Podiatric Dermatology Lecture 2: Psoriasis

Front 1

Which type of psoriasis is HLA-cW6 associated with?

Back 1

Type I- early onset

The peak occurs at around age 20.
Psoriasis is a common, dynamic, immunological disorder that manifests itself on the extensor surfaces of the body.

Front 2

The palm of the hand equals what percentage of the skin?

Back 2

1%

Psoriasis manifesting on more than 10% of the body is considered severe.

3-10 is considered moderate.

Front 3

Which type of psoriasis has the auspitz sign and is considered the most severe?

Back 3

Chronic Plaque Psoriasis

Front 4

What is the 1st line TX of plaque psoriasis?

Back 4

Dovonex ointment

Dovonex is a Vit. D analog that is equivalent to a mid potency steroid.

The max dosage is 100mg/week.

Front 5

What is the 2nd line TX for mid-moderate psoriasis?

Back 5

Tazarotene

It is a vitamin A derivative, topical retinoid used to slow skin cell growth. It is normal for psoriasis plaques to become very red before clearing when using tazarotene. The redness is often intense in color, but it is generally not painful.

Front 6

Name 1 TX for severe plaque psoriasis?

Back 6

Soriatane or Methotrexate or Cyclosporine

Soriatane is an oral retinoid, which is a synthetic form of vitamin A. Acitretin is the only oral retinoid approved by the FDA specifically for treating psoriasis.

The exact way Soriatane works to control psoriasis is unknown. In general, retinoids help control the multiplication of cells including the speed at which skin cells grow and shed.

Soriatane is indicated for use in adults with severe plaque, guttate, pustular, erythrodermic, or palmoplantar psoriasis.

Do not take Soriatane if:

* You are pregnant, planning to become pregnant, or breastfeeding:
* You have severe liver or kidney disease:

Front 7

What is PUVA therapy?

Back 7

PUVA is a Psoralen + UVA treatment for Eczema, Psoriasis and Vitiligo, and mycosis fungoides.

The Psoralen is applied or taken orally to sensitize the skin, then the skin is exposed to UVA. Long term use has been associated with higher rates of skin cancer.

Psoralens are photosensitizing agents found in plants. They have been known since ancient Egypt but have only been available in a chemically synthesized form since the 1970s

Front 8

What drug therapy is indicated for psoriatic arthritis/ plaque and nail dx?

HINT: It inhibits TNF-alpha

Back 8

Remicade-therapy (INFLIXIMAB)

Front 9

What kind of psoriasis often follows streptococcal throat infections in children or young adults?

Back 9

Guttate psoriasis

It can also follow rapid discontinuation of systemic meds: steroids/mtx/cyclosporine

Front 10

What is the differential DX of guttate psoriasis?

Back 10

Pityriasis rosea

Front 11

What drug therapy associated with guttate psoriasis is also helpful for dactylitis (sausage digits)

Back 11

Remicade

Front 12

What is the tx for guttate psoriasis?

Back 12

UVB therapy.

PUVA therapy.

Short term MTX.

If step present, use Antibiotics.

Front 13

This type of psoriasis has 2 types, generalized known as Von Zumbusch and chronic (affecting palms and soles)

What is it?

Back 13

Pustular Psoriasis

Front 14

What kind of pustules are seen with this Pustular psoriasis?

Back 14

Superficial sterile pustules, with fine desquamation, they become scaly & brown and peel off.

Front 15

What is the Tx for pustular psoriasis?

For generalized?

For chronic?

Back 15

Generalized Tx: Soriatane

Chronic: Dovenex, Tazorac

Front 16

Inverse psoriasis usually manifests itself where?

Back 16

Interdiginous areas/ scalps and nails

How would you describe it?

What are people usually 2* infected with?

Hint 16

red plaques, may or may not have scales. usually macerated.

Candida

Front 17

What is the tx for inverse psoriasis?

Back 17

NON-fluorinated topical steroids.

Front 18

Erythrodermic psoriasis is rare, and severe. Plaques merge to form erythroderma and exfoliative dermatitis.

What are some of the differentials?

Back 18

Atopic Eczema. CTCL. PRP. Drug Rxns.

Erythrodermic dermatitis usually follows infections, or inappropriate steroid use. It can result in cardiac failure or renal failure! BAD STUFF MO FO!

Front 19

What are some tx options for erythrodermic psoriasis?

Back 19

TX: consider hospitalization

MTX, Soriatane, Topicals, avoid phototherapy until its under control

Front 20

Describe pitriasis rubra pilaris

Back 20

Rare with reddish orange lesions involving hair follicles.

Most classic is adult onset, begins at scap and moves caudally

Front 21

Pityriasis rosea appears where?

Back 21

Trunks, Arms, Thighs

Front 22

What is the hallmark lesion associated with pityriasis rosea?

Back 22

Herald patch, which is misdiagnosed as ringworm

After this appears, one gets salmon colored lesions

Inverted x-mas tree on the back.

Front 23

What is the Diff DX for pitriasis rosea?

Back 23

Syphillus

Front 24

What is the tx for pitriasis rosea?

Back 24

Mild steroids, disappears in 6-8 weeks

Front 25

Describe lichen planus?

Back 25

Plentiful, pruritic, polygonal, polished, purple, papular, plantar

Front 26

Lichen planus presents as what?

Back 26

Acute eruptions, flat topped, shiny, polygonal, violaceous papules

Wickhams striae

Front 27

What are wickhams straie?

Back 27

fine lacy network of lines on top of papule

Front 28

Lichen planus may resemble what other condition on the LE?

Back 28

SLE

Also graft-vs-host disease can also produce lichenoid like eruptions--but more generalized!

Front 29

What is the most important thing to remember in regards to lichen planus and the nails?

Back 29

Scars them permanently!

Front 30

What are TX options for lichen planus?

Back 30

Topical steroids, systemic steroids for severe cases

Front 31

Name the oral steroid one should give for severe lichen planus cases?

Back 31

ORAL Prednisone