Clinical Flashcards
What is a macule?
hyperpigmented flat lesion which is <1cm
what is a patch?
hyperpigmented flat lesion which is >1cm
what is a papule?
raised well defined lesion which <0.5cm
what is a nodule?
raised well defined lesion which >0.5cm
what is a plaque?
raised flat top lesions that grow horizontal which is > 1cm
what is a wheal?
a raised compressible dermal swelling
what is a vesicle?
a fluid filled lesion <0.5 cm
what is a bulla?
fluid filled lesion >0.5 cm
what is a pustule?
pus filled lesion
what is a cyst?
nodule with semi solid material
what is an erosion?
superficial skin break in the epidermis
what is an ulcer?
deep skin break down to the dermis
what is a fissure?
linear split in the epidermis
what is lichenification?
increased appearance of skin markings
what is atrophy?
loss of epidermis +/- dermis
surface remains in tact
what is scale?
accumulated fragments of keratin layer
what is crust?
dried exudate
what is a scar?
normal tissue replaced by fibrous tissue
what are the characteristics of hypopigmented rashes?
paler - lack melanin
what are the characteristics of hyperpigmented rashes?
increased melanin
contain hemosiderin
direct chemical staining
what is psoriasis?
a chronic inflammatory skin condition characterised by scaly erythematous plaques, which typically follows a relapsing course
what is the pathogenesis of psoriasis?
epidermis in psoriatic plaques is hyperproliferative. there is proliferation and dilation of blood vessels in the dermis and infiltration of inflammatory cells
what are “trigger” factors associated with psoriasis?
streptococcus infection
stress
skin trauma (Koebener phenomenon)
alcohol
obesity
smoking
drugs: lithium, NSAIDs, beta blockers , antimalarials and sudden oral or potent topical corticosteroid withdrawal
what types of psoriasis are there?
- Pustular psoriasis
may be generalized or localized.
Generalised pustular psoriasis (a potentially life-threatening medical emergency)
Rapidly developing widespread erythema, followed by the eruption of white, sterile non-follicular pustules which coalesce to form large lakes of pus.
Lesions associated with systemic illness, such as fever, malaise, tachycardia, weight loss, and arthralgia.
Usually presents in people with existing or previous chronic plaque psoriasis, but can also occur in people without a history of psoriasis.
Localized (palmoplantar) pustular psoriasis
Lesions on the palms and soles, such as yellow-brown pustules within established psoriasis plaques, or redness, scaling, and pustules at the tips of the fingers and toes.
2.Erythrodermic psoriasis
Erythrodermic psoriasis is a potentially life-threatening medical emergency.
Diffuse, widespread severe psoriasis that affects more than 90% of the body surface area
It can develop gradually from chronic plaque psoriasis or appear abruptly, even in people with mild psoriasis
Lesions may feel warm, and may be associated with systemic illness, such as fever, malaise, tachycardia, lymphadenopathy, and peripheral oedema
3.Chronic plaque psoriasis (psoriasis vulgaris)
most common type
Monomorphic, erythematous plaques covered by adherent silvery-white scale, usually on the scalp, behind the ears, trunk, buttocks, periumbilical area, and extensor surfaces (such as forearms, shins, elbows, and knees).
Lesions which are typically distributed symmetrically and can coalesce to form larger lesions.
- Scalp psoriasis
affects 75–90% of people with psoriasis.
It typically presents as chronic plaque psoriasis affecting the scalp area.
The whole scalp can be affected, or individual plaques may be visible. Plaques may be very thick, particularly in the occipital region.
5.Facial psoriasis
Well-demarcated plaques on the face, similar to those of chronic plaque psoriasis.
Lesions which may affect the hairline.
Possible mild scaling around the eyebrows and nasolabial folds, which may be due to co-existent seborrhoeic dermatitis (so-called ‘sebo-psoriasis’)
6.Flexural psoriasis
Itchy psoriasis lesions affecting areas such as the groin, genital area, axillae, inframammary folds, abdominal folds, sacral and gluteal cleft.
The elderly, immobile, and people who are overweight or obese are at increased risk of being affected
Lesions of chronic plaque psoriasis which are well-defined, but there may be little or no scaling, due to friction and occlusion at these sites.
Lesions are often red and glazed in appearance, and there may be a fissure in the skin crease.
7.Guttate psoriasis
Small, scattered, round or oval (2 mm to 1 cm in diameter) scaly papules, which may be pink or red.
Multiple lesions which may occur all over the body over a period of 1–7 days, particularly on the trunk and proximal limbs. Lesions may occur on the face, ears, and scalp, but rarely affect the soles of the feet.
A first presentation of psoriasis (classically after acute streptococcal upper respiratory tract infection), or as an acute exacerbation of plaque psoriasis.
8.Nail psoriasis
Nail psoriasis more commonly affects fingernails than toenails and may affect all parts of the nail and surrounding structures.
Nail changes can occur with any type of psoriasis, and are particularly common in people with psoriatic arthritis (up to 90% of people are affected). The incidence of nail involvement increases with the duration of psoriasis.
Nail pitting (depressions in the nail plate) is the most common finding.
Discolouration (for example the ‘oil drop sign’) — orange-yellow discolouration of the nail bed.
Subungual hyperkeratosis — hyperproliferation of the nail bed, with accumulation of keratinocytes under the nail.
Onycholysis — detachment of the nail from the nail bed, which may allow bacteria and fungi to enter and cause infection.