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
βThere are multiple well-demarcated, raised erythematous plaques over the extensor surfaces.β
βThese range in size from 1-6cm.β
βThere is scaling across the surface of these lesions, but no other secondary features.β
βThese lesions are consistent with chronic plaque type psoriasis.β
Nails
βThere is also evidence of pitting, subungual hyperkeratosis, onycholysis and Beau lines on the finger nails.β
βThese are characteristic psoriatic nail changes.β
Joints
βI can also see a symmetrical polyarthropathy of the distal inter-phalangeal joints with active synovitis.β
βThis could be evidence of psoriatic arthritis.β
Differential diagnosis
Other types of psoriasis
Eczema
Psoriatic plaques with nail changes
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)
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Questions
Please list three associations with psoriasis?
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What are some complications of psoriasis?
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OSCE stations
Dermatological skin exam
Psoriasis skin exam
Psoriasis history
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