Podcast
Questions and Answers
What is the primary characteristic of psoriatic lesions?
What is the primary characteristic of psoriatic lesions?
Which factor is NOT mentioned as a provocative factor for psoriasis?
Which factor is NOT mentioned as a provocative factor for psoriasis?
What is a significant family history finding in psoriasis patients?
What is a significant family history finding in psoriasis patients?
In psoriatic skin, what is the transit time for epidermal cell maturation?
In psoriatic skin, what is the transit time for epidermal cell maturation?
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In which age group is psoriasis most likely to first appear?
In which age group is psoriasis most likely to first appear?
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Which of the following is a common type of infection that may trigger guttate psoriasis?
Which of the following is a common type of infection that may trigger guttate psoriasis?
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Which drug class may trigger psoriasis in genetically predisposed individuals?
Which drug class may trigger psoriasis in genetically predisposed individuals?
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How does exposure to sunlight and humidity affect psoriasis?
How does exposure to sunlight and humidity affect psoriasis?
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What is the main symptom of Lichen Planus (LP)?
What is the main symptom of Lichen Planus (LP)?
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Which of the following groups is most affected by Lichen Planus?
Which of the following groups is most affected by Lichen Planus?
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Which clinical type of Lichen Planus is associated with painful ulcerative lesions on mucous membranes?
Which clinical type of Lichen Planus is associated with painful ulcerative lesions on mucous membranes?
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What precipitating factor is specifically mentioned that may contribute to Lichen Planus?
What precipitating factor is specifically mentioned that may contribute to Lichen Planus?
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How long may Lichen Planus lesions on mucous membranes persist?
How long may Lichen Planus lesions on mucous membranes persist?
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Which medication is used as a topical treatment for Lichen Planus?
Which medication is used as a topical treatment for Lichen Planus?
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Which of the following is a potential differential diagnosis for Lichen Planus?
Which of the following is a potential differential diagnosis for Lichen Planus?
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What is a potential role of stress in Lichen Planus patients?
What is a potential role of stress in Lichen Planus patients?
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Which clinical type of psoriasis is most commonly associated with nail involvement?
Which clinical type of psoriasis is most commonly associated with nail involvement?
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What distinguishes the scales of psoriasis from those of seborrheic dermatitis?
What distinguishes the scales of psoriasis from those of seborrheic dermatitis?
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In which area of the body does flexural psoriasis commonly appear?
In which area of the body does flexural psoriasis commonly appear?
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What characteristic is NOT commonly associated with nail psoriasis?
What characteristic is NOT commonly associated with nail psoriasis?
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Which type of psoriasis is often preceded by an acute streptococcal infection?
Which type of psoriasis is often preceded by an acute streptococcal infection?
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What is a common symptom of palmoplantar psoriasis?
What is a common symptom of palmoplantar psoriasis?
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Which of the following findings is associated with the oil spot phenomenon in nail psoriasis?
Which of the following findings is associated with the oil spot phenomenon in nail psoriasis?
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What is the most common presentation of psoriatic arthritis?
What is the most common presentation of psoriatic arthritis?
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Auspitz's sign, observed by scraping psoriasis lesions, demonstrates what characteristic?
Auspitz's sign, observed by scraping psoriasis lesions, demonstrates what characteristic?
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Which statement about arthritis mutilans is correct?
Which statement about arthritis mutilans is correct?
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What joint involvement is most commonly associated with arthropathic psoriasis?
What joint involvement is most commonly associated with arthropathic psoriasis?
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Which type of psoriasis is characterized by pustules?
Which type of psoriasis is characterized by pustules?
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In psoriatic arthritis, which joint is unusual for being primarily affected?
In psoriatic arthritis, which joint is unusual for being primarily affected?
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What condition is often associated with spondylitis in psoriatic arthritis?
What condition is often associated with spondylitis in psoriatic arthritis?
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Which of the following clinical features is NOT typical of lichen planus?
Which of the following clinical features is NOT typical of lichen planus?
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Which findings would you expect to see in a skin biopsy for psoriatic arthritis?
Which findings would you expect to see in a skin biopsy for psoriatic arthritis?
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Study Notes
Papulosquamous Skin Diseases
- Papulosquamous disorders are conditions characterized by papules and scaly plaques.
Psoriasis
- Psoriasis is a common, chronic, scaly, immune-mediated disease affecting people of all ages (approximately 2%).
- It's typically a lifelong condition with no cure, but treatments help manage symptoms.
- Genetic predisposition is a significant factor; up to 50% of patients have a positive family history.
- Environmental factors also play a role in the development of psoriasis in genetically predisposed individuals.
- The exact cause of psoriasis isn't known; however, it's believed to involve an immune reaction leading to increased epidermal cell proliferation.
- The transit time for epidermal cell maturation from the basal layer to the surface is significantly reduced in psoriatic skin (3-4 days compared to 28 days in normal skin).
- The prevalence of psoriasis in the population is estimated to be 1-2%.
- The disease typically first manifests in the late teens and 50s. Both sexes are equally affected, although in children, girls are more commonly affected than boys (HLA-Cw6).
Provocative Factors for Psoriasis
- Trauma: Psoriasis lesions often develop at sites of prior trauma or injury (e.g., scratching, the Koebner phenomenon).
- Calcium Metabolism: Abnormalities in calcium metabolism, such as hypocalcaemia, may contribute to psoriasis.
