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Nursing Field Notes / Integumentary Β· Skin Infections & Inflammatory Conditions Β· Pathophysiology Course
🩹 SKIN INFECTION & INFLAMMATION SETNG-147 CellulitisNG-209 ImpetigoNG-067 TineaNG-202 HSV & ShinglesNG-225 Psoriasis

Psoriasis 🩹

Autoimmune skin β€” silvery plaques, and the one word patients need to hear

NG-225 INTEGUMENTARY Β· AUTOIMMUNE ADHD-friendly visual edition

Psoriasis is a chronic autoimmune disease in which the body attacks its own skin, pushing keratinocyte turnover from about 30 days down to 3–5 days. Immature cells pile up as well-demarcated red plaques topped with thick silvery scale on extensor surfaces β€” elbows, knees, scalp, sacrum and nails. There is no organism, so it is not contagious β€” that sentence is the single most important thing you will teach. Care is moisturise relentlessly, climb the treatment ladder only as far as needed, remember that sunlight helps, and always ask about the joints.

📄 Simple Nursing original — opens in Drive →

⚑ Skin in a hurryAutoimmune T cells drive keratinocyte turnover from ~30 days to 3–5 days. Cells pile up unfinished.
🩹 Silvery scale, sharp edgeWell-demarcated red plaques with silvery-white scale on EXTENSOR surfaces β€” elbows, knees, scalp, sacrum.
🚫 NOT contagiousNo bug is involved. This is the single most important thing you will ever teach a psoriasis patient.
🦴 Ask about jointsUp to a third develop psoriatic arthritis. Morning stiffness > 30 min β†’ refer early.
🧬

THE SKIN MODEL

STEP 0 Β· LEARN THIS ONCE

Same skin drawing as every page in this set β€” but look closely: there is no organism anywhere in it.

πŸ”¬ Skin cutaway β€” normal on the left, psoriatic plaque on the right

NO ORGANISM Cellulitis, impetigo, tinea and shingles all have something living in the picture. Psoriasis does not. The immune system is the pathogen β€” which is why it is treated by calming immunity down, and why it can never be caught from another person.

PSORIASIS Β· the same skin model β€” normal on the left, plaque on the right No bacteria, no fungus, no virus β€” the patient's own immune system drives the skin to grow too fast. Stratum corneum dead keratin β€” the barrier Granular + spinous layers living keratinocytes Basal layer & rete ridges new cells are born here Papillary dermis capillary loops Reticular dermis collagen, glands, follicles Subcutaneous fat adipose lobules Fascia / muscle sebaceous gland hair bulb arteriole venule EPIDERMIS + PAPILLAE NORMAL SKIN PSORIATIC PLAQUE 1 2 3 4 5 THE WHOLE DISEASE IN ONE LINE: Autoimmune T cells order keratinocytes to divide far too fast, so cells pile up unfinished β†’ a thick, raised plaque topped with silvery scale. 🚫 NO organism anywhere in this picture β€” it is NOT contagious.
  • β‘  THICK SILVERY SCALE β€” keratinocytes shed before they mature (parakeratosis: they still carry their nuclei)
  • β‘‘ NO granular layer β€” the maturation step is skipped entirely
  • β‘’ DILATED, TORTUOUS CAPILLARIES β€” climbing high into long dermal papillae β†’ the plaque is red, and lifting the scale bleeds
  • β‘£ ELONGATED RETE RIDGES β€” acanthosis, a thickened epidermis β†’ the plaque is raised
  • β‘€ T LYMPHOCYTES β€” the autoimmune engine, releasing TNF-Ξ±, IL-17 and IL-23
silvery scale thickened epidermis dilated capillaries T lymphocytes neutrophil microabscesses
🧠 Long ridges + long capillaries + thin epidermis over them = the Auspitz sign. The picture explains the sign.

πŸ“– Lesion vocabulary β€” psoriasis is the PLAQUE + SCALE disease

A plaque is a raised, flat-topped lesion larger than 1 cm. Add silvery scale and you have psoriasis.

