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67 Cards in this Set
- Front
- Back
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Th1 or Th2 response mediated?
psoriasis |
Th1
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Th1 or Th2 response mediated?
atopic dermatitis |
Th2
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Chronic or acute?
psoriasis atopic dermatitis |
chronic disease due to exaggerated immune response in the skin.
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What HLA type people are prone to psoriasis?
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HLA-B13, -B17, -B37, Cw6
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What HLA type people are prone to psoriatic athritis?
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HLA B27.
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Is there a genetic component to psoriasis?
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Yes.
PSORS1 on chromosone 6. |
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What is the peak age onset for psoriasis?
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2 peaks
- 20-30 yrs old - 50-60 yrs old |
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What is Koebner phenonmenon?
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skin lesions appearing on lines of trauma
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Triggering factors for psoriasis.
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- infections
- HIV - hypocalcemia - stress - drugs: lithium, beta-blockers, antimalarials, interferon. - alcohol, smoking |
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What is a common infectious agent that triggers psoriasis?
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strep
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What drugs tend to trigger psoriasis?
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- lithium
- beta-blockers - antimalarials - interferons |
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Name an endocrine condition that triggers psoriasis.
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hypocalcemia
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Name two social acitivities that trigger psoriasis.
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drinking
smoking |
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What is the pathogenesis of psoriasis?
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- Langhans cells activated
- Th1 activation - macrophages - cytokines: TNF alpha -> neutrophil activation and keratinocyte proliferation - adhesion molecules on endothelial cells. |
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What is this disease?
- well demarcated plaques with silvery scale - on scalp, elbows, knees, sacrum, umbilicus, nails. |
Psoriasis
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What is this disease?
- pits and oil pots on nails |
psoriasis of nail
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How does psoriasis manifest in nails?
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pits and oil pots
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What subtypes of psoriasis are there?
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- plaque: erythematous, scaly plaque
- guttate(eruptive): small lesions over the trunk and proximal extremeties, common in children, often proceded by strep throat infection. - pustular: sterile pustules in palms or soles or generalized. - erythrodermic: generalized erythema and scaling, often accompanied by abnormal thermoregulation, or fluid and electrolyte balance. |
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What type of psoriasis is this?
- erythematous, scaly |
plaque type
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What type of psoriasis is this?
- small lesions over the trunk and proximal extremeties - common in children - often preceded by strep throat infection. |
guttate (eruptive) type
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What type of psoriasis is this?
- sterile pustules in palms or soles or generalized - not always infectious |
pustular type
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What type of psoriasis is this?
- generalized erythema and scaling - accompanied by abnormal thermoregulation, or fluid and electrolyte balance. |
erythrodermic
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Which of the following types of psoriasis is most common?
- plaque - guttate - pustular - erythrodermic |
- plaque
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What is the treatment difference between localized and generalized psoariasis?
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localized: topical therapy
generalized: oral therapy, UV light therapy |
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What types of therapies are there for localized psoriasis?
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- initial treatment: topical steroids twice daily
- maintenance therapy: VitD analogues (calcipotriene) - Tazarotene |
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Mechanism of corticosteroid.
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- reduction in inflammation (Th1)
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Side effects of corticosteroid.
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- atrophy
- telangiectasia - hypopigmentation - striae - glaucoma - cataracts - hypothalamic/pituitary/adrenal axis suppession |
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Mechanism of VitD analogues.
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- suppress keratinocyte proliferation
- induction of epidermal differentiation |
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Side effects of VitD analogues.
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- irritation
- hypercalcemia, hypercalceuria - photosensitivity |
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What is this drug?
Mechanism - suppress keratinocyte proliferation - induction of epidermal differentiation |
VitD analogue
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Name a VitD analogue.
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Calcipotriene
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How long is VitD therapy last for maximum benefit in psoarisis?
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8-12wks
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What is this drug?
adverse effects: - irritation - hypercalcemia, hypercalceuria - photosensitivity |
VitD analogue (calcipotriene)
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Mechanism of Tazarotene.
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- retinoid receptor agonist
- normalizes epidermal differentiation |
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Adverse effects of Tazarotene.
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- irritation of skin
- prohibited in pregnancy |
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What are some treatment therapies for generalized psoriasis?
