Lecture 7 Part 1

Psoriasis affects 1-3% of the US population, equally affecting males and females, more common among Caucasians, less common among African Americans, Asians, and Native Americans.

Onset ranges from birth to over age 100, with highest incidence in the 20s and a secondary peak around age 60. Childhood onset is a risk factor for worse disease.

Psoriasis has a heritable component. About 1/3 of patients have affected relatives. 65% of identical twins are concordant for the disease.

A common type, characterized by sharply-bordered, red plaques with silvery scales. The plaques usually itch and commonly affect elbows, knees, scalp, buttocks, and umbilicus.

Characterized by numerous small (1-2 cm) plaques, similar to chronic plaque psoriasis, often following a strep infection. Commonly affects the trunk.

Various types exist, including chronic plaque, guttate, pustular, inverse, erythrodermic, nail psoriasis, and psoriatic arthritis.

When more than 10% of the body is covered by the psoriasis.

Affects hands and feet, with small pustules on red skin, predominantly on palms and soles.

Diagnosis is usually straightforward based on the rash's appearance, but atypical cases require ruling out other factors like fungal infections.

A family history of psoriasis can be a helpful diagnostic indicator.

Cold weather, lack of sunlight, and stress can worsen psoriasis.

Blood drops appearing after gently removing psoriasis scaling.

Psoriatic plaque formation at skin trauma sites.

Cases where psoriasis doesn't present with the typical appearance, demanding further investigation to rule out other possible causes.

Munro's microabscesses, rete ridge elongation, and perivascular lymphocytic infiltrate are hallmark pathological features.

Psoriasis is chronic with periods of remission and exacerbation, with potential for remission in 40% of patients, and often subsides in elderly patients.

Psoriasis likely involves a misdirected immune response against keratinocytes, triggered by similar proteins on the surface of Streptococci.

Psoriasis is a chronic systemic inflammatory disease, leading to distress, depression, social avoidance and comparable quality-of-life impact to congestive heart failure.

Th1 cytokines (like IL-1, IL-8, IFN-γ, TNF-α, IL-12, and IL-23) are upregulated in psoriatic lesions, and drugs targeting these pathways help treat the disease.

Topical treatment for psoriasis is suitable for up to 10% body area affected. It is ineffective for nail, palm, or sole conditions. Topical steroids are effective but lose efficacy with prolonged use, and discontinued use may result in disease flares.

Topical steroids can cause skin thinning, telangiectasia (small blood vessels), and systemic absorption if used on large areas. Use cautiously on face, genitals, and other sensitive areas.

Vitamin D analog topical treatment for psoriasis. Works gradually, is very safe, but less rapid in onset than topical steroids.

Psoriasis is treated with topical, UV light, and systemic therapies. Decisions depend on disease severity, treatment risks, and patient compliance.

A vitamin A analog/retinoid used for treating psoriasis, known for its effectiveness but slower action compared to topical steroids. It can cause skin irritation and is categorized as pregnancy category X due to potential birth defects.

A vitamin D analog used for treating psoriasis, known for its effectiveness and slow action compared to topical steroids.

A medication applied directly to the skin to reduce inflammation and itching associated with psoriasis.

A safe and effective treatment for psoriasis, delivered through specialized light units. Patients receive treatments 3 times per week and may experience significant improvement in disease symptoms.

A highly effective and safe light therapy for psoriasis, more effective than regular UVB. It utilizes specific narrow wavelengths of light, delivered 3 times per week at a dermatologist's office.

Highly effective treatment for psoriasis but carries potential side effects. Patients take a photosensitizing medication and undergo light therapy. It can be very effective but requires long-term follow-up and careful monitoring.

Medication taken orally or intravenously to treat severe psoriasis affecting more than 10% of the body surface area or psoriatic arthritis. These medications are effective but have significant side effects requiring careful monitoring by a doctor.

Commonly used medications for systemic therapy in patients with psoriasis. They work well but have significant side effects and require careful monitoring by a physician.

A common skin condition characterized by red, scaly patches, often found on the scalp, face, and chest. It's thought to be caused by an overgrowth of Malassezia yeast.

Treatment focuses on reducing yeast populations and inflammation. Ketoconazole cream is often used, and shampoos with ingredients like zinc pyrithione can help with scalp involvement.

A skin condition that causes red, bumpy, and sometimes pus-filled areas around the mouth, often seen in young women.

It is often linked to steroid use, either intentional or unintentional (like from nasal sprays or inhalers).

