Table of Contents
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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