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Psoriasis

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

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 plaqueMost common and described here
GuttateRaindrop lesions
SeborrhoeicLesions around nose and ears
FlexuralFlexural surfaces affected
PustularPustular 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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OSCE stations

  1. Dermatological skin exam
  2. Psoriasis skin exam
  3. Psoriasis history
  4. More here
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Eczema
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