LESION MORPHOLOGY β€” the vocabulary behind every skin question Side-on cutaway (top) + what you see looking down at the skin (bottom). MACULE flat, color only Β· < 1 cm SIDE VIEW β–Ύ LOOKING DOWN β–Ύ e.g. freckle PAPULE solid raised bump Β· < 1 cm SIDE VIEW β–Ύ LOOKING DOWN β–Ύ e.g. insect bite PLAQUE raised flat-topped Β· > 1 cm SIDE VIEW β–Ύ LOOKING DOWN β–Ύ e.g. psoriasis VESICLE clear fluid blister Β· < 1 cm SIDE VIEW β–Ύ LOOKING DOWN β–Ύ e.g. shingles BULLA big fluid blister Β· > 1 cm SIDE VIEW β–Ύ LOOKING DOWN β–Ύ e.g. bullous impetigo PUSTULE pus-filled Β· any size SIDE VIEW β–Ύ LOOKING DOWN β–Ύ e.g. impetigo CRUST dried exudate Β· on top SIDE VIEW β–Ύ LOOKING DOWN β–Ύ e.g. honey crust SCALE flaking keratin Β· on top SIDE VIEW β–Ύ LOOKING DOWN β–Ύ e.g. tinea
🧠 Plaque = a papule that grew up. Bigger than 1 cm and flat on top.
πŸ”₯

PATHO & TRIGGERS

STEP 1 Β· WHY IT HAPPENS

An immune system that attacks its own skin, plus a trigger that sets it off.

🧠 The one-sentence definition

Psoriasis is a chronic autoimmune inflammatory disease in which immune cells attack healthy skin, causing massively accelerated division of epidermal cells. The immature cells pile up on the surface as thick, silvery, scaly plaques.

It is lifelong, comes in flares and remissions, and is not curable β€” but it is very controllable.

🧠 "Psoriasis = skin in a hurry." Nothing is invading; the factory is just running far too fast.

βš™οΈ Mechanism, step by step

Genetic predisposition + a trigger
β–Ό
T lymphocytes are wrongly activated in the skin
β–Ό
They release cytokines (TNF-Ξ±, IL-17, IL-23)
β–Ό
Keratinocytes divide ~10Γ— too fast β€” 3–5 days instead of ~30
β–Ό
Immature cells stack up + capillaries dilate and grow
β–Ό
Raised red plaque with silvery scale
🧠 The cytokines in that box are exactly what the biologic drugs block β€” TNF, IL-17, IL-23.

⏩ The speed problem β€” 30 days vs 4 days

THE SPEED PROBLEM β€” 30 days vs 4 days A keratinocyte is born at the bottom of the epidermis and travels to the surface. In psoriasis it is rushed β€” and arrives unfinished. NORMAL TURNOVER dermis a thin invisible layer sheds quietly β‰ˆ 28–30 DAYS Cells flatten, lose their nuclei, fill with keratin and form an invisible, waterproof barrier. Old cells fall away as fast as new ones arrive β€” the skin stays smooth. PSORIATIC TURNOVER dermis unfinished cells PILE UP = thick silvery scale β‰ˆ 3–5 DAYS Cells arrive with their nuclei still inside (parakeratosis) and cannot form a proper barrier. They stack up faster than they can be shed β†’ a raised plaque with silvery scale.
🧠 The scale IS the cells. Silvery flakes are keratinocytes that were rushed to the surface before they finished.

