Term
| What is the Koebner phenomenon? |
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Definition
| Injury to skin such as cut or burn causes psoriasis to develop. |
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Term
| What drugs may cause psoriasis? |
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Definition
| Li, chloroquinine, B-blockers used in bipolar disorder |
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Term
| What are the various causes of psoriasis? |
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Definition
| drugs, genetics, infection, stress, alcohol, smoking |
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Term
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Definition
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Term
| What 4 points of the pathophysiology of psoriasis? |
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Definition
Increased epidermal cell turnover rate
Epidermis thickens, granular layer abscent
Dermal capilliaries dilated, tortuous and closer to skin surface
Lymphocytes and langerhans cells release cytokines, causing release of more inflammatory cells, causing increased turnover in epidermal cells |
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Term
| What are the types of psoriasis? (9) |
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Definition
| Guttate, chronic plaque, of scalp, of nails, of palms and soles, flexural/inverse, Erythrodermic/generalised pustular, psoriatic arthropathy |
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Term
| What are the symptoms of psoriasis? |
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Definition
Red scaly sharply demarcated plaque of any size and shape affecting any part of body (face is spared)
Scale is silvery, flakes off to show tiny bleed spots
Not itchy when inflammed |
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Term
| When is Guttate psoriasis often observed? |
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Definition
| in children after a streptococcal sore throat, self limiting after a few weeks |
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Term
| How does Guttate psoriasis manifest? |
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Definition
| multiple small drop-like plaques all over the body |
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Term
| What is the most common type of psoriasis? |
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Definition
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Term
| How does chonic plaque psoriasis manifest? |
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Definition
| persistent medium/large plaques on trunk and limbs |
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Term
| How does psoriasis of the nails manifest? (3) |
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Definition
| pitting, oncholysis(separation of nail from bed), hyperkeratosis under the nail |
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Term
| How does psoriasis of palms and sole manifest? |
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Definition
Inflammed, scaly, sharply, demarcated with sterile, pin-head sized pustules
Pustules dry up to form brown spots with thick fissured skin-> infection |
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Term
| What areas does flexural/inverse psoriasis affect? |
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Definition
| axillar, genitalia, groin, submammory area |
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Term
| What psoriasis is life-threatening? |
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Definition
| erythrodermic & generalised pustular psoriasis |
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Term
| How does erythrodermic & generalised pustular psoriasis manifest? |
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Definition
| whole skin involved; pustules coalesce to form sheet of puss |
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Term
| What may mild to moderate plaque psoriasis be treated with? |
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Definition
| dithranol, tars, topical steroids, calcipotriol |
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Term
| What treatment may widespread plaque psoriasis require? |
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Definition
dithranol, tars, topical steroids
UVB, PUVA
methotrexate, cyclosporin, acitretin, hydroxyurea
RePUVA (acitretin, methoxysalen, UVA) |
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Term
| What treatments are used in Guttate psoriasis? |
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Definition
| Penicillin, tars, topical steroids, UVB, PUVA, calcipotriol |
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Term
| What treatment may be requied in erythrodermic psoriasis |
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Definition
Hospitalisation
Baths, emollients, MTX, acitretin, cyclosporin |
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Term
| What type of psoriasis may indicate tetracycline? |
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Definition
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Term
| What type of psoriasis may indicate topical keratolytics? |
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Definition
| palmoplantar hyperkeratotic psoriasis |
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Term
| What does scalp psoriasis treatment consist of? |
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Definition
| topical steroids, tar shampoo, dithranol pomades, systemic therapy |
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Term
| What do emollients acheive when treating psoriasis? |
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Definition
| prevent drying and formation of fissures |
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Term
| What may be given with emollients to improve penetration? |
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Definition
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Term
| Why are creams and oinments preferred of aqueous and alcoholic solutions? |
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Definition
| may cause stinging on inflamed skin |
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Term
| When is dithranol unsuitable? |
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Definition
highly inflamed areas
face flexures |
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Term
| How is tar used in conjunction with UVB therapy? |
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Definition
| tar bath followed by UVB irradiation |
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Term
| Which psoriasis therapy may cause hypercalcaemia with excess use? |
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Definition
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Term
| What is Systemic therapy? |
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Definition
Psoralen + UVA
Psoralen interferes with DNA synthesis (reduce cell turnover rate) when activated by long wave UV
Psoralen taken PO 2hrs prior UVA |
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Term
| What are the side effects of systemic therapy (PUVA) |
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Definition
nausea, pruritis, drying of skin
melanoma/non-melanoma cancer (long term)
Eyes must be protected during UVA to prevent cataracts |
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Term
| What is most effective in treating psoriatic arthritis? |
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Definition
MTX; requires supplementation of Folic acid 5mg every other day.
Metoclopramide for nausea |
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Term
| How is MTX induced Acute marrow suppression or GI bleeding reversed? |
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Definition
folonic acid rescue;
(IV or IM folonic acid over 12-24hrs) |
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Term
| What should be monitored during cyclosporine treatment |
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Definition
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Term
| What psoriasis treatment contraindicates phototherapy? |
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Definition
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Term
| What are the adverse effects of acitretin? |
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Definition
liver abnormalities
decreased bone maturation in children
dry skin: lips and mucous membranes |
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Term
|
Definition
Psoralen PO, then long wave UV phototherapy.
Psoralen is activated by UVA to interfere with DNA synthesis, decreasing epidermal cell turnover. |
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