Psoriasis in Primary Care: A Quiz

August 22, 2018

How is psoriasis best managed in the primary care setting? Take this quick quiz to test your knowledge.

For more information:Hackethal V. Psoriasis: a primary care primer. Rheumatology Network. April 30, 2018. Accessed August 21, 2018.

In my previous article Psoriasis: A Primary Care Primer, I outlined classic symptoms, common comorbidities, assessment of affected body surface area, and treatment options. I invite you to take the following 5-question quiz based on my article. Consider it a “refresher course”!

(Image credit: ©ChristineLangerPueschel/Shutterstock.com)

Question 1. Which type of psoriasis is most commonly seen in primary care?

ANSWER: About 2% of the US population has psoriasis, and 90% of these cases are plaque psoriasis. Plaque psoriasis is characterized by well-defined, erythematous, silvery-white hyperkeratotic scaling plaques on extensor surfaces and/or the scalp. Nail changes-with pitting, keratin buildup under the nail, and separation from the nail bed-may also be seen. Other types of psoriasis include guttate, pustular, inverse/flexural, palmoplantar pustular, and erythrodermic.

Source: Tucker R. Assessment and management of psoriasis in adults in primary care. The Pharmaceutical Journal. March 2018. Accessed August 21, 2018.

Question 2. Which of the following is not a risk factor for psoriasis: smoking, obesity, female sex, or alcohol consumption?

ANSWER: Female sex is not a risk factor for psoriasis, which affects women and men about equally. Risk factors for psoriasis include smoking, alcohol consumption, high body mass index (BMI), and stress. The condition usually presents between ages 15 and 25 (in 75% of patients), with another spike in disease presentation at ages 55 to 60 years.

Source: Tucker R. Assessment and management of psoriasis in adults in primary care. The Pharmaceutical Journal. March 2018. Accessed August 21, 2018.

Question 3. Psoriatic arthritis develops in about what percentage of persons with psoriasis?

ANSWER: Research suggests that psoriatic arthritis develops in about 5% of persons with psoriasis. Patients with psoriatic arthritis are at increased risk for depression/anxiety and cardiovascular disease; the latter is mostly seen in those with severe disease. Annual assessment in primary care with referral to a rheumatologist when psoriatic arthritis is suspected is recommended.

Source: Wilson F, Icen M, Crowson C, et al. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study.Arthritis Rheum. 2009;61:233-239.

Question 4. About what percentage of the body surface area is affected in moderate psoriasis?

ANSWER: According to the National Psoriasis Foundation, mild psoriasis affects less than 3% of body surface area, moderate psoriasis affects 3% to 10%, and severe psoriasis affects over 10%. The surface area of the palm and five fingers composes roughly 1% of total body surface area.

Source: National Psoriasis Foundation. About psoriasis. Accessed August 21, 2018.

Question 5. Which of the following is not a topical agent used for the treatment of psoriasis: Taclonex, Enstilar, tazarotene, or apremilast?

ANSWER: Research suggests that about 80% of plaque psoriasis is mild to moderate, which is often treatable with topical agents. Topical agents for psoriasis include corticosteroids, vitamin D analogues, coal tar, tazarotene (a vitamin A derivative), Taclonex (an ointment that combines the vitamin D analogue calcipotriol and the corticosteroid betamethasone), and Enstilar (the foam version of calcipotriol plus betamethasone). Systemic agents for moderate to severe disease include retinoids, cyclosporine, apremilast, and biologics.

Source: Menter A, Korman NJ, Elmets CA, et al, for the American Academy of Dermatology. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009;60:643-659. doi: 10.1016/j.jaad.2008.12.032