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FCM > Block 1- PPT 5 Acne and Papulosquamous Disorders > Flashcards

Block 1- PPT 5 Acne and Papulosquamous Disorders Flashcards

1
Q

Is Psoriasis Acute or chronic?

A

Chronic

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2
Q

Psoriasis are flares related to?

A

systemic or environmental factors
life stress events
Infection
medication

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3
Q

most common Psoriasis type

A

plaque-type (extensor, scalp)

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4
Q

Guttate Psoriasis appearance

A

small salmon-pink papules, may be scaly

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5
Q

Guttate Psoriasis starts on the ___.

A

Starts on trunk

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6
Q

Guttate Psoriasis can have a sudden onset 2-3 weeks after having ___.

A

post upper respiratory infection (URI) with group A beta-hemolytic streptococci

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7
Q

Location of psoriasis

A

scalp, trunk, and limbs (elbows, knees, palms, soles)

Also: eyes, joints, glans penis, sacrum and intergluteal clefts

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8
Q

features of psoriasis

A 
Distribution: symmetric
Shape- Oval
Well -circumscribed borders
Focal, raised, inflamed, edematous
Color: Red- rich, full
Scale: dry, thin, silvery-white
Pruritic – can vary in intensity
Nail Psoriasis- “pits”
Koebner phemomenon (trauma -> plaques)
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9
Q

what is the Koebner phenomenon?

A

when a pt with a hx of psoriasis develop psoriasis in response to trauma(like an incision site)

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10
Q

Etiology of psoriasis

A

Autoimmune

Genetic, but many know of no relatives with Ps.

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11
Q

Pathophysiology of psoriasis

A

Very complex immune upregulation of T cell activity and numbous cytokines.

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12
Q

epidemiology of psoriasis

A

2-3% of the world, all races, most commonly starts in 20’s or 50’s

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13
Q

differential diagnosis for psoriasis

A 
Drug eruption
Lichen Planus
Nummular eczema
Tinea corporis
Cutaneous lupus
Cutaneous T-cell lymphoma
Pityriasis rosea
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14
Q

if you are unsure if pt has psoriasis, you must perform a ____.

A

punch biopsy

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15
Q

when should you refer a psoriasis pt to derm?

A

Large area
Treatment unsuccessful
Comorbid arthritis

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16
Q

treatment for psoriasis

A
  1. Strong corticosteroids (consider the risks)
  2. Vitamin D analogs (calcipotriene) and Topical Calcineurin Inhibitors (tacrolimus): weak, but safe for thin skin
  3. Phototherapy (UVB)
  4. Oral-Apremilast (Otezla), Methotrexate, acitretin, cyclosporine
  5. Biologics
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17
Q

psoriasis consults

A

dermatology, possible rheumatology

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18
Q

effects of psoriasis on pt

A

impacts quality of life: depression, early death, incurable disease.

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19
Q

About 10% of psoriasis pts develop _____.

A

inflammatory arthritis

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20
Q

Patient education for psoriasis

A

Chronicity of disease: not curable
Caution in overuse of steroids
Avoid/Minimize ETOH consumption and smoking
Weight loss can alter disease course!

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21
Q

10% with Plaque Psoriasis have ____.

A

Psoriatic Arthritis

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22
Q

signs and symptoms of Psoriatic Arthritis

A

Joints: red, warm, tender, inflamed
Joint deformity (late)
Dactylitis/Sausage digits
Many presentations

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23
Q

syphilis etiology

A

the bacteria Treponema pallidum- a spirochete

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24
Q

primary syphilis characteristic

A

painless ulcer (chancre)

