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Applied Pathophysiology > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What is psoriasis?

A

Inflammatory and hyperplastic disease of the skin

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2
Q

what are hallmark characteristics of psoriasis?

A

erythema (redness)

elevated,scaly plaques

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3
Q

what is the global prevalence of psoriasis?

A

0.1%-8.5%

in reality, its ~double

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4
Q

what is the avg age of getting psoriasis? what is early onset and late onset psoriasis?

A

avg: 23-37 years
early: 16-22yrs
late: 57-60yrs

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5
Q

what is the difference between early and late onset?

A

early is usually more severe, extensive, and likely to have an affected 1st degree family member

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6
Q

what are 5 external predisposing factors?

A 
obesity
alcohol consumptions
smoking
stress
viral/bacterial infections (HIV)
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7
Q

how does smoking affect psoriasis?

A

breath in foreign particles and trigger immune response

increases risk and severity

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8
Q

how does HIV affect psoriasis?

A

can predispose to disease onset or trigger relapse

shed antigen can lead to bacteria colonizing on skin and shedding proteins that can trigger an immune response

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9
Q

What kinds of infections are associated with psoriasis?

A

strep throat (streptococcal pharyngitis) - can cause a flare or trigger onset
thrush (candida albicans)
boils (staphylococcal skin infections) - cause flare
viral upper respiratory infections - cause flare

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10
Q

what is the koebner phenomenon?

A

skin lesions forming at the site of skin trauma (cuts, bruises, bumps, etc)
occurs 1-2wks after injury to dermis layer

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11
Q

what are 5 physiologic roles of skin?

A

1) barrier to elements and pathogens
2) thermo-regulator protecting the body from excessive heat loss/overheating
3) protects from UV radiation
4) wound repair and regeneration
5) synthesizes vitamin D

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12
Q

what are the 3 layers of skin?

A

epidermis
dermis
hypo-dermis

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13
Q

what is the function of the epidermis?

A

physical barrier

protects the skin from environment

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14
Q

what is the dermis?

A

layer of connective tissue containing blood vessels?

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15
Q

what is the function of the hypo-dermis?

A

provides structural integrity of the skin

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16
Q

what is the outermost layer of strata on the epidermis?

A

stratum corneum

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17
Q

what are 4 cell types found in the epidermis? which is most abundant

A

keratinocytes - most abundant
melanocytes
langerhans cells
merkel cells

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18
Q

what is the function of keratinocytes?

A

produce keratin

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19
Q

what is keratin?

A

key structural material making up the outer layer and integrity of skin, hair, and nails

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20
Q

what is the function of melanocytes?

A

pigment production

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21
Q

what is the function if langerhans cells?

A

detects, attacks, neutralizes, and eliminates foreign bodies

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22
Q

what is the function of merkel cells?

A

involved in the function of touch

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23
Q

what is the life cycle of keratinocytes?

A

start in basal layer (basal cells)
differentiate on transit from basal cell to stratum corneum
lose nuclei and organelles and become corneocytes

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24
Q

what is the stratum corneum comprised of?

A

dead keratinocytes (corneocytes) that have migrated from basal cells

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25
Q

What is the first step of T-cell mediated autoimmune response?

A

unknown skin antigen stimulates immune response

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26
Q

What is the second step of T-cell mediated autoimmune response?

A

impaired differentiation and hyperproliferation of keratinocytes on the stratum corneum layer of epidermis

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27
Q

What is the third step of T-cell mediated autoimmune response?

A

Activation of T cells (TH1 and TH7) via antigen presenting cells releases inflammatory mediators (cytokines, chemokines) that drive the immune system induced response

28
Q

What do activated T cells do to the epidermis?

A

induce keratinocyte proliferation

decrease differentiation which promotes a build up of skin plaques

29
Q

what is the result of abnormal keratinocyte proliferation?

A

faster maturation than normal (3-5 days rather than >30days)
scales and flakes (plaques)
causes other cells to be formed incorrectly

30
Q

what are rete ridges?

A

epithelial extensions

strikingly and evenly elongated; contain retained nuclei and important in psoriasis diagnosis

31
Q

what are 4 key skin changes in psoriasis?

A

epidermal thickening
bright erythema
silvery psoriatic plaques
elongated rete ridges

32
Q

what causes epidermal thickening?

A

abnormal keratinocyte proliferation/differentiation

33
Q

what causes bright erythema?

A

abnormal angiogenesis and increased capillary permeability

34
Q

what causes silvery psoriatic plaques?