- Immunologic Abnormalities: Underlying immune system abnormalities are associated with psoriasis.
- Infections: Streptococcal infections, particularly sore throat, are often implicated in triggering psoriasis, particularly in cases of guttate psoriasis.
- Medications: Certain drugs (e.g., antimalarials, beta-blockers, and lithium) can induce psoriasis in genetically susceptible individuals.
- Climate/Environment: Psoriasis may be influenced by environmental factors such as sunlight exposure and humidity.
- Psychological Factors: Stress and emotional distress can be triggers for psoriasis outbreaks.
- Endocrine Factors: Hormonal changes, such as during pregnancy, may contribute to psoriasis exacerbations.
Clinical Features of Psoriasis
- The primary lesion in psoriasis is a well-defined, erythematous plaque covered by laminated silvery scales.
- Common affected sites include extensor surfaces of the limbs (elbows, knees), the sacral area, and the scalp.
- Psoriasis lesions are often asymptomatic, although mild itching may occur, particularly in flexural psoriasis.
Clinical Types of Psoriasis
- Chronic Plaque Psoriasis (Psoriasis Vulgaris): This is the most common type, characterized by well-defined, erythematous plaques covered by silvery scales. Often associated with nail involvement. Scraping the lesion with a glass slide produces pinpoint bleeding (Auspitz sign).
- Guttate Psoriasis: This type primarily affects children and young adults, presenting with small, rounded, raindrop-like lesions typically on the trunk. Often preceded by a streptococcal infection.
- Scalp Psoriasis: Erythematous, well-defined, scaly areas on the scalp, typically noticeable at the hairline and behind the ears. Crucial to differentiate it from seborrheic dermatitis, which has different scale characteristics.
- Flexural Psoriasis: Occurs in body folds, where scales may appear less prominent due to skin friction and moisture. Itching is common.
- Nail Psoriasis: Characterized by nail pitting, onycholysis (separation of the nail from the nail bed), and subungual hyperkeratosis (thickening of the tissue under the nail).
- Palmoplantar Psoriasis: Affects the palms and soles, typically presenting as red, dry, thickened skin with deep fissures.
Classification of Psoriatic Arthritis
- Mono- and Asymmetric Oligoarthritis: Inflammation of the interphalangeal joints (both distal and proximal) of the hands and feet is most common. Can manifest as a "sausage digit."
- Asymmetric Distal Interphalangeal Arthritis: Similar to rheumatoid arthritis, but primarily targets smaller joints, such as in the fingers.
- Spondylitis and Sacroiliitis: Axial spondylitis (inflammation of the spine) can mimic ankylosing spondylitis. Peripheral joint involvement is also possible.
Lichen Planus (LP)
- LP is a chronic inflammatory skin disease characterized by itchy, flat-topped, violaceous (purple) papules.
- It often affects the mucous membranes (appearing as lacy white patches).
- The exact cause of LP is unknown, and no specific pathogen has been identified.
- Genetic factors appear important.
- LP can be triggered by trauma (Koebner phenomenon).
- Some evidence suggests that hepatitis C virus involvement may be a contributing factor.
- Stress may also play a part in the spread of lesions.
- Certain medications (e.g., antimalarials, NSAIDs, and gold) have been associated with causing LP.
- LP frequently affects women more than men.
- While the skin form often resolves within 1-2 years, the mucous membrane form is more persistent (5+ years), and more resistant to treatment.
Clinical Features of Lichen Planus (LP)
- LP is primarily characterized by intense itching.
- Lesions are commonly found on the flexural surfaces of the wrists, forearms, legs, genitals, and mucous membranes of the cheeks and mouth.
- Characteristic lesions are violaceous, shiny, flat-topped, and polygonal.
- Close examination often reveals a lacy, reticular (net-like) pattern of whitish lines known as Wickham's striae.
Clinical Types of Lichen Planus (LP)
- Ordinary LP: The most common type.
- Hypertrophic LP: Characterized by thickened, raised lesions.
- Linear LP: Lesions arranged in lines or grooves.
- Lichen Planus Actinic: LP in sun-exposed areas.
- Follicular LP: LP affecting hair follicles.
- LP of the nails: Potential nail changes, such as pterygium and nail dystrophy.
- LP of the mucous membranes: often presenting as lacy white, painful ulcers.
- Atrophic LP: Characterized by thinning of the skin.
- Bullous LP: LP with blisters.
- Generalized LP: LP affecting a large body area.
Diagnosis and Treatment of Psoriasis
- Diagnosis typically involves a skin examination. In some conditions like nail psoriasis, a visual inspection is sufficient
- Additional tests may include scraping of the lesion (grattage test) to assess blood vessel damage.
- Several treatment options can help to manage symptoms.
- Topical treatments (eg emollients, moisturizers, keratolytics) are helpful.
- Systemic treatments are considered for more severe cases, often utilizing immune-modulatory agents and oral medications, along with phototherapy.
Diagnosis and Treatment of Lichen Planus (LP)
- Diagnosis relies on clinical examination and biopsy, often to differentiate it from similar skin conditions
- Treatment involves addressing the symptoms, with topical and oral medications as well
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Description
Explore the complexities of papulosquamous skin diseases, focusing specifically on psoriasis. This quiz covers the characteristics, genetic predisposition, environmental factors, and treatment options available for this chronic condition. Understand the underlying mechanisms and prevalence of psoriasis in the population.