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25
secondary syphilis characteristic
Papulosquamous rash
26
latent syphilis characteristic
rash resolved, labs stay +
27
in primary syphilis, where is chancre located?
at the site of Treponema pallidum inoculation
28
location of primary syphilis
external genitals (glans penis, vulva) >10% extra-genital: Lips, fingers, oropharynx, anus, rectum, other
29
primary syphilis chancre appears _____ post exposure
1 week - 3 months
30
for those diagnosed with primary syphilis, 50% of females and 30% of males never develop or do not detect ___.
the primary lesions (chancre)
31
differential diagnosis for secondary syphilis
pityriasis rosea: scaly patches
32
secondary syphilis can be found on the ___.
trunk, palms, and soles
33
screening test for secondary syphilis
Serum RPR/VDRL
34
Confirmatory test for secondary syphilis is
FTA-ABS
35
treatment for secondary syphilis
Oral doxycycline 100mg BID x 14 days1 If compliance is a concern: IM Penicillin 2.4 units
36
seborrheic dermatitis etiology
abnormal immune response to normal yeast-like flora (malassezia/pityrosporum)
37
seborrheic dermatitis Characteristics
red scaly eyebrows, nasal creases, ears, scalp, rarely mid-chest
38
age group seborrheic dermatitis is typically found in
infants(cradle cap) over age 40 rare in age 15-40: check HIV status
39
seborrheic dermatitis treatment
lmost all cases clear easily with low potency topical corticosteroids
40
Steroid-free options to treat seborrheic dermatitis
Topical calcineurin inhibitors Anti-yeast topicals Sulfur Olive oil, coconut oil
41
characteristics of PITYRIASIS ROSEA
Papulosquamous OVAL plaques with fine collarette of scale Initial lesion is “HERALD PATCH” which is often mistaken for tinea corporis Pityriasis – means “fine scales”; Rosea- “ rose colored or pink”
42
common age group for pityriasis Rosea
Young patient age 10-30
43
location of pityriasis Rosea
trunk, upper extremities : SPARES SUN-EXPOSED SKIN!
44
cause of pityriasis Rosea
Human Herpesirus 8
45
treatment of pityriasis Rosea
topical steroids only if itchy | Most successful option is phototherapy with suntanning or UVB (derm referral)
46
how can you rule out syphilis when diagnosing pityriasis Rosea
Order a serum RPR to rule out syphilis
47
when does pityriasis Rosea typically resolve?
usually resolves spontaneously in 12 weeks | If it persists, do a punch biopsy, consider phototherapy
48
characteristics of lichen planus
``` Pruritic! Papular - flat topped papules Fine scale - sometimes Violaceous Polygonal shape Koebner phenomenon ```
49
does lichen planus have the koebner phenomenon?
yes
50
common locations to find lichen planus
Flexor surfaces of the upper extremities Male Genitalia Mucous membranes
51
etiology of lichen planus
most likely immune mediated
52
oral variant of lichen planus
wickham’s striae
53
important disorder associated with lichen planus?
Hepatitis* – (Hep C, chronic active, 1⁰ biliary cirrhosis)
54
16% of pts w/ Lichen planus were found to be _____.
Hep C+
55
treatment of lichen planus
1. Look for any drugs that may be causing LP 2. Rx topical steroids (class I, II) 3. oral antihistamine (reduce the intense pruritus) 4. Intralesional triamcinolone 5. Many cases are treatment-resistant
56
is Hidradenitis Suppurativa obesity related?
yes
57
what is Hidradenitis Suppurativa?
A chronic, recurring suppurative and scarring disease
58
location for Hidradenitis Suppurativa
apocrine glands: axillae, anogenital, inframammary, pubic
59
is Hidradenitis Suppurativa more common in males or females?
females
60
is Hidradenitis Suppurativa a chronic disease?
yes
61
common age pts are diagnosed with Hidradenitis Suppurativa
post puberty (20’s-30’s)
62
is weight loss often curative in pts with Hidradenitis Suppurativa
yes
63
medication to treat Hidradenitis Suppurativa
Antibiotics, topical for maintenance and oral for flares I&D only briefly helpful isotretinoin 1-2mg/kg x 6 mo, may repeat Q year if indicated Biologics; adalimumab (FDA approved 2015 for HS), infliximab occasionally helpful but >$40,000/year
64
should you do surgical excision of Hidradenitis Suppurativa?
no, it is very risky
65
Rosacea (Acne rosacea) common age group
generally > 30 yrs (typical 30-50)
66
Rosacea (Acne rosacea) is common in pts with ___ skin
fair
67
2 components of Rosacea (Acne rosacea)
1. Vascular- redness, flushing, blushing, telangiectasia | 2. Eruption- papules, pustules
68
what is Rosacea (Acne rosacea) Exacerbated by?
Hot foods and drinks, ETOH- red wines, sun exposure
69
percentage of pts that have ocular redness/itch in Rosacea
50%
70
Rhinophyma is a result of Rosacea that only occurs in men or women?
men
71
treatment for Rhinophyma?
Dermabrasion, Early prevention
72
what triggers rosacea?
sun, heat, wine, niacin
73
A common disorder that affects pilosebaceous follicles and can be characterized by both non-inflammatory and inflammatory lesions
Acne Vulgaris
74
highest demographic of acne vulgaris?
adult females
75
Most common skin condition treated by clinicians
Acne Vulgaris
76
Physical & Psychological Consequences of Acne Vulgaris
1. Permanent scarring and disfigurement 2. Proven increases in depression and anxiety 3. Lowered self-esteem 4. Lowered professional expectations and employability 5. Social inhibition 6. Increased risk of suicide or suicidal ideation
77
the following are true or false acne myths? ``` “Chocolate & Coke worsens acne” “change your diet and you’ll clear up” “People with acne just don’t wash enough” “Makeup/Hair causes acne” “Acne is just a cosmetic disease” “It helps to clean out your pores” ```
false
78
in darker skinned people, the main complaint of acne is the ____.
scarring
79
What causes acne?
1. Sex hormones -> more sebum production 2. Follicle colonized by Proprionibacterium acnes (p.acnes produces FFA -> pro-inflammation) 3. Follicular dyskeratinization ->microcomedos (start of all acne lesions) 4. Host Factors: Genetics, environment, meds (steroids)
80
Non-inflammatory acne includes what 2 things?
1. Open (blackhead) comedones Blackened color is due to oxidized lipids and debris, not dirt 2. Closed (whitehead) comedones Distended follicle whose opening is covered by the intact surface epithelium
81
type of comedone that is open?
blackhead
82
Inflammatory acne includes what 2 things?
Papules Pustules
83
what are papule?
``` Inflamed lesions (less than 0.5 cm in diameter) that appear as small, pink to red bumps on the skin Can be tender to the touch ```
84
what are pustules?
Dome-shaped lesions containing pus (a mixture of white blood cells, dead skin cells and bacteria) These lesions are fragile and may rupture
85
If pustules are not resolved, they can progress to ____.
cysts
86
nodules and cysts are found in inflammatory acne or non-inflammatory acne?
inflammatory acne
87
what are nodules?
Large solid lesions that are lodged deep within the skin and frequently result in scarring May be very painful
88
what are cysts?
Sac-like lesions containing pus Progressed from unresolved pustules Often painful and result in scarring
89
differential diagnosis for acne
``` Cowden disease Milia Miliaria Sebaceous hyperplasia Chloracne Rosacea Syringomas Keratosis pilaris CRP Demodicocis Pyoderma Folliculitis Seborrheic dermatitis Verruca plana DPN Erythromelanosis follicularis faciei ```
90
Propionibacterium acnes is anaerobic/aerobic and gram+/gram-?
Anaerobic Gram (+) Nonmotile bacillus
91
program that provider, pharmacist, and patient must enroll in before taking/prescribing acutane?
ipledge

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