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Flashcards in Miscellaneous Skin Conditions Deck (74)
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1

Epidemiology of Psoriasis

Men = Females
Hereditary
More prevalent further from the equator

2

Pathophysiology of Psoriasis

Cell turnover: 4 days
Normal cell keratinization does not take place
Subnormal blood vessel dilation
Autoimmune component: T lymphocytes

3

Psoriasis Risk Factors

Family Hx
Strep infection can trigger guttate psoriasis
Medications: beta blockers, lithium, anti-malaria
Smoking, obesity, & alcohol
Vitamin D deficiency?

4

Presentation of Psoriasis

Bimodal age distribution: 30-39, 50-69
Gradual or sudden in onset
Pruritus common
Hx of improvement with sun exposure

5

Associated Conditions with Psoriasis

Psoriatic arthritis
CV disease
Malignancy
DM
Metabolic syndrome
HTN
IBD
Serious Infections
Ocular involvement: swollen lids, conjunctivitis, xerosis, uveitis

6

Types of Psoriasis

Plaque
Inverse
Guttate
Erythrodermic
Pustular
Nails

7

Where does plaque psoriasis typically appear?

Knees
Scalp
Elbows
Lower back
Can affect the nails

8

Plaque Psoriasis Presentation

Salmon pink papule & plaques
Sharply marginated with marked silvery-white scaling
Scales are loose, easily removed by scratching
Auspitz sign
Koebner's phenomenon

9

Define Auspitz Sign

Pinpoint bleeding under the scale

10

Define Koebner's Phenomenon

Psoriasis plaques that form at the site of a skin injury
Occurs 1-2 weeks after injury

11

What can Koebner's phenomenon occur from?

Bug bites
Bruises & scrapes
Poison ivy or poison oak
Burns (sun & chemical)
Constant pressure & rubbing
Injections or vaccinations
Skin blemishes from acne, herpes, or chickenpox
Acupuncture or tattoo needles

12

Distribution of Psoriatic Lesions

Symmetrical
Favors elbows, knees, intertriginous areas
Can be localized or all over the body
Extensor surfaces

13

Inverse Psoriasis Locations

Axilla
Groin
Naval
Submammary region
Palms
Scalp
Soles

14

Inverse Psoriasis Characteristics

Common in overweight persons
No scales
Biopsy to differentiate from candidiasis

15

Define Guttate Psoriasis

Eruptive psoriasis

16

Characteristics of Guttate Psoriasis

Small teardrop shape erythematous papule
Scattered diffusely on proximal extremities & trunk

17

Treatment of Guttate Psoriasis

Self limiting (weeks to months)

18

Erythrodermic Psoriasis Presentation

Erythema & scaling head to toe
Inflammatory
Severe pruritis & pain as skin reddens & sheds

19

What is erythrodermic psoriasis have a high risk of?

Systemic infection
Electrolyte imbalances

20

Presentation of Pustular Psoriasis

Acute onset
Widespread erythema, scaling, & sheets of pustules with erosions
Malaise
Fever
Diarrhea
Leukocytosis
Hypocalcemia

21

WHICH SKIN conditions can be life-threatening?

Erythrodermic psoriasis
Pustular psoriasis
Pemphigus
Bullous Pemphigoid

22

Nail Psoriasis

Associated with psoriatic arthritis
Appear before onset of cutaneous psoriasis

23

Presentation of Nail Psoriasis

Nail pitting
Oil drop sign
Subungual hyperkeratosis

24

Treatment of Plaque Psoriasis

Exacerbating factors
Topical therapy
Systemic therapy

25

Drugs That May Exacerbate Psoriasis

Beta-blockers
NSAIDs
Lithium
ACEi
Digoxin

26

Topical Therapy for Plaque Psoriasis

Emollients
Steroids
Vitamin D analogues
Topical retinoids
Calcineurin inhibitors
Coal tar preparations
Phototherapy: UVA, UVB

27

MOA of Emollients

Hydrate stratum corneum
Decrease water evaporation
Soften the scales

28

Examples of Emollients

Eucerin
Lubriderm
Moisturel

29

Education of Emollients

Apply after bathing while skin is still damp

30

What is first line for plaque psoriasis?

Topical steroids