Midterm - Psoriasis Flashcards
a chronic skin disease result in patches of thick red skin covered with
the silvery scales
Psoriasis
These patches are referred as plaque which usually occur on the elbow,
knees, legs, scalp, lower back, face, palm and sole of the feet, nails
Psoriasis
These patches are referred as plaque which usually occur on the
elbow,
knees,
legs,
scalp,
lower back,
face,
palm and
sole of the feet,
nails
The word psoriasis is derive from greek word
‘psora’ →means ‘itching
A greek physician that use the term Psoriasis
vulgaris to refer all dermo and epidermopathies accompanied by Pruritus
Galen of perganon
refer all dermo and epidermopathies accompanied by Pruritus
Psoriasis vulgaris
Since ____ local application and systemic medications are used for the psoriasis
1950
defined as a persistent skin disease causes cell to
build rapidly on the surface of the skin, forming thick silvery, ”scales, itchy,dry and red patches
Psoriasis
Psoriasis is seen from _____ of americans and the western countries
1-3%
Lower rates are found in _________ and psoriasis is rare in ____ ________
Japanese, West Africans
Psoriasis first appears during 2 peak age ranges
16-22 years old
56-60 years old
Some of the factors that may trigger psoriasis are:
Genetic
Autoimmune reaction Infection
Injury to skin
Stress
Obesity
smoking
Medications for Psoriasis
lithium
antimalarial medications inderal
indomethacin
STRESS, GENECTIC, AUTOIMMUNE REACTION AND MEDICATION CAUSE
HYPERACTIVE OF T-CELLS
HYPERACTIVE OF T-CELLS causes it which DEREGULATED INFLAMMATORY PROCESS
EPIDERMIS INFILTRATION AND KERATINOCYTE PROLIFERATION
DEREGULATED INFLAMMATORY PROCESS causes
LARGE PRODUCTION OF VARIOUS CYTOKINES ( INTEFERRON, INTERLEUKIN-12)
Examples of Cytokines
INTEFERRON
INTERLEUKIN-12
LARGE PRODUCTION OF VARIOUS CYTOKINES leads to
SUPERFICIAL BLOOD VESSEL DILATED
VASCULAR ENGORGEMENT
SUPERFICIAL BLOOD VESSEL DILATED AND
VASCULAR ENGORGEMENT could lead to
EPIDERMAL HYPERPLASIA AND IMPROPER CELL
MATURATION
EPIDERMAL HYPERPLASIA AND IMPROPER CELL
MATURATION causes
FAILS TO RELEASE ADEQUATE LIPIDS WHICH LEAD TO FLAKING, SCALING PRESENTATION OF PSORIASIS LESION
FAILS TO RELEASE ADEQUATE LIPIDS WHICH LEAD TO
FLAKING, SCALING PRESENTATION OF PSORIASIS LESION
FAILS TO RELEASE ADEQUATE LIPIDS WHICH LEAD TO FLAKING, SCALING PRESENTATION OF PSORIASIS LESION. This could cause
SILVER SCALING OF SKIN
There are several types of psoriasis include
Plaque psoriasis
Guttate psoriasis
Inverse psoriasis
Pustular psoriasis
Erythrodermic psoriasis
Nail psoriasis
Psoriatic arthritis
-most common type of psoriasis.
-also known as psoriasis vulgaris
-appear as raised, inflammed
- red skin covered by silvery patches or scales
PLAQUE PSORIASIS
PLAQUE PSORIASIS is seen on
Elbows, Knees, sacrum,Scalp, lower back, Hands and Fee
PLAQUE PSORIASIS isa also termed as
psoriasis vulgaris
Characterized by eruption of small (0.5 to 1.5 cm in diameter) papules over the upper trunk and proximal extremities
GUTTATE PSORIASIS
GUTTATE PSORIASIS
manifests at an
early age
Latin Gutta means
drop
*_________________ __________infection frequently
precedes or is concomitant with the onset
or flare
Streptococcal throat
Localized in the major skin folds, such as the axilla, the inguinal and inflammatory areas and sweating areas
INVERSE PSORIASIS
INVERSE PSORIASIS is commonly seen on
Obese clients
Scaling is usually minimal or absent, and the lesions appear glossy, smooth and bright red.
INVERSE PSORIASIS
It is usually uncommon but mostly appear in adults. It appear as pus filled lesion surrounded by red skin. It is the serious condition so immediate medical attention is required.
