SM_257a: Papulosquamos Disorders

Question 1

Psoriasis is an ____ skin disease that consists of ____ and has a predilection for the ____ and ____

Answer 1

Psoriasis is an inflammatory skin disease that consists of thick well defined scaly plaques (raised) with silvery scale and has a predilection for the elbows and knees

Question 2

Thick scaly rash with silvery scale on elbows and knees is ____

Answer 2

Thick scaly rash with silvery scale on elbows and knees is psoriasis

Question 3

Psoriasis can be ____ or cover ____

Answer 3

Psoriasis can be localized or cover the entire body

• Erythrodermic psoriasis: entire body red and scaly
• Palmoplantar psoriasis: on palms and soles
• Can involve scalp
• Can involve nails

Question 4

Psoriasis affecting the nails includes ____ and ____

Answer 4

Psoriasis affecting the nails includes pits and onycholoysis

• Onycholoysis: yellow discoloration caused by lifting of nail plate from the bed

Question 5

Bright red rash with silvery scalp and abnormal looking nails is ____

Answer 5

Bright red rash with silvery scalp and abnormal looking nails is psoriasis

Question 6

Psoriasis histology includes ____ caused by ____

Answer 6

Psoriasis histology includes elongated thickened epidermis caused by overly rapid production of keratinocytes

(migration to stratum corneum in 3-7 days vs 28 days, also thick stratum corneum and proliferation and dilation of blood vessels near surface)

Question 7

Psoriasis is a ____ condition that has onset at ____ and involves a ____ factor

Answer 7

Psoriasis is a chronic condition that has onset at any age of life and involves a genetic factor

(patients with psoriasis sometimes have relatives with disease but not always)

Question 8

Psoriasis is an ____ mediated condition with _____ driven by a complex cascade of inflammatory mediators

Answer 8

Psoriasis is an immune mediated condition with hyperproliferation driven by a complex cascade of inflammatory mediators

Question 9

____ and overexpression of cytokines ____, ____, and ____ play a pivotal rolate in psoriasis

Answer 9

T cells and overexpression of cytokines TNF-alpha, IL-17, and IL-23 play a pivotal rolate in psoriasis

Question 10

Psoriasis triggers include ____, ____, ____, and ____

Answer 10

Psoriasis triggers include Streptococci (Strep pharyngitis), stress, trauma (skin injury), and drugs

(Guttate psoriasis is an example of an environmental trigger)

Question 11

Describe psoriatic arthritis

Answer 11

Psoriathic arthritis

• 1–30% of patients with psoriasis
• Inflammatory immune mediated arthritis
• May lead to destructive, disabling arthritis
• Signs and symptoms: morning stiffness (lower back, neck, hands, feet) that improves after 30 min - 1 hour after waking, dactylitis (sausage digits), and enthesitis

Question 12

Localized psoriasis is treated mainly with ____

Answer 12

Localized psoriasis is treated mainly with high potency topical steroids (clobetasol, triamcinolone)

Question 13

Widespread psoriasis is treated with ____ that includes ____, ____, and ____

Answer 13

Widespread psoriasis is treated with targeted therapy (large molecule drugs targeting specific cytokines that drive psoriasis) that includes TNF-alpha blockers, IL-23 blockers, and IL-17 blockers

(most superior skin clearance)

Question 14

Widespread psoriasis treatment includes ____, ____, and ____

Answer 14

Widespread psoriasis treatment includes TNF-alpha blockers, IL-23 blockers, and IL-17 blockers

(targeted therapy: large molecule drugs targeting specific cytokines that drive psoriasis: most superior skin clearance)

Question 15

Seborrheic dermatitis is ____

Answer 15

Seborrheic dermatitis is redness and thin yellow waxy flaking around the nose (nasolabial folds), eyebrows, beard area, ears, hairline, and scalp

Question 17

Seborrheic dermatitis may be related to the presence of ____

Answer 17

Seborrheic dermatitis may be related to the presence of yeast (Pityrosporum ovale)

Question 18

Seborrheic dermatitis treatment includes ____ and ____

Answer 18

Seborrheic dermatitis treatment includes antifungal creams and mild topical steroid

Question 19

Pityriasis rosea is an ____, an ____ process, and often begins with ____

Answer 19

Pityriasis rosea is an oval salmon colored thin macule or patches with thin scale mostly affecting the trunk, an acute self resolving process (3-8 weeks), and often begins with a single larger initial patch (herald patch) before other macules appear

Question 20

Herald patch and acute self resolving refer to ____

Answer 20

Herald patch and acute self resolving refer to pityriasis rosea

Question 21

____ pattern on the back refers to pityriasis rosea

Answer 21

Christmas tree pattern on the back refers to pityriasis rosea

Question 22

____ may cause pityriasis rosea

Answer 22

Possible reactivation of HHV-6 or HHV-7 may cause pityriasis rosea