Psoriasis Flashcards
(134 cards)
1
Q
Most common type of psoriasis in children? Followed by ??
A
Plaque psoriasis
Guttate psoriasis
2
Q
Gene involved in psoriasis?
A
HLA-cw6
3
Q
Marker for sacroiliitis associated psoriasis??
A
HLA-B27
4
Q
PSOR1 gene encodes for??
A
Corneodesmosin
5
Q
Target cells in psoriasis?
A
Interfollicular epidermis
6
Q
How does psoriasis induction occur??
A
TNF-a and IFN-a release from plasmacytoid DC via TLR-9
7
Q
What is the key for entrance?
A
Psoriatic T-cells express a1b1 integrin that interact with BM collagen type 4
8
Q
What cells prominent in active lesions and marginal zones of expanding plaque ??
And what histology is seen??
A
Neutrophils
Spongiform pustules of kogoj +
Munro microabsess
9
Q
What’s responsible for prominent angiogenesis??
A
VEGF
10
Q
What IL that decreases in psoriasis??
A
10
11
Q
Which subunit does ustekinhmab work on ??
A
P40
12
Q
What do dendritic cells secrete??
A
TNF-a
IFN-a
IL-23
13
Q
What does IL-23 do ??
A
Stimulates Th-17 = release of IL-17 and 22 leading to keratinocytes proliferation and dermal inflammation
14
Q
Which IL that it’s levels correlate with psoriasis severity ??
A
IL-22
15
Q
What cells release ?
IFN-a
IFN-gamma
A
a: DC
Gamma: activated T-cells and NK T-cells
16
Q
What pathway is key feature of psoriasis??
A
IFN-gamma (vasodilation and T-cell accumulation)
17
Q
What mediates neutrophilic migration?
A
CXCL8
18
Q
What are the anti microbial peptides that increase in psoriasis?
A
Beta-defensin 1
Secretory leukocyte protease inhibitor
19
Q
What causes keratinocyte proliferation in psoriatic plaques??
A
STAT3
20
Q
What promotes chemotactic activity ?
A
Human b defensin 2 binds to TLR4 = high CCR6
21
Q
Mention 7 causes of psoriasis ?
A
1- external
2-infection
3-HIV
4-drugs
5-habits
6-psychology
7-endocrine
22
Q
External causes of psoriasis?
A
Sunburn
Morbillifirm drug eruption
Viral exanthem
23
Q
Infections causing psoriasis?
A
Strep pharyngitis
Dental abscess
Impetigo
Perianal abscess
24
Q
Strep pharyngitis induces psoriasis via ??
A
Expression of Il-23R and CLA
25
Endocrine causes of psoriasis?
Hypocalcemia (but not abnormal viD levels)
26
Drugs causing psoriasis
Lithium
Imiquimod
Rapid tapering of steroids
TNFai
B-blocker
Antimalarial
27
What is impetigo herpetiformis ?
Pustular psoriasis of pregnancy
28
Auzpitz signs ??
Pinpoint bleeding after removal of silvery white micaceous scales
29
What causes auzpitz sign ?
Elongated vessels in dermal papillae + thinning of suprapapillary epidermis
30
What indicates unstable psoriasis?
Presence of pinpoint papules
31
Whats wornoff ring sign ?
Pale blanching rings surrounding psoriatic lesions
32
What are 9 types of psoriasis?
Chronic plaque, guttate, pustular, nail, oral mucosa, scalp, psa, flexural, erythrodermic
33
Percentage of genetalia involvement?
45%
34
Percentage of remitting plaque psoriasis in 5 years ?
15%
35
Types of psoriasis?
1-type 1: positive family hx and positive HLA-cw6
2-type 2: negative
36
What’s the most common cause of guttate psoriasis ??
URTI (> 50% have positive ASI and Anti DNAse)
37
Characteristic of erythrodermic psoriasis?
Nail changes
Face is spared centrally
38
What are pustular variants?
1- generalized
2-palmoplantar pustulosis
3-acrodermatitis continua of hallopeau
39
What triggers generalized pustular psoriasis??
Pregnancy, steroids tappering? Hypocalcemia, infections, topical irritation
40
Genes involved in generalized pustlar psoriasis ?
ADAM17, CARD14, DIRA, DITRA
41
Types of generalized pustular psoriasis?
Von zumbach pattern
Annular pattern
Exathemic pattern
Localized pattern
42
What is von zumbach pattern?
Fever + painful erythema and pustules
43
Gene mutation of von zumbach pattern ?
Homozygous IL-35R gene mutation
44
What is annular pattern?
Erythema and scaling with pustulation at advancing edge (central healing )
45
Exanthemic type ?
Follows infection
Acute eruption of small pustules appearing and disappearing over few days
46
What is the localized pattern pustular psoriasis ??
