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Applied Pathophysiology > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What is psoriasis?

A

Inflammatory and hyperplastic disease of the skin

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2
Q

what are hallmark characteristics of psoriasis?

A

erythema (redness)

elevated,scaly plaques

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3
Q

what is the global prevalence of psoriasis?

A

0.1%-8.5%

in reality, its ~double

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4
Q

what is the avg age of getting psoriasis? what is early onset and late onset psoriasis?

A

avg: 23-37 years
early: 16-22yrs
late: 57-60yrs

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5
Q

what is the difference between early and late onset?

A

early is usually more severe, extensive, and likely to have an affected 1st degree family member

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6
Q

what are 5 external predisposing factors?

A 
obesity
alcohol consumptions
smoking
stress
viral/bacterial infections (HIV)
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7
Q

how does smoking affect psoriasis?

A

breath in foreign particles and trigger immune response

increases risk and severity

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8
Q

how does HIV affect psoriasis?

A

can predispose to disease onset or trigger relapse

shed antigen can lead to bacteria colonizing on skin and shedding proteins that can trigger an immune response

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9
Q

What kinds of infections are associated with psoriasis?

A

strep throat (streptococcal pharyngitis) - can cause a flare or trigger onset
thrush (candida albicans)
boils (staphylococcal skin infections) - cause flare
viral upper respiratory infections - cause flare

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10
Q

what is the koebner phenomenon?

A

skin lesions forming at the site of skin trauma (cuts, bruises, bumps, etc)
occurs 1-2wks after injury to dermis layer

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11
Q

what are 5 physiologic roles of skin?

A

1) barrier to elements and pathogens
2) thermo-regulator protecting the body from excessive heat loss/overheating
3) protects from UV radiation
4) wound repair and regeneration
5) synthesizes vitamin D

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12
Q

what are the 3 layers of skin?

A

epidermis
dermis
hypo-dermis

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13
Q

what is the function of the epidermis?

A

physical barrier

protects the skin from environment

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14
Q

what is the dermis?

A

layer of connective tissue containing blood vessels?

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15
Q

what is the function of the hypo-dermis?

A

provides structural integrity of the skin

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16
Q

what is the outermost layer of strata on the epidermis?

A

stratum corneum

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17
Q

what are 4 cell types found in the epidermis? which is most abundant

A

keratinocytes - most abundant
melanocytes
langerhans cells
merkel cells

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18
Q

what is the function of keratinocytes?

A

produce keratin

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19
Q

what is keratin?

A

key structural material making up the outer layer and integrity of skin, hair, and nails

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20
Q

what is the function of melanocytes?

A

pigment production

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21
Q

what is the function if langerhans cells?

A

detects, attacks, neutralizes, and eliminates foreign bodies

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22
Q

what is the function of merkel cells?

A

involved in the function of touch

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23
Q

what is the life cycle of keratinocytes?

A

start in basal layer (basal cells)
differentiate on transit from basal cell to stratum corneum
lose nuclei and organelles and become corneocytes

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24
Q

what is the stratum corneum comprised of?

