10- Seb Derm, Psoriasis, Erythroderma Flashcards
Chronic, superficial, inflammatory disease with a predilection for the scalp, eyebrows, eyelids, nasolabial crease, lips, ears, groin, axillae
Yellow, greasy scaling on erythematous base
Seborrheic dermatitis
Mild form of seborrheic dermatitis -dandruff is also called
Pityriasis sicca
Treatment of seborrheic dermatitis
Antifungals-
Scalp: ketoconazole selenium sulfide tar zinc pyrithione shampoo 2-3x a week
Topical calcineurin inhibitors- associated with burning sensation (tacrolimus etc)
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
Psoriasis
This sign is seen in psoriasis
- removal of scale produces bleeding points
Auspitz sign
Almost half of psoriatic arthritis patients have this type of human leukocyte antigen
HLA B27
Patients with this type of psoriasis have plaque psoriasis and psoriatic arthritis
Generalized pustular psoriasis
Von Zumbusch psoriasis
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
Generalized pustular psoriasis
Episodes of generalized pustular psoriasis are often provoked by
Withdrawal of systemic corticosteroids
Drug of choice for generalized pustular psoriasis (von Zumbusch)
Acitretin
Pustular psoriasis of pregnancy
Flexural erythema studded with pustules— generalized pustular flare
Impetigo herpetiformis
Treatment for impetigo herpetiformis
Delivery
Prednisone 1mg/kg/day
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
Reiter syndrome
Isomorphic response in psoriasis where lesions of psoriasis appear at a different site (scratches, incisions, burns etc)
Koebner phenomenon
Concentric blanching of erythematous skin at or near the periphery of a healing psoriatic plaque
First sign that psoriasis is responding to phototherapy
Woronoff ring
Which HLA is more associated with pustular psoriasis?
HLA B27
Which HLA is more associated with palmoplantar psoriasis?
HLA B8
Which HLA is more associated with guttate and erythrodermic psoriasis?
HLA B13 B17
Which interleukin is capable of inducing Th2 response and improve psoriasis?
IL-4
Psoriasis is a hyperproliferative disorder driven by inflammatory mediators
Which of the T helper cells are involved?
Th1
Th17
Antimalarials can induce erythrodermic flares of psoriasis
What is the best prophylactic drug to take when traveling to an endemic area?
Quinine derivatives
Steroid Topical tx for psoriasis
Class 1 steroids x 2 weeks
Low to mid strength- intertriginous, face
Intralesional triamcinolone- diluted with saline to make 2.5-5mg/mL
Other topicals for psoriasis
- Crude coal tar
- Tazarotene-retinoid: modulate keratinocyte differentiation and hyper proliferation (combined with steroids)
- tacrolimus- thin lesions
- phototherapy: NB UVB 311nm
- PUVA
Effective in treatment of plaque type and scalp psoriasis
Calcipotriene (Vit D3)
This therapy for psoriasis is an effective method treatment that is inexpensive even in patients with poor response to biologic agents
Goeckerman technique
What is the Goeckerman technique
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
What is the Ingram technique for psoriasis?
Daily coal tar bath in warm water
Daily exposure to UV light
Anthralin paste to each plaque
Talcum powder and stockinette dressings
Oral psoralen used in PUVA may produce this disease
Cataracts
PUVA therapy can increase the risk of acquiring this cancer
SCC
melanoma
Standard systemic treatment for psoriasis
Methotrexate
15-30mg per week
Before starting methotrexate treatment, these are the labs to be requested
9
LFT Bilirubin Serum albumin Creatinine Alkaline phosphatase CBC with platelet Hepa B and C serology HIV Urinalysis
Monitoring for methotrexate therapy in psoriasis
CBC once a week
LFT once a month
At the start or when dosage is changed
What is the therapeutic benefit of cyclosporine in psoriasis?
2-5mg/day
Downmodulation of pro inflammatory epidermal cytokines
Monitoring for cyclosporine treatment in psoriasis
Blood pressure
Creatinine
Biologic agents in psoriasis can block this immunologic modulator
TNF a
Characteristic triad of Reiter syndrome
Arthritis
Conjunctivitis
Urethritis
There is no specific test to diagnose Reiter syndrome but these are the most consistent
Peripheral leukocytosis 10-20k
Increased ESR
Males, mean onset 35y
Pruritic, follicular papulopustules, grouped- peripheral extension
Trunk and UE affected, asymmetric distribution
Spontaneous remission and exacerbation for several years
Eosinophilic pustular folliculitis
Treatment of eosinophilic pustular psoriasis
Indomethacin
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
Dermatitis repens
Bilateral and symmetrical dermatosis
Thenar/hypothenar eminences or cental palms or soles
Erythematous pustules that enlarge and coalesce to form small lakes of pus
Palmoplantar pustulosis
Palmoplantar pustulosis is strongly associated with
Thyroid disorder
Cigarette smoking
Lithium