🎯 Triggers β€” and the one that is NOT a trigger

WHAT SETS IT OFF β€” and the one that does NOT Students lose marks here constantly: sunlight is usually HELPFUL in psoriasis. Sunburn is not β€” but moderate sun exposure is good. πŸ˜– STRESS Emotional or physical β€” a classic flare trigger. πŸ€’ SICKNESS Any infection; strep throat can set off guttate psoriasis. 🦠 SEPSIS Severe systemic infection. 🩹 SKIN TRAUMA Cuts, scratches, sunburn, tattoos β€” Koebner. πŸ’Š DRUGS Beta blockers, lithium, antimalarials, NSAIDs; and stopping systemic steroids. 🚬 SMOKING & ALCOHOL Both worsen disease and reduce treatment response. ❄️ COLD, DRY WEATHER Winter flares; dry skin cracks and itches. βš–οΈ OBESITY Linked to more severe disease and metabolic syndrome. β˜€οΈ SUNLIGHT IS NOT A TRIGGER Moderate sun exposure usually IMPROVES psoriasis. That is the whole idea behind UVB phototherapy. But avoid SUNBURN β€” that is trauma β†’ Koebner.
🧠 "S Β· S Β· S β€” Stress, Sickness, Sepsis." And the trap: SUN IS GOOD, not a trigger. Sunburn is bad because it is trauma.

πŸ§ͺ Cause β†’ treatment class: the rule that runs this whole set

NAME THE ORGANISM β†’ THE DRUG CLASS NAMES ITSELF This one rule answers most skin-infection questions. The suffix tells you the class. BACTERIAL clusters = staph chains = strep Staph aureus Β· Strep pyogenes ANTIBIOTIC cephalexin Β· dicloxacillin Β· clindamycin Β· mupirocin (topical) Β· doxycycline or TMP-SMX if MRSA suspected Cellulitis Β· Impetigo FUNGAL branching hyphae + spores dermatophytes (Trichophyton) ANTIFUNGAL topical "-azole" (clotrimazole, miconazole, ketoconazole) Β· terbinafine Β· oral terbinafine / griseofulvin for scalp & nails Tinea (ringworm) VIRAL enveloped DNA virus HSV-1 / HSV-2 Β· varicella-zoster ANTIVIRAL the "-cyclovir" family: acyclovir Β· valacyclovir Β· famciclovir β€” start early, they shorten but do not cure Cold sores Β· Shingles β—€ THIS PAGE β–Ά AUTOIMMUNE T cell attacks keratinocytes the patient's own T cells IMMUNOMODULATION topical corticosteroids Β· vitamin D analogue (calcipotriene) Β· phototherapy Β· methotrexate Β· biologics (e.g. infliximab) Psoriasis Β· Eczema
🧠 No organism β†’ no antibiotic, no antifungal, no antiviral. You calm the immune system instead.
πŸ”Ž

CLUES

STEP 2 Β· WHAT YOU SEE

Sharp-edged red plaques with silvery scale, on the outside of joints, in a patient who feels well.

πŸ‘€ Signs & symptoms

  • Well-demarcated plaques β€” you can trace the edge with a finger
  • Raised and flat-topped, deep red or salmon-pink underneath
  • Thick, loose, SILVERY-WHITE scale on the surface
  • Symmetrical and on EXTENSOR surfaces β€” elbows, knees, scalp, sacrum
  • Itching, burning or soreness; plaques may crack and bleed
  • Nail changes β€” pitting, oil-drop discoloration, lifting, thickening
  • The patient is systemically well β€” no fever, no pus, no spreading redness
🧠 "Sharp · Silver · Symmetrical · Stretched-out (extensor)." Four S's.

🧬 The main types

  • Plaque (vulgaris) β€” by far the commonest; the classic silvery plaques
  • Guttate β€” sudden crop of small "raindrop" spots on the trunk, often after strep throat, common in children and young adults
  • Inverse (flexural) β€” smooth, shiny, red patches in the skin folds with little scale
  • Pustular β€” sterile pustules; generalized pustular psoriasis is a medical emergency
  • Erythrodermic β€” widespread redness and shedding; emergency (fluid loss, temperature instability, infection risk)
  • Nail and scalp psoriasis often accompany any of the above
🧠 "Guttate = gutter = raindrops" β€” small drop-like spots after a sore throat.

