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Papulosquamous dermatoses > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

Prevalence:

A

-2 % worldwide

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2
Q

% of patients with psoriatic arthritis?

A
  • 5-30%
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3
Q

Age of onset:

A
  • bimodal distribution peaking at 20-30 years, and 50-60 years
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4
Q

General pathogenesis of psoriasis:

A
  • caused by environmental triggers in genetically predisposed patients
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5
Q

triggers for psoriasis:

A

SICK LAB - stress/smoking - Infection (group A strep, URI) - hypoCalcemia - Koebnerization - Lithium - antimalarias/ACEI/alcohol - Beta blockers Others: TNF alpha inhibitors!!!, CCB’s, NSAIDs

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6
Q

most important psoriasis susceptibility region is ___ which is present in ____ % of patients

A
  • PSORS1 - 50%
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7
Q

strongest HLA association:

A
  • HLA cw6 (C-wia-six)
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8
Q

HLA cw6 is positive in ____ % of early onset psoriasis

A
  • 90%
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9
Q

strongest HLA risk factor for early onset disease is_____

A
  • HLA cw6
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10
Q

HLA-B27 is a/w

A
  • sacroiliitis-associated psoriasis - PsA - pustular psoriasis
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11
Q

HLA cw6 is a/w which subtype of psoriasis?

A
  • guttate
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12
Q

HLA- B13 and HLA-B17 a/w:

A
  • guttate and erythrodermic psoriasis
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13
Q

HLA A,B,C encode _____

A
  • MHC class 1 on nucleated cells
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14
Q

HLA DR, DP, DQ encode ____

A
  • MHC class 2 on APC’s
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15
Q

Name the variants of psoriasis:

A
  • guttate - palmoplantar - inverse - erythrodermic - pustular (including impetigo herpetiformis in pregnancy, and Von Zumbusch)
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16
Q

The two generalized pustular psoriasis are:

A
  • impetigo herpetiformis - Von Zumbusch
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17
Q

Impetigo herptiformis presentation and management:

A
  • presents in pregnant patients, begins in flexures then generalizes w/ toxicity - early delivery recommended
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18
Q

Von Zumbusch presentation:

A
  • rapid and generalized, painful skin, fever, leukocytosis, hypoalbuminemia
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19
Q

Risk factor for Von Zumbusch :

A
  • hypocalcemia
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20
Q

Palmoplantar pustulosis presents as ____ and has a ____ course.

A
  • pustules and yellow-brown macule localized to plams/soles - chronic course
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21
Q

Palmoplantar pustulosis may be a/w sterile inflammatory bone lesions in _____

A

SAPHO syndrome

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22
Q

Acrodermatitis of Hallopeau presents as:

A
  • lakes of pus on distal fingers, toes, and nail beds–> nail shedding - think of “lake hallopeua”
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23
Q

1 cause of pityriasis amianacea is ____

A

psoriasis

24
Q

Nail findings in psoriasis:

A
  • Proximal matrix= Pits - Distal matrix= leukonychia and loss of transparency - nail bed= oil spots, splinter hemorrhages, onycholysis, sublingual hyperkeratosis
25
Q

Psoriatic arthritis is more likely if ____ and ____ are involved.

A
  • nails - scalp
26
Q

PsA presents as ____

A
  • morning stiffness >30-45 mins
27
Q

5 types of PsA:

A
  • oligoarthritis with swelling and tenosynovitis of hands (60-70% of cases!!!!!!) - asymmetric DIP with nail damage - RA-like - Arthritis mutilans (rare and most severe) - Ankylosing spondylitis
28
Q

most common type of PsA

A

oligoarthritis with swelling and tenosynovitis of hands (60-70% of cases!!!!!!)