It's important to distinguish perioral dermatitis from rosacea and perioral acne by looking for the distinctive rim of normal skin around the lips and the background red tinge.

The primary treatment is to stop using steroids. In some cases, other medications may be used to reduce inflammation.

A type of yeast that naturally lives on our skin and can contribute to skin conditions like seborrheic dermatitis.

A mild form of seborrheic dermatitis that affects the scalp.

Methotrexate, used for psoriasis, can cause liver damage. Regularly monitoring liver health with biopsies is crucial, particularly as the total dose reaches 1.5-3.0 grams.

Certain factors increase the risk of liver damage while taking methotrexate. These include alcohol consumption, hepatitis B or C, diabetes, and being overweight.

Taking folic acid while on methotrexate can reduce side effects, but it also lessens the medication's effectiveness.

Acitretin, a vitamin A derivative, is a common treatment for psoriasis. It can cause elevated triglyceride levels, which may require lipid-lowering medication.

Acitretin can cause birth defects. Women on Acitretin should avoid pregnancy for at least three years after the last dose.

Cyclosporine, an immunosuppressant, can be highly effective for psoriasis, but carries serious risks. Long-term use (over a year) can lead to irreversible kidney damage, increased infections, hypertension, and electrolyte imbalances.

Biologic therapy, including monoclonal antibodies to TNF-alpha, soluble TNF-alpha receptors, and monoclonal antibodies to IL-12/23, offers a new, effective approach to psoriasis treatment.

Despite its effectiveness, a major drawback of biologic therapy is its high cost, averaging around $15,000 per year.

This type involves small pus-filled bumps (pustules) on red skin, mainly on the palms and soles, and can be localized or widespread.

When psoriasis affects 10% or more of the body surface.

Streptococcal infections can trigger psoriasis or cause flares. This is thought to be due to M-proteins on the bacteria resembling keratinocyte proteins, leading to misdirected immune responses against skin cells.

Psoriasis is primarily considered an immune system disorder, as evidenced by the effectiveness of immunosuppressant drugs like cyclosporine in treating the condition.

While environmental factors play a role, there is a strong genetic predisposition to psoriasis, with a 65% concordance rate in identical twins.

Psoriatic lesions have high levels of Th1-type cytokines (IL-1, IL-8, IFN-gamma, TNF-alpha, IL-12, IL-23). Targeting these pathways is a focus of new psoriasis treatments.

Topical treatments are suitable for psoriasis affecting up to 10% of the body. For more extensive disease, systemic therapies are needed.

Prolonged use of topical steroids can lead to skin thinning, visible blood vessels, and potential systemic absorption if used over a large area.

Choosing a psoriasis treatment depends on disease severity, patient's risk factors for treatment side effects, and their likelihood of following the treatment plan.

A severe form of psoriasis characterized by widespread pustules, fever, and electrolyte abnormalities. It often develops from other psoriasis types or after stopping systemic steroids.

Psoriasis affecting body folds (armpits, groin, etc.), presenting as moist, red plaques with sharp borders and minimal scaling. It can be mistaken for fungal infections, so a KOH scraping is necessary to rule it out.

A widespread form of psoriasis covering over 90% of the body surface. It can develop suddenly or gradually, and is often hard to differentiate from other rashes. It can cause problems with temperature regulation and heart failure.

Psoriasis affecting the nails, causing pitting, yellow discoloration, nail separation, and debris buildup under the nails. It can affect all 20 nails and is a risk factor for psoriatic arthritis.

A form of arthritis affecting one third of psoriasis patients. The most common form is asymmetric oligoarthritis, affecting several joints in the hands and feet.

Inverse psoriasis needs to be distinguished from fungal infections. A KOH (potassium hydroxide) scraping is used to confirm a diagnosis by identifying fungal elements, which are absent in inverse psoriasis.

Pustular psoriasis of Von Zumbusch is characterized by widespread pustules, fever, hypocalcemia, and electrolyte abnormalities. It can quickly become life-threatening.

Patients with erythrodermic psoriasis often experience temperature deregulation, high output cardiac failure, and hypoalbuminemia (low blood protein).

Methotrexate, acitretin, and ciclosporin are commonly used medications. They work well but have significant side effects and require careful monitoring by a physician.

Tazarotene can cause skin irritation and is categorized as pregnancy category X due to potential birth defects.

Seborrheic dermatitis is a common skin condition characterized by red, scaly patches, often found on the scalp, face, and chest. It's thought to be caused by an overgrowth of Malassezia yeast.