Pustules at the edge of pre existing psoriatic plaque (reflects unstable phase) after application of topical anthralin or tar
47
Palmoplantar pustulosis ??
Sterile pustules + yellow brown macules
More chronic
48
What triggers pamoplantar pustulosis ?
Smoking
Stress
Local infection
49
Palmoplantar pustulosis is seen in ??
SAPHO
SYNOVITIS, acne, pustulosis, hyperostosis, osteitis
50
What is acrodermatitis continua of hallupeau ?
Pustules on distal portions of fingers and toes and nails
= nail shedding( pustules on nail bed)
51
acrodermatitis continua of hallupeau is associated with??
Annulus migrans of tongue
52
Most common sites of scalp psoriasis?
Periphery of face
Retroauriculae area
Posterior upper neck
53
Name the scalp psoriasis scales ?
Asbestos like (pityriasis amianticia)
54
Causes of pityriasis amiantacea ?
Seb dermatitis
Scalp psoriasis
Secondary infected atopic dermatitis
Tinea capitis
55
If scalp psoriasis is associated with alopecia, think of ?
TNF-ai induced psoriasis
56
Describe flexural psoriasis ?
Shiny pink-red sharply demarcated thin plaques + central fissuring
57
Most common site of flexural psoriasis?
Retroauricular
Intergluteal cleft
Inguinal crease
Axilla
58
What causes flexural psoriasis?
Localized dermatophyte, candida, bacteria
59
What is the manifestation of oral mucosa psoriasis?
Annulus migrans
(Migratory annular erythematous lesion with white scales)
60
Most common site of annulus migrans ?
Tongue
61
What causes nail pitting ?
Focal parakeratosis of proximal portion of nail matrix
62
Nail parts that are affected in nail psoriasis??
Nail bed, matrix and hyponychium
63
What are 7 nail changes in psoriasis??
Pitting
Oil drop/salmon patches
Subungual hyperkeratosis
Onycholysis
Leukonychia and loss of transparency
White pourly adherent nail
Splinter hemorrhage
64
What causes subungual hyperkeratosis and onycholysis ??
Parakeratosis of distal nail bed
65
What causes leukonychia ??
Involvement of midportion of nail matrix and if total matrix is involved = white pourly adherent nail
66
What causes oil drop patch ??
exocytosis of WBC beneath nail plate (involving nail bed)
67
What causes splinter hemorrhage??
Capillary fragility
68
Wgat could exacerbate nail psoriasis??
Trying to remove it
69
What helps the most in nail psoriasis??
IL-17
JAKi
MTX
70
Risk factors for PSA ?
1- early age
2- female
3- polyarticular involvement
4- positive family history
5-radiologic findings
71
Most common type of PSA ??
Mono-asymmetrical-oligoarthritis (DIP)
72
5 major types of PSA ?
1- mono-asymmetrical-oligoarthritis
(Sausage digits)
2- DIP arthritis
3- RA-like
4- arthritis mutilans
5- spondylitis and sacroiliitis
73
DIP arthritis presentation??
Fixed flexed position joints
74
Arthritis mutilans presentation?
Severe rapidly progressive joint inflammation- osteolysis = short wide digits = telescoping phenomenon
75
What are juxta articular manifestations?
Tendonitis
Enthesitis
Dactylitis
76
What are other 4 associations with psoriasis??
1- skin diseases
2- cancer
3- infection
4- systemic internal disease
77
What are skin diseases that increase in psoriasis??
Lichen simplex chrinicus
Seborrheic dermatitis
78
What are skin diseases that decrease in psoriasis??
AD, allergic contact, asthma , urticaria
79
What cancer related to psoriasis??
Non melanoma skin cancer (SCC)
80
Risk factors to develop skin cancer in psoriasis??
PUVA >200
Cyclosporine
81
Common infections in psoriasis?
- onychomycosis
- candida esp (flexural psoriasis)
82
What reflects risk to develop CVS disease ?
CRP
83
Life expectancy of psoriasis?
3.5-4.5 years reduction
84
What causes dyslipidemia in psoriasis?
IL-6 and TNF-a (target adipocyte)
85
What chronic diseases associated with psoriasis?
- CVS
- dyslipidemia
- DVT
- non alcoholic steatohepatitis
- crohn disease
86
non alcoholic steatohepatitis is related to ??
Obesity, dyslipidemia and PSA
AST:ALT RATIO > 1
87
Other disorders??
- ILVEN
- Reactive arthritis
- Sneddon-Wilkinson disease
- AGEP
88
ILVEN ??
Inflammatory linear verrucous epidermal nevus- follows blasckow lines
89
Reactive arthritis triad ?
