Apr10 M2-Papulosquamous, rosea and psoriasis Flashcards

1
Q

papulosquamous lesion def

A
  • raised scaly disease

- rash (but we never say rash)

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2
Q

papulosquamous lesion ddx

A
  • psoriasis
  • tenia versicolour
  • eczema
  • atopic dermatitis
  • pityriasis rosea
  • dermatophytes
  • secondary syphilis
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3
Q

important things to note in a papulosquamous lesion

A
  • location

- well defined or not well defined

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4
Q

patient with generalized redness and scaling, focal to palms or soles and sometimes knees and elbows ddx
THE CLASSIC 7

A

(papulosquamous lesion ddx)

  • psoriasis
  • pityriasis rosea
  • secondary syphilis
  • dermatitis (seborrheic, atopic, etc.)
  • lichen planus
  • pityriasis rubra pilaris
  • tinea
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5
Q

rosea appearance

A
  • oval raised plaque (not patch bc has texture)

- pink

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6
Q

rosea charact and cause

A
  • benign skin eruptions

- cause = viral infection (not contagious anymore when have the rash)

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7
Q

rosea charact and name of the primary lesion usually seen

A

Herald patch

-2-10 cm oval round plaque. largest lesion

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8
Q

rosea what happens after the primary lesion

A
eruptive phase (1-2 weeks later)
-increased number of similar smaller lesions (round oval plaques but smaller diameter)
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9
Q

rosea charact of the eruptive phase

A
  • can last 3-5 months
  • doesn’t go higher than neck and jaw
  • may be itchy
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10
Q

characteristic rosea appearance

A
  • fir tree or drooping pine tree (sapin) appearance on the back
  • follow linear pattern
  • few to hundreds of lesions
  • nothing on the phase
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11
Q

tx of pityriasis rosea

A
  • wait. resolves on its own

- can treat symptomatically with topical steroids, sunlight, phototherapy, etc.

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12
Q

charact of the eruptive phase of rosea (charact of the lesions)

A

symmetric wrinkled scaly papules that parallel skin fold lines

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13
Q

psoriasis associated morbidities

A
  • metabolic syndrome (obesity, hyperlipidemia, CV disease)

- arthropathy and arthritis

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14
Q

classical psoriasis type

A

psoriasis vulgaris

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15
Q

psoriasis causes

A

the disease is polygenic (genetic) and then you have triggering factors:

  • strep infection (guttate psoriasis)
  • drugs (IFN, beta blockers)
  • stress
  • HIV
  • direct trauma
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16
Q

other possible cause of psoriasis

A

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*
17
Q

4 types of psoriasis

A
  1. vulgaris (well demarcated red silvery scaly plaques. elbow and umbilicus)
  2. guttate (rosea like, nails and scalp
  3. erythrodermic (red dry peeling scaling skin on whole body)
  4. pustular (palms and soles)
18
Q

psoriasis vulgaris charact

A
  • well demarcated
  • many lesions
  • symmetrical red papules and plaques
  • on extensors and scalp
19
Q

palmoplantar psoriasis def

A
  • subtype of vulgaris
  • plaque or pustular lesion on palms or soles
  • redness and fissuring
20
Q

pustular psoriasis charact

A
  • beefy red plaques
  • coalescing sterile pustules
  • red lesions
21
Q

guttate psoriasis charact

A
  • droplet like
  • small plaques and papules
  • red
  • post-STREP
22
Q

erythrodermic psoriasis charact

A
  • red over 90%+ of the body
  • scaling
  • emergency bc losing heat and water
23
Q

ddx of erythroderma

A
  • atopic dermatitis
  • cutaneous T cell lymphoma
  • eczema
24
Q

classical findings to check on physical exam for psoriasis

A
  • 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.)
25
Q

histopathology findings of psoriasis

A
  • keratosis
  • loss of stratum granulosum
  • higher mitotic rate
  • rete pegs fusion (psoriasiform hyperplasia)
  • dilated tortuous capillaries
  • intraepidermal neutrophils
26
Q

how findings of psoriasis histopathology correlate with the symptoms

A
  • keratosis and loss of granulosum = SCALE
  • high mitotic rate = PLAQUE
  • intraepidermal neutrophils = INFLAMMATION AND PRURITUS
  • elongated rete pegs = THICK PLAQUES
  • tortuous dilated capillaries = ERYTHEMA
27
Q

psoriasis tx

A
  • emollients
  • gentle care
  • petrolatum ointmes