PEST

Psoriasis Epidermiology Screening Tool

A score of >3 triggers a referral to rheumatology

33
Q

How do you measure the severity of psoriatic disease?

A
  • PASI (Psoriasis Area and Severity Index)
  • DLQI (Dermatology Life Quality Index)

Severe = A PASI score of >=10 or a DLQI score of >10 or significant functional or psychological morbidity.

34
Q

What is the mainstay of topical treatment in psoriasis?

A

Vitamin D Analogues (Dovonex)

35
Q

How many grams of dovonex can you use per week before you are at risk of hypercalcaemia?

A

No more than 100g per week otherwise Hypercalcaemia can result.

36
Q

What % of patients suffer from irritation from dovonex?

A

15%

37
Q

What is a potential theoretical complication from tar based therapy?

A

Skin tumours

(Although all studies have no proven this)

38
Q

Why is salicylic acid useful?

A

It helps to descale the plaques before vitamin D analogues or steroids are used.

39
Q

How is dithranol used in psoriasis?

A
  • Day treatment - because it stains skin, hair and clothing.
  • Left on for 1-2 hours then washed off
  • Can cause irritation.
  • Good for large plaques.
40
Q

What area of the body is coal tar useful for?

A

Scalp Psorasis

41
Q

What is the best way to treat facial psoriasis?

A

Tacrolimus or Pimecrolimus + low dose steroids-tar combination

(Alphosyl HC in the UK)

42
Q

What is the best way to treat genital psoriasis?

A

Steroid + Antifungal/Antibacterial cream

43
Q

What is the best way to treat scalp psoriasis?

A
  • Lather & Massage the scalp for 5 minutes with antikeratolytic shampoo.
    • Or try Cocois Co or SebCo overnight and Wash out with a keratolytic shampoo
  • Topical steroid gel at night for 1 month and then switch to just weekends as maintenance therapy.
  • Calcipotriol/steroid combiation gel to the scalp is useful as a regular therapy.
  • Methotrexate can be used occasionally.
44
Q

What is the best way to treat nail psoriasis?

A
  • Keep nails short
  • Topical calcipotriol/steroids can be applied to the nail bed
  • Intralesional steroids in the nail matrix can help
  • Methotrexate or biologic agents can be useful.
45
Q

PUVA vs Narrow bank UVB therapy

Which is mroe effective?

Which has more side effects?

A
  • PUVA is more effective
  • UV B has less side effects.
    • No risk of cataracts
    • No need to take Psoralen.
    • No need for glasses like in PUVA
46
Q

What is the recommended total dosage for both PUVA or narrow band UV B?

A

150 to 200 cumulative treatments

47
Q

What should not be combined with PUVA?

A

Methotrexate or Cyclosporin

due to risk of carcinogenesis

48
Q

UVB + other therapy is superseded by immunosuppressive therapies.

However, what is the INGRAM REGIMEN?

A

Dithranol in Lassar’s paste + Tar baths + UVB

49
Q

What is Re-PUVA and why is it useful?

A

Retinoid PUVA

  • Acitretin started before the UVA
  • Benefits
    • Lower doses of light are needed for effect.
    • Lower incidence of skin cancer.
50
Q

What form of psoriasis is methotrexate particularly useful for?

Why are low dose capsules used?

A

Psoriatic arthritis

  • To avoid taking too much. (It has the highest number of drug errors)
51
Q

What are some complications of methtrexate?

A

Liver and lung fibrosis

52
Q

How long does it take to work?

A

6 weeks to show improvement

12 weeks to reach maximum effect.

53
Q

What drugs can interact with methotrexate?

A
  • Sulphonamides
  • Trimethoprim
  • NSAIDsa
54
Q

What serological marker has replaced regular liver biopsies in patients?

A

Procollagen 3 assay

(The level reflects the degree of liver fibrosis from hepatic collagen synthesis)

55
Q

How effective is methotrexate?

A

75% improvement in 90% of psoriatic patients.

56
Q

How effective is ciclosporin and how does it work?

A

Improves chronic plaque psoriasis by 60-70% in 4 weeks.

It immunomodulates T-Cells.

57
Q

How long should ciclopsorin be used and why?

A

12 months due to nephrotoxicity.

(But this often can be longer if people want clear skin and are willing to give up renal function for it)

58
Q

How should ciclosporin be monitored?

A

Every 3 months for renal function and blood pressure.

59
Q

What other systemic drugs can be used in psoriasis?

A
  • Oral retinoids - combined with other drugs.
  • Fumaric acid esters - can cause GI side effects or flushing
  • Apremilast - - similar efficacy to methotrexate but doesn’t need regular blood tests.
  • Mycophenolate Mofetil - not very useful.
  • Hydroxyurea - can cause pancytopaenia, leukaemia and skin side effects.
  • Biological therapies

Dermatology Diploma (39 decks)

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