Psoriasis

Question 1

Psoriasis?

Answer 1

Chronic, inflammatory disorder

Question 2

What is the age of onset for psoriasis?

Answer 2

It peaks from 16-22 years old and 57-60 years old

Question 3

Etiology of psoriasis?

Answer 3

• largely idiopathic
• autoimmunity (has a strong genetic component ~30% HLA and MHC gene mutations)
• Genetic predisposition

Question 4

Explain the Patho of psoriasis and compare it to what would normally occur if psoriasis was not present.

Answer 4

Lesions on the surface of the body (identified on the outer, superficial layer of the skin). No infection present. Cell cycle in the the epidermis -> rapid cell division and replacement of dead cells with new cells: Basal layer: cells grow and are pushed up to the surface as dead cells are continuously sloughed off. This epidermal cell cycle takes about 30 days normally, but in psoriasis this cycle takes about 3-4 days (very rapid). Division and differentiation in this short amount of time results in incomplete division and differentiation -> cells do not slough off the top, but remain one the surface and stack up to form scaly patches on the skin.

Question 5

Cell cycle of the epidermis?

Answer 5

Rapid cell division and replacement of dead cells with new cells.

Question 6

Explain the patho behind autoimmunity in psoriasis.

Answer 6

T cell autoimmune response -> abnormal T cell activity brings about self-targeting. Trauma to skin can trigger the response -> T cell activity -> release mediators that specifically target the keratinocytes and the cells in the blood vessels -> triggers growth in these cells -> more keratinocytes =more keratin

Question 7

Hyperkeratosis?

Answer 7

linked to abnormal growth of keratinocytes and increase epidermal cell turnover resulting in scale patches

Question 8

What can exacerbations in psoriasis be triggered by?

Answer 8

emotional stress, physical trauma, infection, drugs

Question 9

Manifestations of psoriasis?

Answer 9

• psoriatic patches

- nail dystrophy, erosion, and pitting d/t abnormal amount of keratin

Question 10

Where are some common areas for psoriatic patches to occur?

Answer 10

knees, elbows, scalp

Question 11

What is a complication of psoriasis?

Answer 11

• psoriatic arthritis in distal joints

Question 12

Treatment options for psoriasis?

Answer 12

Manage disease progression;
Apply topical cream/ointment to affect areas: 
- salicylic acid
- coal tar
- Anthralin 
- Retinoids 
- Vitamin D 
- Steroids 

Systemic:

• Methotrexate
• Cyclosporine
• Biologic agents: TNF
• Phototherapy

Question 13

Can psoriasis be cured/

Answer 13

No

Question 14

Methotrexate?

Answer 14

Anti-folate (immunomodulatory drug) that inhibits the action of folic acid, involved in DNA replication and cell division

Question 15

What is phototherapy?

Answer 15

Applying photons (units of light) directly to specific areas of the integument using Ultraviolet B rays, which decreased the rate of cell proliferation.