29
Q

Good way to distinguish RA from PsA

A
  • PsA affects PIPs, DIPs, usually spares MCPs - RA affects MCPs, PIPs, spares DIPs
30
Q

Common trigger for guttate psorisasis

A
  • group A strep infection (oropharynx or perianal)
31
Q

Dactylitis is ____ and seen in ____ % of patients with PsA

A
  • swelling of fingers (sausage digit) - 15-30%
32
Q

Histology of psoriasis:

A
  • confluent PK - Munro’s micro abscesses (collections of neuts in the stratum corneum, neuts in horn) - decreased or absent granular layer - regular acanthoses with thinning over dermal papilla, which contain dilated capillaries
33
Q

Munro’s microabcesses are:

A
  • collections of neutrophils in stratum corneum (neuts in the horn)
34
Q

The granular layer in psoriasis is _____

A
  • decreased or absent
35
Q

7 basic steps of psoriasis immunology in order:

A
  1. environmental triggers + genetic susceptibility 2. Keratinocyte injury and increased antigen presentation 3. Increased production of proinflammatory cytokines (IL-23, IL-12, IL-17, IFN-gamma, TNF, and IL-22) 4. Activation of T cells by myeloid dendritic cells leading to Th1 and Th17 activation and proliferation 5. epidermal acanthuses and abnormal keratinocyte proliferation 6. Increased production of beta defensins, cathelicidin LL37.
36
Q

Th17 cells are stimulated by ____ . This in turn increases release of _____ and ____ which causes keratinocyte replication

A
  • IL-12 and IL-23 - Th17 cells lead to release of IL-17 and IL-22
37
Q

Th1 cells are stimulated by _____ and lead to production of ____________.

A
  • stimulated by IL-12
38
Q

Two main cytokines involved in the increase in keratinocyte replication:

A
  • IL-17 and IL-22 (these are released by Th17 cells.
39
Q

IL-12, which stimulates Th1 cells promotes CD8 T cells to secrete:

A
  • IFN-gamma - IL-2,6,8,12
40
Q

IFN-gamma activates _____ to secrete ____ and _____

A
  • macrophages - TNF-alpha and IL-23
41
Q

Th17 cells release ____, ____ and ____

A
  • IL-17 - IL-22 - TNF-alpha
42
Q

Th2 cells are stimulated by ____ and produce _____, which is decreased in psoriasis

A
  • IL-4 - produce IL-10
43
Q

IL-10 is an anti-inflammatory cytokine which inhibits _____

A
  • Th1 cells - since there is less IL-10, there are more Th1 cells that release more pro inflammatory cytokines
44
Q

Mechanism of topical corticosteroids:

A
  • decrease pro-inflammatory cytokines like TNF-alpha and increase IL-10 (anti-inflammatory cytokine)
45
Q

MOA of Calcipotriene:

A
  • vitamin D analog that decreases KC proliferation and blocks IL-2, IL-6, and IFN-gamma
46
Q

Which molecule leads to neutrophil chemotaxis and micro abscess of munro formation?

A
  • CXCL8
47
Q

Associated comorbidities of psoriasis:

A
  • decreased risk of allergies and superinfections - increased risk of cardiovascular diseases, HLD, HTN, DM, metabolic syndrome
48
Q

Micropustules of Kogoj are_____

A
  • collection of neutrophils in stratum spinosum
49
Q

Where are micro pustules of Kogoj and munro microabcesses located in skin?

A
  • munro are neuts in the stratum corneum - Kogoj are neuts in the stratum spinosum - remember “Marilyn Monroe is always on top”
50
Q

First line tx for mild-moderate psoriasis?

A
  • topical CS
51
Q

Fist line tx for moderate-severe psoriasis?

A
  • NB-UVB (311-313nm)
52
Q

How often does psoriasis spontaneously remiss?

A

<35% of the time, the rest tend to have chronic course

53
Q

Woronoff ring is ____

A
  • pale blanching ring around psoriatic lesion
54
Q

Scraping of psoriasis scale off will lead to ____ which is called _____ sign.

A
  • pinpoint bleeding - auspitz sign
55
Q

Auspitz sign occurs due to____

A
  • dilated capillaries and supra-papillary plate thinning
56
Q
A

Papulosquamous dermatoses (7 decks)

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