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Patho > Psoriasis > Flashcards

Psoriasis Flashcards

0
Q

Describe the parameters of early onset of psoriasis

A
  • 16-22 years
  • more severe and extensive
  • first-degree family member most likely affected
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1
Q

What is the mean age of occurance?

A

~ 23-37

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2
Q

Describe the parameters of late onset of psoriasis

A
  • 57-60 years
  • milder form
  • no first-degree relatives affected
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3
Q

Psoriasis is the most prevalent _____________ condition

A

autoimmune

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4
Q

Does psoriasis affect men or women more?

A
  • It affects them equally.

- Hormones play no role when it comes to psoriasis

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5
Q

What factors play a role in creating an “inappropriate immune response”?

A

genetic predisposition +/- predisposing factor + precipitating trigger

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6
Q

What are the predisposing factors that can contribute to psoriasis?

A
  • obesity
  • alcohol consumption
  • smoking
  • stress
  • viral/bacteria infections (can predispose disease onset or trigger relapse)
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7
Q

What kind of infections can be linked with psoriasis?

A
  • strep throat
  • candida albicans
  • HIV
  • staph infections (boils)
  • viral upper respiratory infections
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8
Q

What are the other triggers associated with psoriasis?

A
  1. Drugs
    - NSAIDS, lithium, beta-blockers
  2. Cold, dry weather
  3. Skin trauma
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9
Q

What is Koebner phenomenon?

A
  • psoriasis associated with skin trauma
  • can occur in area of damage or on other places
  • occurs within 7-14 days of dermis damage
  • increased change when psoriatic lesions are already present
  • injury can be caused by:
    • physical injury
    • chemical burns
    • excessive rubbing
    • sunburns
    • allergic reaction
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10
Q

What are the physiological roles of the skin?

A
  • barrier to elements and pathogens
  • thermoregulator protecting the body from excessive heat loss or overheating
  • UV radiation protection
  • wound repair and regeneration
  • synthesizes vitamin D
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11
Q

What type of skin cell is mainly affected in psorasis?

Where are they found?

A
  • keratinocytes
  • key structural material of the stratum corneum (outer skin layer)
  • found in epidermis
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12
Q

What are melanocytes?

A

the skin cells that product pigment

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13
Q

What are Langerhans cells?

A

The skin cells that detect, attack, neutralize and eliminate foreign bodies

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14
Q

What are merkell cells?

A

cells involved with the function of touch

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15
Q

Psoriasis is an autoimmune disease mediated by ___________.

A

T-cells

16
Q

Explain how T-cells contribute to psoriasis.

A
  • T-cells (Th1 and Th17) are activated by an APC (antigen presenting cell)
  • this causes the release of cytokines and chemokines (inflammatory mediators)
  • immune system response is induced
  • epidermis is flooded with activated T-cells
  • activated T-cells induce keratinocyte proliferation, therefore reducing destruction
  • this leads to a buildup in skin plaques
17
Q

Plaques contain _____ more keratinocytes than normal skin

A

30%

  • due to activated T-cells (they induce keratinocyte proliferation)
18
Q

What is the significance of “rete ridges”?

A
  • they help diagnose psoriasis
19
Q

What are the major pathogenic changes in psoriasis?

A
  1. Epidermal thickening (keratinocyte abnormalities)
  2. Bright erythema (new blood vessels formation)
  3. Silvery psoriatic scales (parakeratotic keratinocytes and neutrophil accumulation)
  4. Elongated “rete ridges”
20
Q

Why are scented emollients bad for psoriasis?

A
  • they will cause irritation/burning

- causes more keratinocytes accumulation

21
Q

Name the types of psoriasis

A
  • psoriasis vulgaris (chronic plaque)
  • guttate
  • flexural
  • erythrodermic
  • pustular
  • palmoplantar
  • scalp
  • nail
22
Q

Describe guttate psoriasis

A
  • “drop” psoriasis
  • most common in children and young adults
  • can occur suddenly or can be caused from infection, stress
  • small, red, individual tear drop lesions
  • location = limbs, trunk or face
23
Q

Describe flexural (inverse) psoriasis

A
  • smooth, shiny, inflammed patches
  • occurs on flexors surfaces (armpits, groin, underneath breasts, under butt folds)
  • can be mistaken for candida infections
24
Q

Describe erythrodermic psoriasis

A
  • least common form (super rare)
  • covers most of the body (75-90%)
  • may occurs from drug reactions, trauma, emotional stress or illness
  • red, inflammed patches with peeling, sparse scaling
  • can evolve from chronic plaque or erupt
25
Q

Describe pustular psoriasis

A
  • clearly defined, raised bumps filled with white fluid (white blood cells, non-infectious pus) surrounded by red skin
  • also known as vonZumbusch psoriasis
  • intense burning/itching
  • localized to hands and feet (or inner thigh)
26
Q

Describe psoriasis vulgaris (chronic plaque)?

A
  • vulgaris = common…most common form 80-90% of pts

APPEARANCE:

  • red/pink scaly plaques
  • raised, well defined, flat topped
  • covered with silvery white scales that shed constantly

LOCATION:

  • arms, legs, lower back, genitalia, elbows, knees and butt
  • extensor surfaces
27
Q

Describe palmoplantar psoriasis

A
  • can be hyperkeratotic or pustular
  • limited to palms and soles of the feet
  • difficult to treat
  • possibly aggravated by trauma
28
Q

Describe scalp psoriasis

A
  • difficult to differentiate between dandruff/seborrhea
  • can occur alone or with other types
  • found along hairline, forehead, back of neck, around ears

APPEARANCE:
mild - dry, fine scales
severe - thick, crusted plaques

29
Q

Describe nail psoriasis

A
  • can be present in any psoriasis pts

Several forms:
- pitting on nail surface
Subungual hyperkeratosis - silvery white crusting under free edge, thickening of nail plate
Onycholysis - nail separates from bed at free edge

30
Q

Describe psoriatic arthritis

A
  • may appear 7-10 years after skin psoriasis occurs
  • affects nail/scalp psoriasis pts between 30-50 y.o.

APPEARANCE

  • joint deformity
  • red, warm and inflammed

LOCATION:
- distal joints of fingers, fingers, wrists, ankles, knees, back and neck

31
Q

What are the goals of psoriasis treatment?

A
  • tailor management to individual (physical and psychological aspects)
  • improve quality of life
  • longterm remission and disease control
  • minimize drug toxicity
  • evaluate/monitor efficacy and suitability of individual treatments
  • remain flexible and respond to changing needs
32
Q

How do you measure the success of psoriasis treatment?

A
  1. Clearance
    • disease is controlled with no signs or symptoms
  2. Control
    • response to therapy that satisfies both patient and doctor
  3. Remission
    • disease is controlled for extended time period (partial or completely) without treatment other than routine skin care
33
Q

How do you measure treatment failure of psoriasis?

A
  1. Exacerbation
    • worsening of the disease
  2. Flare
    • exacerbation while on therapy
    • condition will be different than original disease (size of area covered, more severe)
  3. Rebound
    • exacerbation is due to med discontinuation
34
Q

What is used to treat psoriasis?

A
  • Emollients
  • Keratolytics
  • Topical agents (most common. Ex. corticosteriods)
  • Systemic therapy
  • Phototherapy (UVB light)
35
Q

How are keratolytics helpful with psoriasis?

A
  • soften plaques and help promote corticosteroid penetration
  • decrease keratinocyte proliferation
  • decrease T-cell activation
  • reduce inflammation

Patho (15 decks)

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