Additional conditions Flashcards

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1
Q

What is Pityriasis rosea ?

A
  • It is an acute viral rash which lasts about 6–12 weeks.
  • It is characterised by a herald patch followed by similar, smaller oval red patches that are located mainly on the chest and back.
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2
Q

Who is most commonly affected by pityriasis rosea?

A

Teenagers & young adults

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3
Q

Many patients with pityriasis rosea have no prodrome, but in a small number of patients what may they give a history of having ?

A

A history of recent upper respiratory viral infection (cough, cold, sore throat or similar).

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4
Q

What are the clinical features of pityriasis rosea ?

A
  • Solitary lesion ‘Herald patch’ appears 2-4days before onset of rash
  • Herald patch = an oval pink or red plaque which is scaly on its inside edge
  • Secondary rash occurs = multiple smaller oval scaly (on there inside edge) patches/plaques.
  • Christmas tree effect following the ribs
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5
Q

What part of the body does pityriasis rosea mainly affect?

A

Back & chest.

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6
Q

What is shown in this pic ?

A

Herald patch - pityriasis rosea

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7
Q

What is shown in this pic ?

A

They secondary rash in pityriasis rosea

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8
Q

How is pityriasis rosea diagnosed ?

A

Clinically

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9
Q

What is the treatment of pityriasis rosea?

A

Self-limiting so no treatment needed.

If itch consider giving 1 or more of the following:

  1. sedating oral antihistamine (for example chlorphenamine
  2. An emollient
  3. A midly-moderately potent TCS
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10
Q

What is lichen planus ?

A

It is a chronic inflammatory skin condition affecting the skin and mucosal surfaces. There are several clinical types of lichen planus that share similar features on histopathology.

  • Cutaneous lichen planus
  • Mucosal lichen planus
  • Lichen planus of the nails
  • Lichenoid drug eruption
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11
Q

What parts of the body does cutaneous lichen planus tend to affect?

A

Location can be anywhere, but most often front of the wrists, lower back, and ankles.

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12
Q

What are the clinical features of lichen planus ?

A
  • Violaceous (pink/ purple) Papules & polygonal (many angled) plaques that are shiny, flat-topped, firm & have fine white lines crossed across them (Wickhams striae)
  • Lesions are itensley itchy
  • Plaques can be hypertrophic
  • Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
  • Oral involvement common (50% of cases) - typically a white-laced pattern on the buccal mucosa
  • Nail involvement - thinning of the nail plate & longitudinal ridging seen
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13
Q

What is shown in this pic ?

A

Oral involvement of lichen planus

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14
Q

What is shown in this pic ?

A

Nail features seen in lichen planus

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15
Q

Describe what a lichenoid drug eruption is

A

This refers to a lichen planus-like rash caused by medication

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16
Q

List the common drugs which cause lichenoid drug eruptions

A
  • Gold
  • Quinine e.g. hydroxyquinine
  • Thiazides
  • Furosemide
  • B-blockers
  • Catopril - ACEi
17
Q

How can lichenoid drug eruptions be distinguished from regular lichen planus ?

A
  • Rash is usually extensive and distirbuted symmetrically over the trunk & limbs
  • Wickham striae are usually absent
  • Nail and mucous membrane (e.g., mouth) involvement is uncommon
  • History of starting a new drug in the past year
18
Q

How is the diagnosis of lichen planus or a lichenoid drug eruption confirmed ?

A

Skin biopsy

19
Q

What are the characterisitic microscopic features of lichen planus ?

A
  • Hyperkeratosis
  • Thickened granular layer
  • Jagged (saw-tooth) baseline of epidermis
  • A dense band of lymphocytes and histiocytes at the DEJ.
20
Q

What is the treatment of lichen planus ?

A

Local treatments for the symptomatic cutaneous or mucosal disease are:

  • topical steroids are the mainstay of treatment
  • benzydamine mouthwash or spray is recommended for oral lichen planus

Widespread/severe lichen planus tx = Oral steroids (prednisolone) + one of the following:

  • Acitretin
  • Hydroxychloroquine
  • Methotrexate
  • Azathioprine
  • Mycophenolate mofetil
  • Phototherapy
21
Q

What is vitiligo ?

A

It is an acquired depigmenting disorder of the skin, in which pigment cells (melanocytes) are lost. It presents with well-defined milky-white patches of skin (leukoderma).

22
Q

Who in particular can vitiligo be a problem for ?

A

Black people

23
Q

What are the clinical features of vitiligo?

A
  • Well-demarcated patches of white (depigmented) skin
  • The peripheries tend to be most affected
  • Trauma may precipitate new lesions (Koebner phenomenon)
  • Without treatment, individual lesions usually enlarge over time and patches may merge to form extensive geographical patterns.
24
Q

What conditions is vitiligo associated with ?

A
  • T1DM
  • Addison’s disease
  • Autoimmune thyroid disorders
  • Pernicious anaemia
  • Alopecia areata
25
Q

How is vitiligo diagnosed ?

A

Clinically

26
Q

What is the treatment of vitiligo ?

A
  • Sunblock for affected areas of skin
  • Camouflage make-up
  • Topical corticosteroids may reverse the changes if applied early

There may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients

27
Q

What is shown in this pic ?

A

Vitiligo

28
Q

What clinical feature is shown here ?

A

Beau’s line - caused by transient arrest in nail growth, which occurs during acute stress/illness

29
Q

What is shown here ?

A

Subungual haemorrhage:

  • Presents as a discoloured or pigmented nail (reddish, purple, brown, black, or a combination), which may be painless, tender, or painful.
30
Q

What are the causes of sungunal haemorrhage ?

A

Typically caused by trauma to the nail:

  • A recalled painful event (eg, crush injury or blunt trauma)
  • A non-recalled repetitive micro-trauma (eg, tight or ill-fitting shoes).