⭐ Two signs with names β€” Auspitz & Koebner

TWO SIGNS WITH NAMES β€” Auspitz and Koebner Both are exam favorites, and both make sense once you have seen the cross-section above. THE CLASSIC PLAQUE WELL-DEMARCATED β€” a sharp edge Raised Β· flat-topped Β· deep red Loose SILVERY-WHITE scale on top Itchy or sore; may crack and bleed. AUSPITZ SIGN Lift the scale β†’ PINPOINT BLEEDING The dilated capillaries sit right under a paper-thin epidermis, so they tear open. Never do this deliberately β€” it hurts and it can Koebnerise. KOEBNER PHENOMENON New plaques appear along an INJURY line Scratch Β· surgical scar Β· sunburn Β· tattoo Β· friction from a waistband or a dressing. Protect the skin β€” trauma makes NEW disease.
🧠 Auspitz = A for After you lift the scale (bleeding). Koebner = K for Knock/injury makes new plaques.

πŸ—ΊοΈ Extensor vs flexural β€” plus the nails

EXTENSOR vs FLEXURAL β€” the single best discriminator Psoriasis sits on the OUTSIDE of joints. Eczema hides on the INSIDE. Ask where it is before you ask what it looks like. PSORIASIS Β· EXTENSOR Elbows Β· knees Β· scalp & hairline Β· lower back / sacrum Β· nails Β· behind the ears ECZEMA Β· FLEXURAL Inner elbows Β· behind the knees Β· neck Β· wrists Β· around the eyes Β· cheeks in babies NAIL PSORIASIS β€” up to half of patients PITTING tiny dents, like a thimble OIL-DROP SIGN a yellow-brown patch under the plate ONYCHOLYSIS the plate lifts off the nail bed THICKENING crumbly build-up under the nail WHY NAILS MATTER Nail changes are a strong clue to PSORIATIC ARTHRITIS β€” they cluster with joint disease, so always look at the nails. Pitting points to psoriasis; thick crumbly yellow nails alone may be fungal. If you are unsure, they can be tested.
🧠 Psoriasis is on the OUTSIDE of the joint. Eczema is on the INSIDE. That one line sorts most stems.

🦴 Psoriatic arthritis β€” psoriasis is not only skin-deep

PSORIATIC ARTHRITIS β€” psoriasis is not only skin-deep Roughly a third of people with psoriasis develop inflammatory joint disease. Skin usually comes first β€” so ask about joints at every visit. THE HAND β€” what to look for DACTYLITIS the whole finger swells β€” a "sausage digit" DIP JOINTS The joints nearest the NAILS are typically hit β€” unlike rheumatoid arthritis. NAIL PITTING travels with joint disease Morning stiffness lasting more than 30 minutes, joint pain, swelling, and heel or low-back pain (enthesitis / spondylitis). WHAT THE NURSE DOES ABOUT IT πŸ”Ž ASK, every visit “Any joint pain, swelling, or morning stiffness lasting more than half an hour?” Skin disease usually appears years before the joints. ⏱️ Refer EARLY Untreated joint inflammation causes permanent damage. Early rheumatology referral protects function. πŸƒ Keep moving Gentle range-of-motion and low-impact exercise maintain joint function; rest during acute flares. ❀️ Screen the whole patient Psoriasis carries higher risk of cardiovascular disease, metabolic syndrome, diabetes, IBD, depression. πŸ«‚ Treat the emotional load Visible plaques affect body image, relationships, work and sleep. Depression is common β€” ask, and refer.
🧠 "Skin first, joints later." Ask about morning stiffness at every visit β€” early referral prevents permanent damage.
🩺

CARE

STEP 3 Β· WHAT YOU DO

Moisturise relentlessly, calm the immune system as far as you need to, and treat the person, not just the plaque.

