Table of Contents Suggested approach to psoriasis OSCE station ExamineDescribing lesionsDifferential diagnosisTypes of psoriasisManagementQuestionsOSCE stations 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 examSkinScalp Ears NailsHand 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 psoriasisEczema Psoriatic plaques with nail changesPsoriatic plaques Types of psoriasis Chronic plaqueMost common and described hereGuttateRaindrop lesionsSeborrhoeicLesions around nose and earsFlexuralFlexural surfaces affectedPustularPustular lesions on palms/solesErythrodermic>90% of skin affected Management Avoid precipitantsEmollientsTopical treatmentsCombination treatments (e.g. Dovobet ointment or Enstilar foam) often used first lineVitamin D analogues, e.g. calcipotriolTopical corticosteroidsCoal tarDithranolTopical retinoidsPhototherapySystemic rheumatological drugs (methotrexate, ciclosporin, infliximab) Questions Please list three associations with psoriasis? Oops! This section is restricted to members. What are some complications of psoriasis? Oops! This section is restricted to members. What is Koebner phenomenon? Oops! This section is restricted to members. OSCE stations Dermatological skin examPsoriasis skin examPsoriasis historyMore here