257. Papulosquamous Disorders

Question 1

Psoriasis Clinical Presentation

Answer 1

Inflammatory Skin Disease, Very Common
Thick Well Defined Plaques (raised) with Silvery Scale
Predilection for Elbows/Knees
Can affect nails - pitting/onchylosis - yellow discoloration from lifting nail plate from bed (impaired adhesion)

Question 2

Psoriasis Histology and Pathophysiology

What cytokines/cells/triggers/complications

Answer 2

H: Elongated, Thickened Epidermis (keratinocytes migrate 4x faster than normal)
P: Chronic Condition (onset any age of life, genetics involved)
Immune-Mediated Condition - hyperproliferation from cascade of inflammatory mediators
Mixed Th1/Th17 response with overexpression of TNFa, IL-17, IL-23
Triggered by: Streptococci, Trauma (skin injury), Drugs (B-blockers, Li+)

10-30% will develop PsA - inflammatory/immune mediated arthritis
sx: morning stiffness <30 minutes, dactylitis (sausage digits)

Question 3

Psoriasis Tx

localized vs. widespread

Answer 3

Localized: High Potency topical steroids (Clobetasol, Triamcinolone)

Widespread: Targeted Tx - TNFa blockers, IL-23 blockers, IL-17 blockers

Question 4

Seborrheic Dermatitis

what it is, cause, tx

Answer 4

Redness + thin yellow (waxy) flaking around nose (nasolabial folds) eyebrows, beard, ears, hairline/scalp
Related to overgrowth of yeast: Pityrosporum Ovale

Tx: antifungal creams
mild topical steroids

Question 5

Pityriasis Rosea

what it is, etiology, tx

Answer 5

Oval, salmon-colored thin macules/patches with thin scale on trunk (begins as larger “herald” patch before spreading to diffuse macules)

Christmas tree pattern on trunk

Etiology: possible reactivation of HHV 6/7 (may be preceded by URI)

tx: Acute Self-Resolving in 3-8 weeks