Self Care- Psoriasis Pathophys

  1. What is psoriasis characterized by?
    • thickening of the epidermis
    • parakeratosis
    • elongated rete ridges
    • mixed cellular infiltrate
  2. What are scales a result of?
    • hyperproliferative epidermis with premature maturation of keratinocytes
    • incomplete cornification with retention of nuclei in stratum corneum
  3. What contributes to the overall thickness of lesions?
    • hyperproliferation of the dermis
    • inflammatory infiltrate
  4. What does the inflammatory infiltrate consist of?
    • dendritic cells (dermis)
    • macrophages (dermis)
    • T cells (dermis)
    • neutrophils (epidermis)
    • some T cells (epidermis)
  5. What is the general treatment strategy?
    • 1. moisturize
    • 2. sloughing away plaques and lesions (exfoliate, keratolytics)
    • 3. decrease epidermal cell proliferation (anti-mitotic)
    • 4. normalize epidermal cell turnover (newer retinoids, promote differentitation - prevent mitosis)
    • 5. pathogenesis-based approaches (immunosuppressant therapy)
  6. The risk of psoriasis is higher in what types of people?
    • 1st and 2nd degree relatives
    • monozygotic twins
  7. The 9 chromosomal loci linked to psoriasis are referred to as what?
    psoriasis susceptibility 1 through 9 (PSORS1 through PSORS 9)
  8. What are the key cytokines produced by innate immune cells?
    • TNF-a
    • interferon-a
    • interferon-y
    • interleukin-1B
    • interleukin-6
  9. What do the key cytokines activate?
    myeloid dendritic cells
  10. What do activated dendritic cells do?
    present antigens and secrete mediators (IL-12 and IL-23)
  11. What do IL-12 and IL-23 lead to?
    differentiation of type 17 and type 1 helper T cells (Th17 and Th1)
  12. What do T cells secrete?
    • IL-17A
    • IL-17F
    • IL-22
  13. What do the mediators secreted from T cells do?
    • activate keratinocytes
    • induce production of antimicrobial peptides, proinflammatory cytokines, chemokines, and S100 proteins
  14. What does IL-12 do?
    promotes proliferation and differentiation of Th1 helper T cells
  15. What do TNF-a/INFy from Th1 cells promote?
    • chemotaxis
    • integrin formation (ICAM)
    • keratinocyte proliferation
  16. What does IL-23 do?
    promotes proliferation and differentiation of Th17 helper T cells
  17. What do IL-17 and IL-22 promote?
    hyperproliferation of keratinocytes
  18. What is the immune response due to?
    • antigen or result of trauma
    • intracellular cell adhesion molecules (ICAM)
    • antigen presenting cells (APCs)
  19. Where do overactive T cells migrate from?
    lymph nodes
  20. what cytokines are primarily involved in psoriasis?
    • TNF-a
    • IFN-y
    • IL-2
  21. What are other cytokines involved?
    • granulocyte-macrophage colony-stimulating factor
    • RANTES (regulated on activation, normal T-cell expressed and secreted)
    • MIG (monokine induced by INF-y -->attracts T-cells)
    • IL-1,6,8,12
  22. What are the contributing factors of psoriasis?
    • climate
    • stress
    • alcohol (greater on men)
    • smoking (greater on women)
    • infection (Streptococcal)
    • trauma (Koebner response)
    • Drugs
  23. What drugs aggrevate psoriasis?
    • B-blockers
    • Lithium
    • ACE-inhibitors
    • Interferons
    • NSAIDS
    • Tetracyclines
    • Some antimalaria drugs
  24. What is an Auspitz sign?
    small pinpoints of bleeding when scales are removed
  25. What are characteristics of vulgaris psoriasis?
    • most common
    • sharply demarcated, erythematous plaques possible covered with silvery/white scales
    • affects elbows, knees, scalp, lower back
    • skin is usually dry, may be itchy
    • Auspitz sign
  26. What are characteristics of guttate psoriasis?
    • younger age
    • sudden onset
    • often induced by Streptococcal infections (URI, tonsillitis, strep throat)
    • small, scaly, erythematous spots
    • trunk or limbs
    • more widespread
    • not associated with white plaque buildup
    • *can for vulgaris later
  27. What are characteristics of inverse psoriasis?
    • skin folds
    • smooth, red, without plaque
    • irritated by friction, sweat retention, warmth
  28. What are characteristics of pustular psoriasis?
    • mainly adults
    • may be sudden
    • *may develop FROM vulgaris
    • usually palms and soles (palmo-plantar pustulosis PPP)
    • generalized (Von Zumbusch)
    • rarely on fingertips (acropustulosis)
    • white pustules with surrounding erythema (does NOT imply infection)
    • rare
  29. What are the characteristics of erythrodermic psoriasis?
    • red
    • may have life threatening consequences
    • affects most of body surface**
    • erythema and exfoliation cause widespread itching with pain
    • immediate or gradual onset
    • more peeling than scales
    • can lead to protein loss, fluid loss, edema, infection --> hyperthermia, tachycardia, edema, dehydration, SOB
  30. How is psoriasis diagnosed?
    • observation
    • biopsy of skin lesion
    • family history
Card Set
Self Care- Psoriasis Pathophys
Fall 2011 PT Module III- Psoriasis