psoriasis

Question 1

psoriasis age of onset

Answer 1

bimodal peaks 20-30 and 50-60 mostly

Question 2

psoriasis

Answer 2

chronic multi-system disease with predominantly skin and joint manifestations

Question 3

plaque

Answer 3

scaly, erythematous patches, papules and plaques that are sometimes pruritic

Question 4

inverse/flexural

Answer 4

lesions are located in the skin folds

Question 5

guttate

Answer 5

presents with drop lesions, 1-10 mm salmon pink papules with a fine scale

Question 6

erythrodermic

Answer 6

generalized erythema covering nearly the entire body surface area with varying degrees of scaling

Question 7

pustular

Answer 7

generalized or palmoplantar

Question 8

Guttate psoriasis

Answer 8

• acute onset of raindrop sized lesions on the trunk and extremities - often preceded by streptococcal pharyngitis - significant change for long term remission after single episode

Question 9

Answer 9

guttate psoriasis

Question 10

inverse/flexural psoriasis

Answer 10

erythematous plaques in the axilla, groin, and inframammary region and other skin folds

may lack sacle due to moistness of area

Question 11

Answer 11

inverse flexural psoriasis

Question 12

Answer 12

inverse flexural psoriasis

Question 13

pustular psoriasis

Answer 13

• psoriatic lesions with pustules
• often triggered by corticosteroid withdrawal
• when generalized can be life threatening, hospitalization may be required

Question 14

Answer 14

pustular psoriasis

Question 15

Answer 15

pustular psoriasis

Question 16

palmoplantar psoriasis

Answer 16

• may occur as either plaque or pustular type
• often functionally disabling

Question 17

Answer 17

palmoplantar psoriasis

Question 18

psoriatic erythroderma

Answer 18

involved almost the entire skin surface; skin is bright red

Question 19

symptoms of psoriatic erythroderma

Answer 19

assoc with fever, chills, malaise - flu like symptoms

high morbidity and mortality

hospitalization is sometimes required

Question 20

erythroderma

Answer 20

erythema affecting > 90% BSA body surface area

Question 21

causes of erythroderma

Answer 21

drugs, psoriasis, atopic dermatitis, cutaneous lymphoma, underlying malignancy, others

Question 22

management of erythroderma

Answer 22

extensive topical therapy, monitor fluids/electrolytes, and treat underlying cause

Question 23

plaque psoriasis

Answer 23

well demarcated plaques with overlying silvery scale and underlying erythema

Question 24

chronic plaque psoriasis is typically ____ and ____

Answer 24

symmetric and bilateral

Question 25

auspitz sign

Answer 25

bleeding after removal of scale

Question 26

koebner phenomenon

Answer 26

lesions induced by trauma trauma can trigger or fuel psoriasis by icreasing cytokines

Question 27

most common form of psoriasis

Answer 27

plaque psoriasis (80-90% patients affected)

Question 28

how many patients with plaque psoriasis have mild to moderate disease

Answer 28

80% - localized or scattered covering \<5% of body surface area

Question 29

how many patients have moderate to severe disease

Answer 29

20% have moderate to severe affecting \>5% of the body surface area or affecting crucial body areas such as hands, feet, face, or genitals

Question 30

psoriasis pathogenesis

Answer 30

cytokines from immune cells trigger a hyperproliferative state resulting in thick skin and excess sale - systemic treatments target these cytokines and immune cells

Question 31

is there a genetic component?

Answer 31

yes - 33% with fam hx

Question 32

patients with psoriasis may be at increaed risk for

Answer 32

metabolic syndrome, obesity, depression, smoking, alcohol use

Question 33

psoriasis and HIV

Answer 33

more severe

Question 34

characteristic locations for psoriasis

Answer 34

scalp ears elbows knees (extensor surfaces) umbilicus gluteal cleft nails sites of recent trauma

Question 35

Answer 35

erythematous plaque around the umbilicus

Question 36

what elements in the history are important to ask when considering the diagnosis of psoriasis?

Answer 36

- fam hx - medications - recent illness/past medical history - social history

Question 37

steroid withdrawal

Answer 37

can cause psoriasis

Question 38

Answer 38

erythematous and edematous foot, with dactylitis (sausage digit) of the 2nd toe destruction of the DIP joints also see onychodystrophy - nail pitting and onycholysis

Question 39

subtypes of nail psoriasis

Answer 39

can occur in all subtypes

Question 40

nail psoriasis and psoriatic arthritis

Answer 40

indicates higher risk for arthritis

Question 41

fingernail onychodystrophy are involved in how many patients toenails

Answer 41

50% 35%

Question 42

pitting

Answer 42

punctuate depressions of the nail plate surface

Question 43

onycholysis

Answer 43

separation of the nail plate from the nail bed

Question 44

subungual hyperkeratosis

Answer 44

abnormal keratinization of the distal nail bed also higher risk of joint disease

Question 45

psoriatic arthritis PsA

Answer 45

seronegative spondyloarthropathies mild to severe usually with relapsing/remitting oligoarthritis - distal inerphalangeal joints most common

Question 46

Answer 46

subungual hyperkeratosis - abnormal keritinizatoin of the distal nail bed

Question 47

onset of psoriatic arthritis in patients with psoriasis

Answer 47

30-50 age more likely with severe skin disease 10-15%

Question 48

psoriatic arthritis

Answer 48

swelling of the PIP joints of the 2-4th digits, DIP involvement of the 2nd digit

Question 49

treatment of psoriatic arthritis

Answer 49

mandatory to prevent joint destruction like the picture with desquamation of skin and joint swellig arthritis mutilins

Question 50

treatment for localized psoriasis \<5% BSA and first line agents

Answer 50

topical treatment high potency topical steroid +/- calcipotriene (vit d analog)

Question 51

topical medications for psoriasis are more effective when used with

Answer 51

occlusion - allows for better penetration of medicine ex. saran wrap, wet wrap, gloves, socks

Question 52

why do we do systemic treatment for psoriasis

Answer 52

used in addition to topical treatment for moderate - severe disease or for limited disease with high impact on quality of life (ex palmoplantar or genital)

Question 53

Do we prescribe oral steroids for psoriasis?

Answer 53

oral prednisone should never be used as they can severely flare psoriasis upon discontinuation!!!

Question 54

what is systemic treatment based on

Answer 54

patient preference, side effect profile, co-morbidities

Question 55

3 types of systemic treatment

Answer 55

photo therapy oral medications biologic agents

Question 56

phototherapy

Answer 56

narrow - UVB light or psoralen plus UVA liight PUVA

Question 57

systemic treatment for psoriasis oral medications

Answer 57

methotrexate, acitretin, cyclosporine

Question 58

biologic agents used for psoriasis systemic treatment

Answer 58

TNF alpha inhibitors (infliximab, etanercept, adalimumab) IL 12/23 blocker (ustekinumab)