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psoriasis Flashcards

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Dermatology Board Prep flashcards
1
Q

psoriasis age of onset

A

bimodal peaks 20-30 and 50-60 mostly

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2
Q

psoriasis

A

chronic multi-system disease with predominantly skin and joint manifestations

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3
Q

plaque

A

scaly, erythematous patches, papules and plaques that are sometimes pruritic

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4
Q

inverse/flexural

A

lesions are located in the skin folds

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5
Q

guttate

A

presents with drop lesions, 1-10 mm salmon pink papules with a fine scale

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6
Q

erythrodermic

A

generalized erythema covering nearly the entire body surface area with varying degrees of scaling

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7
Q

pustular

A

generalized or palmoplantar

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8
Q

Guttate psoriasis

A
  • acute onset of raindrop sized lesions on the trunk and extremities - often preceded by streptococcal pharyngitis - significant change for long term remission after single episode
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9
Q
A

guttate psoriasis

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10
Q

inverse/flexural psoriasis

A

erythematous plaques in the axilla, groin, and inframammary region and other skin folds

may lack sacle due to moistness of area

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11
Q
A

inverse flexural psoriasis

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12
Q
A

inverse flexural psoriasis

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13
Q

pustular psoriasis

A
  • psoriatic lesions with pustules
  • often triggered by corticosteroid withdrawal
  • when generalized can be life threatening, hospitalization may be required
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14
Q
A

pustular psoriasis

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15
Q
A

pustular psoriasis

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16
Q

palmoplantar psoriasis

A
  • may occur as either plaque or pustular type
  • often functionally disabling
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17
Q
A

palmoplantar psoriasis

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18
Q

psoriatic erythroderma

A

involved almost the entire skin surface; skin is bright red

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19
Q

symptoms of psoriatic erythroderma

A

assoc with fever, chills, malaise - flu like symptoms

high morbidity and mortality

hospitalization is sometimes required

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20
Q

erythroderma

A

erythema affecting > 90% BSA body surface area

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21
Q

causes of erythroderma

A

drugs, psoriasis, atopic dermatitis, cutaneous lymphoma, underlying malignancy, others

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22
Q

management of erythroderma

A

extensive topical therapy, monitor fluids/electrolytes, and treat underlying cause

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23
Q

plaque psoriasis

A

well demarcated plaques with overlying silvery scale and underlying erythema

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24
Q

chronic plaque psoriasis is typically ____ and ____

A

symmetric and bilateral

25
Q

auspitz sign

A

bleeding after removal of scale

26
Q

koebner phenomenon

A

lesions induced by trauma

trauma can trigger or fuel psoriasis by icreasing cytokines

27
Q

most common form of psoriasis

A

plaque psoriasis (80-90% patients affected)

28
Q

how many patients with plaque psoriasis have mild to moderate disease

A

80% - localized or scattered covering <5% of body surface area

29
Q

how many patients have moderate to severe disease

A

20% have moderate to severe affecting >5% of the body surface area or affecting crucial body areas such as hands, feet, face, or genitals

30
Q

psoriasis pathogenesis

A

cytokines from immune cells trigger a hyperproliferative state resulting in thick skin and excess sale

  • systemic treatments target these cytokines and immune cells
31
Q

is there a genetic component?

A

yes - 33% with fam hx

32
Q

patients with psoriasis may be at increaed risk for

A

metabolic syndrome, obesity, depression, smoking, alcohol use

33
Q

psoriasis and HIV

A

more severe

34
Q

characteristic locations for psoriasis

A

scalp

ears

elbows

knees (extensor surfaces)

umbilicus

gluteal cleft

nails

sites of recent trauma

35
Q
A

erythematous plaque around the umbilicus

36
Q

what elements in the history are important to ask when considering the diagnosis of psoriasis?

A
  • fam hx
  • medications
  • recent illness/past medical history
  • social history
37
Q

steroid withdrawal

A

can cause psoriasis

38
Q
A

erythematous and edematous foot, with dactylitis (sausage digit) of the 2nd toe

destruction of the DIP joints

also see onychodystrophy - nail pitting and onycholysis

39
Q

subtypes of nail psoriasis

A

can occur in all subtypes

40
Q

nail psoriasis and psoriatic arthritis

A

indicates higher risk for arthritis

41
Q

fingernail onychodystrophy are involved in how many patients

toenails

A

50%

35%

42
Q

pitting

A

punctuate depressions of the nail plate surface

43
Q

onycholysis

A

separation of the nail plate from the nail bed

44
Q

subungual hyperkeratosis

A

abnormal keratinization of the distal nail bed

also higher risk of joint disease

45
Q

psoriatic arthritis PsA

A

seronegative spondyloarthropathies

mild to severe usually with relapsing/remitting oligoarthritis - distal inerphalangeal joints most common

46
Q
A

subungual hyperkeratosis - abnormal keritinizatoin of the distal nail bed

47
Q

onset of psoriatic arthritis in patients with psoriasis

A

30-50 age

more likely with severe skin disease

10-15%

48
Q

psoriatic arthritis

A

swelling of the PIP joints of the 2-4th digits, DIP involvement of the 2nd digit

49
Q

treatment of psoriatic arthritis

A

mandatory to prevent joint destruction

like the picture with desquamation of skin and joint swellig arthritis mutilins

50
Q

treatment for localized psoriasis <5% BSA and first line agents

A

topical treatment

high potency topical steroid +/- calcipotriene (vit d analog)

51
Q

topical medications for psoriasis are more effective when used with

A

occlusion - allows for better penetration of medicine

ex. saran wrap, wet wrap, gloves, socks

52
Q

why do we do systemic treatment for psoriasis

A

used in addition to topical treatment for moderate - severe disease or for limited disease with high impact on quality of life (ex palmoplantar or genital)

53
Q

Do we prescribe oral steroids for psoriasis?

A

oral prednisone should never be used as they can severely flare psoriasis upon discontinuation!!!

54
Q

what is systemic treatment based on

A

patient preference,

side effect profile,

co-morbidities

55
Q

3 types of systemic treatment

A

photo therapy

oral medications

biologic agents

56
Q

phototherapy

A

narrow - UVB light or psoralen plus UVA liight PUVA

57
Q

systemic treatment for psoriasis oral medications

A

methotrexate, acitretin, cyclosporine

58
Q

biologic agents used for psoriasis systemic treatment

A

TNF alpha inhibitors (infliximab, etanercept, adalimumab)

IL 12/23 blocker (ustekinumab)

Derm (8 decks)

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