Common skin conditions Flashcards
What percentage of adults does psoriasis affect?
2%
=> COMMON
What is the most common type of psoriasis?
chronic plaque psoriasis (psoriasis vulgaris)
Where do the plaques in psoriasis commonly appear?
extensors (elbow, knee)
scalp, sacrum, hands, feet, trunk
nails
How do the plaques in psoriasis commonly look?
Symmetrical on body
Sharply demarcated
scaly
erythematous plaques
What is the Koebner phenomenon?
psoriasis develops in area of skin trauma
e.g. scar from surgery
What is Auspitz sign?
- removal of surface scale reveals tiny bleeding points
dilated capillaries in elongated dermal papillae
Describe the appearance of Guttate psoriasis
Widespread
Smaller plaques
closer together
Describe the appearance of Palmoplantar pustular psoriasis
Psoriasis with pustules focused on the palms of hands and soles of feet
Describe the appearance of Erythrodermic psoriasis
widespread and pustular
rare
What problems can psoriasis cause in the nails?
Onycholysis
Nail pitting
Dystrophy
Subungal hyperkeratosis
What comorbidities often exist with psoriasis?
metabolic syndrome (obesity, hypertension, diabetes, lipid abnormalities)
arthritis Crohn’s disease cancer depression uveitis
In what case of psoriasis is life expectancy reduced, and by how much?
reduced by 4 years in patients with severe psoriasis
Due to increased cardiovascular risk
3x increased risk of myocardial infarction
What topical therapies can be given for psoriasis?
Vitamin D analogues e.g. Calcipotriol (Dovonex) ointment Coal tar Dithranol Steroid ointments EMOLLIENTS
What phototherapy treatments can be used for psoriasis?
Narrowband UVB then PUVA
What systemic treatments can be used for psoriasis?
immunosuppression e.g. methotrexate Immune modulation (targeted biological agents) e.g. TNF Alpha
How is acne vulgaris defined?
inflammatory disease of the pilosebaceous unit
What age does acne usually affect males vs females?
14 -17 years in females
16 -19 years in males
Describe the pathogenesis of acne
Poral occlusion
Bacterial colonisation of duct (P acnes)
Dermal inflammation
Sebum production
What sites does acne vulgaris affect most?
Face, upper back, anterior chest
most sebaceous glands
Describe the morphology of lesions seen in acne
Comedones - open (blackhead) and closed (whitehead)
Pustules and papules
Cysts
Erythema
How is acne graded?
Mild- scattered papules and pustules, comedones
Moderate - numerous papules, pustules and
mild atrophic scarring
Severe - cysts, nodules and significant scarring
Describe the progression of treatments for acne
Avoid oily substances, triggers
Topical Tx:
Benzoyl peroxide
Retinoids
Topical antibiotics
Systemic treatment:
Antibiotics (at least 6 months)
Isotretinoin (Roaccutane)
What areas does rosacea normally affect?
Nose, chin, cheeks and forehead
What age does rosacea usually affect?
30 – 60 years, male and female
Describe the morphology of Rosacea lesions?
Papules, pustules and erythema with no comedones
Prominent facial flushing
can also cause unshapely/large nose – rhinophyma
Conjunctivitis / gritty eyes
What can exacerbate the facial flushing seen in rosacea?
sudden change in temperature
alcohol
spicy food
How is rosacea managed without drugs?
Avoid triggers
wear high factor sunscreen
avoid topical steroids
What topical treatments are used in rosacea?
Metronidazole, Ivermectin (to reduce demodex mite)
What oral therapy is used in rosacea?
Oral tetracycline long term
Isotretinoin low dose if severe
What special treatments can be offered if a rosacea patient has Telangiectasia OR
Rhinophyma?
Telangiectasia : vascular laser
Rhinophyma: surgery/ laser shaving
Describe the morphology of Lichen Planus
Violaceous (pink/ purple) flat-topped shiny papules
volar wrists/ forearms, shins and ankles
Wickham’s striae – fine lace-like pattern on surface of papules and buccal mucosa
How long does Lichen Planus usually last before burning out?
12- 18 months
How should Lichen Planus be treated?
TREAT SYMPTOMATICALLY
topical steroids (potent or very potent), oral steroids if extensive
How do we differentiate between Bullous Pemphigoid and Pemphigus?
Bullous 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
Indicates plane of cleavage within the epidermis
Is Bullous Pemphigoid Nikolsky’s Sign positive or negative?
Negative
Is Pemphigus Nikolsky’s Sign positive or negative?
Positive
Patients of what age usually get Bullous Pemphigoid?
elderly
Describe the distribution and appearance of Bullous Pemphigoid
localized to one area, or widespread on the trunk and proximal limbs
large tense bullae on normal skin on erythematous base
blisters burst to leave erosions
How can bullous pemphigoid present earlier in disease?
Uritcarial itchy plaques
Where does Pemphigus Vulgaris usually affect?
scalp, face, axillae, groins
How does Pemphigus Vulgaris appear on the skin?
Flaccid vesicles/bullae – thin roofed
Lesions rupture to leave raw areas
Mucosal involvement (eyes, genitals)
How long does it take for Pemphigus Patients to achieve remission?
Most patients achieve remission on treatment within 3 – 6 months
How can Bullous pemphigoid and pemphigus be diagnosed?
Skin biospy with direct immunofluorescence
Indirect immunofluorescence
How can bullous pemphigoid and pemphigus be treated?
Systemic steroids
Other immunosuppressive agents
In pemphigoid: tetracycline antibiotics
Topicals: emollients, topical steroids, topical antisepsis / hygiene measures
