Integumentary Function

Full Answer Section

• Skin Injury/Trauma (Koebner Phenomenon): Any injury to the skin can trigger new psoriatic lesions at the site of trauma. This includes cuts, scrapes, burns, insect bites, vaccinations, or even aggressive scratching.
• Medications:
  • Beta-blockers: Used for high blood pressure and heart conditions.
  • Lithium: Used for bipolar disorder.
  • Antimalarials: Such as chloroquine or hydroxychloroquine.
  • NSAIDs (Nonsteroidal Anti-inflammatory Drugs): While often used for pain, they can sometimes worsen psoriasis in some individuals.
  • ACE inhibitors: Used for high blood pressure.
  • Withdrawal of Systemic Corticosteroids: Abruptly stopping oral corticosteroids can lead to a severe flare-up (rebound effect), often leading to pustular or erythrodermic psoriasis.
• Weather/Climate:
  • Cold, dry weather: Often worsens psoriasis, as skin tends to be drier and less exposed to beneficial sunlight.
  • Lack of sunlight: UV light can be therapeutic for psoriasis, so reduced exposure can lead to flares.
• Alcohol Consumption: Excessive alcohol intake can worsen psoriasis and interfere with the effectiveness of some treatments.
• Smoking: Tobacco use is linked to both the onset and worsening of psoriasis.
• Obesity: Being overweight or obese can increase the severity of psoriasis and make it harder to treat.
• Hormonal Changes: Puberty, pregnancy (though some women improve during pregnancy), and menopause can influence psoriasis activity.

Different Clinical Types of Psoriasis:

1. Plaque Psoriasis (Psoriasis Vulgaris):

   • Description: The most common type, affecting about 80-90% of people with psoriasis.
   • Appearance: Characterized by well-demarcated, red (erythematous) plaques covered with silvery-white scales.
   • Location: Commonly found on the extensor surfaces (elbows, knees), lower back, and scalp. In K.B.'s case, it has become generalized.

2. Guttate Psoriasis:

   • Description: Often triggered by a streptococcal infection (e.g., strep throat). It's more common in children and young adults.
   • Appearance: Small, drop-like (guttate means "drop") lesions, typically red, scaly papules and plaques.
   • Location: Primarily on the trunk, arms, and legs.

3. Inverse Psoriasis (Flexural Psoriasis):

   • Description: Occurs in skin folds where skin rubs against skin.
   • Appearance: Smooth, red, shiny patches without the typical silvery scales due to moisture in the folds.
   • Location: Armpits, groin, under breasts, in the belly button, and in the genital area. K.B.'s groin involvement suggests this could be co-occurring.

4. Pustular Psoriasis:

   • Description: A less common and more severe form. Can be generalized (widespread) or localized.
   • Appearance: Characterized by widespread red skin with small, non-infectious, pus-filled blisters (pustules).
   • Symptoms: Can be accompanied by fever, chills, fatigue, and rapid pulse, indicating a systemic reaction.
   • Triggers: Often triggered by abrupt withdrawal of systemic corticosteroids, infections, certain medications, or stress.

5. Erythrodermic Psoriasis:

   • Description: The least common but most severe form, covering nearly the entire body surface. It's a medical emergency.
   • Appearance: Widespread, fiery red skin that is shedding in sheets.
   • Symptoms: Can disrupt the body's temperature regulation, leading to fever, chills, significant fluid loss, and potential heart failure.
   • Triggers: Abrupt withdrawal of systemic corticosteroids, severe sunburn, infection, or other systemic medications.

6. Psoriatic Arthritis:

   • Description: A chronic inflammatory arthritis that affects some people with psoriasis.
   • Symptoms: Joint pain, stiffness, swelling, and reduced range of motion. Can affect any joint, but often affects peripheral joints (fingers, toes), spine, and sacroiliac joints.
   • Skin Involvement: Can occur before, after, or concurrently with skin psoriasis.

Sample Answer

Let's break down K.B.'s case study.

1. Most Common Triggers for Psoriasis and Different Clinical Types

Most Common Triggers for Psoriasis:

Psoriasis is a chronic autoimmune condition, and while its exact cause is unknown, certain factors can trigger a flare-up or worsen existing psoriasis. The most common triggers include:

• Stress: Emotional or psychological stress is a very common trigger for psoriasis exacerbations.
• Infections:
  • Streptococcal infections (Strep throat): Particularly common in triggering guttate psoriasis, especially in children and young adults.
  • Other infections: Viral infections (e.g., common cold, flu), yeast infections, or even local skin infections can sometimes trigger flares.