Conjunctivitis + urethritis + arthritis (polyarthritis or sacroiliitis)
90
What causes urethritis in rieters disease?
Chlamydia trachomatis
Less shigella and salmonella
91
Ocular changes in reactive arthritis?
Conjunctivitis
Iritis
Uveitis with glucoma
Keratitis
92
Skin lesions in rieters syndrome?
5%
Keratoderma blennorhagicum
Balanitis circunata
93
Tt of rieter ??
Self limited
Antibiotics +NSAID
Steroids
94
Subcorneal pustular dermatosis??
Sneddon wilkinson disease
95
Describe sneddon wilkinson disease ??
Annular polycyclic lesions on flexural areas + gravity induced demarcation (clear fluid superior and pus filled inferior) in vesiculopustules
96
What is associated with sneddon wilkinson disease ??
IgA paraproteinemia
97
Main ddx of sneddon Wilkinson disease ??
Subcorneal eosinophilic igA pemphigus
98
Best tt of sneddon Wilkinson??
Dapsone
99
AGEP ?
- acute febrile drug eruption starting on the face
100
Causes of AGEP ?
- drugs
- enteroviral infection
- mercury
101
Genes responsible for AGEP ??
HLA-B5
HLA-DR11
HLA-DQ3
102
Mutation of AGEP ??
IL-36R
103
Test prior sensitization ??
Skin patch test (0.75% metronidazole)
104
Sign and symptoms of AGEP ??
Fever + rash starting on face and intertriginous zones (axilla and groin)
Followed by dissemination
105
Percentage of mucosal involvement in AGEP ??
50%
106
Most common involved organ in AGEP ??
Liver > kidney > lung
107
Electrolyte abnormalities in AGEP ?
Hypocalcemia
108
Drugs causing AGEP ??
Aminopenicillin
Cephalosporine
Clindamycin
Diltiazem
109
Tt of AGEP ??
Withdrawal of causative agent + topical cs
110
First line tt of psoriasis ??
Topical cs
111
How to increase lipophilicity of topical CS ??
1- add hydroxyl group
2- add propionate, furuate, valerate (have anti inflammatory effects)
112
Does increase frequency of application makes tt better ?
No
Once is same as twice
113
Best topical for maintenance ??
Betamethasone dipropionate (for 12w)
114
What is the problem of topical CS in psoriasis ??
Fast development of tachyphylaxis and rebounding
115
What is the maximum dise of super potent and potent steroid ??
Super : 50g/w
Potent : 100g/w
116
Contraindications of topical steroids ??
1- active bacterial, viral, fungal infections.
2- skin atrophy
3- allergic contact
4- pregnancy/ lactation
117
What are the 3 viD analogs ??
1- calcipotriene (calcipotriol)
2- calcitriol
3- ta-calcitol
118
Fxn of ViD analog??
1- inhibition of keratinocyte proliferation
2- inhibition of neutrophils
3- activation of TGase (enhances cornified lipid envelope)
119
Side effects of overdose ViD analogue??
Hypercalcemia
120
What is daivobet ??
Calcipotriene + betamethasone dipropionate
121
Dose of anthralin ??
Not more than 3x weekly (highly irritant)
122
Fxn of anthralin ?
Similar to ViD analog
1- inhibition epidermal proliferation
2- inhibition of mitogen induced T lymphocytes proliferation
3- inhibition of neutrophils
123
Contraindications of anthralin ??
1- unstable progressive plaque psoriasis
2- pustular psoriasis
3- erythrodermic psoriasis
124
Which FDA approved psoriasis topical treatment??
Tazarotene
125
What are targets of tazarotene ??
Inhibitors of K16, and TGase
126
Changes of psoriasis??
Increase K6,16
Increase Involucrin
Decrease K10,1
Decrease loricrin
Decrease IL-10
127
Contraindications of topical retinoids ??
1- unstable progressive plaque psoriasis
2- allergic contact
3- erythrodermic psoriasis
4- pregnancy/lactation
128
Other topicals ::
10% salicylic acid
Coal tar
TCI (face and flexures)
129
AFDA approved systemic 1st line tt of psoriasis??
MTX
130
What is the maximum dose of MTX in psoriasis??
25mg
131
Systemic tt of psoriasis ??
- MTX
- cyclosporine
- retinoid
- biologics
- apremilast
132
Dose of acitritin in types of psoriasis ??
1- pustular : 1mg/kg/day
2- chronic plaque : 0.5 mg/kg/day
3- erythrodermic: 0.25 mg/kg/day
133
Biological tt of psoriasis??
All are human ab except ?
- infliximab (chimeric ab)
- ixekizumab (humanized)
134
What are category B biologics ??
1- TNF-ai
2- ustekinumab
3- secukinumab
