Lecture 7 Part 1
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What demographic group has the highest incidence of psoriasis?

  • Caucasians (correct)
  • Hispanics
  • African-Americans
  • Asians

    • At what age range is the incidence of psoriasis typically highest?

  • Childhood
  • Teenage years
  • 20s (correct)
  • 60s

    • What is the most common type of psoriasis?

  • Pustular psoriasis
  • Guttate psoriasis
  • Inverse psoriasis
  • Chronic plaque psoriasis (correct)

    • What percentage of the body coverage classifies psoriasis as 'moderate to severe'?

    <p>10%</p> Signup and view all the answers

    Guttate psoriasis most commonly follows which type of infection?

    <p>Streptococcal infection</p> Signup and view all the answers

    What is a characteristic feature of chronic plaque psoriasis?

    <p>Sharply-bordered, red plaques with silvery scale</p> Signup and view all the answers

    What is the heritability chance of psoriasis if one parent is affected?

    <p>10%</p> Signup and view all the answers

    Which of the following types of psoriasis is predominantly localized to the hands and feet?

    <p>Pustular psoriasis</p> Signup and view all the answers

    Which type of arthritis is characterized by a 'pencil in cup' deformity on x-ray?

    <p>Arthritis mutilans</p> Signup and view all the answers

    What is the Auspitz sign associated with?

    <p>The appearance of blood drops when scales are removed</p> Signup and view all the answers

    Which factors are known to exacerbate psoriasis?

    <p>Cold weather and lack of sunlight</p> Signup and view all the answers

    In which condition may psoriatic arthritis manifest without skin manifestations?

    <p>Psoriatic arthritis</p> Signup and view all the answers

    Which of the following is NOT a classic pathological finding in psoriasis?

    <p>Thickening of the dermal layer</p> Signup and view all the answers

    What is the Koebner phenomenon?

    <p>Development of plaques from skin trauma</p> Signup and view all the answers

    What is the typical course of psoriasis disease?

    <p>Chronic with remissions and exacerbations</p> Signup and view all the answers

    What is a major side effect of Acitretin?

    <p>Hypertriglyceridemia</p> Signup and view all the answers

    In which of the following patients is Methotrexate contraindicated due to an increased risk of liver toxicity?

    <p>A patient who is diabetic</p> Signup and view all the answers

    What is the recommended time frame for a woman to avoid pregnancy after receiving a single dose of Acitretin?

    <p>3 years</p> Signup and view all the answers

    What is the primary limitation in the use of biologic therapy for psoriasis?

    <p>High cost</p> Signup and view all the answers

    What is a common characteristic of seborrheic dermatitis?

    <p>Non-adherent, greasy, yellow-white scale</p> Signup and view all the answers

    Which medication needs regular CBC checks due to the risk of bone marrow toxicity?

    <p>Methotrexate</p> Signup and view all the answers

    What is a common area affected by seborrheic dermatitis?

    <p>Scalp</p> Signup and view all the answers

    Which therapy is considered first line for treating seborrheic dermatitis?

    <p>Ketoconazole cream</p> Signup and view all the answers

    What is a notable long-term risk of Cyclosporine treatment?

    <p>Renal function loss</p> Signup and view all the answers

    Which area is likely to be affected by seborrheic dermatitis?

    <p>Oily areas of the skin</p> Signup and view all the answers

    Which of the following best describes the seasonal variation of seborrheic dermatitis?

    <p>Worsens in fall/winter</p> Signup and view all the answers

    What is a primary characteristic that differentiates perioral dermatitis from rosacea?

    <p>A thin rim of normal skin separating the lips from the rash</p> Signup and view all the answers

    What cause is primarily linked to the development of perioral dermatitis?

    <p>Application of steroids to the perioral skin</p> Signup and view all the answers

    Which of the following shampoos is effective for treating seborrheic dermatitis on the scalp?

    <p>Pyrithione zinc shampoo</p> Signup and view all the answers

    How does the effectiveness of narrowband UVB compare to regular UVB?

    <p>More effective</p> Signup and view all the answers

    Severe seborrheic dermatitis can indicate serious underlying conditions. Which of the following is associated?

    <p>HIV</p> Signup and view all the answers

    What significant side effect is associated with PUVA therapy?

    <p>Severe sunburn-like reactions</p> Signup and view all the answers

    What is an undesirable effect of applying steroids to the perioral area?

    <p>Promotes the development of perioral dermatitis</p> Signup and view all the answers

    What condition indicates the need for systemic therapy in psoriasis?

    <p>Greater than 10% body surface area involvement</p> Signup and view all the answers

    How often must patients undergo narrowband UVB treatments at a dermatologist's office?

    <p>Three times a week</p> Signup and view all the answers

    What major concern is associated with the long-term use of PUVA therapy?

    <p>Skin cancer</p> Signup and view all the answers

    What is the primary treatment consideration when determining therapy for psoriasis?