A

dead keratinocytes (corneocytes) that have migrated from basal cells

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25
What is the first step of T-cell mediated autoimmune response?
unknown skin antigen stimulates immune response
26
What is the second step of T-cell mediated autoimmune response?
impaired differentiation and hyperproliferation of keratinocytes on the stratum corneum layer of epidermis
27
What is the third step of T-cell mediated autoimmune response?
Activation of T cells (TH1 and TH7) via antigen presenting cells releases inflammatory mediators (cytokines, chemokines) that drive the immune system induced response
28
What do activated T cells do to the epidermis?
induce keratinocyte proliferation | decrease differentiation which promotes a build up of skin plaques
29
what is the result of abnormal keratinocyte proliferation?
faster maturation than normal (3-5 days rather than >30days) scales and flakes (plaques) causes other cells to be formed incorrectly
30
what are rete ridges?
epithelial extensions | strikingly and evenly elongated; contain retained nuclei and important in psoriasis diagnosis
31
what are 4 key skin changes in psoriasis?
epidermal thickening bright erythema silvery psoriatic plaques elongated rete ridges
32
what causes epidermal thickening?
abnormal keratinocyte proliferation/differentiation
33
what causes bright erythema?
abnormal angiogenesis and increased capillary permeability
34
what causes silvery psoriatic plaques?
accumulation of parakeratotic keratinocytes and neutrophils in stratum corneum
35
what are some symptoms of psoriasis? which is most common? (7pts)
``` scaling (most common) itching skin redness tightness of skin bleeding burning sensation fatigue ```
36
what are the 8 different kinds of psoriasis? which is the most/least common?
``` guttate (drop) psoriasis flexural (inverse) psoriasis erythrodermic psoriasis - least common pustular psoriasis (von Zumbusch psoriasis) chronic plaque (psoriasis vulgaris) - most common palmo-plantar psoriasis scalp psoriasis nail psoriasis ```
37
what is guttate psoriasis?
small, tear drop, separate lesions over upper trunk and proximal extremities (legs, arms, torso, back) that is triggered by a bacterial infection (respiratory, throat)
38
what group is guttate psoriasis more common in?
young adults
39
how do you treat guttate psoriasis?
take care of skin, keep it moisturized | goes away on its own
40
what is flexural (inverse) psoriasis?
non infectious autoimmune disease where smooth, shiny inflamed patches show up in flexor surfaces (armpits, under breasts, skin folds in booty)
41
what does flexural psoriasis look like?
thin, minimally scaly, raw, tender, itchy, well defined patches
42
what is erythrodermic psoriasis?
red, inflammatory patches with sparse scaling and peeling of the skin caused by drug reactions, trauma, emotional stress or illness covers 75-90% of skin surface
43
what complications could arise form erythrodermic psoriasis?
infections malabsorption anemia
44
What is pustular psoriasis?
white pustules (raised bumps) surrounded by red skin causing intense itching and burning, mostly in the hands and feet
45
Who is pustular psoriasis most common in? Is it contagious?
adults, not contagious
46
what is psoriasis vulgaris?
raised, well defined flat-topped plaques with sharp borders (symmetrical) typically covered with silvery white scales that consistently shed
47
where is psoriasis vulgaris typically found in the body?
``` arms legs elbows knees genitalia lower back butt ```
48
what is palmo-plantar psoriasis?
hyperkeratotic or pustular psoriasis on the palms of hands or soles of feet
49
what is scalp psoriasis?
dandruff-like psoriasis found along the hairline, forehead, back of neck or around ears
50
what does mild scalp psoriasis look like? severe?
mild: dry, fine scales severe: thick, crusted plaques
51
what are 4 subtypes of nail psoriasis?
pitting subungual hyperkeratosis onycholysis oil drop sign
52
what is pitting nail psoriasis?
discrete, well circumscribed depressions on nail surface
53
what is subungual hyperkeratosis?
silvery white crusting under free edge of nail with some thickening of nail plate
54
what is onycholysis psoriasis?
nail separates from nail bed at free edge
55
what is oil drop sign?
pink/red colour change on nail surface
56
what are 3 measures of treatment success?
1) clearance (disease controlled with no symptoms) 2) control (response to therapy that satisfies pt and physician) 3) remission (disease is controlled for an extended time period either partially or completely w/o treatment other than routine skin care)
57
what are 3 measures of treatment failure?
1) exacerbation (worsening of disease) 2) flare (exacerbation while on therapy and the condition is different than the original disease) 3) rebound (exacerbation due to discontinued treatment)
58
what are 6 non-pharm treatments to reduce/eliminate psoriasis?
``` stress smoking alcohol trauma drugs infections ```
59
what are 3 topical options for treatment?
emollients/moisturizers keratolytics topical agents (corticosteroids and vit D3 analogues)
60
how do emollients/moisturizers help treat psoriasis?
hydration of stratum corneum | provide protective film to decrease dehydration
61
how do keratolytics help treat psoriasis?
soften plaque by promoting cellular desquamation
62
how do corticosteroids help treat psoriasis?
anti-inflammatory; reduces production of cytokines and decreases scaling/itching
63
how do vitamin D3 analogues help treat psoriasis?
inhibit proliferation of keratinocytes and decrease inflammation
64
what are three systemic treatment options for psoriasis?
methotrexate cyclosporine biologics
65
how does methotrexate help treat psoriasis?
decrease proliferation rate of keratinocytes
66
how does cyclosporine help treat psoriasis?
inhibit T cell activation
67
how does phototherapy help treat psoriasis?
UVB light decreases cells involved in psoriasis pathogenesis

Applied Pathophysiology (11 decks)

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