December 1, 2015 - Papulosquamous

Question 1

Psoriasis

Answer 1

A prototypical papulosquamous condition. Well-demarcated erythematous papules and plaques with silvery scale. Usually on extensor surfaces.

This is a multifactorial disease in patients who are genetically predisposed.

30% of patients have a family history.

Demonstrates “Auspitz’s Sign”

Question 2

Auspitz’s Sign

Answer 2

When the individual silvery scales are plucked from the psoriatic plaques, tiny pinpoint capillary bleeding may be seen, which is the sign.

Question 3

Guttate Psoriasis

Answer 3

Numerous small papular lesions with silvery scaling evolve suddenly over the body.

This occurs 1-3 weeks after streptococcal pharyngitis.

Question 4

Erythrodermic Psoriasis

Answer 4

Generalized erythema and scale covering the entire body may occur secondary to…

- Over vigorous therapy

- A superimposed drug reaction

- Withdrawal from oral corticosteroids

Question 5

Psoriasis Inversus

Answer 5

Plaques evolve in intertriginous areas. Basically, psoriasis that develops only in areas that are moist and wet. These areas are usually unaffected in regular psoriasis.

The typical silver scale is absent because of the moisture.

Question 6

Psoriasis Topical Treatment

Answer 6

Patients are counseled to avoid irritants and use a moisturizer. This is extremely important; if this is not done, any other treatment won’t work.

- Topical corticosteroids

- Topical calcineurin inhibitors

• Photo therapy

Question 7

Psoriasis Systemic Treatment

Answer 7

Corticosteroids (short-term)

Methotrexate

Cyclosporine

Dapsone

Biologics

Question 8

Psoriatic Nails

Answer 8

Occur in 50% of cases and can be a clue to the diagnosis.

Nail pits look like “pick-like” depressions

Question 9

Pityriasis Rosea

Answer 9

Is a usually benign skin rash. Classically, it begins with a single “herald rash” lesion, which is followed in 1 or 2 weeks by a generalized body rash.

Often preceded by an upper respiratory infection.

Spontaneously resolves in 1-2 months.

Question 10

Lichen Planus

Answer 10

Characterized by flat topped polygonal, purple papules.

Typical locations are ankles, wrists, mouth, genitalia.

Question 11

Secondary Syphilis

Answer 11

Presents with red or copper-coloured scaling papules and plaques that are sometimes annular and are usually generalized and often include the palms and soles.