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Senior - Derm 1 > 3 - Inflammatory Disorders > Flashcards

3 - Inflammatory Disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

What physically and emotionally disabling skin condition starts in childhood, persists into adulthood, and is worse in winter?

A

Chronic plaque psoriasis

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2
Q

People with chronic plaque psoriasis are at increased risk for:

A

Psoriatic arthritis

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3
Q

Describe the morphology of chronic plaque psoriasis

A

Begins as red, discrete flat-topped scaling papules
that coalesce to form round to oval plaques

Thick, adherent, silvery-white scale

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4
Q

What is Auspitz sign?

A

Removal of scales of plaque psoriasis leading to pinpoint bleeding

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5
Q

Distribution of plaque psoriasis

A

Scalp
Extensor surfaces
Presacral and groin

Usually symmetric and bilateral
Diffuse or confluent

Pitting or “oil spots” on nails

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6
Q

Etiology of chronic plaque psoriasis

A

Hyperproliferation of the epidermis

7x faster transit than normal (4 days vs 30 days)

Cells pile up and cannot be released fast enough

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7
Q

Management of chronic plaque psoriasis

A

If over 5% BSA: systemic therapy (methotrexate, soriatane, cyclosporine, biologics, UVA)

If under 5% BSA: topical therapy

  • Class I or II and taper to triamcinolone as plaque thins
  • steroid vacation (take a break)
  • control stress
  • keratolytic (salicylic acid) can be used prior to steroid to remove scale
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8
Q

non steroid Topical meds for chronic plaque psoriasis

A

Topical Vit D - Calcitriol - very effective - even better when combined with steroid

Calcipotriene (Dovonex) - Vit D3 derivative

Tazarotene - topical retinoid

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9
Q

Txt of scalp plaque psoriasis?

A

Keratolytic gel, tar shampoo, triamcinolone

Diffuse and thick scale - calcipotriene and betamethasone dipropionate lotion

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10
Q

Slide 11

A

Meds

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11
Q

How will plaque psoriasis appear if it’s in the intertriginous areas?

A

Smooth, red plaques with a macerated surface

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12
Q

Pitting psoriasis of nail matrix results in loss of:

A

Parakeratotic cells from surface of nail plate

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13
Q

What is Guttate psoriasis?

A

Sudden appearance of scaling papules on the trunk / extremities (spares palms/soles), typically happens following a strep / viral URI

Indicates propensity to develop chronic plaque psoriasis

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14
Q

Describe the morphology of Guttate Psoriasis

A

Teardrop, diffuse, scattered

Multiple, tiny discrete red papules with thick white scale

May have classic plaques on elbows, knees

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15
Q

Guttate psoriasis distribution

A

Truncal and proximal extremities

May have nail pitting

May be on classic areas (knees / elbows)

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16
Q

Etiology of Guttate psoriasis

A

Genetic and environmental factors leading to an

aberrant immune response in the skin may contribute to disease development (Strep/Viral infxn)

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17
Q

Management of Guttate psoriasis

A

Throat cx to r/o strep

UVB 6-8 weeks = 1st line!

Topicals usually impractical due to diffuse area

Keep moist with emollients

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18
Q

What’s the deal with pustular psporiasis

A

Rare but sometime fatal

Toxic, febrile, leukocytosis

Middle age, usually

Painful

Smokers

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19
Q

Morphology of pustular psoriasis

A

Numerous tiny, sterile pustules evolve from an
erythematous base and coalesce into lakes of pus

Deep-seated pustules middle of palm or sole of foot) primary

Pustules don’t rupture - they dry up, harden, and fall off

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20
Q

Management of pustular psoriasis

A

Class I topical

NO ORAL STEROIDS

ABX for secondary infx

Emollients

Oral or topical PUVA

Retinoids

Cyclosporine

Methotrexate

Relapses common

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21
Q

Describe seborrheic dermatitis:

A

Common, chronic inflammatory dz

Peaks in infancy, maternity, teens (high hormonal periods)

Flares in dry winter, stress, change in hygiene

Severe in elderly

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22
Q

What is one of the MC cutaneous manifestations of AIDS?

A

Seborrheic dermatitis

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23
Q

Morphology of seborrheic dermatitis?

A

Fine white or yellow greasy flakes

May have an inflamed base

Pruritic

Red papules

Annular with raised edge

Cradle cap

Secondary staph infx

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24
Q

Distribution of seborrheic dermatitis

A

Scalp and scalp margins

Eyebrows and base of eyelashes

Nasolabial folds

EAC’s

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25
Q

Etiology of seborrheic dermatitis

A

Hereditary - flared by environment, possibly caused by yeast

Hyperproliferation process (similar to psoriasis)

Glandular problem (oily skin)

Tends to persist in adults with periods of remission and exacerbation

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26
Q

Management of seborrheic dermatitis

A

OTC anti-dandruff shampoos

Selenium sulfide

Tar based

Ketaconazole for yeast overgrowth

Topical steroids

Dicloxacillin for secondary infx

Oral antifunfgals for bad cases

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27
Q

Atopic dermatitis

A

Chronic, pruritic eczematous disease

Almost always begins in childhood

Remitting/recurring course

Improves with age

FHX or allergies, atopy, asthma, sinusitis

Flares with cold, dry weather, stress, illness, irritants

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28
Q

Morphology of atopic dermatitis

A

Erythema progressing to papules and plaques with:

  • flaking
  • xerosis
  • cracking
  • excoriations
  • fissures

Patchy or confluent
Lichenification over time
Secondary staph with flares

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29
Q

Where would you see atopic dermatitis in adults on PE:

A 
Bilateral flexor creases
Hands
Neck 
Waist
Wrists and ankles
Spares the face except the eyelids
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30
Q

Where would you see atopic dermatitis in kids?

