Pathophys - Psoriasis Flashcards
explain what the skin looks like in psoriasis
raised areas of abnormal tissue
skin is red-purple, dry, raised, and itchy
often covered by white scaly areas
true or false
psoriasis is autoimmune related
true
name 5 types of psoriasis
plaque
guttate
inverse
pustular
erythrodermic
of the 5 types of psoriasis, which is most common
plaque psoriasis
(~90% of psoriasis cases are plaque psoriasis)
what does plaque psoriasis typically look like?
red patches with white scales on top
what areas does plaque psoriasis typically affect?
can it affect any area?
can affect any area, but most typically affects the back of the forearms, shins, navel area (abdomen), and SCALP
as mentioned, plaque psoriasis presents as red patches with white scales on top
what is at the surface?
dead cells
explain the typical presentation of guttate psoriases
there are numerous small and scaly red/pink pustules
lesions drop shaped
much more spread out than plaque psoriasis – spread over very large areas of the body like the trunk ,limbs, and scapl
the lesions seen in guttate psoriasis are often associated with what?
streptococcal infections
link isn’t very clear, but following or late into a streptococcal infection, guttate psoriasis may appear
true or false
in guttate psoriasis, the red lesions are often covered with white, scaly patches on top
false
they appear red
this is true for plaque psoriasis
true or false
psoriasis is caused by bacteria
NO - it is autoimmune
explain the appearance of pustular psoriasis
small, NONINFECTIOUS (never bacteria) pus-filled blister
under the pustule, the skin is red and tender
may be localized or widespread
in ______ psoriasis, it almost look like whiteheads
pustular psoriasis
explain the presentations of inverse psoriasis and include where it typically presents
patches are SMOOTH and inflamed – different from the other types
forms red patches in FOLDS of the skin - like the genitals, armpits, btwn buttox, under breasts, and in the folds of obese ppl
another term for inverse psoriasis
flexural psoriasis
in _______ psoriasis, there are NO RAISED AREAS, making it different from the other types
inverse/flexural psoriasis
which type of psoriasis may be fatal and why
erythrodermic psoriasis
because it covers 90% of the body – there is extreme inflammation and exfoliation of the skin. disrupts the body’s ability to regulate temperature and act as a barrier
explain how erythrodermic psoriasis presents itself
it is WIDESPREAD – affecting 90% of the body. causes widespread exfoliation of the skin and severe dryness, itching, swelling, and pain
may arise from the other types of psoriasis
increased risk of death and infection
how is it that the skin can act as a barrier
the cells outside are dead and keratinized - hard for things to get through
explain how seborrhec-like psoriasis presents itself
forms red, GREASY scales/plaques
in areas like scalp, forehead, folds next to nose, around mouth, above sternum, and in general - in skin folds
seborrhec-like psoriasis has clinical aspects of _____ and _____
psoriasis and seborrheic dermatitis
nail psoriasis occurs in about _____% of people with psoriasis
40%
name some changes that can occur in psoriasis of the finger nails
pitting/whitening of nails
bleeding under the nails
yellow-red discoloration
thickening of skin under nails
loosening and separation of nail
nail crumbling
psoriatic arthritis is a form of……
chronic inflammatory arthritis
where does psoriatic arthritis typically affect?
it is also associated with psoriasis of the…..
can occur in any joint, but mostly affects the fingers and toes, secondary hips, knees, spine, sacro iliac joint
associated also with psoriasis of the skin and nails
psoriatic arthritis involves painful inflammation of the joints and………
surrounding connective tissue
true or false
the cause of psoriasis is not clearly understood
true
as mentioned, the cause of psoriasis is not clearly understood
name some factors that are potential factors in causation
autoimmunity
genetics (ppl often have family history)
associated with genes related to MHC AND T CELLS
psoriasis seems to be assocated with genes related to…….
MHC AND T CELLS
________- loci from different chromosomes are associated with psoriasis
there is also an increase in ______ haplotypes
9
HLA haplotypes
name 3 general immunologic factors assosciated with psoriasis
t lymphocytes (helper and killer)
proinflammatory cytokines
dendritic cells/other APCs (secrete the cytokines)
name 2 subtypes of CD4 cells that appear to drive the inflammatory response and dermatosis in psoriasis
TH1 and TH17
name some proinflammatory cytokines involved in psoriasis
IL12
IL17
IL22
IL23
IFNY
TNFa
in psoriasis, what causes the increase in inflammatory cellular elements?
(like CD4, CD8, APC)
keratinocyte growth factor
the combination of __________ and ____________are the most likely causes of psoriasis changes
BUT WE DONT KNOW THE CAUSE****8
PROINFLAMMATORY CYTOKINES AND EPIDERMAL GROWTH FACTORS
name some environmental stimuli (3) that may contribute to psoriases development
infections
photosensitivity
certain drugs
the 3 environmental stimuli - photosensitivty, infections, and certain drugs - may produce _________ in apparently normal skin
psoriatic plaques
in psoriasis, there is an abnormal growth of what?
abnormally excessive and rapid growth of the epidermis – causes raised red patches
the abnormally excessive and rapid growth of epidermal cells seen in psoriasis is driven by what?
what is the result of this abnormal growth?
driven by keratinocyte growth factor
causes a sequence of pathological events —
-initiation phase begins due to skin trauma/infection/even certain drugs
the initiation phase leads to activation of the immune system
skin cells are replaced in 3-5 days (norm is 28-30) bc of the premature maturation of keratinocytes —–bc of an inflammatory cascade in the dermis
as mentioned, in psoriasis, there is premature maturation of keratinocytes (3-5 days vs normal 28-30)
what is this premature maturation due to?
by an inflammatory cascade in the dermis, involving dendritic cells, macrophages, and T lymphocytes
there is a dysregulation of regulatory T lymphocytes which allows the reaction to continue even when there’s no stimulus
what may be an inflammatory stimulus in psoriasis?
what is the APC involved - levels of this cell are increased in psoriasis patients
DNA from dying cells may be an inflammatory stimulus
dendritic cells
explain the pathologic appearance of psoriasis
the skin is thickened with hyperkeratosis (thickening of skin) and parakeratosis (nuclei in in the stratum corneum when their shouldn’t be)
the nucleated layers of the epidermis (below the strat corneum) is also thickened
dermal papillae may be altered (appear as bulbs instead of cones)
capillaries of the dermis are dilated
