psoriasis

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Questions and Answers

What are the two main types of psoriasis commonly recognized?

Plaque psoriasis and guttate psoriasis are the two main types.

Describe the key histopathological feature of psoriasis.

The key histopathological feature of psoriasis is the presence of a thickened epidermis with parakeratosis and a band-like infiltrate of lymphocytes in the dermis.

What is the defining characteristic of Pityriasis Rosea?

Pityriasis Rosea is characterized by a herald patch followed by a widespread rash in a Christmas tree distribution.

What treatment options are available for managing psoriasis?

Treatment options for psoriasis include topical corticosteroids, systemic medications such as methotrexate, and phototherapy. Signup and view all the answers

Explain the relationship between psoriasis and psoriatic arthritis.

Psoriatic arthritis is a chronic inflammatory arthritis that can occur in patients with psoriasis, affecting joints and causing pain. Signup and view all the answers

What is the most common type of psoriasis characterized by well-demarcated lesions?

Plaque psoriasis (vulgaris) Signup and view all the answers

Name one histopathological feature associated with psoriasis.

Acanthosis Signup and view all the answers

Describe one characteristic of guttate psoriasis.

Acute onset of raindrop-sized lesions on the trunk and extremities. Signup and view all the answers

What type of psoriasis is characterized by pustular lesions and may become life-threatening?

Pustular psoriasis Signup and view all the answers

State one potential manageability issue associated with palmoplantar psoriasis.

Functionally disabling for the patient. Signup and view all the answers

Which form of psoriatic arthritis resembles rheumatoid arthritis?

Rheumatoid arthritis-like psoriatic arthritis Signup and view all the answers

What skin change is commonly seen in nail psoriasis?

Nail pitting Signup and view all the answers

Identify a common risk factor for increased psoriasis severity related to lifestyle.

Alcohol consumption Signup and view all the answers

What are some common therapeutic options for patients with psoriasis affecting more than 20% of their body?

Options include UVB therapy, methotrexate, acitretine, cyclosporine, and biological therapies such as adalimumab and etanercept. Signup and view all the answers

Describe the clinical manifestation of pityriasis rosea and its typical presentation.

Pityriasis rosea typically presents with a herald patch, followed by numerous lesions oriented along skin lines, giving a 'Christmas-tree distribution.' Signup and view all the answers

What histopathological feature is commonly observed in psoriasis?

Hyperkeratosis without parakeratosis is a typical histopathological finding in skin affected by psoriasis. Signup and view all the answers

Identify and briefly explain two types of lichen planus.

Two types of lichen planus are annular, characterized by ring-like lesions, and hypertrophic, which features thickened papules. Signup and view all the answers

How does topical treatment for pityriasis rosea address the symptoms?

Topical steroids and antihistamines can help soothe itching and reduce inflammation associated with pityriasis rosea. Signup and view all the answers

What distinguishes guttate psoriasis from other forms of psoriasis?

Guttate psoriasis is characterized by small, drop-shaped lesions often triggered by infections such as strep throat. Signup and view all the answers

Name two biological therapies used for psoriasis and their significance.

Adalimumab and infliximab are biological therapies that target specific immune responses, important for managing moderate to severe psoriasis. Signup and view all the answers

What is the estimated mean duration for pityriasis rosea to resolve without treatment?

The mean duration of pityriasis rosea is about 5 weeks, with more than 80% of cases resolving by 8 weeks. Signup and view all the answers

Study Notes

Psoriasis Treatment

Topical Steroids are used for patients with less than 20% involvement
Calcipotriol (dovonex), Tazorotene, and Anthralene are other topical treatment options
Tar preparations are also used for treatment
Intralesional steroid injection is another treatment option

Psoriasis Treatment - Greater Than 20% Involvement

UVB (Ultraviolet B) and Narrow band Ultraviolet B (NB-UVB) light therapy
PUVA (psoralen and UVA) therapy
Methotrexate
Acitretine
Cyclosporine
Biological therapy (adalimumab, etanercept, infliximab)

Pityriasis Rosea

Common and benign
Usually asymptomatic
Self-limiting skin eruption of unknown etiology
Human herpesvirus 6 is a possible cause
More common in young adults with a 1:1 male to female ratio
More common in spring and fall
Clinical Manifestations:
- Herald patch is the first sign
- Single 2- to 10-cm round to oval lesion
- collarette scale (fine, wrinkled, tissue-like scale attached to border of plaque)
- Frequently located on the trunk or proximal extremities
- Numerous lesions on the back oriented along skin lines give the appearance of "Christmas-tree distribution"
Types:
- Ordinary type
- Papular type
- Inverted type
- Flexural type
- Inflammatory type
- Purpuric type
- Aborted type
Differential Diagnosis:
- Guttate psoriasis
- Secondary Syphilis
- Multiple tinea corporis
- Pityriasis versicolor
- Seborrheoic dermatitis
- Discoid eczema
- Drug rash
Treatment:
- Self-limited
- Topical steroid
- Antihistamine
- Sunlight or artificial UVB
- Erythromycin

