Psoriasis Flashcards by Monique Pretorius

Genetics of psoriasis

How well did you know this?

Not at all

Perfectly

Epidemiology of psoriasis

How well did you know this?

Not at all

Perfectly

Pathogenesis of psoriasis

1) Role of T-cells and dendritic cells
- T cell driven disease
-intergrin alpha1beta1 on psoriatic T cells allow for interaction with BM collagen 4
- epidermis: CD8+ dermis: mix CD8+, CD4+
- increase dendritic cells, pro inlflammatory dendritic cells (produce TNF alpha)
- pDC initiate psoriasis via production of IFN alpha

2) cytokines and chenokines
- increase in Th1 cytokines (IFN gamma and IL 2)
- decrease level of anti-inflammatory IL 10
- IL 23 stimulate Th17 - release IL17 and IL22 (prolif of KC)
T cells release IFN gamma
Chemokines - traffic leukocytes (CXCL8 - neutros, CXCL9-11 attract T cells)
Chemerin - attract pDC

3) innate immunity and role of keratinocyte
-kc : B defensin , TLR, TNF alpha, cathelicidin unregulated
- IFN gamma drive keratinocyte stem cell proliferation
-IFN gamma activate STAT3 - link KC and immune cells

How well did you know this?

Not at all

Perfectly

Triggers of psoriasis

How well did you know this?

Not at all

Perfectly

Discuss HIV and psoriasis

How well did you know this?

Not at all

Perfectly

Immunopathogenesis of psoriasis

How well did you know this?

Not at all

Perfectly

Describe the clinical features of psoriasis

How well did you know this?

Not at all

Perfectly

Discuss nail psoriasis

How well did you know this?

Not at all

Perfectly

Name the types of psoriasis

1) chronic plaque psoriasis
2) gutatte psoriasis
3) erythrodermic psoriasis
4) pustular psoriasis
5) nail psoriasis
6) psoriatic arthritis
7) localised psoriasis: scalp/oral mucosa
8) flexural psoriasis
Related lesions
9) pustulosis of palms and soles
10) acrodermatitis continua of hallopeau

How well did you know this?

Not at all

Perfectly

Describe chronic plaque psoriasis

How well did you know this?

Not at all

Perfectly

Describe guttate psoriasis

How well did you know this?

Not at all

Perfectly

Erythrodermic psoriasis

How well did you know this?

Not at all

Perfectly

Name 3 variants relates to pustular psoriasis

How well did you know this?

Not at all

Perfectly

Describe the types of generalised pustular psoriasis

How well did you know this?

Not at all

Perfectly

Name the triggering factors for pustular psoriasis

Pregnancy (impetigo herpetiformis)
Rapid tapering if corticosteroids
Hypocalcaemia
Infections
Topical irritants

How well did you know this?

Not at all

Perfectly

Name key point regarding pustulosis of the palms and soles

How well did you know this?

Not at all

Perfectly

Name key points regarding acrodermatitis continua of hallopeau

Also add rx: topical cs, 5-FU, tci, calcipotriol, systemic (mtx, cyclosporine, acitretin, PUVA)

How well did you know this?

Not at all

Perfectly

Name and describe special locations of your psoriasis

How well did you know this?

Not at all

Perfectly

Pathogenesis of psoriatic arthritis

CD8+ cells in synovial fluid, HLA B27, Th17. 5-30% of patients with skin psoriasis
No specific serology test - erosive change radiologically NB

How well did you know this?

Not at all

Perfectly

Name and describe the types of psoriatic arhritis.

How well did you know this?

Not at all

Perfectly

On a picture describe the types of arthritis affecting different hands of the joint

How well did you know this?

Not at all

Perfectly

Name and describe the disorders related to psoriasis.

1) ILVEN - linear, psoriasiform lesions (scaling + erythematous) that follow lines of Blaschko. Chronic and resistant to treatment
2) Reactive arthritis (Reiters disease) - strong association with HLA-B27. Urethritis, arthritis, ocular findings, oral ulcers, psoriasiform skin lesions, caused by Chlamydia Trachomatis, Shigellosis
Skin: predilection for soles, extensors of legs, penis, dorsal hands, fingers, nails and scalp
plantar surface: thick, yellow scale, pustular (keratoderma blenorrhagicum), psoriatic plaques on penis: balanitis circinata
Self limiting (weeks to months)
In HIV can be severe
3) Sneddin wilkinson disease
Annular and polycyclic (commences in felxures), very superficial SUBCORNEAL sterile pustules is the hallmark. Gravity induced demarcation - clear fluid, pus inferior, cyclic course. May be associated with IgA paraproteinemia, response to dapsone supports that its a seperate entity
NB - need IMF to distinguish from subcorneal pustular dermatosis type IGA pemphigus

How well did you know this?

Not at all

Perfectly

Name psoriasis associations with other skin diseases

How well did you know this?

Not at all

Perfectly

Psoriasis association with infections

How well did you know this?

