Psoriasis

Question 1

What is the skin turnover rate in healthy and psoriasis?

Answer 1

Psoriasis: in 3 days

Healthy Skin: in 30 days

Question 2

What is psoriasis?

Answer 2

Psoriasis is a skin disease that causes red, itchy patches, most commonly on the knees, elbows, trunk, and scalp

It tends to go through cycles, flaring for a few weeks or months,

Psoriasis has 2 peaks of onset, the first at age 20-30 years and the second at age 50-60 year

Question 3

Are silvery plaques common in psoriasis?

Answer 3

Yes, it is seen in 90% of cases

Question 4

Is scalp involvement in psoriasis common?

Answer 4

Yes, 50-80% of patients have some degree of scalp involvement.

Psoriasis on the scalp are more outwardly visible, affect social interactions, and harder to treat due to skin thickness

Question 5

What is the clinical presentation of psoriasis on nails?

Answer 5

Pitted nails are common in individuals with psoriasis

Question 6

What are some atypical presentations of psoriasis?

Answer 6

Guttae: hive like appearance, but will remian in the same spot over time

Pustular: Looks like necrotizing tissue, send patient to ER

Question 7

What can make psoriasis worse?

Answer 7

Cold weather

Stress

Trauma

Question 8

Do psoriasis lesions cause scarring?

Answer 8

Suprisingly no, they can look pretty bad, but once resolved there is no trace of them even occurring in the first place

Question 9

What are some potential etiologies for psoriasis?

Answer 9

Autoimmune (T-cell and TNF(tissue necrotizing factor) dysfunction)

Genetic factors+environmental factors(infection, trauma, and some drugs)

Question 10

Are dry skin lotions effective in psoriasis treatment?

Answer 10

They should be used in all cases. This can help reduce the amount of steroid needed to acheive similar effects (steroid-sparing)

Question 11

Are keratolytics effective in psoriasis treatment?

Answer 11

They can soften up scales, but are alnmost ineffective on their own, but it is commonly used in combination products (can enhance steroid penetration)

Question 12

Are tar-based treatments for psoriasis effective?

Answer 12

They are better compared to keratolytics like salicyclic acid because tar products actually reduce skin turnover rate

Question 13

Are steroids effective in psoriasis treatment?

Answer 13

It is the mainstay of therapy (use mid potency agents, except for face and skin folds)

Steroids are commonly used in combination products for psoriasis (dry skin lotions help reduce steroid use)

Question 14

What is the benefit of using 2 steroid products in psoriasis?

Answer 14

Use a lower potency agent when psoriasis is at its peak (this is because the skin is damaged, therfore increased absorption)

Use a higher potency agent in milder psoriasis

Question 15

Are vitamin D analogs like Calcipotriol effective in psoriasis treatment?

Answer 15

They reduce skin turnover rates and patients see results in 2 weeks (slower than steroids)

Effective in mild-moderate cases

Question 16

What is the benefit of using vitamin D analog/steroid combination product in psoriasis?

Answer 16

These products are fairly effective, but they also have the added benefit of not having long-term side effects that would are charcteristic of steroid use on its own

Minimal side effects after 52 weeks of use

Question 17

How is scalp psoriasis treated?

Answer 17

Potent steroids are more effective compared to vitamin D analogs alone, but the combo of steroid/vitamin D analog is the most effective

MD’s will often opt with the combo product from the get-go

Question 18

Is preventative therapy in psoriasis reccomended?

Answer 18

No, just play catch up when flare-ups appear

Question 19

What is the efficacy of retinoids in psoriasis treatment?

Answer 19

Retinoids reduce cell proliferation

Tazarotene is a common retinoid used in psoriasis agents, but it is fairly irritating. steroid/retinoid products take away the irritation.

Question 20

What is the efficacy of phototherapy in psoriasis treatment?

Answer 20

This was the historical treatment for psoriasis, but now we have identified the exact wavelengths that target psoriasis.

Narrow band UVB and UVA + photoactive agent both decrease cell proliferation

Question 21

What is the efficacy of biologic agents in psoriasis agents?

Answer 21

This is reserved for very severe cases after everything else has been exhausted

TNF and IL-23 antagonists are examples of biologic agents

Side effects are concerning

Question 22

What is psoriatic arthritis?

Answer 22

About 20% of psoriasis cases also involve arthritis. The fingernails are often involved

The following drugs are used:
Methotrexate (antimycotic)
Cyclosporine (immunosupressant)