Psoriasis Flashcards
psoriasis is a chronic multisystem disease with predominantly _____ and _____ manifestations
- skin and joint
age of onset of psoriasis
- 20-30s - 50-60
____% of patients with a family history have psoriasis
- 33% - strong genetic component
does psoriasis just go away after treatment or does it wax and wane over time?
- waxes and wanes
what form of psoriasis are scaly, erythematous patches, papules, and plaques that are sometimes pruritic
- plaque
what form of psoriasis are lesions located in the skin folds of the axilla, groin, inframammary region do they have scale? why?
- inverse/flexural - no; due to moistness of area
what form of psoriasis presents with raindrop lesions, 1-10 mm salmon-pink papules with a fine scale
- gluttate
what form of psoriasis are generalized erythema covering nearly the entire body surface area with varying degrees of scaling
- erythrodermic
what form of psoriasis are generalized or palmoplantar
- pustular
what form of psoriasis is the acute onset of raindrop sized lesions on the trunk and extremities
- gluttate psoriasis
gluttate psoriasis often preceded by
- streptococcal pharyngitis
gluttate psoriasis chance for long term remission after single episode
- significant chance
what type of psoriasis is characterized by corticosteroid withdrawal
- pustular
when generalized, pustular psoriasis can be _______
- life threatening
what type of psoriasis is often misdiagnosed as athlete’s foot
- palmoplantar psoriasis
what type of psoriasis involves almost the entire skin surface where the skin is bright red
- psoriatic erythroderma
by definition, erythema in erythroderma affects what percent body surface area
> 90%
what type of psoriasis often requires hospital admission to manage complications such as high output heart failure and sepsis
- psoriatic erythroderma
how to distinguish the cause of psoriatic erythroderma
- biopsy
treatment of psoriatic erythroderma
- topical therapy - monitor fluids/electrolytes - treat underlying cause
what is auspitz sign
- bleeding after removal of scale
what is koebner phenomenon
- lesions induced by trauma
what is the most common form of psoriasis
- plaque psoriasis
what is the pathogenesis of psoriasis
- cytokines trigger hyper proliferative state resulting in thick skin and excess scale
how can trauma (ie Koebner phenomenon) trigger or fuel psoriasis
- increases cytokines
psoriasis can be more severe in patients with _____
- HIV
key areas for psoriasis
- scalp - ears - extensor surfaces - umbilicus - gluteal cleft - nails - sites of recent trauma
what does psoriatic onychodystrophy indicate
- nail psoriasis - higer risk of psoriatic arthritis
what you see in psoriatic onychodystrophy
- pitting - depressions of nail plate surface - onycholyisis - separation of the nail plate from the nail bed - subungual hyperkeratosis - abnormal keratinization of the distal nail bed
most common joints in psoriatic arthritis
- distal interphalangeal joints
what treatment of psoriasis is indicated if it is localized
first line agents
- topical treatment - high potency topical steroid +/- calcipotriene
topical medications for psoriasis are more effective when used with _____ with allows for better penetration
- occlusion
what treatment is used in addition to topical treatment for moderate-severe disease or for limited disease with high impact on quality of life
- systemic treatment
should oral steroids be used in psoriasis why
- no - can severely flare psoriasis upon discontinuation
3 choices for systemic treatment
- phototherapy - oral medications - biologic agents
phototherapy for systemic treatment of psoriasis
- narrow band UVB light - psoralen plus UVA light
oral medications systemic treatment of psoriasis
- methotrexate - acitretin - cyclosporine
biologic agents for systemic treatment of psoriasis
- TNF-alpha inhibitors - IL 12/23 blocker
up to 90% of patients with psoriatic arthritis may have ____ changes
- nail changes
