Psoriasis

Question 1

psoriasis is a chronic multisystem disease with predominantly _____ and _____ manifestations

Answer 1

• skin and joint

Question 2

age of onset of psoriasis

Answer 2

• 20-30s - 50-60

Question 3

____% of patients with a family history have psoriasis

Answer 3

• 33% - strong genetic component

Question 4

does psoriasis just go away after treatment or does it wax and wane over time?

Answer 4

• waxes and wanes

Question 5

what form of psoriasis are scaly, erythematous patches, papules, and plaques that are sometimes pruritic

Answer 5

• plaque

Question 6

what form of psoriasis are lesions located in the skin folds of the axilla, groin, inframammary region do they have scale? why?

Answer 6

• inverse/flexural - no; due to moistness of area

Question 7

what form of psoriasis presents with raindrop lesions, 1-10 mm salmon-pink papules with a fine scale

Answer 7

• gluttate

Question 8

what form of psoriasis are generalized erythema covering nearly the entire body surface area with varying degrees of scaling

Answer 8

• erythrodermic

Question 9

what form of psoriasis are generalized or palmoplantar

Answer 9

• pustular

Question 10

what form of psoriasis is the acute onset of raindrop sized lesions on the trunk and extremities

Answer 10

• gluttate psoriasis

Question 11

gluttate psoriasis often preceded by

Answer 11

• streptococcal pharyngitis

Question 12

gluttate psoriasis chance for long term remission after single episode

Answer 12

• significant chance

Question 13

what type of psoriasis is characterized by corticosteroid withdrawal

Answer 13

• pustular

Question 14

when generalized, pustular psoriasis can be _______

Answer 14

• life threatening

Question 15

what type of psoriasis is often misdiagnosed as athlete’s foot

Answer 15

• palmoplantar psoriasis

Question 16

what type of psoriasis involves almost the entire skin surface where the skin is bright red

Answer 16

• psoriatic erythroderma

Question 17

by definition, erythema in erythroderma affects what percent body surface area

Answer 17

> 90%

Question 18

what type of psoriasis often requires hospital admission to manage complications such as high output heart failure and sepsis

Answer 18

• psoriatic erythroderma

Question 19

how to distinguish the cause of psoriatic erythroderma

Answer 19

• biopsy

Question 20

treatment of psoriatic erythroderma

Answer 20

• topical therapy - monitor fluids/electrolytes - treat underlying cause

Question 21

what is auspitz sign

Answer 21

• bleeding after removal of scale

Question 22

what is koebner phenomenon

Answer 22

• lesions induced by trauma

Question 23

what is the most common form of psoriasis

Answer 23

• plaque psoriasis

Question 24

what is the pathogenesis of psoriasis

Answer 24

• cytokines trigger hyper proliferative state resulting in thick skin and excess scale

Question 25

how can trauma (ie Koebner phenomenon) trigger or fuel psoriasis

Answer 25

- increases cytokines

Question 26

psoriasis can be more severe in patients with \_\_\_\_\_

Answer 26

- HIV

Question 27

key areas for psoriasis

Answer 27

- scalp - ears - extensor surfaces - umbilicus - gluteal cleft - nails - sites of recent trauma

Question 28

what does psoriatic onychodystrophy indicate

Answer 28

- nail psoriasis - higer risk of psoriatic arthritis

Question 29

what you see in psoriatic onychodystrophy

Answer 29

- pitting - depressions of nail plate surface - onycholyisis - separation of the nail plate from the nail bed - subungual hyperkeratosis - abnormal keratinization of the distal nail bed

Question 30

most common joints in psoriatic arthritis

Answer 30

- distal interphalangeal joints

Question 31

what treatment of psoriasis is indicated if it is localized first line agents

Answer 31

- topical treatment - high potency topical steroid +/- calcipotriene

Question 32

topical medications for psoriasis are more effective when used with _____ with allows for better penetration

Answer 32

- occlusion

Question 33

what treatment is used in addition to topical treatment for moderate-severe disease or for limited disease with high impact on quality of life

Answer 33

- systemic treatment

Question 34

should oral steroids be used in psoriasis why

Answer 34

- no - can severely flare psoriasis upon discontinuation

Question 35

3 choices for systemic treatment

Answer 35

- phototherapy - oral medications - biologic agents

Question 36

phototherapy for systemic treatment of psoriasis

Answer 36

- narrow band UVB light - psoralen plus UVA light

Question 37

oral medications systemic treatment of psoriasis

Answer 37

- methotrexate - acitretin - cyclosporine

Question 38

biologic agents for systemic treatment of psoriasis

Answer 38

- TNF-alpha inhibitors - IL 12/23 blocker

Question 39

up to 90% of patients with psoriatic arthritis may have ____ changes

Answer 39

- nail changes