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MSS > 28. Inflammatory Disorders > Flashcards

28. Inflammatory Disorders Flashcards

1
Q

Most common psoriasis

A

Plaque (most common) • Extensor extremities most common; pink patches and plaques with overlying silvery scale

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2
Q

Inverse – Flexural psoriasis are located:

A

• Axillae, groin, perineum, chest

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3
Q

• Drop-like, 2-10mm, symmetric trunk/proximal extremities • Often triggered by Group A Strep What type of psoriasis is this?

A

Guttate

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4
Q

– Pustular psoriasis is usually located on:

A

• May be localized to palms and soles or be generalized

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5
Q

Generalized erythema; amount of scaling is variable, what kind of psoriasis is this?

A

– Erythrodermic

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6
Q

immune-mediated polygenic skin condition. Mutlifactoral triggers disease in predisposed individuals. lesions are well-demarcated erythematous papules and plaques,
ranging in size from pinpoint to < 20 cm in diameter, with overlying micaceous or silvery scale

A

Psoriasis

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7
Q

Other signs of psoriasis besides skin changes

A

Nail changes can also be seen with pitting
(pinpoint indentations in the nail plate), thickening, and yellow discoloration.
20-30% developing psoriatic arthritis have
increased risk of metabolic syndrome and atherosclerotic cardiovascular disease

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8
Q

When evaling a pt with psoriasis, what other things should we take into consideration?

A

recent infections
– may trigger flares, particularly Streptococcal
• risk factors for HIV
– HIV patients often have worse disease
• Ask about joint symptoms
– Up to 20% also have psoriatic arthtitis
• Evaluate body mass index (BMI)
– Correlation between obesity and prevalence and
severity of psoriasis

• Ask about CV risk factors– see increased risk for CV

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9
Q
A
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10
Q

Genetics and psoriasis

A

• Ask about other family members with
psoriasis
– Strong genetic predisposition for psoriasis
– Multiple psoriasis genes identified
– 1/3 with a positive family history

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11
Q

How can mediation be involved in pt presenting with psoriasis

A

can be triggered or exacerbated by
many medications, including:
– Systemic corticosteroid withdrawal
– Beta blockers (propranolol, metoprolol)
– Lithium
– Anti-malarials (chloroquine, hydroxychloroquine)
– Interferons

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12
Q

What is this… what types of pts may have this

A

Pencil in cup deformity seen in pts with psoriasis arthritis

Psoriasis arthritis seen in 20-30% pts

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13
Q

What joint issues should we keep in mind with psoriasis pts?

A

oligoarthritis (common in knee) and psoriasis arthritis. See sausage fingers, pencil in cup deformities, flexure deformities and bone destruction

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14
Q

What type of nail changes do we see with psoriasis?

A

Pitting, discoloration, onycholysis in 25-30% pts

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15
Q

In psoriasis we see development of skin lesions at site of injury… this is called:

A

Koebner phenomenon

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16
Q

Pt has psoriais:
– Localized (<5% BSA)

Tx recommendation?

A

topicals alone

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17
Q

Pt has psoriasis that can be chacterized as:

Generalized
Tx?

A
  • systemic/phototherapy + topicals
    • Refer to dermatologist for management
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18
Q

What are some aggravating factors

A

– Concurrent infection
– Medications
– Obesity

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19
Q

For localized or mild psoriasis, tx?

A

opical corticosteroids are first-line therapy. Other topical agents include retinoids, coal tar derivatives, and calcineurin inhibitors

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20
Q

used in psoriasis
to induce terminal differentiation and inhibit proliferation of keratinocytes, as well as modulating
the immune response.

A

Topical vitamin D analogues (e.g. calcipotriene, calcitriol)

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21
Q

Psoriasis: extensive disease or recalcitrance to topical
corticosteroids, treatment with what two things should we consider?

A

phototherapy or systemic medications may be indicated.

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22
Q

Systemic agents used in the treatment of psoriasis include

A

methotrexate, cyclosporine, acitretin,
and targeted immune modulators (“biologics”).

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23
Q

Biologic therapies target

A

T cells and cytokines
involved in the pathogenesis of psoriasis. TNF-α inhibitors used for psoriasis include etanercept,
infliximab, and adalimumab.

24
Q

What should we avoid in pts with psoriasis?

A

Oral corticosteroids should be avoided in patients with psoriasis as withdrawal of the corticosteroids will provoke a flare of their disease, often pustular. C

25
Q

TNF alpha blockers for psoriasis

A

Entanercept, Infliximab, Adalimumab

26
Q

IL-12, IL23 blocker used for psoriasis tx

A

Ustekinumab

27
Q

What UV is used for phototherpy of psoriasis

A

narrrowband UVB and sometimes UVA

28
Q

psoriasis on face an groin, used what class of topical coritcosteroids?

A

Class V and VI

29
Q

Psoriasis on the body… what class of corticosteoids should we use

A

Class III to IV

30
Q

What class of coriticosteroids should we use for psoraisis on hands and feet

A

Class I and II, strongest

31
Q

Inflammatory disease of skin, hair, nails and
mucous membranes
• Flat-topped (planar) polygonal pruritic pink or
violaceous (purple) papules or plaques
• Flexural lower legs, ankles, wrists, genitalia
most common

A

Lichen Planus

32
Q

Describe this lichen planus

A

• Flat-topped (planar) polygonal pruritic pink or
violaceous (purple) papules or plaques

SUPER itchy

33
Q

What exposures are associated with increased incidence of Lichen Planus?

