Inflammatory Skin Conditions

Question 1

What type of condition is psoriasis?

Answer 1

non contagious
chronic
autoimmune condition causing skin inflammation

Question 2

What is the clinical presentation of psoriasis?

Answer 2

silvery plaques that can be very itchy
can also present with associated conditions e.g., psoriatic arthritis

Question 3

What is the hypodermis made up of and what is its function?

Answer 3

made up of fat and connective tissue that anchors skin to underlying muscle

Question 4

What is found in the dermis?

Answer 4

nerves
sweat glands
lymph and blood vessels

Question 5

What is the name of the layer found above the stratum basale?

Answer 5

stratum spinosum

Question 6

What type of immune cell can be found in the stratum spinosum?

Answer 6

dendritic cells

Question 7

What are dendritic cells?

Answer 7

star shaped immune cells
these patrol, looking for invading microbes to present to lymphocytes

Question 8

How is the epidermal skin barrier created?

Answer 8

via keratinisation in the stratum granulosum
this is where keratinocytes flatten out, get rid of intracellular structures and die

Question 9

Describe the stratum lucidum layer of the epidermis and where it is found

Answer 9

2-3 cell layers thick
made up of translucent dead keratinocytes
this is only found in thick skin e.g., on palms and soles of feet

Question 10

What is the uppermost layer of the epidermis called?

Answer 10

stratum corneum
this is where old dead cells are sloughed off, leading to skin flakes and dandruff

Question 11

What is the effect of cytokines on the skin?

Answer 11

increased keratinocyte proliferation and recruitment of immune cells

Question 12

What is the cause of psoriasis?

Answer 12

cause of inflammation is unclear, but there seems to be a genetic component
trauma and infection can also be triggers

Question 13

Describe keratinocytes in a patient with psoriasis

Answer 13

produce more keratin
retain nuclei - parakeratosis
do not adhere to each other properly, causing a scaly appearance

Question 14

What is auspitz sign?

Answer 14

localised spots of bleeding where scaly plaques have come off the skin

Question 15

What is the most common type of psoriasis?

Answer 15

plaque psoriasis

Question 16

Describe the signs and symptoms of plaque psoriasis

Answer 16

inflamed and red flattened areas that may appear like white-silver scales
can be very itchy

Question 17

Where is plaque psoriasis most commonly seen?

Answer 17

scalp and tensor regions e.g., the elbows

Question 18

What is guttate psoriasis?

Answer 18

small, red individual spots found on the trunk and limbs
this starts in childhood, sometimes being triggered by an infection

Question 19

What is inverse psoriasis?

Answer 19

smooth and shiny red lesions found within skin folds e.g., under the breasts

Question 20

What is pustular psoriasis?

Answer 20

red skin with tender white elevations filled with pus
usually found on hands and feet

Question 21

What is erythrodermic psoriasis?

Answer 21

fire-red scales that are extremely itchy and painful
these scales tend to fall off in large sheets and can be found on any large patch of skin

Question 22

How is psoriasis diagnosed?

Answer 22

mostly based on distribution of skin damage
tissue biopsy can confirm

Question 23

What is the management for psoriasis?

Answer 23

1st line - moisturisers and emollients
2nd line - topical and then systemic immunosuppression
3rd line - UV phototherapy

Question 24

What causes the scale which you see over skin plaques in pts who have psoriasis?

Answer 24

parakeratosis - excess keratin with retained nuclei due to accelerated turnover of keratinocytes