Psoriasis

Question 1

psoriasis

Answer 1

• chronic, inflm disorder
• variable course of progression
• recurrence
• lesions develop

Question 2

what age is peak of psoriasis

Answer 2

16-22 & 57-60 yrs

Question 3

etiology

Answer 3

• largely idiopathic

- autoimmunity (HLA & MHC gene mutation)

Question 4

patho

Answer 4

• lesions on surface of body
• no infection present
• cell cycle in epidermis –> rapid cell division & replacement of dead cells

Question 5

basal layer cell cycle

Answer 5

cells grow & get pushed up to surface as dead cells are continuously sloughed off

Question 6

psoriasis cell cycle duration (cell turnover)

Answer 6

~3-4 days

normal is ~30 days

Question 7

rapid cell cycle consequence

Answer 7

incomplete division & differentiation –> cells don’t slough off at top, but remain on surface & stack to form scaly patches on the skin

Question 8

4 components of psoriasis patho

Answer 8

1) autoimmunity
2) inflm
3) accelerated cell cycle & epidermal thickening
4) remissions & exacerbations

Question 9

autoimmunity in psoriasis

Answer 9

skin trauma triggers T-cell response –> T-cells activated –> mediators release that target keratinocytes & cells in blood vessels –> triggers growth in these cells

(more keratinocytes = more keratin [protein])

Question 10

inflm in psoriasis

Answer 10

influx of inflm cells (d/t skin trauma) –> inflm damage further traumatizes skin (initiates cycle)

Question 11

accelerated cell cycle & epidermal thickening in psoriasis

Answer 11

hyperkeratosis –> abn growth of keratinocytes & inc epidermal cell turnover –> scaly patches

Question 12

remissions & exacerbations in psoriasis

Answer 12

exacerbations triggered by varying things (ex. emotional stress, physical trauma, infection, drugs)

Question 13

mnfts

Answer 13

• psoriatic patches
• nail dystrophy, erosion & pitting
• psoriatic arthritis in distal joints (cmplx)

Question 14

common areas for psoriatic patches

Answer 14

knees, elbows, scalp

Question 15

cause of nail dystrophy, erosion & pitting

Answer 15

d/t abn amount of keratin

Question 16

Tx

Answer 16

• incurable
• manage disease progression
• topical cream/ointment to affected areas
• systemic management

Question 17

topical creams/ointment used

Answer 17

• salicylic acid
• coal tar
• anthralin
• steroids
• vitamin D
• retinoids

Question 18

systemic management

Answer 18

• methotrexate
• cyclosporine
• biologic agents
• phototherapy

Question 19

methotrexate (anti-folate)

Answer 19

Immunomodulatory drug inhibits folic acid action (involved in DNA replication & cell division) –> blocks cell division –> dec turnover of keratinocytes & T-cells

Question 20

cyclosporine

Answer 20

immunomodulatory drug

Question 21

biologic agents

Answer 21

TNF (tumor necrosis factor):

• apoptosis of cells
• regression of tumors

Question 22

phototherapy

Answer 22

Apply photons to specific areas of integument –> dec rate of cell proliferation