Apr10 M2-Papulosquamous, rosea and psoriasis Flashcards
papulosquamous lesion def
- raised scaly disease
- rash (but we never say rash)
papulosquamous lesion ddx
- psoriasis
- tenia versicolour
- eczema
- atopic dermatitis
- pityriasis rosea
- dermatophytes
- secondary syphilis
important things to note in a papulosquamous lesion
- location
- well defined or not well defined
patient with generalized redness and scaling, focal to palms or soles and sometimes knees and elbows ddx
THE CLASSIC 7
(papulosquamous lesion ddx)
- psoriasis
- pityriasis rosea
- secondary syphilis
- dermatitis (seborrheic, atopic, etc.)
- lichen planus
- pityriasis rubra pilaris
- tinea
rosea appearance
- oval raised plaque (not patch bc has texture)
- pink
rosea charact and cause
- benign skin eruptions
- cause = viral infection (not contagious anymore when have the rash)
rosea charact and name of the primary lesion usually seen
Herald patch
-2-10 cm oval round plaque. largest lesion
rosea what happens after the primary lesion
eruptive phase (1-2 weeks later) -increased number of similar smaller lesions (round oval plaques but smaller diameter)
rosea charact of the eruptive phase
- can last 3-5 months
- doesn’t go higher than neck and jaw
- may be itchy
characteristic rosea appearance
- fir tree or drooping pine tree (sapin) appearance on the back
- follow linear pattern
- few to hundreds of lesions
- nothing on the phase
tx of pityriasis rosea
- wait. resolves on its own
- can treat symptomatically with topical steroids, sunlight, phototherapy, etc.
charact of the eruptive phase of rosea (charact of the lesions)
symmetric wrinkled scaly papules that parallel skin fold lines
psoriasis associated morbidities
- metabolic syndrome (obesity, hyperlipidemia, CV disease)
- arthropathy and arthritis
classical psoriasis type
psoriasis vulgaris
psoriasis causes
the disease is polygenic (genetic) and then you have triggering factors:
- strep infection (guttate psoriasis)
- drugs (IFN, beta blockers)
- stress
- HIV
- direct trauma
other possible cause of psoriasis
autoimmunity
- APCs activate T cells. IL-8 and TNF-a release
- adhesion molecules upregulated (ICAM, VCAM, e-selectin)
- chemotaxis of PMNs
- get epidrmal prolif and increased vascularity*
4 types of psoriasis
- vulgaris (well demarcated red silvery scaly plaques. elbow and umbilicus)
- guttate (rosea like, nails and scalp
- erythrodermic (red dry peeling scaling skin on whole body)
- pustular (palms and soles)
psoriasis vulgaris charact
- well demarcated
- many lesions
- symmetrical red papules and plaques
- on extensors and scalp
palmoplantar psoriasis def
- subtype of vulgaris
- plaque or pustular lesion on palms or soles
- redness and fissuring
pustular psoriasis charact
- beefy red plaques
- coalescing sterile pustules
- red lesions
guttate psoriasis charact
- droplet like
- small plaques and papules
- red
- post-STREP
erythrodermic psoriasis charact
- red over 90%+ of the body
- scaling
- emergency bc losing heat and water
ddx of erythroderma
- atopic dermatitis
- cutaneous T cell lymphoma
- eczema
classical findings to check on physical exam for psoriasis
- oil drop like nails
- onchyolysis (separation of nail from nail bed)
- neck and back pain (arthropathy and arthritis)
- Koebner reaction (trauma will trigger psoriasis. burn, scratching, etc.)
