28. Inflammatory Disorders Flashcards
Most common psoriasis
Plaque (most common) • Extensor extremities most common; pink patches and plaques with overlying silvery scale
Inverse – Flexural psoriasis are located:
• Axillae, groin, perineum, chest
• Drop-like, 2-10mm, symmetric trunk/proximal extremities • Often triggered by Group A Strep What type of psoriasis is this?
Guttate
– Pustular psoriasis is usually located on:
• May be localized to palms and soles or be generalized
Generalized erythema; amount of scaling is variable, what kind of psoriasis is this?
– Erythrodermic
immune-mediated polygenic skin condition. Mutlifactoral triggers disease in predisposed individuals. lesions are well-demarcated erythematous papules and plaques,
ranging in size from pinpoint to < 20 cm in diameter, with overlying micaceous or silvery scale
Psoriasis
Other signs of psoriasis besides skin changes
Nail changes can also be seen with pitting
(pinpoint indentations in the nail plate), thickening, and yellow discoloration.
20-30% developing psoriatic arthritis have
increased risk of metabolic syndrome and atherosclerotic cardiovascular disease
When evaling a pt with psoriasis, what other things should we take into consideration?
recent infections
– may trigger flares, particularly Streptococcal
• risk factors for HIV
– HIV patients often have worse disease
• Ask about joint symptoms
– Up to 20% also have psoriatic arthtitis
• Evaluate body mass index (BMI)
– Correlation between obesity and prevalence and
severity of psoriasis
• Ask about CV risk factors– see increased risk for CV
Genetics and psoriasis
• Ask about other family members with
psoriasis
– Strong genetic predisposition for psoriasis
– Multiple psoriasis genes identified
– 1/3 with a positive family history
How can mediation be involved in pt presenting with psoriasis
can be triggered or exacerbated by
many medications, including:
– Systemic corticosteroid withdrawal
– Beta blockers (propranolol, metoprolol)
– Lithium
– Anti-malarials (chloroquine, hydroxychloroquine)
– Interferons
What is this… what types of pts may have this
Pencil in cup deformity seen in pts with psoriasis arthritis
Psoriasis arthritis seen in 20-30% pts
What joint issues should we keep in mind with psoriasis pts?
oligoarthritis (common in knee) and psoriasis arthritis. See sausage fingers, pencil in cup deformities, flexure deformities and bone destruction
What type of nail changes do we see with psoriasis?
Pitting, discoloration, onycholysis in 25-30% pts
In psoriasis we see development of skin lesions at site of injury… this is called:
Koebner phenomenon
Pt has psoriais:
– Localized (<5% BSA)
Tx recommendation?
topicals alone
Pt has psoriasis that can be chacterized as:
Generalized
Tx?
- systemic/phototherapy + topicals
• Refer to dermatologist for management
What are some aggravating factors
– Concurrent infection
– Medications
– Obesity
For localized or mild psoriasis, tx?
opical corticosteroids are first-line therapy. Other topical agents include retinoids, coal tar derivatives, and calcineurin inhibitors
used in psoriasis
to induce terminal differentiation and inhibit proliferation of keratinocytes, as well as modulating
the immune response.
Topical vitamin D analogues (e.g. calcipotriene, calcitriol)
Psoriasis: extensive disease or recalcitrance to topical
corticosteroids, treatment with what two things should we consider?
phototherapy or systemic medications may be indicated.
Systemic agents used in the treatment of psoriasis include
methotrexate, cyclosporine, acitretin,
and targeted immune modulators (“biologics”).
Biologic therapies target
T cells and cytokines
involved in the pathogenesis of psoriasis. TNF-α inhibitors used for psoriasis include etanercept,
infliximab, and adalimumab.
What should we avoid in pts with psoriasis?
Oral corticosteroids should be avoided in patients with psoriasis as withdrawal of the corticosteroids will provoke a flare of their disease, often pustular. C
