Psoriasis Exam 35 Questions with Answers Latest
Demographics - CORRECT ANSWER 2% UK
Male=female (chronic plaque
Onset any age but commonly <40.
... [Show More] Average age 33. Females earlier than males (hormones)
Psoriasis pathogenesis - CORRECT ANSWER Hyperproliferative disorder where the life cycle of keratinocytes shortens causing a 28x normal production of epidermal cells. T-cell medicated.
Psoriasis characteristics - CORRECT ANSWER - red, silver scaling, symmetrical plaques, well circumscribed
- elbows, knees, scalp, sacrum
- nails are affected in 50%
- arthritis in 15%
Types of psoriasis - CORRECT ANSWER - Chronic plaque is most common 90%
- guttate
- erythrodermic
- flexural
- pustular
- sebopsoriasis
Psoriasis pictures - CORRECT ANSWER Well defined erythematous plaque with fine scaling
Hand psoriasis - CORRECT ANSWER Begins in pressure bearing areas and dominant handedness
Less well demarcated psoriasis
Scalp psoriasis - CORRECT ANSWER well defined edge, doesn't extend onto the forehead like seborrhoeic dermatitis
DD Seborrhoeic dermatitis - CORRECT ANSWER
DD Pityriasis amiantacea - CORRECT ANSWER Scales which ensheath and bind down tuft of hairs. Removal of scales can cause erythematous hairless skin. Isolated idiopathic phenomenon.
Women average age 25.
Resolves over months to few years.
Erythroderma psoriasis - CORRECT ANSWER
Flexural psoriasis - CORRECT ANSWER Occurs in groin, axillae, inframammary, intergluteal, antecubital, popliteal fossae
Appears smooth and salmon coloured
Obese patients are more prone
Exacerbated by the friction
DD for flexural disease - CORRECT ANSWER Seborrhoeic dermatitis
Candidiasis
Tinea cruris
Contact/irritant dermatitis
CTCL
Auspitz sign - CORRECT ANSWER pinpoint bleeding after a scale is removed
shows the high vascularity of lesion
Guttate psoriasis - CORRECT ANSWER - means droplet shaped
- precipitated by *strep infection* present 2 weeks after pharyngitis or tonsillitis
- commonest in childhood
- self-limiting
- 40% go on to develop chronic plaque psoriasis
palmoplantar pustular psoriasis - CORRECT ANSWER Rare, not associated with HLA-Cw6
Female:male 9:1
>90% ex or current smokers
25% have chronic plaque psoriasis
Associated with thyroid disease
Generalised pustular psoriasis - CORRECT ANSWER Medical emergency form of plaque psoriasis
Comorbidities with psoriasis - CORRECT ANSWER - Ocular inflammation
- IBD
- arthritis
- spondyloarthropathies
- nail disease
- psychosocial
Effects of psoriasis on the nails - CORRECT ANSWER 50% have nail involvement
- pitting
- onycholysis
- longitudinal ridging
- sub-ungual hyperkeratosis
- oil spots
- dystrophy
Nail psoriasis - CORRECT ANSWER
Cardiovascular disease and psoriasis - CORRECT ANSWER DM, hyperlipidaemia, HTN, higher BMI, MI with severe psoriasis
Gene associated with psoriasis - CORRECT ANSWER HLA-Cw6
What are the 2 types of psoriasis? - CORRECT ANSWER Type 1 is earlier onset <40 75%
Type 2 psoriasis is older onset >40 and not as associated with HLA-Cw6
May be different diseases?
Histological appearance of psoriasis - CORRECT ANSWER Epidermal hyperplasia
Dilated and prominent blood vessels
Infiltrate of leucocytes
Cytokines in psoriasis - CORRECT ANSWER TNFa, IL-17
Triggers for psoriasis - CORRECT ANSWER Infection
- strep
- HIV
Skin trauma
- koebnar (site of trauma)
Drugs
- B-blockers
- NSAIDs
- lithium
- anti-malarials
Stress
Alcohol
Endocrine - pregnancy, hypocalcaemia
Prognosis - CORRECT ANSWER Treatment is suppressive, no cure
50% go into remission at some time but <10% permanent
Mild psoriasis - CORRECT ANSWER - <10% BSA
- may remit spontaneously
- stable
- rarely requires continuous therapy
Topical therpaies - CORRECT ANSWER - Emollients
- Keratolytics
- Coal tar
- Dithranol
- Glucocorticosteroids
- Vit D analogues - calcipotriol, calcitriol, tacalcitol
- tazarotene
Severe psoriasis - CORRECT ANSWER Covers more than 10% of the body and can have a severe impact on the quality of one's life
Second-line therapy - CORRECT ANSWER Photottherapy
- UVB
Photochemotherapy
- PUVA
Inpatient
Systemic agents
- acitretin
- methotrexate = folic acid anatagonist
- ciclosporin
Biologics
Methotrexate SEs - CORRECT ANSWER Hepatotoxicity, bone marrow suppression, nausea
Ciclosporin SEs - CORRECT ANSWER HTN, nephrotoxicity
PUVA SEs - CORRECT ANSWER Skin cancer, photoageing
Acitretin SEs - CORRECT ANSWER Hyperlipidaemia, hepatotoxicity
Biologics - CORRECT ANSWER Anti-TNF
- etanercept
- infliximab (IV)
- adalimumab
Anti-IL12/IL-23p40
- ustekinumab [Show Less]