Psoriasis Flashcards
What is psoriasis characterized by?
I DAVES - Inflammation, Disease waxes and wanes, altered maturation of skin, vascular changes, epidermal hyperproliferation secondary to activation of immune system, Scaly, erythematous patches, papules and plaques that are itchy
What does psoriatic skin look like compared to regular skin on an epidemal cross sectional slide in a microscope
Psoriatic skin has proliferation of epitheliasl cells much deeper
What cell mediates the immue response for psoriasis
T-cells
What is the age of onset of psoriasis?
15-25 yrs old
What is psoriatic arthritis?
skin symptoms of psoriasis that precedes development of the joint symptoms of arthritis
What stimulates the keratinocyte huyperproliferation?
Interleukins (1,6,8,12,17,23), TNF
Where are the IL and TNF released from that cause the hyperproflieration of keratinocytes?
T-cells and keratinocytes
What kind of vascular changes happens during PsO
vasodilation, hyperpermeability, angiogenesis
with joint involvment, what invades the synovium and causes bone resorption and destruction?
The ILs(1,6,8,2,17,23) and TNF
Macrophages and T cells release ____ and it acts of 3 sites. What are the three sites and what is the outcome.
It releases TNF and IL 1, 6, 8, 12, 17, 23. They act on Endothelial cells, Keratinocytes and T-cells: which cause inc adhesion mol, VEGF; hyperproliferation and release of proinflammatory cytokines; induction of IL-1, il-6 and IL-8
What are some causes of PsO?
Genetic, stress, injury to skin, infections, medications, weather
What are the 9 different types of PsO
Plaque/Guttate/Pustular/inverse/erythrodermic/nail/palmar/plantar/scalp/psoriatic arthritis
What joints are usually affected in arthritic PsO?
DIP
What is affected more, finger or toe nails?
finger nails
What are some typical nail changes?
onycholysis (separation from the nail bed), pitting, oil-drops, hyperkeratosis (thickening), discoloration
What are some comorbidities with PsO?
arthritis, CD and UC, CV, metabolic syndrome
What are some assessment tools?
PASI, PGA, BSA, pt assessments of disease and QOL
What do you tx a pt with if they have Psoriasis with psoriatic arthritis?
Anti-TNF’s +/- MTX or just try MTX alone
What are some Anti-TNF’s
etanercept (Embrel), adailumumab (Humira), Infliximab (Remicade), Golimumab (Simponi but not for PsO)
If you have limited Psoriasis with no psoriatic arthritis what do you use first?
Tocials/targeted phototherapy (like Corticosteroid cream and Vit D)
If you dont have psoriatic arthritis but you have extensive disease, or there is no effect from topicals then what do you use?
systemic tx or biologics (anti-TNF or non anti-TNF)
What topicals do you use in mild (limited) disease for PsO?
Topical Corticosteroids, retinoids (vit A), vit D, anthralin, Tar, keratolytics, lubricants
Why are emollients or moisturizers used?
To moisturize, lubricate and soothes dry and flaky skin; retains moisture in the stratum corneum
How often are emollients and mositurizers uesed? contraindications?
1 - 3 times a day; no known ones
What is a common Keratolytic? What is the dose and the frequency? What does it do? What are some adverse effects?
Salicyclic acid (2-6%), apply 1-3 times a day. helps remove scales and reduce hyperkeratosis; can cause skin irritation and systemic absorption
What is a contraindication with salicylic acid topical for PsO?
UVB phototheray
How does Coal Tar work?
suppresses DNA, dec epidermal cell proliferation and scale development
What concentration of coal tar is the most effective?
5%
What are the 4 problems with coal tar?
SSSS: Smell, Sting, Stain, Sensitize
What are some adverse effects of coal tar?
Skin irriation, contact dermatitis, folliculitis, photosensitivity, staining
Can coal tar be used for scalp PsO? How?
yes, shampoo
What is Goekerman regimen?
Coal Tar + UV
What are the 4 properties of Corticosteroids?
Anti-inflammatory, dec in vascular permeablility, antiproliferative, immunosuppressive
What are the different levels of potency?
1-7 (1 is most potent, 7 is least potent) 1 is up to 92%, 7 is as low as 41%
what potency is hydrocortisone?
lowers potency (5,6,7)
What potency is clobetasol propionate?
highest potency (1)
what potency is Fluocinonide?
2 or 3,4
What potency is mometasone furoate?
2
What potency is diflorasone diacetate?
1
What usage restriction is on class 1 topical corticosteroids?
no more than twice daily for up to 2-4 weeks
What are some adverse effects of corticosteroids (topical)
burning, itching, skin atrophy, erythema, folliculities, excessive hair growth, acne, rebound PsO if abrubtly stopped
What are some rare systemic side effects?
hypothalamic-pituitary-adrenal axis suppression
What is calcipotriene? Brand name?
Vit D3 analogue; Dovonex
What is the MoA of Dovonex?
inhibits proliferation and inc differentiation of keratinocytes and decreases T-cell infiltration
What is Dovonex used to tx?
plaque PsO
What is the dose and dosage forms of calcipotriene?
0.005% cream, ointment and scalop solution applied QD or BID; often used in combination with corticosteroids
How long does it take the theraputic response to occur for Calcipotriene (Dovonex)
2 wk
Maximal effect of calcipotriene (dovonex) can take up to how long?
6-8 wk