πŸͺœ The treatment ladder

THE TREATMENT LADDER β€” mild at the bottom, severe at the top You climb only as far as you need to. Every step keeps the moisturiser going underneath it. β‘£ BIOLOGICS TNF inhibitors (infliximab, adalimumab, etanercept), IL-17 and IL-23 inhibitors. Given by injection or infusion. Screen for latent TB and hepatitis first; watch closely for infection. β‘’ SYSTEMIC DRUGS Methotrexate (WEEKLY, never daily; with folic acid; teratogenic), ciclosporin, acitretin, apremilast. Blood tests and monitoring are part of the plan. β‘‘ PHOTOTHERAPY Narrowband UVB in a supervised unit, two to three times a week. Protect the eyes and any unaffected skin. β‘  TOPICALS β€” the workhorse Emollients + topical corticosteroid + vitamin D analogue (calcipotriene), coal tar, salicylic acid to lift scale, calcineurin inhibitors for the face and folds. MORE SEVERE β†’ 🧴 MOISTURISE β€” every day, at every rung, for life Thick emollient right after a bath or shower, on damp skin, locks water in. It softens scale, stops cracking, reduces itch, and makes every other treatment work better. This is the answer students skip.
🧠 Every rung sits on emollient. If "apply moisturiser regularly" is an option, it is rarely wrong.

🧴 THE two NCLEX answers: moisturise & sunlight

1. Moisturise frequently. Apply a thick emollient immediately after bathing, onto damp skin, to trap water in. Use lukewarm (not hot) water, a mild non-soap cleanser, and pat dry β€” never rub.

2. Sunlight in moderation is GOOD. Controlled UV light slows the overactive skin cells. Do not tell a psoriasis patient to avoid the sun β€” but do teach them to avoid sunburn, which is trauma and can trigger Koebner.

🧠 Students answer "avoid sunlight" and lose the mark. Sun helps. Sunburn hurts.

πŸ’Š Topical therapy β€” the workhorse

  • Emollients β€” the foundation, used every day forever
  • Topical corticosteroids β€” the mainstay for flares; use the lowest effective potency for the shortest time, and only mild preparations on the face and folds (skin thinning, striae)
  • Vitamin D analogues (calcipotriene/calcipotriol) β€” often paired with a steroid
  • Coal tar β€” effective; warn about staining and smell
  • Salicylic acid β€” lifts thick scale so other treatments can get in
  • Calcineurin inhibitors β€” steroid-sparing option for the face and folds
  • Apply thin, rub in gently along the direction of hair growth; wash hands after
🧠 Descale first, then treat. Salicylic acid or a soak lifts scale so the active drug reaches skin.

πŸ’‰ Systemic & biologic therapy β€” safety points

  • Methotrexate is dosed WEEKLY, never daily. Daily dosing is a fatal medication error. Folic acid is usually prescribed alongside it
  • Methotrexate is teratogenic β€” it must be stopped and effective contraception used; check pregnancy status. Monitor FBC, LFTs, renal function; avoid alcohol
  • Biologics (infliximab, adalimumab, etanercept; IL-17/IL-23 inhibitors) β€” screen for latent TB and hepatitis first; hold for active infection; teach infection precautions and injection technique
  • Live vaccines are generally avoided on biologics/immunosuppressants β€” check before administering
  • Ciclosporin β€” monitor BP and renal function. Acitretin β€” strongly teratogenic
  • Systemic corticosteroids are generally avoided β€” withdrawal can cause a severe rebound flare
🧠 "Methotrexate: Monday, not morning-and-night." Weekly. Always check the frequency.

πŸ—£οΈ Teaching β€” start with the sentence that matters most

  • "You cannot give this to anyone. It is not an infection." Say it first, and say it to the family too
  • Moisturise daily, especially after bathing; lukewarm water, gentle cleanser, pat dry
  • Protect the skin β€” avoid scratching, picking scale, tight clothing and sunburn (Koebner)
  • Use treatments as prescribed, even when the skin looks better; flares will come and go
  • Stop smoking, moderate alcohol, manage weight, manage stress
  • Report: joint pain or morning stiffness, widespread redness, pustules, fever, or signs of infection on immunosuppressants
  • Signpost support β€” psoriasis charities, patient groups, mental-health support
🧠 The first teaching point is not a cream β€” it is "this is not catching."