A

2-12 ys - Flexural areas
Face and scalp
Patchy or generalized body eczema

Infants - cheeks

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31
Q

Etiology of atopic dermatitis

A

The “itch that rashes”

Dryness that causes cracking which causes itch which causes a rash (eczematous)

Hereditary

May flare with acute allergic situations

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32
Q

Management of atopic dermatitis (general)

A

Hydrate

Wash less often (milder soap)

Shorter bathing time, tepid water

Moisturize immediately after washing

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33
Q

Meds for atopic dermatitis inflammation

A

Mid to high strength topical steroids

Group V fluticasone proprionate cream safe in kids > 3 mos for severe

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34
Q

Important treatment aspect of atopic dermatitis management includes breaking the:

A

Itch-scratch cycle

Use hydroxyzine or diphenhydramine

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35
Q

Use of pimecrolimus cream in atopic dermatitis

A

Apply thin layer to affected areas BID

For immunocompetent patients older than 2 yrs

No occlusive dressings

NO burning sensation

36
Q

Tacrolimus ointment for atopic dermatitis

A

Apply thin layer to affected areas BID

For patients who have failed other topicals

No occlusive dressings

Burning sensation can happen

37
Q

What is the MC inflammatory skin disease?

A

Eczema

Characteristics include - erythema, scale, and vesicles

38
Q

3 stages of eczema?

A

Can occur in any order

  1. Acute
  2. Subacute
  3. Chronic
39
Q

Etiology of acute eczema?

A

Contact allergy (Rhus)

Acute nummular eczema

Stasis derm

Pompylox

40
Q

Acute eczema presents with:

A

Intense erythema

Intense itch

Vesicles

Bullae

41
Q

Txt for acute eczema?

A

Cold wet compress

PO or topical steroids

Antihistamine

ABX if secondarily infected

42
Q

Subacute eczema will present how?

A

Erythema

Scaling

Fissuring

Parched appearance

Moderate itching, pain, burning

43
Q

Etiologies of subacute eczema?

A

Contact allergy

Irritant

Atopic

Nummular eczema

Asteatotic eczema

44
Q

Txt for subacute eczema?

A

Topical steroids (occlusion PRN)

Emollients after

Antihistamines

ABX

45
Q

Chronic eczema will present with:

A

Thickened skin

Accentuated skin lines

Excoriations

Fissuring

Moderate to intense itch

46
Q

Etiologies of chronic eczema

A

Atopic

Habitual scratching

LSC

Nummular eczema

Asteatotic eczema

47
Q

Treatment for chronic eczema?

A

Topical steroids with occlusion for best results

Antihistamines

ABX

Emollients

48
Q

What is dyshidtrotic eczema (pomphyolyx)?

A

Distinctive reaction pattern - symmetric vesicular hand and foot dermatitis

Moderate to severe itching PRECEDES the appearance of vesicles

Unknown etiology (maybe atopic, stress, irritants…)

Most common in teens to middle age

49
Q

Describe dyshidtrotic eczema (pompholyx)?

A

Multiple tiny deep seated vesicles (tapioca lesions)

Palms and lateral aspects of fingers and hands or feet

Palms may be red and wet with perspiration

Surrounding erythema

Very pruritic

50
Q

Explain the progression of dyshidrotic eczema:

A

Vesicles slowly resolve in 3-4 weeks

Replaces with scale…progresses to lichenification and cracking, peeling, and fissuring

Pain then replaces pruritis

Secondary infx can be problematic

51
Q

Management of dyshidrotic eczema?

A

Lifestyle mods (avoid water, irritants, trauma)

Use bland emollients

Potent steroid then wean

ABX if indicated

Hydroxyine for pruritus

Cool, wet compress

Elimination diet (figure out a potential cause)

IF ALL ELSE FAILS - low dose methotrexate

52
Q

What is asteatotic eczema?

A

Occurs after excessive drying in the winter months and among the elderly

Atopic patients more likely

More of an itch than a rash

53
Q

Describe the morphology of asteatotic eczema

A

Lower legs - dry and scaly with accentuation of the skin lines (xerosis)

Red plaques with thin, long, horizontal superficial fissures - resembles cracked porcelain

Minimal erythema

Excoriations without other lesions

54
Q

Etiology of asteatotic eczema

A

Cold, dry weather and long, hot showers

55
Q

Management of asteatotic eczema?

A

Shower less, and not with hot water, mild soap

Emollients immediately after bath

Steroids if bad enugh

If oozing, crusts, infx - wet compress, ABX

56
Q

Who gets nummular eczema?

