Psoriasis

Question 1

What is psoriasis ?

Answer 1

Common, life long, genetic auto-immune disorder

Question 2

Which race and sex are most affected by psoriasis?

Answer 2

It has a higher incidence in whites but is equal in distribution b/w sexes

Question 3

Peak ages of onset for psoriasis?

Answer 3

B/w 16 & 22
and
B/w 57 & 60

Question 4

Elements of physical discomfort with psoriasis

Answer 4

Pain
Itching 
Stinging 
Cracking
Bleeding of lesions

Question 5

Common anatomic locations for psoriasis in descending order ?

Answer 5

Scalp 
Elbows 
Legs
Knees 
Nails 
Gluteal cleft
Palms/soles

Question 6

Psoriasis clinical presentation

Answer 6

Erythematous, raised patches with silvery scales 
Symmetric 
Pruritic/Painful 
Pitting Nails
Arthritis in 10-20% of patients

Question 7

Pathophysiology of psoriasis

Answer 7

For Psoriasis, there is an alteration of the cell kinetics of keratinocytes.
The usual turnover is 18 days, however for psoriasis it drops to 2 days. This causes 28 times the normal production of epidermal cells.

Normal T cells help to protect the body against infection and disease
In psoriasis, T cells are put into action by mistake and become so active that they trigger other immune responses

There is inflammation and a rapid turnover of skin cells. Additionally, tumour necrosis factor (TNF) causes inflammation, leading to the formation of painful, disfiguring psoriasis plaques
TNF is found in high levels in psoriatic plaques and plays a critical role in their formation and inflammation

Question 8

Characteristics of psoriasis

Answer 8

Symmetric lesions
Usually found on face, extensor joints, anogenital area, palms, truck, scalp, ears, intertriginous areas (where two skin areas rub together)

Question 9

Associated factors of psoriasis

Answer 9

Genetic: Autosomal dominant inheritance

Nongenetic:
Mechanical, UV, chemical injury
Infections: Strep, viral, HIV
Rx Drugs, stress, endocrine, hormonal, obesity alcohol, smoking

Question 10

Genes associated with psoriasis

Answer 10

HLA-Cw6
IL-12/IL-23 p40
IL-23R
IL-23 p19

Question 11

Types of Psoriasis

Answer 11

Plaque 
Guttate 
Erythrodermic
Pustular
Nail psoriasis 
Palmar 
Psoriatic arthritis 
Scalp psoriasis

Question 12

Plaque Psoriasis

Answer 12

Dry scaling patches (common psoriasis) most common

Question 13

Guttate psoriasis

Answer 13

Drop-like dots, occurs after strep or viral infection

Question 14

Erythrodermic psoriasis

Answer 14

Exfoliation of fine scales (total body “dandruff”)

Question 15

Pustualar psoriasis

Answer 15

Pus-like blisters, non infectious, fluid contains white blood cells

Question 16

Palmar/plantar

Answer 16

Erythema, thickening and peeling of the skin, blistering is often present. Can lead to disability.

Question 17

Psoriatic arthritis

Answer 17

Inflammation, swelling, and joint destruction

Question 18

Nail Changes for psoriasis

Answer 18

Fingernails > Toes

Onycholysis (separation from the nail bed)
Pitting 
Subungual debris accumulation 
Colour alterations 
*pitting rules out fungal infection