Clinical Cases Flashcards
What questions should be asked to any patient with suspected psoriasis?
if theyve had any problems with their scalp or joint pain or nails
What might be seen on examination of the nails of a patient with psoriasis?
pitting; onycholysis; subungal hyperkeratosis; dystrophy
What does guttate psoriasis look like?
small, red/salmon pink papules on the skin with scales
What often precipitates guttate psoriasis?
strep throat infection
What is the auspitz sign?
removal of surface scale reveals tiny bleeding points
What is auspitz sign caused by pathologically?
dilated capillaries in elongated dermal papillae
What are the 4 main types of psoriasis?
chronic plaque psoriasis (psoriasis vulgaris)
guttate psoriasis
palmoplantar pustular
erythrodermic/ widespread pustular
What other diseases are psoriasis patients at risk of?
cardiovascular risk is increased
Why are lifestyle questions important in psoriasis?
as CVS risk is increased, risk factors need to be managed
What are the topical therapies available for psoriasis?
vitamin D analogues coal tar dithranol steroid ointments emollients
What are the actions of emollients?
anti-inflammatory
anti-hyperkeratotic
What other treatments are there for psoriasis?
phototherapy
immunosppression
immune modulation (anti-TNFalpha)
What is the pathogenesis of acne?
poral occlusion
bacterial colonisation of duct (p. acnes)
dermal inflammation
increased sebum production
What is the morphology of acne?
comedones
pustules and papules
cysts
erythema
What are the topical treatments available for acen?
benzoyl peroxide
topical vit A derivatives
topical antibiotics
What are the systemic treatments available for acne?
antibiotics
isotretinoin
Why are there no comedones found in rosacea
rosacea is not a disease of the pilosebaceous unit
Aside from facial effects, what else can be caused by rosacea?
conjuctivitis/gritty eyes
What are the topical therapies available for rosacea?
metronidazole
ivermectin
What are the systemic therapies available for rosacea?
tetracycline
isotretinoin
What are Wickham’s striae?
whitish lines seen in the papules of lichen planus and in the buccal mucosa
What drugs can cuase lichenoid drug eruptions?
ACEI; statins
How is lichen planus treated?
topical steroid
What areas does lichen planus typically effect?
volar wrists/forearms, shins and snkles
What is the difference between bullous pemphigoid and pemphigus?
pemphigoiD- split is Deeper through DEJ
pemphiguS-split more Superficial, intra-epidermal
What is Nikolsky’s sign?
top layers of the skin slip away from the lower layers when slightly rubbed
What does Nikolsky’s sign indicate?
plane of cleavage is within the epidermis
What age of patient is bullous pemphigoid seen in?
elderly patients
Where is bullous pemphigoid seen on the body?
localised to one area or widespread on the trunk and proximal limbs
What is seen early in the disease progression of bullous pemphigoid?
urticated itchy plaques
What areas does pemphigus vulgaris affect?
scalp, face, axillae, groins
Is pemphigus or pemphigoid nikolsky sign positive?
pemphigoid
Does pemphigus or pemphigoid tend to have muscosal involvement?
pemphigus
