4. PSORIASIS

Question 1

a chronic, noninfectious, inflammatory disease of the skin in which the production of epidermal cells occurs faster than norma

Answer 1

Psoriasis

Question 2

Psoriasis may occur at any age but is most common between the ages of ___ and ___ years.

Answer 2

15 and 35

Question 3

Main sites of the body affected:

Answer 3

• scalp
• areas over the elbows and knees
• lower part of the back
• genitalia
• nails

Question 3

Psoriasis may be associated with _________ factor–negative arthritis of multiple joints

Answer 3

asymmetric rheumatoid

Question 3

An _____________ may develop in which the disease progresses to involve the total body surface (erythrodermic psoriatic state).

Answer 3

exfoliative psoriatic state

Question 4

PSORIASIS RISK FACTORS:

Answer 4

• Stress
• Smoking
• Trauma
• Medication
• Infections
• Family history
• Immunocompromised

Question 5

Psoriasis may cause _____ and _____; observers may stare, comment, ask embarrassing questions, or even avoid the person

Answer 5

despair and frustration

Question 5

PSORIASIS CLINICAL MANIFESTATIONS:

Answer 5

• Lesions -red, raised patches of skin covered with silvery scales.
• Multiple bleeding points
• Nail pitting, discoloration, crumbling beneath the free edges, and separation of the nail plate.
• Acutely ill, with fever, chills, and an electrolyte imbalance -erythrodermic psoriasis

Question 6

Who are especially vulnerable to its
psychological effects.

Answer 6

Teenagers

Question 7

What must be addressed first

Answer 7

any precipitating or aggravating factors

Question 8

An assessment is made of _____, because psoriasis is significantly affected by stress.

Answer 8

lifestyle

Question 9

Most important principle of psoriasis
treatment:

Answer 9

Gentle removal of scales (bath oils, coal tar preparations and a soft brush used to scrub the psoriatic plaques).

* bath oils
* coal tar preparations
* soft brush

Question 10

Application of emollient creams containing ____ or ____ after bathing–to soften thick scales.

Answer 10

alpha-hydroxy acids (Lac-Hydrin, Penederm) or salicylic acid

Question 11

Three types of therapy are standard:

Answer 11

1. topical
2. systemic
3. phototherapy

Question 12

Three types of therapy are standard:

used to slow the overactive
epidermis

Answer 12

Topical Therapy/Treatment

Topical corticosteroid therapy acts to reduce inflammation.

Medications include tar preparations (eg, coal tar topical [Balnetar]), alpha-hydroxy or salicylic acid, and corticosteroids.

Question 13

Three types of therapy are standard:

TYPES of Topical Therapy

Answer 13

Calcipotriene (Dovonex**; not recommended for use by elderly patients because of their more fragile skin, or in pregnant or lactating women)
**Tazarotene (Tazorac) as well as vitamin D are additional nonsteroidal agents.
*Occlusive (plastic) dressing may improve effectiveness.

Question 13

Three types of therapy are standard:

Biologic agents act by inhibiting activation and migration, eliminating the T cells completely, slowing postsecretory cytokines or inducing immune deviation:
* Infliximab (Remicade)
* Etanercept (Enbrel)
* Efalizumab (Raptiva)
* Alefacept (Amevive)
* Adalimumab (Humira)

Answer 13

Systemic Therapy

Question 14

Three types of therapy are standard:

TYPES of oral agents Systemic Therapy

2 types of systemic theraphy: Oral agents and Photochemotherapy

Answer 14

• Methotrexate –patients should avoid drinking alcohol, should not be administered to pregnant women.
• Cyclosporine A
• Oral retinoids –ie: synthetic derivatives of vitamin A and its metabolite, Vitamin A acid
• Etretinate

Question 15

Three types of therapy are standard:

TYPES of Photochemotherapy Systemic Therapy

Answer 15

• Psoralens and ultraviolet A (PUVA) therapy
• Ultraviolet B (UVB) light therapy
• Excimer laser therapy

Question 16

It is associated with long-term risks of skin cancer, cataracts, and premature aging of the skin.

Answer 16

Photochemotherapy

Question 17

TYPES of Photochemotherapy Systemic Therapy

may be used for severely debilitating psoriasis.

Answer 17

Psoralens and ultraviolet A (PUVA) therapy

Question 17

TYPES of Photochemotherapy Systemic Therapy

may be used to treat generalized plaque and may be combined with the topical cream, calcipotriene (Dovonex).

Answer 17

Ultraviolet B (UVB) light therapy

Question 17

TYPES of Photochemotherapy Systemic Therapy

may be another treatment.

Answer 17

Excimer laser therapy

Question 18

PSORIASIS DIAGNOSIS

Answer 18

*Risk for infection
*Disturbed body Image
*Impaired skin integrity related
* Social isolation
*Hopelessness
*Helplessness
*Deficient knowledge related to Psoriasis

Question 19

Goals for the patient may include:

Answer 19

• achievement and maintenance of skin integrity
  *improved thought processes
• absence of infection
  *improved thought processes
  *increased comfort
  *increased socialization
  *increased knowledge regarding disease
• absence of complications

Question 19

PSORIASIS ASSESSMENT:

Examine areas especially affected:

Answer 19

• elbows
• knees
• scalp
• gluteal cleft
• all nails (for small pits)

Question 20

factors that provoke it:

Answer 20

• any irritation or injury to the skin
• any current illness
• emotional stress
• unfavorable environment
• drug

Question 20

Consult a _____ to assist in the diagnosis and treatment of the arthropathy

Answer 20

rheumatologist

Question 20

Advise patient that topical ______ preparations on face and around eyes predispose to cataract development.

Answer 20

corticosteroid