    <p>Severity of disease</p> Signup and view all the answers

    Which type of psoriasis treatment is generally effective for patients with up to 10% body involvement?

    <p>Topical therapy</p> Signup and view all the answers

    What are the potential side effects of long-term use of topical steroids?

    <p>Skin thinning and telangiectasia</p> Signup and view all the answers

    What is a known drawback of calcipotriene as a topical treatment for psoriasis?

    <p>Slow onset of action</p> Signup and view all the answers

    At what age is the incidence of psoriasis second highest?

    <p>60s</p> Signup and view all the answers

    Which psoriasis type is characterized by sharply-bordered, red plaques with silvery scales?

    <p>Chronic plaque psoriasis</p> Signup and view all the answers

    What is a notable risk factor for worse psoriasis disease outcomes?

    <p>Childhood onset</p> Signup and view all the answers

    Which type of psoriasis may involve hundreds of small plaques and often follows a streptococcal infection?

    <p>Guttate psoriasis</p> Signup and view all the answers

    What percentage of psoriasis patients are reported to have at least one affected relative?

    <p>33%</p> Signup and view all the answers

    In which demographic is psoriasis least prevalent?

    <p>African-Americans</p> Signup and view all the answers

    Which characteristic is typical of pustular psoriasis?

    <p>Small pustules on red bases</p> Signup and view all the answers

    What body coverage is classified as 'moderate to severe' in psoriasis?

    <p>10% or more</p> Signup and view all the answers

    What is the percentage concordance of psoriasis between monozygotic twins?

    <p>65%</p> Signup and view all the answers

    What type of infections are often associated with the initiation or exacerbation of psoriasis?

    <p>Streptococcal infections</p> Signup and view all the answers

    Which cytokine is NOT mentioned as being upregulated in psoriatic lesions?

    <p>IL-15</p> Signup and view all the answers

    Which of the following is considered a systemic treatment for psoriasis?

    <p>Methotrexate</p> Signup and view all the answers

    What is a potential short-term side effect of prolonged use of topical steroids in psoriasis treatment?

    <p>Telangiectasia</p> Signup and view all the answers

    What treatment is recommended for psoriasis with more than 10% body area affected?

    <p>Systemic therapy or ultraviolet light therapy</p> Signup and view all the answers

    How does the onset time of calcipotriene compare to topical steroids in psoriasis treatment?

    <p>Works slower than topical steroids</p> Signup and view all the answers

    What impact does psoriasis have on patients' quality of life compared to congestive heart failure?

    <p>Is equally impactful as heart failure</p> Signup and view all the answers

    What triggers pustular psoriasis of Von Zumbusch in patients with pre-existing psoriasis?

    <p>Discontinuation of systemic steroids</p> Signup and view all the answers

    What type of psoriasis is characterized by moist, red plaques with sharp borders and little scale, primarily affecting body folds?

    <p>Inverse psoriasis</p> Signup and view all the answers

    What serious systemic complications can occur with erythrodermic psoriasis?

    <p>Hypocalcemia and electrolyte abnormalities</p> Signup and view all the answers

    Which of the following features is NOT associated with nail psoriasis?

    <p>Bright red coloration</p> Signup and view all the answers

    What is a distinguishing characteristic of psoriatic arthritis?

    <p>It can manifest in the absence of skin symptoms</p> Signup and view all the answers

    Which type of psoriasis can develop suddenly in patients with no previous history of this condition?

    <p>Erythrodermic psoriasis</p> Signup and view all the answers

    How is inverse psoriasis commonly misdiagnosed?

    <p>As a fungal infection</p> Signup and view all the answers

    How many nails can be affected by nail psoriasis?

    <p>Any number from one to all 20 nails</p> Signup and view all the answers

    What side effect is commonly associated with Tazarotene when it is applied?

    <p>Skin irritation</p> Signup and view all the answers

    What is a primary reason for using systemic therapies in psoriasis treatment?

    <p>To manage severe disease affecting greater than 10% of the body</p> Signup and view all the answers

    What is a recommended application schedule for calcipotriene after a month of mixed treatment?

    <p>On weekdays only</p> Signup and view all the answers

    Which therapy specifically involves taking a medication before treatment to increase effectiveness?

    <p>PUVA</p> Signup and view all the answers

    What significant long-term risk is associated with PUVA therapy?

    <p>Skin cancer</p> Signup and view all the answers

    What is the mechanism of action for Tazarotene as a psoriasis treatment?

    <p>It is a vitamin A analog/retinoid</p> Signup and view all the answers

    Why is narrowband UVB therapy preferred over regular UVB therapy?

    <p>It emits a more effective and specific wavelength of light</p> Signup and view all the answers

    Which of the following oral medications is commonly used for psoriasis treatment and requires regular monitoring?

