| • | 5 types of psoriatic arthritis |
| • | clinical pearl - psoriasis plaques are well-demarcated/sharply marginated therefore always consider psoriasis when you see a plaque like this (tinea is also sharply marginated) |
| • | clinical pearl - psoriasis in a child, check for strep (pharyngitis vs. perianal strep) |
Clinical Variants:
| • | Von Zumbush = generalized pustular psoriasis |
| • | in pregnant woman = impetigo herpetiformis (often with with no history of psoriasis) |
Inverse Psoriasis:
| • | intertriginous distribution: axilla, groin, submammary region, navel, intergluteal fold |
| • | sometimes ddx of “sebopsoriasis” comes up (especially if scalp and/chest involved) |
boards favorites:
treatment
topical:
Steroids
| • | but tachyphylaxis, therefore intermittent regimen (2 of every 5 weeks) |
| • | anti-mitotic and anti-inflammatory |
| • | avoid systemic steroids - rebound |
topical tars and anthralin
| • | = hydrocarbons with anti-mitotic activity (tars also anti-inflammatory) |
systemic:
PUVA
| • | psoralen intercalates with DNA strands; binds to them when irradiated |
methotrexate
| • | folate antagonist à inhibits cellular proliferation |
| • | long term concern = liver toxicity |
acitretin (Soriatane)
| • | especially pustular psoriasis |
| • | can be used in conjunction with PUVA |
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