Psoriasis

Question 1

What is psoriasis?

Answer 1

chronic inflammatory disorder

Question 2

What causes psoriasis?

Answer 2

• largely idiopathic
• has a genetic component (~30%)
• autoimmunity (non-traditional)

Question 3

What is the pathology of psoriasis?

Answer 3

• T cell autoimmune response (they aren’t destroying anything though)
• there is skin trauma > T cells are activated > they release mediators > abnormal growth of keratinocytes and blood vessels
• influx of inflammatory cells > inflammatory damage (cycle)
• increase in epidermal cell turnover = cells are abnormal, they stack instead of shedding = scaly patches
• patterns of remission and exacerbations (brought on by stress, trauma, infection, drugs)

Question 4

What are manifestations

Answer 4

• psoriatic patches, usually on elbows, knees, sacral region, scalp
• some patients have problems with their nails (dystrophy and pitting)

Question 5

What is a complication of psoriasis?

Answer 5

psoriatic arthritis: arthritis of the smaller joints (fingers and toes)

Question 6

How is psoriasis treated?

Answer 6

• no cure
• topical vitamin D (supposedly modulates keratinocytes, regulates T cells)
• topical steroids
• topical retinoids (anti-inflammatory and modulates keratinocytes)

if severe:

• methotrexate, cyclosporine (has immuno-suppressant properties, but is fairly toxic and has lots of side effects)
• phototherapy (not tanning beds, uses UVB rays)
• biologic agents (ex. TNF)