Psoriasis

Vivas and Spotters > Dermatology

Psoriasis is a chronic, inflammatory skin disease characterised by keratinocyte hyperproliferation. The most common type is plaque psoriasis, which causes erythematous raised plaques on extensor surfaces.

Suggested approach to psoriasis OSCE station

Examine

Dermatological skin exam
- Skin
- Scalp
- Ears
Nails
Hand joints

Describing lesions

Plaques
- ‘There are multiple well-demarcated, raised erythematous plaques over the extensor surfaces.’
- ‘These range in size from 1-6cm.’
- ‘There is scaling across the surface of these lesions, but no other secondary features.’
- ‘These lesions are consistent with chronic plaque type psoriasis.’
Nails
- ‘There is also evidence of pitting, subungual hyperkeratosis, onycholysis and Beau lines on the finger nails.’
- ‘These are characteristic psoriatic nail changes.’
Joints
- ‘I can also see a symmetrical polyarthropathy of the distal inter-phalangeal joints with active synovitis.’
- ‘This could be evidence of psoriatic arthritis.’

Differential diagnosis

Other types of psoriasis
Eczema

Types of psoriasis

Chronic plaque	Most common and described here
Guttate	Raindrop lesions
Seborrhoeic	Lesions around nose and ears
Flexural	Flexural surfaces affected
Pustular	Pustular lesions on palms/soles
Erythrodermic	>90% of skin affected

Management

Avoid precipitants
Emollients
Topical treatments
- Combination treatments (e.g. Dovobet ointment or Enstilar foam) often used first line
- Vitamin D analogues, e.g. calcipotriol
- Topical corticosteroids
- Coal tar
- Dithranol
- Topical retinoids
Phototherapy
Systemic rheumatological drugs (methotrexate, ciclosporin, infliximab)

Questions

Please list three associations with psoriasis?

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What are some complications of psoriasis?

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What is Koebner phenomenon?

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