A

Middle age to elderly

57
Q

What’s nummular eczema all about?

A

Intense itching, recurs in the same spot every winter, excessive scratching leads to lichenification

58
Q

Describe the morphology of nummular eczema:

A

Discrete, round, coin-shaped red plaque

1-5cm in diameter

Intensely erythematous plaques

Thin, sparse scale that may flake

May become thicker with vesicles on the surface

59
Q

MC location of nummular eczema?

A

Back of the hand

Also found on lower legs, forearms, flanks, hips

60
Q

How do we manage nummular eczema?

A

Potent steroids for 4-6 weeks (group III-IV)

Correct dryness of skin and environment

Antipruritic PRN

61
Q

What is lichen simplex chronicus? (LSC)

A

Basically the end result of chronic scratching over time - possibly a defense mechanism against recurrent trauma (scratching)

Any age

62
Q

Morphology of LSC?

A

Red papules coalesce to a red, scaly, thick plaque with accentuation of skin lines

Excoriations

Cracks and fissures possible

Hyperpigmentation

Nodules (prurigo nodularis)

63
Q

Management of lichen simplex chronicus

A

Long-term therapy to soften and break down lichenified skin

Stop the itch-scratch cycle

Behavior modification

Temovate or Diprolene ointment

Possibly intralesional steroids

Emollients for dryness

1st gen antihistamines for night-time scratching

64
Q

Who gets pityriasis rosea?

A

Young adults (10-35 yrs old)

65
Q

What causes pityriasis rosea?

A

Possible viral origin - some association with HHV 6

Hx of proceeding URI

66
Q

Morphology of pityriasis rosea?

A

Have have herald patch (first and largest lesion, patients may think they have ringworm)

Then eruptive phase - round to oval 1-2cm plaques (salmon pink in white people, hyperpigmented in darker-skinned people)

“Christmas Tree” distribution

Trunk and proximal extremities

67
Q

Management of pityriasis rosea?

A

Patient reassurance, most do not require treatment

Group V topical steroids and antihistamines for the itch

If severe: oral steroids, UVB, oral acyclovir

68
Q

What should be considered in the differential of pityriasis rosea?

A

Syphilis

69
Q

What is lichen planus?

A

A unique inflammatory cutaneous and mucocutaneous membrane reaction

Can happen at any age (avg 20-60yrs)

Can be without cause or caused by meds, chemicals, transplants

Can be part of a Koebner phenomenon (lesion associated with trauma)

70
Q

Describe the morphology of lichen planus

A

The 5 P’s:

  1. Pruritic
  2. Planar (flat-topped)
  3. Polygonal
  4. Purple
  5. Papules / plaques

Also, “persistent”…so it’s really six P’s? These slides are terrible…

71
Q

What is Wickham’s Striae?

A

White lacy pattern of crisscrossed lines on lesion (increase visualization with immersion oil)

Seen in lichen planus

72
Q

Where is lichen planus found?

A

Basically anywhere

Acral - hands and feel, ankles and wrists

Oral lesions (white lacy pattern, erosive and painful)

Nail splitting and dystrophy

Scarring hair loss on scalp

Genital lesions

73
Q

What confirms the dx of lichen planus?

A

Bx

74
Q

Etiology of lichen planus

A

Like most of this crap, we don’t know

But we say..

Maybe associated with liver disease

Maybe associated with Hep C

75
Q

Management of cutaneous lichen planus

A

Control the itching with Hydroxyzine

Topical I or II - may need occlusion

Intralesional steroid injection every 3 to 4 weeks

76
Q

Management of mucous membranous lichen planus

A

Challenging

Steroids in an adhesive base

Azathioprine in resistant cases

77
Q

Management of generalized lichen planus

A

PO steroids for about 3 weeks

78
Q

What are the two main types of contact dermatitis?

A

Irritant (damages barrier, non-immunologic)

Allergic (absorption of antigen - sensitization - with subsequent exposure eruption)

79
Q

MC types of irritant dermatitis?

A

Occupational - hand dermatitis

Diaper dermatitis

80
Q

Morphology of irritant dermatitis ?

A

Damage to the stratum corneum

Inflamed, cracked, fissured skin

When acute, could be exudative and/or vesicular

If chronic - scaly, flaky, lichenified with less erythema

81
Q

Management of irritant dermatitis?

A

Avoid the irritant (duh)

Use emollients

Cool compress for acute inflammation

Topical steroids if severe

82
Q

What is the MC allergic contact derm?

A

Nickel

Poison ivy is 2nd MC

83
Q

Morphology of allergic contact derm?

A

Very red

Inflamed, swollen, vesicular to bullous, exudative and crusty, intensely pruritic

Can be linear (poison ivy) or shaped (ring, watch)

84
Q

Management of allergic contact derm

A

Minimize topical products

Wet compress

Potent topical or PO steroid for 2-3 weeks

Antihistamines

Triamcinolone spray

85
Q

Kim kardashian was diagnosed with psoriasis

A

He doctor assured her it wouldn’t affect her ability to do nothing

Senior - Derm 1 (7 decks)

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