    <p>Methotrexate</p> Signup and view all the answers

    What is the major side effect of Acitretin that requires careful monitoring?

    <p>Hypertriglyceridemia</p> Signup and view all the answers

    Which population has an increased risk of liver toxicity when using Methotrexate?

    <p>Patients who drink alcohol</p> Signup and view all the answers

    What is the recommended waiting period for women to avoid pregnancy after receiving a single dose of Acitretin?

    <p>Three years</p> Signup and view all the answers

    What is a common minor side effect experienced by patients taking Acitretin?

    <p>Dry skin</p> Signup and view all the answers

    Which of the following medications is known to suppress the immune system significantly?

    <p>Cyclosporine</p> Signup and view all the answers

    What is one major concern patients face when using biologic therapy for psoriasis?

    <p>High cost</p> Signup and view all the answers

    In which of the following scenarios is the risk of irreversible renal function loss greatest?

    <p>Patients on Cyclosporine for over one year</p> Signup and view all the answers

    Which condition is known to worsen seborrheic dermatitis particularly during specific seasons?

    <p>Dryness of winter</p> Signup and view all the answers

    What is the primary cause of seborrheic dermatitis?

    <p>Inflammatory reaction to Malassezia yeast</p> Signup and view all the answers

    What characteristic feature helps distinguish perioral dermatitis from rosacea?

    <p>Thin rim of normal skin around the lips</p> Signup and view all the answers

    What type of treatment is primarily used for seborrheic dermatitis?

    <p>Topical antifungals and steroids</p> Signup and view all the answers

    Which condition can severe seborrheic dermatitis indicate?

    <p>HIV</p> Signup and view all the answers

    What typical symptom do most patients with seborrheic dermatitis report?

    <p>Mild itch</p> Signup and view all the answers

    What can discontinuing steroid application treat effectively?

    <p>Perioral dermatitis</p> Signup and view all the answers

    Which of the following is a common topical treatment for seborrheic dermatitis on the scalp?

    <p>Pyrithione zinc shampoo</p> Signup and view all the answers

    What is a known method of application that may contribute to perioral dermatitis?

    <p>Inadvertently using intranasal steroids</p> Signup and view all the answers

    Study Notes

    Psoriasis

    • Affects 1-3% of the US population, equally affecting males and females.
    • More prevalent in Caucasians, less prevalent in African Americans, Asians, and Native Americans.
    • Highest incidence in the 20s, another peak around age 60.
    • Onset can range from birth to over 100 years old.
    • Childhood onset is linked to a more severe form.
    • Genetic component: One affected relative increases risk to 10%, two affected parents to 40%. 65% of identical twins show concordance.
    • Several types: Chronic plaque psoriasis (most common), guttate, pustular, inverse, erythrodermic, nail psoriasis, psoriatic arthritis.
    • Can present with more than one type at a time, and types can change over time.
    • Chronic plaque psoriasis: sharply bordered, red plaques with silvery scales, often itchy, typically affecting elbows, knees, scalp, buttocks, and umbilicus. Can cover up to 90% of the body.
    • Moderate to severe is considered when covering more than 10% of the body.
    • Guttate Psoriasis: small (1-2 cm) plaques, often follows a strep infection, commonly involves the trunk, sometimes a herald patch, or Christmas tree" pattern can distinguish it from pityriasis rosea
    • Pustular Psoriasis: localized (hands, feet) or generalized (Von Zumbusch). Small pustules on red bases.
    • Erythrodermic Psoriasis: affects over 90% of the body, potentially acute or developing from other types, often accompanied by fever, hypocalcemia, and electrolyte imbalances.
    • Nail psoriasis: presents with nail pits, discoloration, separation from nail bed or debris, can be an indicator of psoriatic arthritis.

    Other Psoriasis Types

    • Psoriatic arthritis: affects up to one-third of psoriasis patients. Includes: asymmetric oligoarthritis (most common, affecting several scattered joints, usually hands/feet), symmetric arthritis of small joints, asymmetric arthritis of distal joints, arthritis mutilans (pencil-cup deformity), and ankylosing spondylitis.
    • Inverse psoriasis: affects body folds (armpits, groin, etc.). Red plaques with minimal scaling.
    • Erythrodermic psoriasis: affects over 90% of the skin surface, can be acute or from another form, problematic due to temperature regulation problems and other systemic issues.

    Diagnosis and Treatment

    • Diagnosis: appearance of the rash/lesions is key. Family history useful. Nail & butt assessment can be helpful. Biopsy might be needed, especially for atypical skin conditions.
    • Treatment: Topical steroids (short-term, potential for side effects), calcipotriene (vitamin D analog), tazarotene (retinoid). Ultraviolet light therapy (various types, including narrowband UVB and PUVA), systemic medications (e.g., methotrexate, acitretin, cyclosporine, biologics), are used for more severe cases.

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