Integument Exam II (Psoriasis)

Helpfulness: 0
Set Details Share
created 4 days ago by clarketk
5 views
updated 4 days ago by clarketk
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

What is an incurable chronic inflammatory multi system disease that is associated with decreased QoL and emotional distress

Psoriasis

2

Patients with Psoriasis have (increased/decreased) life expectancy

Decreased

3

Why do patients with psoriasis often have decreased life expectancy?

Comorbidities

4

Psoriasis effects ~2% of the population, and is less frequent in people of what descent?

African/Asian

5

T/F: Psoriasis affects men more than women

False, affects men and women equally

6

What are the 2 peak ages of onset for Psoriasis?

  • 20-30 years old
  • 50-60 years old
7

What two components are associated with the Etiology of Psoriasis?

  • Genetics
  • Triggers
8

What are some triggers associated with Psoriasis?

  • Injury to skin (trauma)
  • Psychogenic stress
  • Climate
  • Infection
  • Smoking
  • Alcohol
  • Obesity
  • Medications
9

What is the Koebner phenomenon?

An aspect of psoriasis that's well-known but not completely understood. Describes the formation of psoriatic skin lesions on parts of the body that aren't typically where a person with psoriasis experiences lesions.

Injury to Skin

10

What is the acronym to remember medications that exacerbate Psoriasis?

NAILS

11

What does NAILS represent?

  • NSAIDs
  • Antimalarials; ACE inhibitors; Antidepressants (Fluoxetine)
  • Inderal (β-adrenergic blockers)
  • Lithium
  • Steroid Withdrawal
12

Psoriasis is an immune-mediated chronic inflammatory disease of the skin in which Epidermal hyperplasia and dermal inflammation are a result of _________

Activated T cells

13

What contributes to hyper-proliferation of basal cell keratinocytes

Cytokines and Growth Factors

14

What is the turnover for a typical Psoriatic plaque cell?

4 days

15

What is the turnover for a normal epidermal cell?

25-30 days

16

What 3 stages are involved in the pathophysiology of Psoriasis?

  1. Binding to epithelial cells
  2. Trafficking
  3. Activation
17

What are some comorbidities associated with Psoriasis?

  • Psoriatic arthritis (PsA)
  • Metabolic syndrome
  • Crohn's disease
  • Multiple Sclerosis
  • Psychological illness
  • Cutaneous T-cell lymphoma
18

What are some risks associated with psoriasis?

  • Decreased life expectancy
  • Increased rates of mortality
  • Independent risk factor for atherosclerosis
19

T/F: Recent study showed Psoriasis was significantly associated with coronary artery disease

True

20

Approximately what percentage of the North American population is affected by psoriasis?

2%

21

Which of the following may cause medication induced psoriasis?

  1. Chloroquin
  2. Meloxicam
  3. Lithium
  4. All of the above

All of the above

22

DM is a 30 year old actress who has had psoriasis for the past 10 years. Which of the following is a potential co-morbidity of psoriasis that DM should be screened for?

  1. Depression
  2. Metabolic syndrome
  3. Psoriatic arthritis
  4. Crohn’s disease
  5. All of the above

All of the above

23

What is diagnosis of Psoriasis based upon?

Recognition of the characteristic psoriatic lesion

24

Is diagnosis of Psoriasis based on laboratory tests?

No

25

What ways can Psoriasis be classified?

Objective and Subjective Parameters

  • Mild
  • Moderate
  • Severe
26

What are 2 tools that are used to assess Psoriasis?

  • Psoriasis Area and Severity Index (PASI)
  • Dermatology Life Quality Index (DLQI)
27

What 2 things does the (Psoriasis Area and Severity Index) PASI measure?

Severity and Coverage

28

What is included in the assessment of Psoriasis using the PASI?

  • Body Surface Area (BSA)
  • Erythema
  • Induration
  • Scaling
29

What is the range of possible scores for the PASI?

0 (normal) - 72 (highest)

30

What is considered a severe case of Psoriasis according to the PASI?

> 10

31

What is commonly used to measure efficacy when using the PASI to assess cases of Psoriasis?

PASI 75 (75% improvement)

32

What are the 3 major signs and symptoms of Psoriasis?

  1. Well demarcated, erythematous lesions
  2. Pruritus
  3. Lesions may be physically debilitating or socially isolating
33

What is defined as Mild Psoriasis?

≤ 5% BSA involvement

34

How much of your BSA is the size of your palm, typically?

1%

35

What is defined as moderate Psoriasis

PASI ≥ 8

36

What is defined as severe Psoriasis?

PASI ≥ 10, DLQI ≥ 10, or BSA ≥ 10%

37

The "Rule of Tens" refers to assessing which level of Psoriasis? (Mild, moderate, severe)

Severe

38

What are the 5 types of Psoriasis?

  1. Plaque psoriasis (psoriasis vulgaris)
  2. Inverse
  3. Guttate
  4. Pustular
  5. Erythrodermic
39

What is the most common type of Psoriasis?

Plaque psoriasis

40

What areas does Plaque Psoriasis commonly affect?

  • Elbows
  • Knees
  • Scalp
  • Genitals
  • Nails
41

T/F: Plaque Psoriasis presents itself with well-defined, sharply demarcated red patches with white/silver flakes

True

42

What do lesions of Plaque Psoriasis start as?

Small papules

43

In plaque psoriasis, small papules grow and unite to form what?

Plaques

44

What is the Auspitz's sign?

