Notes by Koudeza Khanom

Psoriasis: OSCE Station

1. Identification, consent, rapport
2. General Examination:
The patient is comfortable at rest and not in obvious pain
Before I begin, can I check if there are any tender areas?
3. Hands: onycholysis, pitting, ridging, thickening..
4. Progress up limbs: arms, torso
Check typical places:
Hands, elbows, knees
Scalp
Umbilicus, sacrum, groin, sole of foot
Typical appearance: symmetrical well demarcated red plaques with silver scales.
Note may just be read in flexures eg groin, with no scale
5. Describe lesion: site distribution, type, size, measure it! Shape, outline & border
colour, surface features and textures?
6. When moving to scalp ensure you feel it (scalp feels rough or even lumpy)
7. Then look for other secondary sites of the disease
Extras
Koebner phenomenon: psoriatic lesions at sites of injury, e.g surgical scar
Psoriatic athropathy: joint lesions, look at DIC joints of hands or rheumatoid pattern
Special techniques: Auspitz sign where scraping of scales produces pin point bleeding
Look for other forms of psoriasis e.g guttate (tiny spots with scale), palmar-plantar
(pustular psoriasis)
End Pieces
I have come to the end of the examination, I will now record my findings ( wash hands)
Thank you very much for helping. Do you have any questions?
Summary: Mr S is comfortable at rest and has evidence of classical plaque psoriasis..
These lesions are symmetrically distributed over his elbows, knees and sacrum; they are
well demarcated, oval and erythematous, with silver scales on the surface. There is also
evidence of nail changes and some scalp psoriasis present. Secondary lesions such as
psoriatic arthropathy are not present.

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Notes by Koudeza Khanom

Management
1. Explain nature of condition
2. Remove possible triggers where possible: streptococcal infection, drugs (eg beta
blockers), stress, alcohol as any of these may exacerbate condition.
3. Treatment options
a. Topical
i. Emollients to prevent dryness and cracking (fissuring)
ii. Salicyclic acid ointments to remove scale
iii. Tar based preparations
iv. Topical steroids
v. Dithranol
vi. Vitamin D analogues- slow cell division and differentiation
vii. Tazorotene
viii. Ultraviolet radiation
b. Systemic
i. PUVA ( psoralen and UV A)
ii. Retinoids
iii. Cytotoxics : methotrexate
iv. Systemic Steriods
v. Cylcosporin
vi. Biological e.g monoclonal antibodies
For example medium or large plaques might be treated topically with one of the
following:
Diprosalic ointment - contains steroid and salicylic acid
Dithrocream: short contact treatment with dithranol applied to plaques for one
hour, avoiding normal skin as it can irritate and stain and then washed off
Dovonex- Calcipotriol cream- vitamin D analogue which does not smell or stain

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