PUSTULAR PSORIASIS
PUSTULAR PSORIASIS appear mostly at _____ & ______
hands and feet.
The disease affects all body sites. Erythema is the most prominent feature with superficial scaling / peeling that may appear like burning
ERYTHRODERMIC
PSORIASIS
_______ is the most prominent feature
with superficial scaling / peeling that may
appear like burning
Erythema
ERYTHRODERMIC
PSORIASIS could be caused by
sun burn
allergic reaction
strong coal product use
Commonly seen along with psoriatic arthritis. It appear as a pitting –small- bit nail, yellow-brown nail, tender and painful nail with chalk like debris build up under nails
NAIL PSORIASIS
NAIL PSORIASIS is Treated by ________ ________- into nail or ______ _______
steroid injected
light therapy
If one has NAIL PSORIASIS, you should keep the nails _____ & ______
short and trimmed
This is the condition which involve both psoriasis and joint inflammation
PSORIATIC ARTHRITIS
its appearance of the destruction characteristic of the PSORIATIC ARTHRITIS
Pencil appearance
An effect of the metatarsal bone being jammed into the base of the toe
cup and saucer effect
The most distinctive features of psoriatic arthritis are
Distal interphalangeal joint arthritis
Dactylitis
It will vary according to types of at psoriasis.
Intially the first sign of psoriasis is often
red spots on the body
The patches of skin Dry
swollen and inflammed
Covered with silver white flakes
Raised and thick skin
Other symptoms of psoriasis includes:
Pain
Itching
burning
A Restricted joint motion or pain ,Cracked and bleeding skin, Dandruff on scalp, Pus filled blisters, Genital lesions in males Pitting, small depression on the surface of the nail Yellow, discolored nail
Koebner phenomenon Arthritis
to do DIAGNOSTIC INVESTIGATIONS, one must
Collect history
Physical examinations
Skin biopsy : under local- anesthesia
Blood and radiography
test was done
to rule out psoriatic arthritis
Blood and radiography
Skin biopsy : under
local- anesthesia
the MEDICAL MANAGEMENT aim of psoriasis is to
-Interrupt the cycle that cause an increased production of skin cells
-reducing inflammation and –plaque formation
-Remove scales and smooth skin
Remove scales and smooth skin which is particularly remove by
topical treatment
Psoriasis treatment is divided into three main type
Topical treatment
Light therapy
Systemic medications
commonly first-line therapy in mild to moderate psoriasis and in sites
such as the flexures and genitalia, where other topical treatments can
induce irritation and skin folds.
Topical corticosteroids
Topical corticosteroids Improvement is usually achieved within
2 to 4 weeks
They slows the cells turnover by suppressing the immune system
which reduce inflammation and relieves associated itching
Topical corticosteroids
use for smaller area of skin like hands and feet.
- Strong corticosteroids
- Long term use of Strong corticosteroids may cause
thinning of skin and resistance.
are usually recommended for sensitive area and treating wide spread patches damage skin.
Low potency steroids
To avoid systemic effects of ______ __________ a maximum of ____ ointment may be used per week
class I glucocorticoid,,50 g
For small plaques (< 4cm)
-_____________ ____________ aqueous suspension ________ diluted with
normal saline is injected into the lesion
triamcinolone acetonide, 10 mg/mL
Calcipotriene (calcipotriol) example brand name
Betdaivonex
Potent_____ ______________ are superior to calcipotriene.
topical corticosteroids
calcipotriene was more effective than ____ ___ or __________
coal tar or anthralin
The efficacy of _____________ is not reduced with long-term
treatment
calcipotriene
calcipotriene generally should be applied _____ daily
twice
It inactivates calcipotriene
- Salicylic acid
the only major concern of using Calcipotriene is
Hypercalcemia
When the amount used does not exceed the recommended ______________, calcipotriene can be used with a great margin of safety
100 g/week
Calcipotriene is often used in combination with or in rotation with _________ ______________ in an effort to maximize therapeutic effectiveness while minimizing steroid- related skin atrophy.