What happens if you try to scratch of the top layer of a psoriatic plaque, it will bleed underneath

45

Erythematous smooth plaques with minimally scaling describes which type of Psoriasis?

Inverse

46

In which type of Psoriasis are lesions commonly located in skin folds?

Inverse

47

Guttate Psoriasis occurs in what % of patients?

< 2

48

Individual small, fine red scales describes which type of Psoriasis?

Guttate

49

Which type of Psoriasis is typically triggered by bacterial infection (ex: strep throat)

Guttate

50

Typically localized pustules on palms and soles that are rarely generalized describes which type of Psoriasis?

Pustular

51

This type of Psoriasis presents itself as widespread large, red inflamed patches covering most of BSA and may occur gradually or acutely

Erythrodermic

52

What is another name for Nail disease?

Psoriatic Onychodystrophy

53

Which type of Psoriasis is usually a going to be considered a medical emergency situation requiring the patient to be hospitalized as soon as possible

Erythrodermic

54

T/F: Psoriatic Onychodystrophy can only occur in plaque psoriasis?

False, can occur in all psoriasis subtypes

55

T/F: ~90% of patients with psoriatic arthritis may have nail changes

True

56

T/F: Psoriatic Onychodystrophy (Nail disease) is not very difficult to treat

False

57

Which of the following is false regarding psoriasis diagnosis?

  1. Determined both objectively and subjectively
  2. Classified as mild, moderate, and severe
  3. Confirmed by biopsy
  4. Not based on laboratory tests

Confirmed by biopsy

58

CK is a 30 year old teacher. Her psoriasis covers 8% of her body surface area. How would you classify CK’s psoriasis?

  1. Mild
  2. Moderate
  3. Severe
  4. Not enough information to determine

Moderate

59

What are the treatment goals of patients with Psoriasis?

  • Minimize or eliminate signs and symptoms
  • Decrease frequency of flares
  • Treat comorbidities
  • Minimize or avoid adverse events from treatment
  • Reduce stress and improve quality of life
60

When managing underlying pathophysiology to treat Psoriasis, what should be considered?

  • Site
  • Severity
  • Duration
  • Previous treatment
  • Age of patient
61
card image

What is the pictured algorithm used to treat?

Mild-Moderate Psoriasis

62
card image

What is the pictured algorithm used to treat?

Moderate-Severe Psoriasis

63

What are some examples of nonpharmacologic therapy for treatment of Psoriasis?

  • Stress-reduction
  • Moisturizers
  • Oatmeal baths
  • Skin protectants (Sunscreen SPF 30 or greater)
  • Eliminate skin irritants
  • Climatotherapy
  • Emollients
64

What is the MOA of Emollients?

Thought to form a film on the skin surface to help retain moisture

65

Approximately how often are emollients applied in the treatment of Psoriasis?

1-3 times daily

66

What are some examples of Emollients used to treat Psoriasis?

  • Aloe vera
  • Petrolatum
  • Baby oil
  • Mineral Oil
67

T/F: Topical agents can be used to treat severe forms of Psoriasis

False, mild to moderate cases

68

What are the 3 steps in the step-down therapy of pharmacologic therapy for Psoriasis?

  1. Topical agents
  2. Phototherapy
  3. Systemic Agents
69

What are some examples of Topical Agents used to treat Psoriasis?

  • Coal Tar
  • Salicylic acid
  • Topical corticosteroids
  • Vitamin D3 analogues
  • Retinoids
  • Anthralin
  • Topical calcineurin inhibitors
70

What is the MOA of Coal Tar?

  • Keratolytic
  • Suppresses DNA synthesis by lessening the mitotic labeling index of keratinocytes
71

What special populations should be considered when suggesting Coal Tar for treatment of Psoriasis?

  • Pregnancy Category C
  • Use in caution with children
72

What are some advantages of Coal Tar in treatment of Psoriasis?

  • Inexpensive
  • Can be combined with ultraviolet light treatment in sever psoriasis (Goeckerman regimen)
  • Typically applied 1-2 times daily (Shampoo 1-2 times weekly)
73

What are some disadvantages of Coal Tar in treatment of Psoriasis?

  • Less commonly used due to limited efficacy and acceptance/ compliance issues
  • Adverse effects
    • Folliculitis
    • Irritant Contact Dermatitis
    • Phototoxicity
    • Carcinogenic in animals
74

What is the MOA of Salicylic Acid?

  • Keratolytic
  • Decreases keratinocyte-to-keratinocyte binding and decreases pH of the stratum corneum
75

What special populations should be considered when suggesting Salicylic Acid for treatment of Psoriasis?

  • Pregnancy category C (for limited localized plaque psoriasis)
  • Avoid use in children
76

What are some patient counseling points for Salicylic Acid in the treatment of Psoriasis?

  • Do NOT use with ultraviolet B (UVB) phototherapy
    • May cause filtering effect reducing efficacy of UVB
  • Avoid use in:
    • Area of involvement > 20% BSA
    • Renal/hepatic impairment
    • In combination with other salicylate drugs
77

What are some advantages of Salicylic Acid?

  • Often combined with other topical therapies (enhances penetration)
  • Inexpensive
78

What are some disadvantages of Salicylic Acid?

  • Adverse effects
    • Irritation
    • Excessive dryness
  • Limited efficacy as monotherapy
79

What is the MOA of topical corticosteroids?

Anti-inflammatory, anti proliferative, immunosuppressive and vasoconstrictive effects

80

What formulation of Topical corticosteroids enhance drug penetration and provide the most potency?

Ointments