Psoriasis

Question 1

Chronic, relapsing, immune related, inflammatory (presence of neutrophils) disease

Answer 1

Psoriasis

Question 2

Onset of Psoriasis

Answer 2

usually at 15-30

Question 3

Layers of the skin affected

Answer 3

Inflmmatory cells
thinner stratum granulosum
Hypercellular stratum spinosum

Question 4

Psoriatic skin

Answer 4

increased production of cells, resulting in decreased regeneration time and thickening of epidermis

Question 5

Classic presentation of psoriasis

Answer 5

circumscribed, erythematous plaques covered with thick silvery white scales which may be associated with itching or burning

Question 6

Normal skin

Answer 6

Proliferative Cell population: 27,000 cells/cumm

Cell cycle Duration: 311 hours (13 days)

Epidermal Transit time: 28 days

Question 7

Psoriatic skin

Answer 7

Proliferative cell proliferation: 52,000 cells/cumm

cell cycle duration: 26 hours (1.5 days)

Epidermal transit time: 3-4 days

Question 8

Etiology of Psoriasis

Answer 8

Manifestation of Genetic and environmental factors

Chromosome 6

Question 9

genetic factors of Psoriasis

Answer 9

Multiple genetic oci
HLA: Cw6, B13, B27

Non-HLA: PSORS1-10 cytokine receptor genes

Question 10

Triggers of Psoriasis

Answer 10

STRESS
TRAUMA
INFECTION
DRUGS (Anti-malarials, lithum, beta-blockers)

cold weather
Sunlight
Obesity
Smoking

Question 11

Type 1 Psoriasis:

Answer 11

(+) family history, and is usually associated with HLA-Cw6

Question 12

Pathophysiology of Psoriasis

Answer 12

Autoimmune disease

T-cell mediated (predoinantly Th1 and Th17)

Question 13

Dendritic Cell and T cell activation and the release of cytokines leads to:

Answer 13

Keratinocyte Proliferation with altered differentiation

Plaque formation

Further release of chemokines and cytokines

Leukocyte recruitment

Angiogenesis

Question 14

Autoimmune T-cell mediated reaction with

Answer 14

Over expression of pro inflammatory type 1 cytokines

Inflammation

Vessel dilation and new vessel formation

Lymphocyte and neutrophilic infiltration in the dermis and epidermis

Accelerated epidermopoiesis

Question 15

RED

Answer 15

Angiogenesis and vasodilation

Question 16

THICK

Answer 16

keratinocyte proliferation

Question 17

SCALY

Answer 17

Poor keratinocyte differentiation

Question 18

Histological Findings

Answer 18

Hyperkeratosis
Parakeratosis
Dilated capillaries/blood vessels
Neutrophils
Stratum spinosum

Question 19

Due to dermal angiogenesis

Bleeding upon removal of scales atop a thinned suprapapillary plate

due to proximity of surface of dilated tortuous blood vessels found on the tips of dermal papillae

Pain on grasping with thumb

Answer 19

AUSPITZ SIGN

Question 20

When scratched, skin produces new lesion

Not exclusive to psoriasis; also present in lichenus planus, verruca vulgaris, vitiligo

Traumatic induction of psoriasis on non lesional skin

Isomorphic response of skin on lines of trauma

Answer 20

Koebner Phenomenon

Question 21

Most common morphology of Psoriasis

Extensor surfaces

Answer 21

Plaque

-psoriasis vulgaris

Question 22

Smaller drop like plaques with finer scales

Commonly associated with prior streptococcal infection in children and adolescents

Answer 22

Guttate

Question 23

There are no bacteria and therefore not contagious. Contains neutrophilic infiltrates

Answer 23

Sterile Pustules

-will not clear with antibiotics

Question 24

Localized to the digits (acral) portion

may destroyed nailbed

Answer 24

Acrodermatitis continua

Question 25

Generalized acute pustular psoriasis Abrupt onset associated with fever, chils and malaise Conglomeration of pustuliness

Answer 25

von Zumbusch

Question 26

Generalized pustular psoriasis of pregnancy

Answer 26

Impetigo herpetiformis

Question 27

End result of a lot of diseases Scaling is not evident if acute generalized erythema with or without scaling

Answer 27

Erythroderma or Exfoliative Dermatitis

Question 28

Can present with oatmeal-like scales with marked erythema Initial site involvd in most patients May extend to anterior or posterior hairline, retroauricular Scaling not as prominent as in children

Answer 28

Scalp Psoriasis

Question 29

Less scaly because the areas are moist Usual Presentation of infantile psoriasis Along body folds

Answer 29

Flexures, Intertriginous, or inverse

Question 30

Ocassionally occurs alone without other skin sites involved; mistaken as onychomycosis May be associated with P. arthritis of the DIP joint in the same digit Onycholysis and pitting rarely occur together

Answer 30

Nail Psoriasis

Question 31

Separation of the nail plate from the nail bed

Answer 31

Onycholysis

Question 32

Dilated blood vessels and erythema of nail bed; signifies beginning parakeratosis

Answer 32

oil spots

Question 33

Dilated blood vessels and erythema of nail bed

Answer 33

Piting

Question 34

Accumulation of keratin under the nail; opaque appearance

Answer 34

Subungual hyperkeratosis

Question 35

Sausage digits

Answer 35

Dactylitis

Question 36

Inflammation commonly on achilles tendon bony attachment

Answer 36

Enthesitis