23: Papulosquamous Diseases - Frush Flashcards
define papulosquamous disease
a heterogeneous group of disorders characterized by scaling papules or plaques
define papule
Small elevated, firm skin lesions under 0.5cm in diameter that are above, rather than within, the surrounding skin
define plaque
Elevated, plateau-like confluence of papules
define scale
Thickened stratum corneum that exfoliates. Accumulated debris of dead epidermal cells resulting in flakes that lift off of the skin
Flat topped, polygonal, violaceous papules of unknown cause
lichen planus
Individual lesions 1-2 mm in diameter
Coalesced lesions 4-5 mm in diameter
6 Ps of lichen planus
Planar (flat topped) Purple Polygonal Pruritic Papules Plaques
good ROS questions lichen planus
Oral lesions found in up to 1/3 of patients
Nails are involved in 10% of patients
Usually affects ages 20-60: Children and elderly less commonly affected
wickham’s striae
Delicate white lace-like pattern of lichen planus
acute v. chronic lichen planus
- acute up to 18 mo
- extremely pruritic
- anterior legs, ankles, feet
-chronic more likely to have oral lesions which can lead to squamous cell carcinoma
koebner’s phenomenon
Lesions will develop in areas of mild trauma - follow scratch lines
occurs in lichen planus
nails of lichen planus
10%
atrophy, RIDGING, grooving or splitting
- pterygium may be seen
- can be confused with onychomycosis
define pterygium
forward growth of cuticle over nail plate
describe actinic lichen planus
- Mildly pruritic
- Sun exposed areas or sunburned skin
- Similar in appearance to granuloma annulare
- Pigmented and/or dyschromic
- Koebnerization present
- Scalp and nails usually not involved
describe annular lichen planus
- Lesions form in annular pattern
- Ring of small confluent papules with central clearing and peripheral spreading
- Lower extremities and penis
describe atrophic lichen planus
- When active lesion go into remission
- Often on mucosal surfaces
- Has scaly white crust with “melting” edges
describe bullous lichen planus
- Tense bullous lesions
- Unaffected skin or
Preexisting lichen planus - Common on lower extremities and feet **
- Changes to characteristic appearance after blister eruption
describe follicular lichen planus
- Lichen planus of hair follicles
- Scalp and lower extremity prevalence
- Sharp pointed, keratotic, follicular papules
- Occasional concurrent skin atrophy and alopecia
- May become permanent
describe hypertrophic lichen planus
- Highly pruritic
- Confluent, firm, lichenified, scaly, and violaceous or hyperpigmented plaques
- Location: Anterior shins, ankles and soles
- Often becomes chronic
- More likely to become malignant ***
- Skin becomes heavily pigmented
- Often permanent
- Skin feels rough or “warty”
describe lichen amyloidosu
- Predilection for Dark skinned middle aged people of Central or South America
- Pruritic papules on anterior shins and ankles
- May coalesce into plaques
describe lichen planus erythematous
- Soft, nonpruritic, round, erythematous papules
- Forearms and ankles
- Older women
describe lichen nitidus
- Mildly pruritic
- Flesh colored to erythematous, tiny, discrete, sharply demarcated, round or flat-topped, shiny papules
- Penis, arms, legs, ankles, back and abdomen
- Occasionally found on palms, soles and toes
- Hyperkeratotic scale commonly present
- Koebner phenomenon
- Nail changes present: Pitting, ridging, thickening and brittleness
lichen dermatitis
Caused by medications or chemical exposure
Color changes from bright red to violaceous to rust brown
Lesions resolve with removal of cause
describe vesicular lichen planus
Precursor or variant of bullous
Mildly to moderately pruritic
Violaceous vesicles
Often found with other forms of lichen planus
treatment lichen planus
Self limiting disease with 60-80% spontaneous clearance in 1 year
Remove questionable offending agents if medically possible
Treat patient’s symptoms (pruritus)
Severe cases: Dapsone or PUVA (8-methoxypsoralen photochemotherapy)
describe pityriasis rosea
Self-limiting, asymptomatic skin eruption
Found most frequently on the trunk or proximal extremities
Starts as solitary round to oval lesion 2 to 10 cm termed herald patch
Eruptive phase begins with spread of smaller lesions
20% of patients have recent history of infection with fever, fatigue, sore throat, and lymphadentitis
Lesions typically resolve in 1 to 3 months
describe pityriasis rubra pilaris
Progressive yet self-limiting
Thick scaling with red follicular papules that can spread into a generalized eruption
Difficult to distinguish from psoriasis
Initial lesion is a small, smooth, red, scaling plaque that slowly enlarges
Soles and palms start to thicken
Eruption can last for months to years: 80% of patients clear within 3 years
what makes psoriasis better? worse?
stress and illness make worse
rest and sunshine make better
Red to brown, slightly raised patches with silvery scales
Affects extensor surfaces primarily
psoriasis
- Small papules to large plaques
- Heal centrally during treatment, giving ring like appearance
- Koebnerization present
- Nail involvement common (similar to onycomycosis )
- 10-15% of patients will have arthritic changes
auspitz sign
removal of psoriasis scales cause pinpoint bleeding
nails of psoriasis
Pitting - 25% Yellow macules Oil spots Distal lysis Dystrophy Resembles onychomycosis
most stable form of psoriasis
psoriasis vulgaris
Patches well defined
Raised
Red base with uniform silvery scale
psoriasis following strep throat
guttate psoriasis
Small, erythematous papules
Appears suddenly
Trunk, lower legs, and feet
Usually resolves after 2-3 months
describe pustular psoriasis
- Located on palms and soles (Usually centrally )
- Can involve just toes
- Acrodermatitis perstans
- Yellow pustules often on erythematous base
- Dries to brown crusts
- Symmetrical and bilateral
- Difficult to treat
what is acrodermatits perstans?
Crusts scale over nails and they fall off
found with pustular psoriasis affecting the toes
distinguishing features…
excoriations and lichenification of skin, often on flexor surfaces
one or more plaques with lichenification in an are that is easily scratched
herald patch preceding annular plaques with collarette scale
pruritic nodules, often on extremities
plaques with thick scale on extensor surfaces
eczema
lichen simplex chronicus
pityriasis rosea
prurigo nodularis
psoriasis
