Podcast
Questions and Answers
What is the primary mechanism causing psoriasis at the cellular level?
What is the primary mechanism causing psoriasis at the cellular level?
Which type of psoriasis accounts for the majority of psoriatic patients?
Which type of psoriasis accounts for the majority of psoriatic patients?
What is one of the associated co-morbidities in moderate to severe psoriasis?
What is one of the associated co-morbidities in moderate to severe psoriasis?
Which of the following is a common triggering factor for psoriasis?
Which of the following is a common triggering factor for psoriasis?
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In which areas of the body does chronic plaque psoriasis most commonly manifest?
In which areas of the body does chronic plaque psoriasis most commonly manifest?
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What age group is associated with Type I onset of psoriasis?
What age group is associated with Type I onset of psoriasis?
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Which of the following statements correctly describes the morphology of plaque psoriasis?
Which of the following statements correctly describes the morphology of plaque psoriasis?
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What percentage of the worldwide population is estimated to be affected by psoriasis?
What percentage of the worldwide population is estimated to be affected by psoriasis?
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What characteristic is most commonly associated with chronic plaque psoriasis?
What characteristic is most commonly associated with chronic plaque psoriasis?
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Which type of psoriasis is characterized by lesions that commonly occur in skin folds and lack visible scaling?
Which type of psoriasis is characterized by lesions that commonly occur in skin folds and lack visible scaling?
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Which nail sign is NOT commonly associated with psoriatic nail disease?
Which nail sign is NOT commonly associated with psoriatic nail disease?
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What percentage of psoriatic arthropathy cases are asymmetric?
What percentage of psoriatic arthropathy cases are asymmetric?
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Which condition is characterized by a shower of discrete lesions following a streptococcal throat infection?
Which condition is characterized by a shower of discrete lesions following a streptococcal throat infection?
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What is a notable feature of plantar psoriasis?
What is a notable feature of plantar psoriasis?
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Which of the following best describes the appearance of well-demarcated lesions in chronic plaque psoriasis?
Which of the following best describes the appearance of well-demarcated lesions in chronic plaque psoriasis?
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What percentage of psoriasis patients is reported to have genital involvement?
What percentage of psoriasis patients is reported to have genital involvement?
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Which treatment is contraindicated for traditional systemic treatment of psoriasis?
Which treatment is contraindicated for traditional systemic treatment of psoriasis?
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What is the role of IL-17 inhibitors in psoriasis treatment?
What is the role of IL-17 inhibitors in psoriasis treatment?
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Which of the following is a recently approved monotherapy for generalized pustular psoriasis (GPP)?
Which of the following is a recently approved monotherapy for generalized pustular psoriasis (GPP)?
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What condition refers to the inflammation of joints in patients with psoriasis?
What condition refers to the inflammation of joints in patients with psoriasis?
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Which medication is a selective tyrosine kinase 2 inhibitor approved for moderate to severe plaque psoriasis?
Which medication is a selective tyrosine kinase 2 inhibitor approved for moderate to severe plaque psoriasis?
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What is a common site for psoriasis manifestations?
What is a common site for psoriasis manifestations?
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Which of the following medications is an oral phosphodiesterase 4 inhibitor approved for psoriasis?
Which of the following medications is an oral phosphodiesterase 4 inhibitor approved for psoriasis?
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Which biological agent is classified as an anti-TNF alpha therapy?
Which biological agent is classified as an anti-TNF alpha therapy?
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What condition is classified as a dermatological emergency due to its potentially life-threatening nature?
What condition is classified as a dermatological emergency due to its potentially life-threatening nature?
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Which of the following symptoms is NOT associated with Generalised Pustular Psoriasis?
Which of the following symptoms is NOT associated with Generalised Pustular Psoriasis?
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Which treatment is NOT typically recommended for Generalised Pustular Psoriasis?
Which treatment is NOT typically recommended for Generalised Pustular Psoriasis?
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What is a common complication of Erythrodermic Psoriasis?
What is a common complication of Erythrodermic Psoriasis?
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Which of the following is a primary indication for systemic therapy in psoriasis?
Which of the following is a primary indication for systemic therapy in psoriasis?
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Which novel topical therapy for plaque psoriasis was FDA approved in July 2022?
Which novel topical therapy for plaque psoriasis was FDA approved in July 2022?