Pityriasis Rosea Treatment

Self-limiting
The mean duration is about 5 weeks
More than 80% resolve by 8 weeks without treatment
Most patients only need reassurance
About 25% request treatment for mild to severe pruritus
- Soothing anti-itch lotions available over-the-counter, topical steroids, and oral antihistamines may help
- Quality evidence for these treatments is lacking
Erythromycin given for 2 weeks helped improve the rash in one study, but subsequent studies failed to validate this

Lichen Planus

Types:
- Annular
- Atrophic
- Linear
- Bullous
- Follicular
- Hypertrophic
- Ulcerative
- LP Actinicus

Lichen Planus - Presentation

Typical lesions are violaceous or lilac-coloured, intensely itchy, flat-topped papules
Usually arise on the extremities, particularly on the volar aspects of wrists and legs
Wickham’s striae present (a characteristic pattern of fine whitish lines seen on the surface of the papule)

Lichen Planus - Histopathology

Hyperkratosis without parakeratosis
Papulosquamous Disorders

Papulosquamous Disorders

Psoriasis
Pityriasis Rosea
Lichen Planus

Psoriasis

Chronic multisystem disease
Predominantly skin and joint manifestations
Skin disease characterized by well-defined erythematous plaques covering with a thick whitish-silvery scale
Age of onset occurs in two peaks: ages 20-30 and ages 50-60, but can be seen at any age
About 30% of patients with psoriasis have a first-degree relative with the disease
Waxes and wanes during a patient’s lifetime
Often modified by treatment initiation and cessation
Has few spontaneous remissions

Psoriasis - Auspitz’s sign

Pinpoint bleeding appearing after scratching of psoriatic skin lesion due to thinning epidermis over dermal papillae

Psoriasis - Koebner phenomenon

Appearance of new skin lesion at the site of trauma

Psoriasis - Epidemiology

Affects about 1-3% of the population
Female:male ratio is 1:1
Any age can be affected
Appears most often between 15-40 years

Psoriasis - Pathogenesis

Genetics: Polygenic inheritance with variable penetrance
The sequence of events is unclear
T cell-mediated inflammatory reaction and subsequent epidermal proliferation
Migration of neutrophils into the epidermis
Proliferation of vessels in papillary dermis

Psoriasis - Triggering or Precipitating factors:

Physical trauma (Koebner’s phenomenon)
Infections: Acute streptococcal infection
Stress
Hormonal and Metabolic factors
Sunlight
Drugs: Systemic or Class I topical corticosteroids, oral lithium, antimalarial drugs, interferon, and beta-adrenergic blockers.

Studies have revealed smoking as a risk factor for psoriasis.
Alcohol consumption is more prevalent in patients with psoriasis and it may increase the severity of psoriasis.
A higher BMI is associated with an increased prevalence and severity of psoriasis.

Psoriasis - Histopathology

Hyper and parakeratosis
Acanthosis: Test-tube appearance
Munro microabscess
Dilated and tortuous capillaries
Perivascular inflammatory infiltrate

Psoriasis - Presentation

Plaque psoriasis (vulgaris)
Guttate psoriasis
Scalp psoriasis
Nail psoriasis
Flexural psoriasis
Palmoplantar psoriasis
Pustular psoriasis
Erythrodermic psoriasis
Psoriatic arthropathy

Plaque Psoriasis (vulgaris)

Most common type
Lesions are well demarcated and range from a few millimeters to several centimeters in diameter
Elbows, knees, lower back and scalp are sites of predilection

Flexures Psoriasis

Psoriasis of the submammary, axillary and anogenital folds
Not scaly
Glistening sharply demarcated red plaques

Guttate Psoriasis

Usually seen in children and adolescents
Acute onset of raindrop-sized lesions on the trunk and extremities
Often preceded by streptococcal pharyngitis
May be the first sign of the disease

Nail Psoriasis

Nail pitting
Onycholysis
Subungual hyperkeratosis
Oil spot lesion
Nail dystrophy

Psoriatic Arthropathy

Distal interphalangeal
Asymmetric mono or oligoarthritis
Rheumatoid arthritis-like
Ankylosing spondylitis-like
Arthritis Mutilans

Pustular Psoriasis

Characterized by psoriatic lesions with pustules
Often triggered by corticosteroid withdrawal
When generalized, pustular psoriasis can be life-threatening
These patients should be hospitalized and a dermatologist consulted.

Palmoplantar Psoriasis

May occur as either plaque type or pustular type
Often very functionally disabling for the patient
The skin lesions of reactive arthritis typically occur on the palms and soles and are indistinguishable from this form of psoriasis.

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