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- UV light therapy
- oral: acitretin, methotrexate, cyclosporin - biological agents: anti-TNF-alpha (etanercept, infliximab, adalimumab), anti-T cell (alefacept, efalizumab) |
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What are the risks of using UV light therapy for generalized psoriasis?
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- skin cancer
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What types of UV light therapy are there?
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- sun exposure
- UVA - UVB - psoralen(photosensitizer) + UVA |
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Effects of acitretin.
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Similar to isotretinoin;
- normalize kerinization - anti-inflammatory |
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Side effects of acitretin.
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lipid elevation
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Which drug is useful in treating on the skin and joint problems in psoriatic arthritis? What is its major toxicity?
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- methotrexate
- major toxicity: liver |
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What is the major toxicity of cyclosporin?
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nephrotoxicity
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Name some oral agents for generalized psoriasis and their side effects.
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acitretin: lipid elevation
methotrexate: liver toxicity cyclosporin: nephrotoxicity |
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Name some biologic agents for generalized psoriasis.
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anti-TNF-alpha:
- etanercept - infliximab - adalimumab anti-T cell - alefacept - efalizumab |
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What are the side effects of biologic agents used for generalized psoriasis?
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risks of serious infections
- reactivation of TB risks of malignancy - lymphomas |
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Psoriasis or atopic dermatitis?
chronic skin condition of infancy, childhood and adolescence |
atopic dermatitis
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What are some characteristics of AD skin?
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Defective barrier function
- increased transdermal water loss - deficient lipids |
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What condition(s) can flare up AD?
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repiratory allergies
food allergies |
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You see these AD lesions in what age group?
- weeping, crusy lesions - face, trunk, extremeties (more in extensor regions) |
infantile
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What kind of AD lesions you see in infants?
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- weeping, crusy lesions
- face, trunk, extremeties (more in extensor regions) |
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You see these AD lesions in what age group?
- dry, lichenified lesions - more on flexors - perioral and periocular - dorsa of hands and foot |
children
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What types of AD lesions you see in children?
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- dry, lichenified lesions (due to scratching)
- more on flexors - perioral and periocular - dorsa of hands and foot |
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You see these AD lesions in what age group?
- dry, lichenified lesions - face, neck, flexors - forsa of hands and feet |
adolescents
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These are skin findings of what disease?
- keratosis pilaris - atopic pleats - ichthyosis vulgaris - hyperlinear palms |
AD
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What is this lesion called? Name a condition associated with it.
- fish-like scaly skin |
ichthyosis vulgaris in AD
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Name some complications of AD.
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- bacterial infection (staph, strep)
- viral infections (HSV, molluscum) - allergic keratoconjuntivitis, keratoconus, cataracts - hypo- and hyperpigmentation of skin (not scars) |
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If AD patients have crusty skin rash, what do they have?
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impertigo caused by staph or strep infection.
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If AD patients presents with vesicles and erosions, what do they have?
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eczama herpeticum cuaes by HSV
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What are some types of management therapy for AD?
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- topical corticosteroids (cornerstone)
- topical calcineurin inhibitors (episodic use, on eyelids/periocular skin) - antihistamines - barrier maintenance |
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Mechanism of calcinurin inhibitors.
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- reduce pro-inflammatory cytokine production
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Name some calcineurin inhibitors.
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pimecrolimus
tacrolimus |
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When is calcineurin inhibitors indicated for AD?
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- episodic treatment
- on eyelids or periocular regions where steroids is not preferred. |
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Name some antihistamines.
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- diphenhydramine
- hydroxyzine - cetirizine - cyprohepradine |
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What is the barrier maintenance therapy for AD?
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MimyX (palmitoylethanolamine)
- reduce transdermal loss - anti-inflammatory |
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Mechanism of MimyX (palmitoylethanolamine)
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MimyX (palmitoylethanolamine)
- reduce transdermal loss - anti-inflammatory |
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What drug is used when AD patient gets a bacterial infection?
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topical antibiotic:
- mupirocin for localized - ceflexin for more widespread - culture to determine if it's MRSA |
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What drug is used if an AD patient has eczema herpeticum?
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acyclovir
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