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Which treatment modality is generally considered first-line for mild to moderate localized psoriasis?
Which treatment modality is generally considered first-line for mild to moderate localized psoriasis?
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What systemic complication can arise from Erythrodermic Psoriasis?
What systemic complication can arise from Erythrodermic Psoriasis?
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Study Notes
Psoriasis Overview
- Psoriasis is a complex, chronic, multifactorial, inflammatory immune-mediated disease.
- It involves hyperproliferation of keratinocytes in the epidermis, increasing the epidermal cell turnover rate.
- Psoriasis onset is bimodal, occurring at any age from infancy to adulthood.
- Common manifestation sites include elbows, knees, scalp, lumbosacral areas, intergluteal clefts, and glans penis.
- Joint involvement is observed in up to 30% of patients.
Psoriasis Treatment
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Treatment strategies are tailored based on several factors:
- Surface area of involvement
- Affected body sites
- Presence/absence of arthritis
- Plaque thickness and scaling
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Mild to moderate localized psoriasis initially responds to topical therapy.
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Severe or extensive disease often requires a combined approach, incorporating systemic therapy, phototherapy, and/or immunosuppressive treatments.
Types of Psoriasis
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Plaque Psoriasis (Vulgaris): Accounts for 80-90% of cases.
- Presents as chronic, demarcated red/pink plaques.
- Characterized by copious silver-white scaling.
- Often shows Koebner's phenomenon (lesions appearing at sites of trauma).
- Affects extensor surfaces of elbows and knees, scalp, lumbosacral areas, intergluteal clefts, and glans penis.
- Up to 45% of patients experience genital involvement.
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Guttate Psoriasis:
- Often follows a streptococcal throat infection.
- Characterized by numerous small, discrete, drop-like lesions (3mm-1cm).
- Lesions are typically round or slightly oval in shape.
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Inverse Psoriasis:
- Usually occurs in skin folds.
- Lesions lack the scaling commonly observed in other psoriasis types.
- Characterized by shiny pink-to-red, sharply demarcated plaques.
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Plantar Psoriasis:
- Specifically affects the soles of the feet.
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Nail Psoriasis:
- Nail involvement is common, with symptoms like pits, onycholysis, subungual hyperkeratosis, and salmon drop/oil drop lesions.
- Nail involvement can be difficult to treat.
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Erythrodermic Psoriasis:
- Characterized by generalized erythema and scaling affecting 80-90% of the body surface area.
- Systemic symptoms are common, including edema, tachycardia, protein/fluid loss, hypothermia, causing a dermatologic emergency.
- Common underlying causes include severe psoriasis, atopic dermatitis, mycosis fungoides, and drug reactions.
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Pustular Psoriasis:
- Localized: Palms and soles are commonly affected. Presenting as sterile pustules on an erythematous base.
- Generalized: Can be life-threatening, presenting with abrupt onset, fever, tender skin lesions. Requires immediate medical attention.
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Psoriatic Arthropathy:
- Involves joint inflammation in up to 30% of people with psoriasis
- Five types exist:
- Asymmetric (60-70%)
- Symmetric Polyarthritis
- DIP
- Destructive
- Axial Arthritis
Topical Treatment
- Primarily for mild-to-moderate localized psoriasis.
- Novel topical therapies include topical phosphodiesterase 4 inhibitors (Roflumilast, Tapinarof).
Systemic Treatment
- Used for extensive or severe psoriasis.
- Traditional: Methotrexate, ciclosporine, retinoids (acitretin)
- Novel: Apremilat, JAK inhibitors
- Biological Agents: targeting inflammatory cytokines (TNF-α, IL-17, IL-12, IL-23), including monoclonal antibody therapies and IL-17 / IL-23 inhibitors
Future Treatment Trends
- Research focuses on developing targeted therapies, particularly directed at specific inflammatory pathways involved in psoriasis.
- Investigating new biologics for various inflammatory targets (p40, IL-12, IL-23, TNF-alpha, IL-22 pathways) demonstrates advancement in potential future therapies for psoriasis treatment.
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Description
This quiz covers the essential aspects of psoriasis, including its definition, causes, and treatment approaches. It also delves into the different types of psoriasis and the factors influencing treatment decisions. Test your knowledge on this complex, multifactorial disease and its management.
