⚕️ FREE MSRA PODCAST – Psoriasis
🎧 A clear, high-yield breakdown of this chronic autoimmune skin condition – perfect for exam prep and clinical understanding.
🧠 Key Learning Points
📌 Definition
Psoriasis is a chronic autoimmune disease characterised by rapid skin cell turnover, resulting in thick, scaly red plaques. It is non-contagious and often fluctuates between remissions and flares.
📌 Causes & Risk Factors
• Genetic predisposition (e.g. HLA-Cw6, family history)
• Triggers: Streptococcal infection (esp. guttate), trauma (Koebner), stress, cold weather
• Drugs: Lithium, beta-blockers, NSAIDs, antimalarials, ACE inhibitors
• Lifestyle: Obesity, smoking, excessive alcohol
🧠 Mnemonic: “SPLIT-D” – Stress, Psoriatic genes, Lithium, Infections, Trauma, Drugs
📌 Pathophysiology
• Overactivation of T cells, particularly Th17, leads to release of IL-17 and TNF-α
• Results in inflammation and keratinocyte hyperproliferation
• Disruption of the normal skin cycle causes the classic thickened plaques
📌 Symptoms
• Well-demarcated red plaques with silvery scales
• Common sites: elbows, knees, scalp, lower back
• Nail changes: pitting, onycholysis, subungual hyperkeratosis
• Psoriatic arthritis symptoms (joint pain, stiffness, swelling)
🧠 Buzz signs:
• Auspitz sign – pinpoint bleeding after scale removal
• Koebner phenomenon – lesions at trauma sites
📌 Differential Diagnosis
• Eczema – more itchy, less well-demarcated
• Seborrhoeic dermatitis – greasy, yellow scales
• Fungal infections (tinea)
• Lichen planus – purple, flat-topped papules
• Cutaneous lupus
📌 Diagnosis
• Primarily clinical diagnosis
• Skin biopsy in atypical cases
• Use PASI (Psoriasis Area and Severity Index) and DLQI (Dermatology Life Quality Index) to assess severity and impact
• Screen for psoriatic arthritis (PASE or Psoriasis Epidemiology Screening Tool)
• Check metabolic markers: BP, BMI, lipids, glucose, uric acid
📌 Management
First-line (mild)
• Emollients
• Topical therapy:
– Potent corticosteroids
– Vitamin D analogues (e.g. calcipotriol)
– Coal tar, salicylic acid, dithranol for thick plaques
– Mild/moderate steroids for face/flexures (max 2 weeks)
🧠 Rule: Potent steroids – max 8 weeks; Very potent – max 4 weeks
Second-line (moderate/severe)
• Phototherapy – Narrowband UVB, PUVA
• Systemic agents:
– Methotrexate
– Ciclosporin
– Acitretin
– Apremilast (PDE-4 inhibitor)
Third-line (severe)
• Biologics – Anti-TNF (e.g. etanercept), Anti-IL-17 (e.g. secukinumab), Anti-IL-23
🧠 Consider if >10% BSA or severe psoriatic arthritis
📌 Complications
• Psoriatic arthritis (~10–30%)
• Metabolic syndrome, obesity, diabetes, hypertension
• Increased cardiovascular risk – MI, stroke
• Mental health issues – anxiety, depression, poor self-esteem
• Rebound flares with inappropriate steroid withdrawal
📌 Prognosis
• Chronic, lifelong condition
• Flares and remissions common
• With appropriate treatment, many patients maintain good symptom control and quality of life
📎 More MSRA Resources for Psoriasis
📝 Revision Notes:
https://www.passthemsra.com/topic/psoriasis-revision-notes/
🧠 Flashcards:
https://www.passthemsra.com/topic/psoriasis-flashcards/
💬 Accordion Q&A Notes:
https://www.passthemsra.com/topic/psoriasis-accordion-qa-notes/
🚀 Rapid Quiz:
https://www.passthemsra.com/topic/psoriasis-rapid-quiz/
🧪 Topic Quiz:
https://www.passthemsra.com/quizzes/psoriasis/
🎓 Full Dermatology Course:
https://www.passthemsra.com/courses/dermatology-for-the-msra/
📣 Explore full revision guides, quizzes, flashcards, and more at
https://www.passthemsra.com
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