Psoriasis

Question 1

Chronic Plaque Psoriasis is worse in what season?

Answer 1

Winter

Question 2

CPP pts usually have what regarding Hx?

Answer 2

Family Hx

Question 3

CPP lesions developed due to trauma are called?

Answer 3

Koebnerize (koebner phenomenon)

Question 4

What are pts at risk for w/ CPP?

Answer 4

Psoriatic arthritis

Question 5

CPP morphology begins as?

Answer 5

Red, discrete flat-topped scaling papules that coalesce to form oval plaques
-Thick, adheren, silvery white scale

Question 6

Removal of CPP scales cause?

Answer 6

Auspitz sign (pinpoint bleeding)

Question 7

CPP distribution?

Answer 7

Scalp, extensor surfaces, presacral, groin
Symetrical and bilateral
Pitting - oil spots on nails

Question 8

CPP etiology

Answer 8

Hyperproliferation of epidermis (7x faster)

cells pile up and cannot release

Question 9

CPP worse w/?

Answer 9

Stress, poor healt/diet
Strep - do a throat culture
Sys CCS
BB
Lithium

Question 10

Pt w/ CPP req what lab test?

Answer 10

Strep Throat culture

Question 11

CPP mangement >5% BSA -

Answer 11

Systemic therapy

• Methotrexate
• Soriatane
• Cyclosporine
• UVA

Question 12

CPP mangement <5% BSA - Primary CCS

Answer 12

Topicals Class I-II > taper to triamicinolone
-Clobetasol
-Fluocinonide
Keralytic (Salicyclic acid 6%) prior to CCS on moist skin (removes scale)

Question 13

CPP mangement <5% BSA - other

Answer 13

Top Vit-D (calcitriol) -combo CCS (toxic)
Ex- Calcipotriene Hydrate and Betamethasone Dipropionate

Tazarotene - topical retinoid
UVB light therapy (burns superficial layer)

Question 14

CPP mangement scalp

Answer 14

Keratolytic gel (Use 1st if sig scaling)
Tar shampoo
Foam preps (triamcinolone/flucinolone)

Question 15

CPP mangement scalp w/ Diffuse/Thick scale?

Answer 15

Calcipotriene & Betamethasone dipropionate lotion

Question 16

Pt w/ rash that is refrac highly consider?

Answer 16

10d (PO) ABX

Question 17

CPP in Intertriginous areas look

Answer 17

Scaling dispersed

Appears smooth, red, macerated plaques

Question 18

Guttate psoriasis usually found in?

Answer 18

Young adults (1st indication of psoriasis affinity)
Strep throat/viral UTI 1-2wks prior

Question 19

Guttate psoriasis appears?

Answer 19

White scaling red papules on trunk/ prox ext (knee/bo)
NOT palm/soles.
Pinpoint-1cm - diffuse, teardrop, scattered
+- itch or nail pitting

Question 20

Guttate psoriasis progresses to?

Answer 20

Spon resolve or classic psoriasis

Question 21

CPP pt that has a Guttate psoriasis flare is due to?

Answer 21

Post strep/viral URI

Question 22

Guttate psoriasis management

Answer 22

Strep Cx
1st line - UVB
Empiric TXT w/ PCN or Erythromycin 10d
Keep moist w/ emollients

Question 23

Pustular Psoriasis incidence is?

Answer 23

Serious sometimes fatal

Pt is toxic, febrile,^WBC, and in pain

Question 24

Pustular Psoriasis pop?

Answer 24

Usually, middle aged adults, smokers

Question 25

Pustular Psoriasis morphology

Answer 25

Many tiny, sterile pustules evolving from erythematouse base that coalesce into a lake of pus.
Pustules wont rupture - dry, harden, fall off

Question 26

Pustular Psoriasis distribution

Answer 26

Deep seated pustules on palm/sole (primary)
Spread to involve the rest of the hand/foot
Can appear anywhere however

Question 27

Pustular Psoriasis is ass/w what other lesions or S/S

Answer 27

Erythema, 
fissures, 
lichenification, 
exudative changes, 
crust

Question 28

Can Pustular Psoriasis koebnerize?

Answer 28

Yes - esp dominant hand

Question 29

Pustular Psoriasis etiology

Answer 29

Manifestation of psoriasis
Koebnerization
Poor health, stress, Infection

Question 30

Pustular Psoriasis management

Answer 30

Refer derm
NO (PO) CCS
Top C-I - clobetasol - wean if improves (+plastic occl)
2ndy Inf - ABX (diclox, cephalexin)
Emollients
PUVA (top/po then UVA light)
Acitretin - retinoid
Cyclosporine - immunosupressant
Methotrexate