topical corticosteroids
Other vitamin D analogues are
tacalcitol and maxacalcitol
- In view of their efficacy, cosmetic
acceptability and relative safety, tacalcitol and maxacalcitol may accepted as first-choice therapies in the topical treatment of
______ to ______________ _____________.
mild to moderate psoriasis
it is used to treat skin diseases dates back nearly 2000 years
Coal Tar
The use of tar to treat skin diseases dates back nearly _____ ______
2000 years
is the dry distillation product of organic matter heated in the
absence of oxygen
Tar
In 1925, Goeckerman introduced ____ ____________ _____________
which uses crude coal tar and UV light for the treatment of
psoriasi
“The Goekerman technique”
He introduced “The Goekerman technique
Goekerman
The Goekerman technique is developed on
1925
Coal tar, in concentrations ________ can be compounded in creams, ointments, shampoos and in
pastes
5- 20%
Coal tar is often combined with ________ _____ (2-5% ), which by its keratolytic action leads to better absorption of
the coal tar
salicylic acid
Coal tar’s Disadvantages include: allergic reactions, folliculitis, it has foul smell and appearance and can stain clothing and other items. It is also a ___________
carcinogenic
Tazarotene’s brand names are
zar, Zarotex
It is a third-generation retinoid
* It reduces mainly scaling and plaque thickness,with limited effectiveness on erythema by
normalize the DNA activity
Tazarotene
it is available in ______ & ______ gels, and a cream
0.05% and 0.1 %
it is available in ______ & ______ gels, and a cream
0.05% and 0.1 %
when Tazarotene is used as a monotherapy, a significant
proportion of patients develop local
irritation(especially with the __ formulations).
1%
Tazarotene is use along with ___________ ______
sun screen lotion
They inhibit activation of T- cells which inturn reduces inflammation and plaque build up.
Topical Calcineurin Inhibitors & Pimecrolimus
Topical Calcineurin Inhibitors (TCI) example are
Tacrolimus”Tarolimus”
Pimecrolimus cream example is
Elidel
Topical Calcineurin Inhibitors
& Pimecrolimus are not effective in
plaque psoriasis
However, Topical Calcineurin Inhibitors & Pimecrolimus , for treatment of ________ & __________ ___________, these agents appear to provide effective treatment
inverse and facial
psoriasis
Between treatment periods, skin care with emollients should be performed to avoid ________
dryness
They reduce scaling, may limit painful fissuring, and can help control pruritus
Emollients
Emollients are best applied immediately after
bathing or showering
The use emollients in combination with________ __________ improves hydration while minimizing treatment costs
topical treatments
MED is also knwon as
minimal erythema dose
In minimal erythema dose. The patient wears a thick cotton
shirt which has __ small, vertical
holes on its back
10
The patient is exposed to __ __ of
UV on the back while all the holes
are opened
50 mj
The first hole is closed and another exposure is given By that time the skin under the first hole was exposed to __ __ of UV while the skin under the second hole
was exposed to ____ ___
50 mj, 100 mj
After 24-72 hours the skin of the back is examined and the first skin area showing well-defined erythema is determined and the amount of UV causing it is called
the minimal erythema dose
a wavelength of light in a range too short for human eye to see
Ultraviolet light
When exposed to the UV light ,the activated ________ in the skin are
destroy which lead reduces scaling and inflammation
T–cells
Sun exposure should be for brief duration of time to improve
psoriasis
Control dose of UVB light from an artificial- light source may improve ____ to ___________ __________symptoms
mild to moderate psoriasis
UVB phototherapy is also called-
Broadband UVB
can be use to treat to single
patches and psoriasis resistant to topical treatment
ULTRAVIOLET BOARDBAND PHOTOTHERAPY
Side effect: reddness, dryness and itching- which can be minimize by using moisturizer
ULTRAVIOLET BOARDBAND PHOTOTHERAPY
involves taking light- sensitizing medication (psoralen) before
exposure to UVA light
Photochemotherapy
UVA light penetrate deeper in skin and- _________ make more responsive to UVA
exposure
psoralen
Side effect:
Nausea
Headache
burningitching, wrinkle skin or skin cancer
Photochemotherapy
A controlled beam of UVB light of a specific wavelength is directed to
the psoriasis plaque to control scaling and inflammation
EXIMER LASER
In the EXIMER LASER, It does not harm healthy skin and a More powerful ___ _____is used
UVB light
Side effects of using Eximer Laser are
Side effect : redness and blistering
used different form of light to destroy the tiny blood vessel that
contribute to psoriasis plaque
Pulse dye laser
Pulse dye laser’s side effects are
bruising, scarring
Combine UV light with other treatment such as retinoids frequently improve phototherapy effectiveness
COMBINATION LIGHT THERAPY
Vitamin a is also called
Retinol