Not at all

Perfectly

Psoriasis association with cancer

1. Increased risk of cancer including lymphoma (treatment with immunosuppressants can increase risk) 2. PUVA - increased risk of skin cancer (esp SCC and esp if used with cyclosporin) 3. PUVA increased risk for melanoma 4. Chronic inflammation 5. Associated with obesity, smoking, alcohol - also increase risk of malignancy

Psoriasis Associations with internal diseases

Laboratory Abnormalities in psoriasis

Bacteriology in psoriasis

No qualitative disorders BUT number if bacteria increased by 2x (can be problematic if colonized by S. Aureus)

Differential diagnosis of psoriasis

1. Inflammatory: Seb derm, LSC, chronic eczema 2. Neoplastic: MF, single lesions Bowens, Extra-mammary pagets, Langerhans cell histiocytosis 3. Infectious: secondary syphiliis, tinea corporis 4. Other: dermatomyositis, AGEP, PRP, pustulosis of palms and soles, reiters

Describe the histopatholgy in psoriasis vulgaris

Describe the histopathology in Guttate psoriasis

Describe the histopathology in pustular psoriasis

1. Accumulation of neutrophils is prominent - neutrophils accumulate between keratinocytes 2. In Stratum corneum - large accumulates of neutrophils with surrounding parakeratosis 3. exaggerated spongiform pustules of Kogoj + munro microabscesses are formed 4. other: in reactive arthritis - cutaneous findings are similar (spongiform pustules seen in palmoplantar lesions). Sneddon wilkonson - subcorneal pustules = characteristic finding

Name the differential diagnosis of a subcorneal/intra epidermal neutrophiloc psutule

Describe the histology of the initial psoriatic skin lesions

Describe the histopathological features of a atable psoriatic lesion

Does the histology of an active psoriatic plaque show hypogranulosis or hypergranulosis?

Hypogranulosis - Granular layer is absent

Describe granulocytes in psoriasis

Describe proteases in psoriasis

Describe the action of vitamin D3 analogue (topical) on psoriasis

Tabulate the indications and contraindications of vitamin D analogues

Describe the mode of action of topical corticosteroids in psoriasis

Anti-inflammatory and anti-proliferative

Name the indications and contra-indications of topical steroids in psoriasis

Name the adverse effects of topical corticosteroids

LOCAL 1. epidermal atrophy (shiny, wrinkled, fragile, hypopigmentation, prominent vasculature, stellate pseudoscars, stria, purpura 2. Steroid addiction/rebound 3. Glaucoma/cataracts 4. Allergic/irritant contact dermatitis 5. Tachyphylaxis 6. Facial hypertrichosis 7. Folliculitis/miliaria 8. Genital ulceration 9. Granuloma gluteale infantum 10. Norweigan/crusted scabies 11. Exacerbations/increased susceptibility for bacterial/viral infection 12. Reactivation of Kaposi Sarcoma 13. Peri-oral dermatitis, rosacea, acne 14. Delayed wound healing SYSTEMIC 1. Suppression of hypothalamic - pituitary adrenal axis 2. Iatrogenic Cushings syndrome 3. Growth retardation in infants and children

Risk factors for local atropy and systemic effects in topical corticosteroids

Reasons for short stature in kids with eczema

Discuss the use of anthralin in psoriasis 1) Mechanism of action 2) Indications and contra-indications

Discuss the use of topical retinoids in psoriasis

1) all-trans retinoic acid+13 cis retinoic acid = effective for acne but not effective for psoriasis BUT topical tazarotene that selectively binds to retinoic acid receptor RAR-B and RAR-y can be used to treat psoriasis

Discuss the use of tazarotene

Discuss the use of other topical treatment in psoriasis

Discuss the use of coal tar in psoriasis

Discuss the indications and contra-indications of phototherapy in psoriasis

Discuss the mechanism of action of methotrexate in psoriasis

Discuss dosage and serious side effects of Methotrexate in psoriasis

Discuss the indications and contra-indications of MTX in psoriasis

Discuss all methotrexate side-effects (1)

Discuss all side-effects of MTX in psoriasis

Monitoring of methotrexate

Describe the mechanism of action of cyclosporin in psoriasis

Describe the side-effects of cyclosporin in psoriasis

Describe the indications and contra-indications of cyclosporin in psoriasis

Indications 1) Severe psoriasis 2) conventional therapies failed 3) Can be used in plaque/erythrodermic/pustular/nail psoriasis 4) psoriatic arthritis Contra-indications 1) impaired renal function 2) uncontrolled HPT 3) Primary/secondary immunodeficiency 4) Concomitant immunosuppressive treatment 5) Past/present malignancy 6) Concomitant drugs affecting cyclosporin pharmacokinetics 7) History shows of aresenic exposure 8) Excessive photochemotherpy > 200 PUVA 9) radiotherapy 10) concurrent photochemotherapy 11) Severe infections 12) Active infections 13) Pregnancy and lactation 14) concurrent MTX 15) Significant hepatic disease 16) Hyperuricemia 17) Hyperkalemia 18) Hypersensitivity to cyclosporin 19) Vaccinations with live vaccines 20) seizure d/o 21) Poorly controlled DM 22) Severe chronic organ dysfx 23) Alcohol and drug abuse 24) Malabsorption 25) Unreliable patient

Discuss the mechanism of action of systemic retinoids in psoriasis

Discuss the dosage and efficacy of acitretin in psoriasis

Discuss the pre-acitretin screening

Discuss the evaluation during acitretin treatment in psoriasis

Discuss the indications of acitretin in psoriasis

Discuss the contra-indications for acitretin in psoriasis

Briefly discuss the use of biologics in psoriasis

1) 2 major cytokines - T cells ans cytokines IL 12 and IL23 and TNF alpha 2) Indicated for moderate + severe psoriasis /psoriatic arthritis 3) High cost - therefor reserved id orher treatments contra-indicated or failed 4) Briakinumab withdrawn due to cardiovascular toxicity

Discuss different biologics in psoriasis

Discuss indications and contra-indications of biologics in psoriasis

Discuss general factors of treatment management in psoriasis

1) Exclude triggering factors (meds, stress) 2) Assess disease severity (TBSA, erythema, induration, desquamation 3) impact on quality of life 4) Response to previous treatment eg some patients have very good response to topicals with widespread disease, others localised- recalcitrant to high dose systemica

Discuss the use of additional systemics for psoriasis