10- Seb Derm, Psoriasis, Erythroderma

Question 1

Chronic, superficial, inflammatory disease with a predilection for the scalp, eyebrows, eyelids, nasolabial crease, lips, ears, groin, axillae

Yellow, greasy scaling on erythematous base

Answer 1

Seborrheic dermatitis

Question 2

Mild form of seborrheic dermatitis -dandruff is also called

Answer 2

Pityriasis sicca

Question 3

Treatment of seborrheic dermatitis

Answer 3

Antifungals-
Scalp: ketoconazole selenium sulfide tar zinc pyrithione shampoo 2-3x a week

Topical calcineurin inhibitors- associated with burning sensation (tacrolimus etc)

Question 4

Chronic recurrent inflammatory disease characterized by circumscribed, erythematous, dry, scaling plaques of various sizes covered by silvery white lamellar scales

Scalp, nails, extensor surfaces, umbilical, sacrum

Answer 4

Psoriasis

Question 5

This sign is seen in psoriasis

- removal of scale produces bleeding points

Answer 5

Auspitz sign

Question 6

Almost half of psoriatic arthritis patients have this type of human leukocyte antigen

Answer 6

HLA B27

Question 7

Patients with this type of psoriasis have plaque psoriasis and psoriatic arthritis

Answer 7

Generalized pustular psoriasis

Von Zumbusch psoriasis

Question 8

Sudden onset with lakes of pus periungually, on palms and plaque edges

Erythema and pustules all over with pruritus and intense burning
Mucous membranes affected- geographic tongue

Fever, erythroderma, hypocalcemia and cachexia

Answer 8

Generalized pustular psoriasis

Question 9

Episodes of generalized pustular psoriasis are often provoked by

Answer 9

Withdrawal of systemic corticosteroids

Question 10

Drug of choice for generalized pustular psoriasis (von Zumbusch)

Answer 10

Acitretin

Question 11

Pustular psoriasis of pregnancy

Flexural erythema studded with pustules— generalized pustular flare

Answer 11

Impetigo herpetiformis

Question 12

Treatment for impetigo herpetiformis

Answer 12

Delivery

Prednisone 1mg/kg/day

Question 13

This disease resembles psoriasis except for its tendency for thicker keratotic lesions

(+) HLA B27

Develop reactive arthritis and skin disease after a bout of urethritis or enteritis

Answer 13

Reiter syndrome

Question 14

Isomorphic response in psoriasis where lesions of psoriasis appear at a different site (scratches, incisions, burns etc)

Answer 14

Koebner phenomenon

Question 15

Concentric blanching of erythematous skin at or near the periphery of a healing psoriatic plaque

First sign that psoriasis is responding to phototherapy

Answer 15

Woronoff ring

Question 16

Which HLA is more associated with pustular psoriasis?

Answer 16

HLA B27

Question 17

Which HLA is more associated with palmoplantar psoriasis?

Answer 17

HLA B8

Question 18

Which HLA is more associated with guttate and erythrodermic psoriasis?

Answer 18

HLA B13 B17

Question 19

Which interleukin is capable of inducing Th2 response and improve psoriasis?

Answer 19

IL-4

Question 20

Psoriasis is a hyperproliferative disorder driven by inflammatory mediators

Which of the T helper cells are involved?

Answer 20

Th1

Th17

Question 21

Antimalarials can induce erythrodermic flares of psoriasis

What is the best prophylactic drug to take when traveling to an endemic area?

Answer 21

Quinine derivatives

Question 22

Steroid Topical tx for psoriasis

Answer 22

Class 1 steroids x 2 weeks
Low to mid strength- intertriginous, face
Intralesional triamcinolone- diluted with saline to make 2.5-5mg/mL

Question 23

Other topicals for psoriasis

Answer 23

• Crude coal tar
• Tazarotene-retinoid: modulate keratinocyte differentiation and hyper proliferation (combined with steroids)
• tacrolimus- thin lesions
• phototherapy: NB UVB 311nm
• PUVA

Question 24

Effective in treatment of plaque type and scalp psoriasis

Answer 24

Calcipotriene (Vit D3)

Question 25

This therapy for psoriasis is an effective method treatment that is inexpensive even in patients with poor response to biologic agents

Answer 25

Goeckerman technique

Question 26

What is the Goeckerman technique

Answer 26

2-5% tar prep applied to skin and tar bath OD remove with vegetable oil THEN UV light given Option: add steroids to shorten time for remission

Question 27

What is the Ingram technique for psoriasis?

Answer 27

Daily coal tar bath in warm water Daily exposure to UV light Anthralin paste to each plaque Talcum powder and stockinette dressings

Question 28

Oral psoralen used in PUVA may produce this disease

Answer 28

Cataracts

Question 29

PUVA therapy can increase the risk of acquiring this cancer

Answer 29

SCC | melanoma

Question 30

Standard systemic treatment for psoriasis

Answer 30

Methotrexate 15-30mg per week

Question 31

Before starting methotrexate treatment, these are the labs to be requested 9

Answer 31

``` LFT Bilirubin Serum albumin Creatinine Alkaline phosphatase CBC with platelet Hepa B and C serology HIV Urinalysis ```

Question 32

Monitoring for methotrexate therapy in psoriasis

Answer 32

CBC once a week LFT once a month At the start or when dosage is changed

Question 33

What is the therapeutic benefit of cyclosporine in psoriasis? 2-5mg/day

Answer 33

Downmodulation of pro inflammatory epidermal cytokines

Question 34

Monitoring for cyclosporine treatment in psoriasis

Answer 34

Blood pressure | Creatinine

Question 35

Biologic agents in psoriasis can block this immunologic modulator

Answer 35

TNF a

Question 36

Characteristic triad of Reiter syndrome

Answer 36

Arthritis Conjunctivitis Urethritis

Question 37

There is no specific test to diagnose Reiter syndrome but these are the most consistent

Answer 37

Peripheral leukocytosis 10-20k | Increased ESR

Question 38

Males, mean onset 35y Pruritic, follicular papulopustules, grouped- peripheral extension Trunk and UE affected, asymmetric distribution Spontaneous remission and exacerbation for several years

Answer 38

Eosinophilic pustular folliculitis

Question 39

Treatment of eosinophilic pustular psoriasis

Answer 39

Indomethacin

Question 40

Chronic inflammatory disease of the hands and feet Begins on a digit, paronychia, extending with eruption of pustules and crusting — anonychia (chronic) May involve mucous membranes-tongue Asymmetric throughout course

Answer 40

Dermatitis repens

Question 41

Bilateral and symmetrical dermatosis Thenar/hypothenar eminences or cental palms or soles Erythematous pustules that enlarge and coalesce to form small lakes of pus

Answer 41

Palmoplantar pustulosis

Question 42

Palmoplantar pustulosis is strongly associated with

Answer 42

Thyroid disorder Cigarette smoking Lithium