Treatment for seborrheic dermatitis focuses on reducing yeast populations and inflammation. Ketoconazole cream is often used, and shampoos with ingredients like zinc pyrithione can help with scalp involvement.

Perioral dermatitis is a skin condition that causes red, bumpy, and sometimes pus-filled areas around the mouth, often seen in young women.

Perioral dermatitis is often linked to steroid use, either intentional or unintentional (like from nasal sprays or inhalers).

The primary treatment for perioral dermatitis is to stop using steroids. In some cases, other medications may be used to reduce inflammation.

A thin rim of normal skin separates the lips from the rash in perioral dermatitis, while rosacea can have a more widespread distribution.

Perioral dermatitis presents as erythema, papules, and pustules located around the mouth, with a thin rim of normal skin separating the lips from the rash.

Taking folic acid while on methotrexate can help reduce side effects, but it also decreases the medication's effectiveness.

A potassium hydroxide (KOH) scraping is necessary to differentiate inverse psoriasis from fungal infections. It helps identify fungal elements, which are absent in inverse psoriasis.

Psoriasis is a chronic skin condition characterized by raised, red, scaly patches called plaques. It is caused by an overactive immune system, leading to rapid skin cell growth.

Psoriasis can be triggered by a multitude of factors, including cold weather, stress, infections, and injuries.

Psoriasis is a chronic disease, meaning it's ongoing and can come and go in cycles (exacerbations and remissions) . It can last for years or even decades.

Psoriasis is generally not contagious, meaning it cannot be spread from person to person through contact.

The appearance of the rash is usually diagnostic, but in atypical cases, a biopsy, fungal tests or other tests may be necessary to rule out other conditions.

Psoriasis affects about 2-3% of the population and can occur at any age, but most commonly starts in early adulthood, with peak incidence in the 20s and a secondary peak around age 60.

There are different medications available to treat psoriasis, including topical creams, light therapy, and systemic medications.

There is no cure for psoriasis, but with appropriate treatment, you can manage the symptoms and improve your quality of life.

Psoriasis is primarily an immune system disorder, as evidenced by the effectiveness of immunosuppressant drugs like cyclosporine in treating the condition.

While environmental factors play a role, there is a strong genetic predisposition to psoriasis, with a 65% concordance rate in identical twins.

Psoriatic lesions have high levels of Th1-type cytokines (IL-1, IL-8, IFN-gamma, TNF-alpha, IL-12, IL-23). Targeting these pathways is a focus of new psoriasis treatments.

Topical treatments are suitable for psoriasis affecting up to 10% of the body. For more extensive disease, systemic therapies are needed.

Prolonged use of topical steroids can lead to skin thinning, visible blood vessels, and potential systemic absorption if used over a large area.

Choosing a psoriasis treatment depends on disease severity, patient's risk factors for treatment side effects, and their likelihood of following the treatment plan.

Pustular psoriasis of Von Zumbusch is characterized by widespread pustules, fever, hypocalcemia, and electrolyte abnormalities. It can quickly become life-threatening.

Patients with erythrodermic psoriasis often experience temperature deregulation, high output cardiac failure, and hypoalbuminemia (low blood protein).

Methotrexate is an oral medication used weekly to treat severe psoriasis, effective in up to 80% of patients. Significant side effects include liver damage (requiring biopsies with high cumulative doses) and bone marrow suppression (requiring regular blood checks).

Alcohol consumption, hepatitis B or C, diabetes, and obesity increase the risk of liver damage when taking methotrexate.

Acitretin, a vitamin A derivative, is taken daily for psoriasis. However, it can cause elevated triglyceride levels, requiring lipid-lowering medications. Additionally, it poses a serious risk of birth defects, necessitating a 3-year pregnancy-free period after treatment.

Cyclosporine is a potent immunosuppressant for psoriasis but carries serious risks, including irreversible kidney damage if used longer than a year. Other complications include infections, hypertension, and electrolyte imbalances.

Biologic therapies, like monoclonal antibodies targeting TNF-alpha, are a newer, effective treatment option for psoriasis. They offer a better short-term risk/benefit ratio than older medications, but their long-term effects are still being studied. A major drawback is their high cost.

Seborrheic dermatitis, a common condition, manifests as red, scaly patches that are often found on the scalp, face, and chest. It's believed to be caused by an overgrowth of Malassezia yeast.

Perioral dermatitis is a skin condition characterized by red, bumpy patches around the mouth, often seen in young women. It's commonly linked to steroid use, even from nasal sprays or inhalers.