Overview - Answer-T-cell mediated chronic skin disease marked by epidermal proliferation
Causing lesions of erythematous papules and plaques covered with silvery scales (with lesions that vary widely in severity and distribution)
Involving recurring remissions and exacerbations
Unpredictable exa...
Psoriasis Exam Questions with Correct
Answers
Overview - Answer-T-cell mediated chronic skin disease marked by epidermal
proliferation
Causing lesions of erythematous papules and plaques covered with silvery scales (with
lesions that vary widely in severity and distribution)
Involving recurring remissions and exacerbations
Unpredictable exacerbations and remissions that are usually controllable with therapy
Flares commonly related to specific environmental factors (such as trauma and sunlight)
and systemic factors (such as infection, drugs, smoking, and alcohol)
Several different forms, with plaque psoriasis (also called discoid psoriasis) the most
common
Overview-Pathophysiology - Answer-Although not completely understood, an antigen
(environmental or internal) triggers cytokine production and cell proliferation.
Innate immune cells stimulate activation of the myeloid dendritic cells in the skin, which
in turn produce cytokines that attract, activate, and differentiate T cells.
T cells produce cytokines that stimulate keratinocytes to proliferate and produce
proinflammatory antimicrobial peptides and cytokines.
These cytokines continue the cycle via a positive feedback loop.
Psoriatic skin cells have a shortened maturation time as they migrate from the basal
membrane to the surface or stratum corneum. (The normal life cycle of skin cells is 28
days; with psoriasis, turnover increases to every 4 days.)
As a result, the stratum corneum develops thick, scaly plaques (the cardinal
manifestation of psoriasis).
Overview-Causes - Answer-Exact cause unknown
Possible triggers related to infection, trauma, or stressful life event.
Overview-Risk Factors - Answer-Family history
Local trauma or irritation
Cold exposure
Infection (such as streptococcal pharyngitis)
Human immunodeficiency virus (HIV) infection
Withdrawal of steroid treatment
Medications, such as lithium carbonate, angiotensin-converting enzyme inhibitors, beta-
adrenergic blockers, tetracycline, nonsteroidal anti-inflammatory drugs, amiodarone
hydrochloride, morphine sulfate, procaine, potassium iodide, salicylates, sulfonamides,
and penicillin
Alcohol use
Smoking
Stress
Genetic influence
, Overview-Incidence - Answer-Psoriasis affects about 2% of the population in the United
States. The disorder affects men and women equally although some studies show that it
appears to affect females slightly more often than males; men experience eye
manifestations more often.
The average age of onset is between the ages of 20 and 30 and again between the
ages of 50 and 60 years.
Overview-Complications - Answer-Pustular psoriasis (severe form and a true
emergency)
Psoriatic arthritis
Erythrodermic psoriasis
Assessment-History - Answer-Family history of psoriasis
History of risk factors
Pruritus and burning
Arthritic symptoms such as morning joint stiffness
Remissions and exacerbations; worse in the winter and improved in the summer
Assessment-Physical Findings - Answer-Erythematous, well-demarcated papules and
plaques covered with silver scales, typically appearing on the scalp, chest, elbows,
knees, back, and buttocks in a symmetrical distribution
In mild psoriasis: plaques scattered over a small skin area
In moderate psoriasis: plaques more numerous and larger (up to several centimeters in
diameter)
In severe psoriasis: plaques covering at least one-half of the body
Friable or adherent scales
Fine bleeding points or Auspitz sign after attempts to remove scales
Thin, erythematous guttate lesions, alone or with plaques, and with few scales (see
Identifying types of psoriasis)
Small indentations or pits, and yellow or brown discoloration of fingernails or toenails
In severe cases, separation of the nail from the nail bed
Diagnostic Test Results-Laboratory - Answer-Rheumatoid factor is negative.
Erythrocyte sedimentation rate may be normal.
Uric acid level may be elevated (pustular psoriasis).
Diagnostic Test Results-Diagnostic Procedures - Answer-Skin biopsy can help rule out
other diseases (rarely done).
Treatment-General - Answer-Depends on the psoriasis type, extent, and effect on the
patient's quality of life
Lesion management
Lukewarm baths
Oatmeal baths
Ultraviolet B light or natural sunlight; home phototherapy
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