A

– Viruses (Hepatitis C)

– Hepatitis B vaccine
– Drugs
• Beta-blockers
• ACE inhibitors
• Thiazide diuretics
• Antimalarials
• Gold and metals
• Penicillamine

34
Q

– Thinning of nail plates
– Longitudinal ridging
– Pterygium formation (scarring)

–What does this pt have?

A

Nail Lichen Planus: 10% of LP patients have nail involvement
• Isolated nail LP may occur

35
Q

Most common locations for mucosal lichen planus

A

Mucosal Lichen Planus
– Oral most common
– Genital
– Pharynx, esophagus, GI tract

36
Q

What are the two types of Lichen planus?

A

– Reticulated: • Linear lace-like pattern of tiny white papules, Buccal mucosa most common, Typically asymptomatic
– Erosive, Gingiva or tongue, Typically painful

37
Q

Topical Tx options for Lichen Planus

A

Topical corticosteroids
• Topical calcineurin inhibitors
• NBUVB phototherapy

38
Q

Systemic Tx options for Lichen planus

A

– Oral corticosteroids
– Metronidazole, Griseofulvin
– Antimalarials
– Acitretin (retinoid)
– Mycophenolate mofetil
– Methotrexate
– Cyclosporine

39
Q

4 week history of this facial eruption. Was treated with a 10 day course of cephalexin with no response Mother reports seeing him occasionally scratch at it, but otherwise not particularly bothered by this. Dx?

A

Atopic Dermatitis

40
Q

most common chronic inflammatory skin disease. Onset in infancy is typical,

A

Atopic dermatitis (AD)

41
Q

What do we tend to see in infants with atopic dermatitis?

A

– Facial involvement predominates early
– Tends to spare midface
– Oozing, crusting common
– Exacerbated by saliva, foods
– Extensor involvement late infancy
– Sparing of diaper area

42
Q

What childhood disease would we expect this guy to have had?

A

Dennie-Morgan folds show evidence of atopic dermatitis

43
Q

where else do we expect to see atopic dermatitis in childhood (NOT infants)

A

Flexural involvement: antecubital and popliteal fossa, wrists, ankles, neck and hands… less crusting

44
Q

Kiddo presents with atopic dermatitis on the foot… has new tender lesions that is not typcial of her eczema according to mom.. What may be going on?

A

Secondary infection with Staph. Aurues or Staphylococcus

45
Q

Infection with Herpes overlying eczema:

A

Eczema herpaticum

46
Q

Treating a Flare of AD:

A

Topicals – Corticosteroids
• Ointments preferred
Immunomodulators :

Calcineurin inhibitors: Tacrolimus , Pimecrolimus
• Antihistamines for pruritus
• Treat/prevent secondary infections
– Bleach baths

47
Q

Factors to consider when choosing topicals for AD

A

– DURATION of lesion; New lesion will often respond to weaker agents, Chronic lesion requires stronger treatment
– LOCATION of lesion; Thin skin (e.g. face, axilla, groin), Higher risk for side effects, should use lower strength med VS Thicker skin (e.g. palms, soles)
– Lower penetration/absorption, higher strength med often equired

48
Q

Systemic Tx of AD

A
  • Phototherapy – Narrowband UVB
  • Systemic agents: Cyclosporine, Methotrexate, Mycophenolate mofetil, Azathioprine
49
Q

Management of Atopic Dermatitis:

A

Maintenance
• Gentle skin care: Daily baths, Gentle cleansers , Thick moisturizer twice daily
• Petrolatum/Aquaphor > Cream > Lotion
– Avoidance of irritants (i.e. fragrance)

50
Q

• Pathogenesis of AD

A

– Barrier-disrupted skin (abnormal barrier)
– Triggers : Allergens, Microbes (especially S. aureus)
and Scratching

51
Q

Immune dysregulation of Atopic Dermatitis
• Acute:
• Chronic:

A
  • Acute: Th2
  • Chronic: Th1
52
Q

DX?

A

Cradle cap or Seborrheic Dermatitis

53
Q

Mom presents with child that has cradle cap… what can it progress to?

A

Seborrheic Dermitis
– Evolves to moist erythematous intertriginous
patches in
• Can be secondarily infected with Candida or
Streptococcus specis
– Dissemination with scaly papules, patches, and
plaques resembling atopic dermatitis/psoriasis
may occur as well

54
Q

This 50 yo male presents
with complaints of itching
and flaking in the scalp for
as long as he can
remember.

A

Adult form of seborrheic Dermatitis

Seen as yellow-red papules, erythema and scaling

Mostly on the scalp–> aslo forehead, medial eyebrow, skin and ear or presternal

55
Q

Tx for seborrheic dermatitis in infants

A

Low potentcy topical steroid, ketoconazol cream, mild shampoos, gentle skin care

56
Q

Tx for Seborrheic derm in Adults

A

Azole cream or shampoo, Low potentcy topical steroid, Shampoos (tar, zinc, sulfide)

MSS (26 decks)

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