Flashcards in Dermatology Deck (39)
Describe the lesions in psoriasis
scaly erythmatous well demarcated lesions on extensor surfaces, sacrum and scalp
Describe the lesions in guttate psoriasis
frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
What can exacerbate psoriasis
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
What are some systemic signs of psoriasis?
Describe the stages in treatment of chronic plaque psoriasis
first-line: topical corticosteroid applied once daily plus vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment
second-line: if no improvement after 8 weeks then offer a vitamin D analogue twice daily
third-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily
short-acting dithranol can also be used
What are the complications of using topical corticosteroids in the treatment of psoriasis?
skin atrophy, striae and rebound symptoms
How long is the maximum amount of time corticosteroids should be used in the treatment of psoriasis?
potent corticosteroids for no longer than 8 weeks at a time
very potent corticosteroids for no longer than 4 weeks at a time
aim for a 4 week break before starting another course of topical corticosteroids
Give examples of vitamin d analogues
calcipotriol (Dovonex), calcitriol and tacalcitol
How do vitamin d analogues work?
reduce cell division and differentiation
they tend to reduce the scale and thickness of plaques but not the erythema
Why are vitamin d analogues preferable to corticosteroids or coal tar in the treatment of psoriasis?
adverse effects are uncommon
they may be used long-term unlike steroids
unlike coal tar and dithranol they do not smell or stain
What treatments can be used for extensive psoriasis?
phototherapy - UVB 3 times a week
What are the adverse effects of phototherapy?
skin ageing, squamous cell cancer (not melanoma)
What oral treatments can be used in psoriasis if disease is extensive or systemic?
first line: methotrexate
biological agents: infliximab, etanercept and adalimumab
red r purple area which does not blanch on pressure
due to bleeding into the skin or mucous membrane
flat area of altered colour
large flat area of altered colour
= solid raised lesion of <0.5cm diameter
solid raised lesion of >0.5cm diameter with a deeper component
palpable scaling raised lesion >0.5cm diameter
raised clear fluid filled lesion <0.5cm diameter
raised clear fluid filled lesion >0.5cm diameter
transient raised lesion due to dermal oedema
well defined rougenign of skin with accentuation of skin markings
rough surface consisting of dried serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis
loss of epidermis and dermis
loss of angle between posterior nail fold and nail plate
spoon shaped depression of nail plate (anaemia)
separation of distal end of nail plate from nail bed (psoriasis)
punctate depression of nail plate