Section 3- Psoriasis, Pityriasiform Flashcards
HLA types most commonly associated with psoriasis
HLA B13 B37 B57
HLA -Cw6
Acute streptococcal infection precipiates this type of psoriasis
Guttate
2 major types of psoriasis
Eruptive, inflammatory type Chronic stable (plaque)
Salmon pink papules with or without scales, “drop”
Scales are lamellar, loose, easily removed
Positive Auspitz sign
Acute Guttate type
Site of predilection of acute guttate psoriasis
Trunk
Site of predilection of chronic stable psoriasis
Elbows Knees Sacral gluteal Scalp Palm/soles
Uncommon site for psoriasis but associated with refractory type
Face
Psoriasis that Results from warm and moist environment
Plaques usually macerated, bright red and fissured, sharply demarcated
In groin, skin folds
Inverse psoriasis
Pathognomonic of psoriasis in nails
Oil spot (yellowish brown spot under nail plate)
Psoriasis is associated with increased morbidity and mortality from what comorbidities?
Cardiovascular
-HTN, hyperlipidemia
metabolic syndrome
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)
Generalized acute pustular psoriasis (Von Zumbusch)
Acral pustule formation, subungual lakes of pus and destruction of nail plate
May lead to permanent loss of nails and scarring
Acrodermatitis continua of Hallopeau
Psoriasis-Asymmetric peripheral joint involvement of upper extremities esp. distal interphalangeal joints
Dactylitis- sausage fingers
Psoriatic arthritis
Psoriatic arthritis is associated with which class of MHC antigen?
MHC class I
Most effective therapy to date for generalized plaque psoriasis
Re-PUVA
Retinoids + PUVA
- acitretin and isotretinoin
What is the triple dose (Weinstein) regimen for methotrexate in the management of psoriasis?
5mg q12 x 3 doses
When px responds, reduce to 2.5mg periodically
What lab tests to order before starting methotrexate
Liver enzymes
CBC
Serum creatinine
Treatment for psoriasis in nails
Systemic MTX and cyclosporine
Most effective in the treatment of acute guttate psoriasis
Narrowband (311nm) UVB irradiation
Long term side effects of PUVA
PUVA keratoses
Squamous cell CA
Dose of cyclosporine in psoriasis treatment
3-5mg/kg per day
What to monitor for when giving cyclosporine
BP
serum creatinine- nephrotoxic
Treatment for generalized pustular psoriasis (von zumbusch)
Treated as extensive burns
Isolation, fluid replacement, blood cultures Oral retinoids (acitretin 50mg/day)
Systemic glucocorticoids- rescue only
Rare, chronic papulosquamous disorder often progressing to erythroderma (cephalocaudal)
Follicular hyperkeratotic papules, reddish orange
Sharply demarcated islands of unaffected skin
Pityriasis rubra pilaris
Most effective treatment in pityriasis rubra pilaris
MTX or retinoids
Type 6- HAART
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
Pityriasis rosea
Most probable cause of pityriasis rosea
Reactivation of HHV 6 and 7
