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Clin Med I Exam I > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

Psoriasis lesions are described as

A

well-demarcated, erythematous plaques WITH SILVER SCALE

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2
Q

What is the peak age of onset for Psoriasis ?

What gender does it favor?

A

30-39 and 50-69

It has no gender prediliction

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3
Q

What are the risk factors of psoriasis ?

A
  • Genetic
  • Smoking
  • Obesity (due to ↑ level of pro-inflammatory cytokines)
  • Drugs(β blockers, lithium antimalarial drugs, NSAIDS, and tetracycline)
  • Infection
  • Alcohol
  • Vit D Deficiency
  • Stress
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4
Q

Chronic Plaque Psoriasis* signs and symptoms?

A
  • most common

- *symmetrically distributed red raisedcutaneous plaques on extensor elbows, knuckles, knees, and gluteal cleft

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5
Q

What is Koebner Phenomenon?

A

development of psoriasis plaques in sites of skin trauma

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6
Q

Guttate Psoriasis* Signs and symptoms ?

A

-abrupt appearance of multiple small (>1cm) psoriatic papules and plaques on Trunk and proximal extremities

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7
Q

Guttate Psoriasis* usually presents …?

A
  • Usually presents after Streptococcal pharyngitis***

- Or presents in child or young adult with no prior history of psoriasis

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8
Q

Pustular Psoriasis* Signs and Symptoms ?

A

-Life threatening complications
→ Can be associated with malaise, fever diarrhea, leukocytosis and hypocalcemia
-Widespread spread erythema, scaling and sheets of superficial pustules*

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9
Q

What are reported causes of Pustular Psoriasis*?

A
  • pregnancy
  • infection
  • withdrawal
  • oral glucocorticoids
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10
Q

Erythrodermic Psoriasis* Signs and Symptoms?

A

-Uncommon (can be acute or chronic)
-Generalized Erythema from head to toe
-↑ risk for infection and electrolyte abnormalities due to loss of barrier protection
-Inpatient management usually necessary
→ not life threatening
-

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11
Q

Inverse Psoriasis signs and symptoms

A
  • Involvement of the intertriginous areas: inguinal, perineal, genital, intergluteal, axillary, or inframmary regions
  • can be easily misdiagnosed as a fungal or bacterial infection
  • Frequently no visible scaling
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12
Q

Nail Psoriasis Signs and Symptoms?

Common in patients with ….?

A

-Nail pitting

Psoriatic arthritis

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13
Q

What are the diagnostic studies that need to be preformed to determine Psoriasis ?

A

-hx and physical
→ fm hx
→ look for clinical manifestations
→ **Auspitz sign (visualization of pinpoint bleeding after removal of scale overlying a psoriatic plaque)
-Skin biopsy (usually to rule out other diagnosis

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14
Q

Treatment and management of Mild-Moderate* Psoriasis Disease

A
  • Topical corticoid steroids
  • Emollients
  • Vitamin D analogs
  • Tacrolimus → given to post transplant patients
  • Tar-T/Gel
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15
Q

Treatment and Management of Moderate-Severe* Psoriasis Disease

A

-Phototherapy (good for widespread disease)
→ UV-B- Can be used alone or in combination with topical therapy
→ Narrow band UVB-More effective, less doses
→ Photochemotherapy (PUVA)-treatment with either oral or bath psoralen followed by UVA radiation
-Excimer laser-high energy user that treats only skin involved
→ Considerably higher doses of UVB (treats faster)
-Methotrexate( patients should be prescribed folic acid while on this med)
-Cyclosporine (T-Cell suppressor)
-Apremilast (Phosphodiesterase 4 inhibitor)
-Biologics
→ TNF α inhibitors
→ IL-17 Inhibitors
→ IL-23 and related cytokine inhibitors

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16
Q

Hidradenitis Suppurativa is described as what kind of condition?

A
  • Chronic follicular occlusive skin condition (pu

- also known as acne inversa

17
Q

Hidradenitis Suppurativa primarily involves what areas ?

A

Intertriginous areas:

  • Axilla
  • Groin
  • Perianal
  • Inframammary
18
Q

Hidradenitis Suppurativa Epidemiology?

A

-Puberty to 40 years of age
-More common in women
→ more common in African American women

19
Q

Hidradenitis Suppurativa pathogenesis ?

A

Follicular occlusion→ follicular rupture→ immune response → sinus tracts in the skin (tunneling) =pus, tunneling, and scarring

20
Q

Hidradenitis Suppurativa risk factors?

A
  • Genetics
  • Pressure/friction on skin
  • Obesity
  • Tobacco use
  • Hormones
  • Staph/Strep
  • Lithium, oral contraception (don’t cause but worsen symptoms)
21
Q

Hidradenitis Suppurativa: Clinical Manifesations?

A
  • primary lesion is a solitary, deep- seated inflamed nodule (diagnosis often missed at this stage - diff dx furunculosis or abscess
  • skin tracts
  • scaring
22
Q

Explain the tx and management for Hidradenitis Suppurativa ?

A

Hurley stage 1:

  • avoid skin trauma
  • smoking cessation
  • weight management
  • emollients

Hurley Stage II

  • Oral tetracyclines
  • Clindamycin
  • Oral Retinoids
  • Antiadrenergic therapies -spironlactone B.C.
  • Punch Biopsy to release the pressure and prevent it from developing into a sinus tract

Hurley Stage III

  • TNF-α inhibitors
  • Prednisone
  • Cyclosporine
  • Surgery
23
Q

Describe Alopecia?

A

Chronic, immune mediated disorder that targets anlagen hair follicles causing non-scarring hair loss

24
Q

What are the risk factors for Alopecia?

A
  • Genetic
  • Severe stress
  • Vit D deficiency
  • Thyroid Disease*********
25
Q

Alopecia Areata*

clinical manifestations

A
  • Smooth circular DISCRETE patches of complete hair loss *over 2-3 weeks
  • May be associated with. pruritus/ burning
  • Nail involvement in 10-20% of patients (onychorrhexis- longitudinal fissuring of nail plate)
26
Q

Alopecia Totalis*

clinical manifestations

A
  • Entire Scalp

- Nail involvement up to 60%

27
Q

Alopecia Universalis*

clinical manifestations

A
  • Entire Body

- Nail involvement up to 60%

28
Q

Alopecia Diagnosis:

A

Physical exam

  • Exclamation point hair at margins***
  • Thyroid Studies***
29
Q

Alopecia 1st line therapies for limited patchy hair loss and extensive hair loss

A

Alopecia First line therapies for limited patchy hair loss:
-Topical or Intralesional corticosteroids (SE: worry about skin atrophy)

Extensive hair loss:
-Topical immunotherapy

30
Q

Alopecia Second line therapies and Systemic therapies

A

2nd line:

  • Rogaine (minoxidil)
  • Anthralin
  • Phototherapy

Systemic Therapy:

  • Oral glucocrticoids
  • Sulfasalazine
  • Methotrexate
  • Cyclosporine
  • Biologics

Clin Med I Exam I (9 decks)

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