A

accumulation of parakeratotic keratinocytes and neutrophils in stratum corneum

35
Q

what are some symptoms of psoriasis? which is most common? (7pts)

A 
scaling (most common)
itching
skin redness
tightness of skin
bleeding
burning sensation
fatigue
36
Q

what are the 8 different kinds of psoriasis? which is the most/least common?

A 
guttate (drop) psoriasis
flexural (inverse) psoriasis
erythrodermic psoriasis - least common
pustular psoriasis (von Zumbusch psoriasis)
chronic plaque (psoriasis vulgaris) - most common
palmo-plantar psoriasis
scalp psoriasis
nail psoriasis
37
Q

what is guttate psoriasis?

A

small, tear drop, separate lesions over upper trunk and proximal extremities (legs, arms, torso, back) that is triggered by a bacterial infection (respiratory, throat)

38
Q

what group is guttate psoriasis more common in?

A

young adults

39
Q

how do you treat guttate psoriasis?

A

take care of skin, keep it moisturized

goes away on its own

40
Q

what is flexural (inverse) psoriasis?

A

non infectious autoimmune disease where smooth, shiny inflamed patches show up in flexor surfaces (armpits, under breasts, skin folds in booty)

41
Q

what does flexural psoriasis look like?

A

thin, minimally scaly, raw, tender, itchy, well defined patches

42
Q

what is erythrodermic psoriasis?

A

red, inflammatory patches with sparse scaling and peeling of the skin caused by drug reactions, trauma, emotional stress or illness
covers 75-90% of skin surface

43
Q

what complications could arise form erythrodermic psoriasis?

A

infections
malabsorption
anemia

44
Q

What is pustular psoriasis?

A

white pustules (raised bumps) surrounded by red skin causing intense itching and burning, mostly in the hands and feet

45
Q

Who is pustular psoriasis most common in? Is it contagious?

A

adults, not contagious

46
Q

what is psoriasis vulgaris?

A

raised, well defined flat-topped plaques with sharp borders (symmetrical)
typically covered with silvery white scales that consistently shed

47
Q

where is psoriasis vulgaris typically found in the body?

A 
arms
legs
elbows
knees
genitalia
lower back
butt
48
Q

what is palmo-plantar psoriasis?

A

hyperkeratotic or pustular psoriasis on the palms of hands or soles of feet

49
Q

what is scalp psoriasis?

A

dandruff-like psoriasis found along the hairline, forehead, back of neck or around ears

50
Q

what does mild scalp psoriasis look like? severe?

A

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

51
Q

what are 4 subtypes of nail psoriasis?

A

pitting
subungual hyperkeratosis
onycholysis
oil drop sign

52
Q

what is pitting nail psoriasis?

A

discrete, well circumscribed depressions on nail surface

53
Q

what is subungual hyperkeratosis?

A

silvery white crusting under free edge of nail with some thickening of nail plate

54
Q

what is onycholysis psoriasis?

A

nail separates from nail bed at free edge

55
Q

what is oil drop sign?

A

pink/red colour change on nail surface

56
Q

what are 3 measures of treatment success?

A

1) clearance (disease controlled with no symptoms)
2) control (response to therapy that satisfies pt and physician)
3) remission (disease is controlled for an extended time period either partially or completely w/o treatment other than routine skin care)

57
Q

what are 3 measures of treatment failure?

A

1) exacerbation (worsening of disease)
2) flare (exacerbation while on therapy and the condition is different than the original disease)
3) rebound (exacerbation due to discontinued treatment)

58
Q

what are 6 non-pharm treatments to reduce/eliminate psoriasis?

A 
stress
smoking
alcohol
trauma
drugs
infections
59
Q

what are 3 topical options for treatment?

A

emollients/moisturizers
keratolytics
topical agents (corticosteroids and vit D3 analogues)

60
Q

how do emollients/moisturizers help treat psoriasis?

A

hydration of stratum corneum

provide protective film to decrease dehydration

61
Q

how do keratolytics help treat psoriasis?

A

soften plaque by promoting cellular desquamation

62
Q

how do corticosteroids help treat psoriasis?

A

anti-inflammatory; reduces production of cytokines and decreases scaling/itching

63
Q

how do vitamin D3 analogues help treat psoriasis?

A

inhibit proliferation of keratinocytes and decrease inflammation

64
Q

what are three systemic treatment options for psoriasis?

A

methotrexate
cyclosporine
biologics

65
Q

how does methotrexate help treat psoriasis?

A

decrease proliferation rate of keratinocytes

66
Q

how does cyclosporine help treat psoriasis?

A

inhibit T cell activation

67
Q

how does phototherapy help treat psoriasis?

A

UVB light decreases cells involved in psoriasis pathogenesis

Applied Pathophysiology (11 decks)

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