Psoriasis

Question 1

psoriasis has what prototypical papulosquamous disease distinctions (3)

Answer 1

1. well-dearcated red plaques
2. thick, plate-like silver scale
3. favors extensor surfaces

Question 2

psoriasis is a chronic disease of the skin and joints and has what increasing risk of developing what

Answer 2

1. metabolic syndrome
2. obesity
3. heart disease
4. arthritis

Question 3

HLA associations with psoriasis

1. type 1
2. type 2
3. HLA ____

Answer 3

1. type I: Cw6
2. type 2: Cw2
3. HLA B27

Question 4

medications associated with triggers for psoriasis

Answer 4

anti-hypertensive

prednisone

Question 5

Type 1 psoriasis age of onset

Answer 5

27

Question 6

PSORS1 located on chromosome

Answer 6

6

Question 7

the scaling that occurs in psoriasis is due to the

Answer 7

thickened stratum corneum

Question 8

what causes the redness of psoriasis

Answer 8

dilated vessels in dermal papillae- eythemia

Question 9

pustules seen in psoriasis is caused by

Answer 9

neutrophils in stratum corneum

Question 10

cytokines that are focused on psoriasis

Answer 10

1. TNF-alpha
2. IL-17
3. IL-23

Question 11

Auspitz sign

Answer 11

thin suprapapillary plates

• small bleeding points underneath the scaling

Question 12

epidermal hyperplasia is driven by

Answer 12

inflammatory cascade

Question 13

which Th cells get activated in psoriasis

Answer 13

TH1 and TH17

Question 14

Koebner phenomenon

Answer 14

the appearance of lesions at sites of injury

Question 15

inverse psoriasis

Answer 15

inverse from the usual extensor pattern—> body folds

** there is a relative absence of scale in body folds due to chronic moisture and friction

Question 16

psoriatic erythrodema

Answer 16

it can be a medical emergency causing infection, hypothermia, malnutrition and a high output of heart failure which causes fluid shifts and electrolyte imbalance

Question 17

clinical pearl about asking every psoriasis patient

Answer 17

joint symptoms, remember that HLA-B27 is linked with both psoriasis and arthirits

Question 18

salmon patching

Answer 18

oil spotting on the nail

Question 19

5 types of psoriatic arthritis

Answer 19

1. asymmetric oligoarthritis
2. symmetric polyarthritis
3. DIP joints only
4. ankylosing spondylitis
5. arthritis mutilans

Question 20

guttate psoriasis

Answer 20

raindrop well demarcated

Question 21

guttate psoriasis in children is often preceded by

Answer 21

strep throat

Question 22

first line therapy topicals for psoriasis

Answer 22

corticosteroids

Question 23

second line therapy topicals for psoriasis

Answer 23

1. vitamin D analogues
2. tazarotene
3. salicylic acid

Question 24

third line therapy topicals for psoriasis

Answer 24

1. short contact anthralin

2. Tar

Question 25

which medication can cause a rebound in psoriasis

Answer 25

prednisone

Question 26

generalized pustular psoriasis

Answer 26

chronic, small white pinpricks with underlying erythremous patches

Question 27

- commonly used with phototherapy - treatment of choice for pustular psoriasis - strengths: non immunosuppressive - weaknesses: slow improvement, low success rate in plaques type as monotherapy **** avoid in females of child bearing potential

Answer 27

acitretin

Question 28

- gold standard treatment - strenghts: moderate response rate, addresses concomitant psoriatic arthritis and reduces inflammatory burden of disease - weaknesses: hepatotoxic, aplastic anemia and GI disstress

Answer 28

methotrexate

Question 29

- use of psoriasis in crisis - advantages: high response rate and rapid improvement - disadvantages: renal tox

Answer 29

cyclosporine

Question 30

- oral small molecule targeting PDE4 - advantages: favorable safety profile and moderate response rate - disadvantages: tolerability with GI distress and cost

Answer 30

apremilast- otezla

Question 31

Humira and adalimumab is what type of antagonist?

Answer 31

TNF

Question 32

what has a higher efficieny than TNF antagonists

Answer 32

anti IL-12/23 agent- ustekinumab