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Flashcards in Dermatology Deck (39)
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1

Describe the lesions in psoriasis

scaly erythmatous well demarcated lesions on extensor surfaces, sacrum and scalp

2

Describe the lesions in guttate psoriasis

frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body

3

What can exacerbate psoriasis

trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

4

What are some systemic signs of psoriasis?

pitting nails
arthropathy

5

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

6

What are the complications of using topical corticosteroids in the treatment of psoriasis?

skin atrophy, striae and rebound symptoms

7

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

8

Give examples of vitamin d analogues

calcipotriol (Dovonex), calcitriol and tacalcitol

9

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

10

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

11

What treatments can be used for extensive psoriasis?

phototherapy - UVB 3 times a week

12

What are the adverse effects of phototherapy?

skin ageing, squamous cell cancer (not melanoma)

13

What oral treatments can be used in psoriasis if disease is extensive or systemic?

first line: methotrexate
ciclosporin
systemic retinoids
biological agents: infliximab, etanercept and adalimumab

14

define purpura

red r purple area which does not blanch on pressure

due to bleeding into the skin or mucous membrane

15

define macule

flat area of altered colour

16

define patch

large flat area of altered colour

17

define papule

= solid raised lesion of <0.5cm diameter

18

define nodule

solid raised lesion of >0.5cm diameter with a deeper component

19

define plaque

palpable scaling raised lesion >0.5cm diameter

20

defin vesicle

raised clear fluid filled lesion <0.5cm diameter

21

define bulla

raised clear fluid filled lesion >0.5cm diameter

22

define wheal

transient raised lesion due to dermal oedema

23

define lichenification

well defined rougenign of skin with accentuation of skin markings

24

define crust

rough surface consisting of dried serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis

25

define ulcer

loss of epidermis and dermis

26

define clubbing

loss of angle between posterior nail fold and nail plate

27

define koilonychia

spoon shaped depression of nail plate (anaemia)

28

onycholysis

separation of distal end of nail plate from nail bed (psoriasis)

29

pitting

punctate depression of nail plate

30

state the four layers of the skin

stratum corneum
stratum granulosum
stratum spinosum
stratum basale