2/18 Psoriasis (Papulosquamous Disease) Flashcards
What are some of the features and physical findings of psoriasis?
Features: ham-colored plaques with loosely adherent silvery scales; present on extensor surfaces (knees, elbows, groin, scalp)
Physical findings
- well demarcated plaques and papules
- symmetrical distribution
- itchy, painful
- nails: **pitting
- Auspitz sign:**pinpoint bleeding that occurs when scales are removed; occurs due to dilated capillaries and thin epidermal layer over papillae
Where does psoriasis usually affect?
extensor surfaces (knees, elbows, groin, scalp)
What is Auspitz sign?
pinpoint bleeding that occurs when scales are removed; occurs due to dilated capillaries and thin epidermal layer over papillae
What is the immunological cause of Psoriasis?
What are some common cytokines involved in its pathogenesis?
T cell mediated disease
IL17, IL23 - there are now drug therapies that target these two cytokines
What are some triggers of Psoriasis?
Trauma
Friction
Changes in skin homeostasis (xs humidity, temp, UV)
Allergens (contact dermatitis)
Drugs
Infections
What is the usual onset of Psoriasis?
BIMODAL
late 20s and early 50s
What are the 4 variants of Psoriasis?
- Guttate - lots of dots all over the body; occurs in children; due to post-strep pharyngitis
- Pustular - localized on palm and soles
- Intertriginious (inverse psoriasis) - affects skin folds (axilla, gluteal cleft, post-auricular)
- Erythrodermic - total body redness
What type of psoriasis is this?
What causes it?
GUTTATE
- caused by strep pharyngitis - bacterial antigens acts as superantigens that cause T cell activation, resulting in lots of dots all over the body.
What type of psoriasis is this?
Where else would you find it?
PUSTULAR
occurs on palms and soles
What type of psoriasis is this?
Where are these normally located?
Inverse psoriasis “intertriginous”
affects areas where there are skin folds (overlapping skin):
- *- axilla
- gluteal cleft
- post-auricular
- butt
- penis**
What type of psoriasis is this?
What causes it?
ERYTHRODERMIC
total body redness; often presents with systemic symptoms
How do you treat psoriasis?
**Topicals Rx: **mild-moderate psoriasis
Phototherapy - moderate-severe psoriasis
Systemics - oral or injected Rx
What are the common causes of death in patients with psoriasis?
- CVD (34%)
- Infection (22%)
- Cancer (21%)
What are some of the topical therapies for psoriasis?
topical steroids
coal tar
UVB phototherapy
Anthraline
Vitamin D analogs (Calcipotriene, Calcipotriol)
Tazarotene (synthetic retinoid)
What are the side effects of using retinoids, such as Tazarotene?
liver toxicities
alopecia
dry skin
nail loss
What are some systemic therapies for psoriasis?
psoriasis “camp”
What are some of the ADRs and contraindications?
MTX - contraindicated in persons on bactram
PUVA - increase risk of melanoma and squamous cell carcinoma
Acitretin - synthetic retinoid ; long half-life; can cause liver toxicities, alopecia, dry skin, and nail loss
Cyclosporins - nephrotoxicity
Biologics: TNFa, antibodies against T cells
What is the PASI score?
measures efficicacy of psoriasis treatment using a composite score of
- erythema
- induration
- desquamation
>75% = great because it means the psoriasis improved by 75%
What does this person have?
How do you tell?
Seborrheic Dermatitis
presence of yellow, greasy scaling papules among red patches
plaques in areas that contain the greatest concentration of sebaceous glands (scalp, face, parasternal)
What does Pityrosporum yeast cause?
Seborrheic dermatitis “dandruff”
What does this person have?
how can you tell?
Seborrheic dermatitis
there are yellow, greasy scaling papules among red patches
What does this patient have?
how do you treat it?
Seborrheic dermatitis
treatment:
remove the scale
low dose corticosteroids
topical antifungal (caused by Pityrosporum yeast)
What is Seborrheic dermatitis?
What is it caused by?
How does it present in adults? children?
How is it treated?
Dandruff
caused by: Pityrosporum yeast
Adults: yellow, greasy scaling papules among red patches + plaques in areas that contain the greatest concentration of sebaceous glands (scalp, face, parasternal)
children: yellow, greasy adherent scale on scalp with minimal erythema;“cradle cap”
What does this person have?
How can you tell?
Pityriasis Rosea
- *Oval** plaque, salmon colored with a
- *thin collar of residual scale** inside the border
What does this person have?
Pityriasis Rosea
Oval plaque, salmon colored with a
thin collar of residual scale inside the border
distribution in a “christmas tree pattern”
What is Pityriasis Rosea?
What is the clinical presentation of it?
What other disease does this resemble and how do you tell them apart?
self-limited disease (possibly of viral etiology)
Clinical Presentation
- HERALD patch appears on trunk (pval plaque, salmon colored with a thin collar of residual scale inside the border)
- 1-2 weeks later, numerous lesions appear with a christmas tree pattern
- clears spontaneously within 4-6 weeks, but hyperpigmentation may take months to resolve
looks like syphillis but does not show up on palms and soles like syphillis
What does this person have?
How can you tell?
Lichen Planus
5 P’S
Purple
polygonal
Pruritic
Papules
Plaques
Sharply defined
surface contains a lacy reticulated pattern
What are the 5 P’S of lichen planus?
Purple
polygonal
Pruritic
Papules
Plaques
Sharply defined
What is lichen planus?
Where does it normally affect?
What is the characteristics of it?
What patients is it common in?
itchy rash on the skin or in the mouth
affects: skin, nails, mucous membranes
(mouth, penis)
5P’S - purple, polygonal, pruritic, papules, plaques,
sharply defined
lacy, reticulated pattern
Koebner Phenomenon - new lesions that may develop in areas of injury
common in HepC, woman, + family history
What is the Koebner phenomenon?
What disease does it happen in?
new lesions that may develop in areas of injury
happens in Lichen Planus
What disease does this patient have?
How can you tell?
Lichen Planus
5P’S - purple, polygonal, pruritic, papules, plaques,
sharply defined
lacy, reticulated pattern
What does this patient have?
How can you tell?
Lichen Planus
lesions commonly develop in the mucus membranes and skin
This is characteristic of what disease?
Lichen Sclerosis
ivory white papules with a faint pink rim with dark brown keratotic follicular plugs
can coalesce to form a smooth, white atrophic surface with a dull or glistening appearance
You’re an OBGYN resident and a patient comes in, wanting to know what’s up with their jizz.
What do you tell them?
How do you tell?
Lichen Sclerosis - a disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital skin if its not treated.
Features: ivory white papules with a faint pink rim with that can coalesce to form a smooth, white atrophic surface with a dull or glistening appearance
What is Lichen Sclerosis?
Where does it normally affect?
Who does it normally affect?
What are some characteristic features of it?
What are some of the clinical features on it?
It’s a disease of unknown etiology
affects skin + mucosal surfaces with a predilection for anogential skin
Females
skin lesons can be asymptomatic, but it can be pruritiic
if it’s not treated, it can lead to irrversible scarring
can develop to squamous cell carcinoma
dx?
lichen sclerosis
dx?
lichen sclerosis
dx?
pustular psoraisis
