Derm: Psoriasis: Free MSRA Podcast

⚕️ 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📌 DefinitionPsoriasis 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📌 ManagementFirst-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 weeksSecond-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 athttps://www.passthemsra.comHashtags#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQandANotes #MSRAAccordions #Psoriasis #PsoriaticArthritis #Dermatology #PassTheMSRA #MultiSpecialtyRecruitmentAssessment