❌ Never do these

  • Never imply psoriasis is contagious, or use isolation precautions for it.
  • Never give methotrexate daily β€” it is a weekly dose.
  • Never scrub, pick or forcibly remove the scale β€” that is trauma and Koebnerises.
  • Never use potent topical steroids on the face or skin folds without a specific order.
  • Never tell the patient to stay out of the sun.
  • Never start a biologic without checking TB/hepatitis screening and for active infection.
🧠 Don't isolate, don't scrub, don't dose it daily, don't ban the sun.

🚨 When psoriasis becomes an emergency

  • Erythrodermic psoriasis β€” widespread redness and shedding over most of the body. The skin barrier fails: fluid and protein loss, hypothermia, high-output heart failure, sepsis risk
  • Generalized pustular psoriasis β€” sheets of sterile pustules with fever and feeling very unwell
  • Often triggered by abrupt withdrawal of systemic steroids, severe infection or drug reactions
  • Nursing: monitor temperature, fluid balance and vital signs; warm environment; meticulous skin care; IV fluids as prescribed; urgent dermatology review
🧠 Skin is an organ. Lose enough of it and the patient behaves like a burns patient.
πŸ”€

TELL THEM APART

STEP 4 Β· THE REAL EXAM SKILL

Silvery scale on the outside of joints, in a well patient, with no organism.

πŸ—ΊοΈ Where each one shows up β€” the whole set, plus eczema

WHERE IT SHOWS UP β€” the real exam skill is telling these apart Same body, five patterns. Distribution narrows the answer before you ever read the description. CELLULITIS one leg, spreading, warm IMPETIGO around nose & mouth, hands TINEA scalp, trunk, groin, feet, nails SHINGLES ONE band, ONE side, stops at midline PSORIASIS EXTENSOR: elbows, knees, scalp, sacrum ECZEMA (contrast) FLEXURAL: inner elbow, behind knee, neck
🧠 Psoriasis = extensor. Eczema = flexural. The two most confused rashes, separated by one word.

πŸ“Š Psoriasis vs eczema vs tinea

PSORIASISECZEMATINEA
CauseAutoimmuneBarrier defect + allergy/atopyFungal infection
WhereExtensor: elbows, knees, scalp, sacrumFlexural: inner elbows, behind kneesWarm, moist: trunk, groin, feet, scalp
EdgeSharply demarcatedIll-defined, blends outRaised active ring with a clear center
ScaleThick, SILVERYFine, dry, may weep or crustFine scale at the edge
SymptomItch, soreness, crackingIntense itchItch
Contagious?NONOYES
Steroid responseImprovesImprovesWorsens (tinea incognito)
🧠 If a steroid made it worse, it was never inflammatory β€” it was fungal.

⭐ NCLEX traps

  • Sunlight is GOOD. The most-missed question on this topic.
  • Psoriasis is NOT contagious β€” no isolation, no gloves-for-fear, and say so to the family.
  • Methotrexate is WEEKLY. Check the frequency on every order.
  • Moisturise after bathing on damp skin β€” not "avoid moisturiser because it is greasy."
  • Do not pick or scrub the scale β€” Koebner makes new plaques.
  • New small "raindrop" spots after a sore throat = guttate psoriasis.
  • Widespread redness + shedding = erythrodermic = emergency, treat like a barrier failure.
  • Joint pain in a psoriasis patient = refer, do not dismiss.
🧠 If the option says "reassure the patient it is not contagious", it is almost always correct.

