Clinical features & cases of rash Flashcards
Which factors cause/contribute to psoriasis?
Genetics, infections, drugs, stress, alcohol
Name a few common medications which can trigger psoriasis
Bipolar medication, beta-blockers
What is the most common form of psoriasis?
Psoriasis vulgaris (chronic plaque psoriasis)
How does psoriasis vulgaris present?
Symmetrically distributed sharply demarcated, scaly, erythematous plaques
Where are the common sites of psoriasis vulgaris?
Extensors, scalp, sacrum, hands, feet, trunk, nails
List the types of psoriasis
Psoriasis vulgaris, guttate, palmoplantar pustular, nail disease, erythrodermic/widespread pustular
What does guttate psoriasis look like?
Small, circular lesions
What is the koebner phenomenon?
Psoriasis which arises in areas of trauma
What are the features of psoriatic nail disease?
Onycholysis, nail pitting, dystrophy, subungal hyperkeratosis
What are the topical treatments for psoriasis?
Vitamin D analogues, coal tar, steroid ointments, emollients
Name two vitamin D analogues
Calcipotriol and calcitriol
What are the other (i.e non-topical) treatments for psoriasis?
Phototherapy (UVB and PUVA), retinoids, immunosupressants (methotrexate and ciclosporin), fumaric acid ester, immune modulators (TNF blockers, etc)
What is a retinoid?
Vitamin A analogue
Psoriasis is associated with obesity. T/F
True - there is some improvement of psoriasis with weight loss
Roughly which percentage of psoriasis patients will develop psoriatic arthritis?
20%
What is acne vulgaris?
Chronic inflammatory disease of the pilosebaceous units
When does acne present? What is the difference between males and females?
After puberty. Males present in their later teens while females present in their early teens
How does acne vulgaris present?
Comedones, pustules, papules and cysts
What are the secondary features of acne vulgaris?
Atrophic & ice-pick scars. Texture changes. Keloid scars (rare)
Describe the acne grading system
Mild - scattered pustules, papules and comedones
Moderate - numerous papules, pustules and mild atrophic scarring
Severe - numerous papules and pustules, cysts, nodules and significant scarring
How is acne treated?
Avoidance of oily substances and triggers, topical and systemic treatments
What are the topical treatments of acne?
Benzoyl peroxide (keratinolytic), retinoids, topical antibiotics
What are the systemic treatments of acne?
Antibiotics, isotretinoin (oral retinoid)
Give an example of a topical retinoid which can be used in the treatment of acne. What is main side effect of this?
Adapalene. Drying out of skin
Which acne medication initially causes an aggrevation of the acne?
Isotretinoin
What are the side effects of isotretinoin?
Hepatitis, photosensitivity, dry lips, increased cholesterol
What precaution must be taken with the prescription of isotretinoin to women of child bearing age?
Contraceptive use
How can bad medication-induced acne flares be treated?
Oral steroids and dapsone (for anti-inflammatory effects)
Where does rosacea typically present?
Nose, chin, cheeks and forehead
How does rosacea present?
Papules, pustules and erythema without comedones. Telangiectasia. Rhinopyma
Which factors can exacerbate rosacea?
Spicy food, alcohol, change in temperature, sunlight
In which age group does rosacea typically present?
Middle aged
How is rosacea managed?
Avoidance of aggravating factors and topical steroids, use of high factor sunscreen, antibiotics, isotretinoin (severe), topical vasoconstrictor (for erythema)
Which antibiotics are used to treat rosacea?
Topical metronidazole, oral tetracylcine (long term)
How can telangiectasia be managed? How can rhinopyma be managed?
Vascular laser. Surgery or laser shaving
A useful reminder to differentiate between bullous pemphigoid and pemphigus vulgaris
PemphigoiD - Deeper (DEJ)
PemphiguS - Superficial (intra-epidermal)
In which age group does bullous pemphigoid typically present?
Elderly patients
What is the typical distribution of bullous pemphigoid?
Localised to one area or widespread on the trunk and proximal limbs
What do bullous pemphigoid blisters look like?
Large and tense blisters on normal or erythematous skin which burst to leave erosions
Bullous pemphigoid has a high risk of scarring. T/F
False - doesn’t scar
Describe an atypical presentation of bullous pemphigoid
Itchy erythematous plaques and papules
What is the nikolsky sign?
Slight rubbing of the skin will cause the top layers to slip away from the bottom layers
Is the nikolsky sign positive or negative in bullous pemphigoid?
Negative
What is the likelihood of mucosal involvement in bullous pemphigoid?
Un
What is the typically distribution of pemphigus vulgaris?
Scalp, face, axillae and groin
What do pemphigus vulgaris blisters look like?
Flaccid and thin-roofed vesicles/bulla which rupture to leave raw areas
There is an increased infection risk when pemphigus vulgaris blisters rupture. T/F
True
Is the nikolsky sign positive or negative in pemphigus vulgaris?
Positive
What is the likelihood of mucosal involvement in pemphigus vulgaris?
High (eyes and genitals)
What is the prognosis of pemphigus & pemphigoid? How long does it take the majority of patients to go into remissions
Chronic, self-limiting course which can vary in length from months to years. Three to six months
What investigations are indicated for pemphigoid/gus?
Skin biopsy with direct immunofluorescence or indirect immunofluorescence
How are pemphigus/goid treated?
Systemic steroids, immunosupressants (methotrexate, azathioprine, ciclosporin, mycophenlate), topical emollients, topical steroids
Which treatments are just indicated in pemphigoid?
Tetracycline antibiotics, nicotinamide
