Alteration of cell kinetics of keratinocytes shortening cell cycle, results in 28-fold production of keratinocytes. T cell mediated disease
What is the pathogenesis of psoriasis?
Infection (streptococcus).
Psychological (stress).
Drugs (steroids).
Trauma (koebnerisation).
Sunburn.
HIV.
Name 6 triggers for psoriasis
Localised, well defined plaque, erythematous base, scaling, most commonly on extensor surfaces.
What is the typical description of a psoriatic lesion?
Plaque psoriasis
Diagnosis?
Flexural psoriasis
Diagnosis?
Tends to be flat
How does flexural psoriasis differ from extensor psoriasis?
Koebnerisation
Diagnosis?
Pitting
Diagnosis?
onycholysis
Diagnosis?
subungual hyperkeratosis
Diagnosis?
Asymmetric.
Symmetric polyarthropathy.
DIP.
Destructive (arthritis mutilans).
Axial arthritis.
What are the 5 types of psoriatic arthropathy?
Inflammatory cells in the dermis
What does histology of psoriasis show?
Plaque.
Sebo-psoriasis.
Guttate.
Erythrodermic.
Pustular (Generalised, Localised).
What are the 5 main types of psoriasis
streptococcal throat infection
What is the most common preceding factor for the development of guttate psoriasis?
guttate psoriasis
Diagnosis?
Palms and soles covered with sterile pustules on erythematous base
Describe localised pustular psoriasis
Life threatening. Abrupt onset. Fever
What are the main characteristics of generalised pustular psoriasis?
Localised pustular psoriasis
Diagnosis?
Fever.
Lethargy.
Dehydration.
Renal failure.
Death.
What are the systemic manifestations of generalised pustular psoriasis (5)
Admit.
Greasy emollients.
IV support.
Systemic therapy.
Avoid or treat concurrent infection.
ITU if necessary.
What is the treatment for generalised pustular psoriasis? (6)
Ciclosporin (this works quickly (unlike methotrexate which can take ~12 weeks for effects).
Acitretin (a retinoid).
What are the two main options for systemic therapy in the treatment of generalised pustular psoriasis
Irritant effect of tar or dithranol, drug eruption, withdrawal of potent topical or systemic steroids.
What are the possible triggers for erythrodermic psoriasis?
Erythrodermic psoriasis
Diagnosis?
Fluid loss.
Hypothermia.
Infection.
Hypercatabolic state.
Shock.
What are the main complications of erythrodermic psoriasis? (5)
Admit.
Greasy emollients.
IV support.
Systemic therapy.
Avoid or treat concurrent infection.
ITU if necessary.
What is the treatment for erythrodermic psoriasis?
Emollients.
Topical agents.
Phototherapy.
Systemic agents.
Biological agents.
What are the 5 main treatment strategies for psoriasis
emollients
What is the 1st line for managing psoriasis?
Topical agents
What is the 2nd line for managing psoriasis?
Phototherapy
What is the 3rd line for managing psoriasis?
Systemic agents
What is the 4th line for managing psoriasis?
Biological agents
What is the 5th line for managing psoriasis?
They are highly teratogenic, and remain in the circulation for 3 years
Why do you not give retinoids to women of childbearing potential?
Vitamin D.
Tar.
Dithranol.
Steroids
What are the main options for topical therapy for the treatment of psoriasis?
Narrow band UVB
UVA plus psoralen (pUVA)
What are the two types of phototherapy you can use for psoriasis
UVA plus psoralen (pUVA)
What is the best phototherapy option for psoriasis?
Retinoids (Acitretin).
Fumaric acid.
Hydroxycarbamide.
Immunosuppression (Methotrexate, Ciclosporin)
What are the four main types of systemic treatment for psoriasis?
Anti-TNF (Etanercept, Infliximab, Adalimumab)
Anti IL-12/23 (Ustekinemab)
What are the two types of biological agents used in the treatment of psoriasis?
psoriasis area severity index (PASI)
What is the objective measurement of psoriasis severity?
Dermatology Life Quality Index
What is the subjective measurement of psoriasis severity?
Lichen planus
Diagnosis?
Lichen planus
Diagnosis?
Wickham's striae (lichen planus)
Diagnsis?
Purple.
Planar.
Polished (Shiny).
Papular.
Pruritic.
Polygonal.
Pigmented.
What are the 7 P words used to describe lichen planus?
Super potent Steroids.
UVB
What are the topical treatment options for lichen planus? (2)
Oral Steroids.
Hydroxychloroquine.
Immunosuppression.
What are the systemic treatment options for lichen planus? (3)
Lichen planus
Diagnosis?
sunlight
What is the trigger for actinic lichen planus?
Herald patch (in pityriasis rosea)
What is shown in the top left part of the picture?
Pityriasis rosea
Diagnosis?
Oval erythematous papules with an inner collarette of scale.
T-shirt distribution.
Lesions follow lines of dermatomes ("christmas tree" pattern)
Describe the main characteristics of the lesions in pityriasis rosea