🧠 One-line contrasts

  • Psoriasis vs tinea β€” solid silvery plaque vs a ring with a clear center
  • Psoriasis vs eczema β€” extensor & sharply edged vs flexural & ill-defined
  • Psoriasis vs cellulitis β€” chronic, scaly, well patient vs acute, hot, febrile patient
  • Psoriasis vs seborrhoeic dermatitis β€” thick silvery scale vs greasy yellowish scale on the scalp and nose folds
  • Nail psoriasis vs fungal nail β€” pitting and oil-drop vs thick crumbly yellow-brown; test if unsure
  • Psoriatic arthritis vs rheumatoid β€” DIP joints and sausage digits vs MCP/PIP and symmetrical small joints
🧠 Silver scale, sharp edge, extensor, well patient. Four boxes ticked = psoriasis.
⚑

QUICK RECALL

SAY IT OUT LOUD
⚑ 30 days β†’ 3–5 daysAutoimmune acceleration of keratinocyte turnover.
🩹 Silvery plaques, EXTENSORSharp edges. Elbows, knees, scalp, sacrum, nails.
🚫 NOT contagious Β· β˜€οΈ sun helpsMoisturise daily. Avoid sunburn (Koebner).
🦴 Ask about jointsPsoriatic arthritis hits the DIP joints. Methotrexate is WEEKLY.
🎯 Cover & check β€” 10 rapid-fire questions
Q1: What is happening in the skin in psoriasis?
Autoimmune T-cell activation drives keratinocytes to divide far too fast β€” turnover falls from about 28–30 days to 3–5 days β€” so immature cells pile up as thick silvery scale on a red, thickened plaque.
Q2: Describe the classic lesion and where it appears.
Well-demarcated, raised, flat-topped red plaques with thick silvery-white scale, symmetrically on extensor surfaces β€” elbows, knees, scalp and hairline, lower back/sacrum β€” plus nail changes.
Q3: What is the Auspitz sign, and why does it happen?
Pinpoint bleeding when scale is lifted off a plaque. The dermal papillae are elongated and packed with dilated capillaries lying just under a very thin epidermis, so removing the scale tears them open.
Q4: What is the Koebner phenomenon?
New psoriatic lesions appearing at sites of skin injury β€” a scratch, surgical scar, sunburn, tattoo or friction. It is why patients are taught to protect their skin and not to pick scale.
Q5: A patient asks whether they can pass psoriasis to their children. What do you say?
Psoriasis is not contagious β€” it cannot be caught or passed on by contact, because there is no infecting organism. There is a genetic tendency, so relatives have a higher chance of developing it, but that is inheritance, not infection.
Q6: Is sun exposure good or bad in psoriasis?
Moderate sun exposure usually improves psoriasis β€” that is the principle behind UVB phototherapy. Sunburn, however, is skin trauma and can trigger new lesions through the Koebner phenomenon, so teach sensible exposure.
Q7: Name the S-S-S triggers, and two others.
Stress, Sickness (infection β€” strep throat can trigger guttate psoriasis) and Sepsis. Others: skin trauma, certain drugs (beta blockers, lithium, antimalarials, and withdrawal of systemic steroids), smoking, alcohol, cold dry weather and obesity.
Q8: What are the two most important pieces of everyday self-care?
Moisturise frequently β€” a thick emollient onto damp skin straight after a lukewarm bath or shower β€” and protect the skin from trauma and sunburn. Emollients underpin every other treatment.
Q9: Give the key safety points for methotrexate.
It is dosed WEEKLY, never daily β€” daily dosing is a fatal error. Folic acid is usually prescribed with it. It is teratogenic, so pregnancy must be excluded and effective contraception used. Monitor complete blood count, liver and renal function, and advise avoiding alcohol.
Q10: A patient with psoriasis reports 45 minutes of morning stiffness and a swollen index finger. What is this and what do you do?
Likely psoriatic arthritis with dactylitis β€” a "sausage digit". It typically affects the DIP joints, unlike rheumatoid arthritis. Report it and arrange early rheumatology referral, because untreated joint inflammation causes permanent damage.