Psoriasis Flashcards
Psoriasis epidemiology?
2% worldwide, bimodal peak @ 20-30 yrs and 50-60 yrs 75% onset before 40 -children plaque psoriasis mc then guttate -family hx in 35-90%
Rate of psoriatic arthritis
5-30%
Most common psoriatic susceptibility gene?
PSORS1 chormosome 6p contains HLA-Cw6 allele
what is the HLA affected in PSORS1?
HLA-Cw6
What cytokine is decreased in psoriasis?
IL-10
What antimicrobial proteins are secreted more in psoriasis?
hBD1-2, cathelicoidin LL37 and SLP1
What cytokine is responsible for the IL-23 response?
IL-6
What cytokine correlates w/ dz severity?
IL-22
Psoriasis triggers?
truama (Keobner phenomenon) [sunburn, morbillifrom drug eruptions etc], infection (strep pharyngitis –> guttate), HIV, hypocalcemia (genarlaized pustular psoriasis), pregnancy, stress, drugs (lithium, beta blockers, antimalrias, TNF alpha inhibitors and CS tapers (pustular))
Triggers of guttate psoriasis?
group A strep infection or URI
Which psoriasis is pregnancy related?
Impetigo herptetiformis –> begins in flexures then generalized w/ toxicity. Early delivery recommended
4 patterns of pustular psoriasis?
Von zumbusch, annular, exanthematic type, localized pattern
Describe the von zumbusch pattern of pusturlar psoriasis
Rapid and generalized, painful skin, fever, luekocytosis, hypoalbuminemia, and malaise; a/w hypocalcermia (risk factor)
What psoriasis disorder can be associated w/ bone lesions?
Palmoplantar pustulosis –> SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis). You get sterile inflammatory bone lesions.
What is acrodermatitis continua of Hallopeuau?
On fingers, lakes of puss, nail shedding and damage
What is the #1 cause of pityriasis aminatacea?
Psoriasis
What nails does psorasis affect most commonly
Fingernails>toenails
What are the nail findings in psoriasis?
- Proximal matrix involvement
- Distal matrix involvement
- Nail bed involvement
The proximal matrix primarily affects pits (small depressions in the nail surface).
The distal matrix is responsible for producing the dorsal surface of the nail, which explains why distal matrix involvement leads to leukonychia and other changes.
What percentage of pt’s can have nail findings w/o rash in psoraisis?
10-15%
What is the RF status of psoriatic arthritis?
RF negative
What are the 5 types of Psoriatic arthritis/patterns
- Oligoarthritis (most common)
- asymmetric DIP involvement
- Rheumatoid Arthirtis (can be RF+)
- Ankylosing Spondylitis
- Arthritis Mutilans
What comorbitities are decreased in psoriasis?
allergic disease and risk of superinfection is decreased
What are first-line topical therapies for children?
Vitamin D3 analogs (CS first line in adults)
What light therapy is more effective for guttate psoriasis?
broad band-UVB is more effective than narrow-band (NB) UVB