Section 3- Psoriasis, Pityriasiform

Question 1

HLA types most commonly associated with psoriasis

Answer 1

HLA B13 B37 B57

HLA -Cw6

Question 2

Acute streptococcal infection precipiates this type of psoriasis

Answer 2

Guttate

Question 3

2 major types of psoriasis

Answer 3

Eruptive, inflammatory type
Chronic stable (plaque)

Question 4

Salmon pink papules with or without scales, “drop”

Scales are lamellar, loose, easily removed

Positive Auspitz sign

Answer 4

Acute Guttate type

Question 5

Site of predilection of acute guttate psoriasis

Answer 5

Trunk

Question 6

Site of predilection of chronic stable psoriasis

Answer 6

Elbows
Knees
Sacral gluteal
Scalp
Palm/soles

Question 7

Uncommon site for psoriasis but associated with refractory type

Answer 7

Face

Question 8

Psoriasis that Results from warm and moist environment

Plaques usually macerated, bright red and fissured, sharply demarcated

In groin, skin folds

Answer 8

Inverse psoriasis

Question 9

Pathognomonic of psoriasis in nails

Answer 9

Oil spot (yellowish brown spot under nail plate)

Question 10

Psoriasis is associated with increased morbidity and mortality from what comorbidities?

Answer 10

Cardiovascular
-HTN, hyperlipidemia
metabolic syndrome

Question 11

Rare life threatening
Abrupt onset
Burning fiery red erythema topped by pinpoint sterile yellow pustules in clusters spreading rapidly over entire body (lakes of pus)

Answer 11

Generalized acute pustular psoriasis (Von Zumbusch)

Question 12

Acral pustule formation, subungual lakes of pus and destruction of nail plate

May lead to permanent loss of nails and scarring

Answer 12

Acrodermatitis continua of Hallopeau

Question 13

Psoriasis-Asymmetric peripheral joint involvement of upper extremities esp. distal interphalangeal joints

Dactylitis- sausage fingers

Answer 13

Psoriatic arthritis

Question 14

Psoriatic arthritis is associated with which class of MHC antigen?

Answer 14

MHC class I

Question 15

Most effective therapy to date for generalized plaque psoriasis

Answer 15

Re-PUVA
Retinoids + PUVA
- acitretin and isotretinoin

Question 16

What is the triple dose (Weinstein) regimen for methotrexate in the management of psoriasis?

Answer 16

5mg q12 x 3 doses

When px responds, reduce to 2.5mg periodically

Question 17

What lab tests to order before starting methotrexate

Answer 17

Liver enzymes
CBC
Serum creatinine

Question 18

Treatment for psoriasis in nails

Answer 18

Systemic MTX and cyclosporine

Question 19

Most effective in the treatment of acute guttate psoriasis

Answer 19

Narrowband (311nm) UVB irradiation

Question 20

Long term side effects of PUVA

Answer 20

PUVA keratoses

Squamous cell CA

Question 21

Dose of cyclosporine in psoriasis treatment

Answer 21

3-5mg/kg per day

Question 22

What to monitor for when giving cyclosporine

Answer 22

BP

serum creatinine- nephrotoxic

Question 23

Treatment for generalized pustular psoriasis (von zumbusch)

Answer 23

Treated as extensive burns

Isolation, fluid replacement, blood cultures 
Oral retinoids (acitretin 50mg/day)

Systemic glucocorticoids- rescue only

Question 24

Rare, chronic papulosquamous disorder often progressing to erythroderma (cephalocaudal)

Follicular hyperkeratotic papules, reddish orange

Sharply demarcated islands of unaffected skin

Answer 24

Pityriasis rubra pilaris

Question 25

Most effective treatment in pityriasis rubra pilaris

Answer 25

MTX or retinoids

Type 6- HAART

Question 26

Herald plaque lesion develops usually on trunk then generalized secondary eruption develops in a christmas tree like pattern

Resolves spontaneously in 6 weeks

Salmon red, oval, fine collarete scale

Answer 26

Pityriasis rosea

Question 27

Most probable cause of pityriasis rosea

Answer 27

Reactivation of HHV 6 and 7