Psoriasis Flashcards
Psoriasis lesions are described as
well-demarcated, erythematous plaques WITH SILVER SCALE
What is the peak age of onset for Psoriasis ?
What gender does it favor?
30-39 and 50-69
It has no gender prediliction
What are the risk factors of psoriasis ?
- 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
Chronic Plaque Psoriasis* signs and symptoms?
- most common
- *symmetrically distributed red raisedcutaneous plaques on extensor elbows, knuckles, knees, and gluteal cleft
What is Koebner Phenomenon?
development of psoriasis plaques in sites of skin trauma
Guttate Psoriasis* Signs and symptoms ?
-abrupt appearance of multiple small (>1cm) psoriatic papules and plaques on Trunk and proximal extremities
Guttate Psoriasis* usually presents …?
- Usually presents after Streptococcal pharyngitis***
- Or presents in child or young adult with no prior history of psoriasis
Pustular Psoriasis* Signs and Symptoms ?
-Life threatening complications
→ Can be associated with malaise, fever diarrhea, leukocytosis and hypocalcemia
-Widespread spread erythema, scaling and sheets of superficial pustules*
What are reported causes of Pustular Psoriasis*?
- pregnancy
- infection
- withdrawal
- oral glucocorticoids
Erythrodermic Psoriasis* Signs and Symptoms?
-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
-
Inverse Psoriasis signs and symptoms
- 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
Nail Psoriasis Signs and Symptoms?
Common in patients with ….?
-Nail pitting
Psoriatic arthritis
What are the diagnostic studies that need to be preformed to determine Psoriasis ?
-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
Treatment and management of Mild-Moderate* Psoriasis Disease
- Topical corticoid steroids
- Emollients
- Vitamin D analogs
- Tacrolimus → given to post transplant patients
- Tar-T/Gel
Treatment and Management of Moderate-Severe* Psoriasis Disease
-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
Hidradenitis Suppurativa is described as what kind of condition?
- Chronic follicular occlusive skin condition (pu
- also known as acne inversa
Hidradenitis Suppurativa primarily involves what areas ?
Intertriginous areas:
- Axilla
- Groin
- Perianal
- Inframammary
Hidradenitis Suppurativa Epidemiology?
-Puberty to 40 years of age
-More common in women
→ more common in African American women
Hidradenitis Suppurativa pathogenesis ?
Follicular occlusion→ follicular rupture→ immune response → sinus tracts in the skin (tunneling) =pus, tunneling, and scarring
Hidradenitis Suppurativa risk factors?
- Genetics
- Pressure/friction on skin
- Obesity
- Tobacco use
- Hormones
- Staph/Strep
- Lithium, oral contraception (don’t cause but worsen symptoms)
Hidradenitis Suppurativa: Clinical Manifesations?
- primary lesion is a solitary, deep- seated inflamed nodule (diagnosis often missed at this stage - diff dx furunculosis or abscess
- skin tracts
- scaring
Explain the tx and management for Hidradenitis Suppurativa ?
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
Describe Alopecia?
Chronic, immune mediated disorder that targets anlagen hair follicles causing non-scarring hair loss
What are the risk factors for Alopecia?
- Genetic
- Severe stress
- Vit D deficiency
- Thyroid Disease*********
