SM 258: Papulosquamous Disorders

Question 1

What is Psoriasis?

Answer 1

An inflammatory skin disease that typically occurs in the elbows and knees, but can occur in any area of the body

Question 2

What does Psoriasis look like?

Answer 2

Well defined, thick scaly rash with silvery scale on elbows and knees (any site is possible though)

Question 3

Is Psoriasis well defined?

Answer 3

Yes - well defined islands with salmon pink color outlining the rash due to increased vasculature

Question 4

What is Onycholoysis?

Answer 4

Yellow discoloration seen by lifting of the nail plate from the bed in Psoriasis

Question 5

How does Psoriasis affect the nails?

Answer 5

Psoriasis effects both the nail itself and the nail bed of skin underneat the nail, causing pitting and onycholoysis

Question 6

What is the histological correlate for the bright led appearance of the Psoriasis rash?

Answer 6

Blood vessels form in effected areas, which show up as white spots on histology

Question 7

What does Psoriasis look like on histology?

Answer 7

An elongated, thickened epidermis is seen due to rapid proliferation of Keratinocytes

This causes the scales we see on skin

Question 8

Is Psoriasis temporary?

Answer 8

No, it’s a chronic condition that can develop at any age of life

Question 9

Is there a genetic basis to Psoriasis?

Answer 9

There is a genetic factor since it runs in families, but not always

Question 10

What causes the hyperprolfieration in Psoriasis?

Answer 10

Psoriasis is an immune mediated condition, with the hyperproliferation of Keratinocytes being driven by a complex cascadde of immune mediators

Question 11

What type of immune cell drives Psoriasis, and with what signalling molecules?

Answer 11

Th1/Th17 T cells, which overexpress TNFalpha, IL-17, IL-12

Question 12

What type of diseases is overexpression of TNFalpha related to?

Answer 12

Skin: Psoriasis
Joints: RA and Psoriatic Arthritis
GI: Crohn’s Disease/UC

Question 13

What can trigger Psoriasis?

Answer 13

Streptococci, Trauma to skin, Beta Blockers and Lithium

Question 14

What is Psoriatic Arthritis?

Answer 14

An inflammatory immune mediated arthritis that can lead to disability

Inflammatory stiffness (improves after moving) and Dactylitis

Driven b TNFalpha overactivation of Osteoclasts

Question 15

What are the treatments for Psoriasis localized disease?

Answer 15

Potent topical steroids like Clobetasol and Triamcinolone

Question 16

Do topical steroids work forever?

Answer 16

No - they work for a few weeks but Psoriasis comes back later

Question 17

What targeted therapies exist for Psoriasis?

Answer 17

Biologics including: TNFalpha blockers, IL-23 blockers (Ustekinumab), and IL-17 blockers (Secukinumab)

Question 18

What is Seborrheic Dermatitis?

Answer 18

Redness and thin yellow flaking around the nose, eyebrows, ears, hairline, and scalp

Question 19

How does Seborrheic Dermatitis differ from Psoriasis?

Answer 19

Asymptomatic: not itchy, and more flakey

Question 20

What may cause Seborrheic Dermatitis?

Answer 20

Pityrosporum Ovale

Question 21

What is the treatment for Seborrheic Dermatitis?

Answer 21

Antifungal creams or mild topical steroids

Question 22

What is Pityriasis Rosea?

Answer 22

Oval salmon colored thin macules or patches with thin scale that mostly effect the trunk, often beginning after a larger initial patch

Question 23

How does Pityriasis Rosea differ from Psoriasis?

Answer 23

No scale, smaller rashes, and Pityriasis Rosea resolves acutely within 3-8 weeks

Question 24

What is the “Christmas Tree” pattern?

Answer 24

A pattern of small rashes on the back that look like a Christmas tree, common in Pityriasis Rosea

Question 25

What could caues Pityriasis Rosea?

Answer 25

Possible reactivation of HHV6 or HHV7, which originally causes a cold