Pathophys - Psoriasis

Question 1

explain what the skin looks like in psoriasis

Answer 1

raised areas of abnormal tissue
skin is red-purple, dry, raised, and itchy
often covered by white scaly areas

Question 2

true or false

psoriasis is autoimmune related

Answer 2

true

Question 3

name 5 types of psoriasis

Answer 3

plaque
guttate
inverse
pustular
erythrodermic

Question 4

of the 5 types of psoriasis, which is most common

Answer 4

plaque psoriasis

(~90% of psoriasis cases are plaque psoriasis)

Question 5

what does plaque psoriasis typically look like?

Answer 5

red patches with white scales on top

Question 6

what areas does plaque psoriasis typically affect?
can it affect any area?

Answer 6

can affect any area, but most typically affects the back of the forearms, shins, navel area (abdomen), and SCALP

Question 7

as mentioned, plaque psoriasis presents as red patches with white scales on top

what is at the surface?

Answer 7

dead cells

Question 8

explain the typical presentation of guttate psoriases

Answer 8

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

Question 9

the lesions seen in guttate psoriasis are often associated with what?

Answer 9

streptococcal infections

link isn’t very clear, but following or late into a streptococcal infection, guttate psoriasis may appear

Question 10

true or false

in guttate psoriasis, the red lesions are often covered with white, scaly patches on top

Answer 10

false

they appear red

this is true for plaque psoriasis

Question 11

true or false

psoriasis is caused by bacteria

Answer 11

NO - it is autoimmune

Question 12

explain the appearance of pustular psoriasis

Answer 12

small, NONINFECTIOUS (never bacteria) pus-filled blister

under the pustule, the skin is red and tender

may be localized or widespread

Question 13

in ______ psoriasis, it almost look like whiteheads

Answer 13

pustular psoriasis

Question 14

explain the presentations of inverse psoriasis and include where it typically presents

Answer 14

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

Question 15

another term for inverse psoriasis

Answer 15

flexural psoriasis

Question 16

in _______ psoriasis, there are NO RAISED AREAS, making it different from the other types

Answer 16

inverse/flexural psoriasis

Question 17

which type of psoriasis may be fatal and why

Answer 17

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

Question 18

explain how erythrodermic psoriasis presents itself

Answer 18

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

Question 19

how is it that the skin can act as a barrier

Answer 19

the cells outside are dead and keratinized - hard for things to get through

Question 20

explain how seborrhec-like psoriasis presents itself

Answer 20

forms red, GREASY scales/plaques

in areas like scalp, forehead, folds next to nose, around mouth, above sternum, and in general - in skin folds

Question 21

seborrhec-like psoriasis has clinical aspects of _____ and _____

Answer 21

psoriasis and seborrheic dermatitis

Question 22

nail psoriasis occurs in about _____% of people with psoriasis

Answer 22

40%

Question 23

name some changes that can occur in psoriasis of the finger nails

Answer 23

pitting/whitening of nails

bleeding under the nails

yellow-red discoloration

thickening of skin under nails

loosening and separation of nail

nail crumbling

Question 24

psoriatic arthritis is a form of……

Answer 24

chronic inflammatory arthritis

Question 25

where does psoriatic arthritis typically affect?

it is also associated with psoriasis of the…..

Answer 25

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

Question 26

psoriatic arthritis involves painful inflammation of the joints and………

Answer 26

surrounding connective tissue

Question 27

true or false

the cause of psoriasis is not clearly understood

Answer 27

true

Question 28

as mentioned, the cause of psoriasis is not clearly understood

name some factors that are potential factors in causation

Answer 28

autoimmunity
genetics (ppl often have family history)
associated with genes related to MHC AND T CELLS

Question 29

psoriasis seems to be assocated with genes related to…….

Answer 29

MHC AND T CELLS

Question 30

________- loci from different chromosomes are associated with psoriasis

there is also an increase in ______ haplotypes

Answer 30

9

HLA haplotypes

Question 31

name 3 general immunologic factors assosciated with psoriasis

Answer 31

t lymphocytes (helper and killer)
proinflammatory cytokines
dendritic cells/other APCs (secrete the cytokines)

Question 32

name 2 subtypes of CD4 cells that appear to drive the inflammatory response and dermatosis in psoriasis

Answer 32

TH1 and TH17

Question 33

name some proinflammatory cytokines involved in psoriasis

Answer 33

IL12
IL17
IL22
IL23
IFNY
TNFa

Question 34

in psoriasis, what causes the increase in inflammatory cellular elements?
(like CD4, CD8, APC)

Answer 34

keratinocyte growth factor

Question 35

the combination of __________ and ____________are the most likely causes of psoriasis changes

BUT WE DONT KNOW THE CAUSE****8

Answer 35

PROINFLAMMATORY CYTOKINES AND EPIDERMAL GROWTH FACTORS

Question 36

name some environmental stimuli (3) that may contribute to psoriases development

Answer 36

infections
photosensitivity
certain drugs

Question 37

the 3 environmental stimuli - photosensitivty, infections, and certain drugs - may produce _________ in apparently normal skin

Answer 37

psoriatic plaques

Question 38

in psoriasis, there is an abnormal growth of what?

Answer 38

abnormally excessive and rapid growth of the epidermis – causes raised red patches

Question 39

the abnormally excessive and rapid growth of epidermal cells seen in psoriasis is driven by what?

what is the result of this abnormal growth?

Answer 39

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

Question 40

as mentioned, in psoriasis, there is premature maturation of keratinocytes (3-5 days vs normal 28-30)

what is this premature maturation due to?

Answer 40

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

Question 41

what may be an inflammatory stimulus in psoriasis?
what is the APC involved - levels of this cell are increased in psoriasis patients

Answer 41

DNA from dying cells may be an inflammatory stimulus

dendritic cells

Question 42

explain the pathologic appearance of psoriasis

Answer 42

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