Derm - Seborrheic Dermatitis, Lichen Planus, Pityriasis Rosea & Psoriasis - Exam 1 Flashcards
What is the theory behind the etiology for Seborrheic Dermatitis?
Immune response to Malessezia furfur (yeast) or it’s metabolites
What typically causes Seborrheic Dermatitis to get worse?
Emotional stress and dry/cold winter months
What is the clinical presentation for infants with Seborrheic Dermatitis?
“Cradle Cap”: yellow, greasy adherent scales on the scalp
What is the clinical presentation for adults with Seborrheic Dermatitis?
Erythematous coalescing macules, patches, or plaques with yellow, greasy-looking scales
Where is Seborrheic Dermatitis typically found on the body?
Scalp, face, ears, pre-sternal skin, upper back
In which population is Seborrheic Dermatitis more severe and extensive?
HIV/AIDS and Parkinson’s
What is the clinical presentation for Seborrheic Blepharitis?
Eyelid edges are pink or irritated with yellow, greasy-appearing flakes that are adherent to lashes
What is the typical treatment for Seborrheic Blepharitis?
Warm compress and eyelid scrubs
What is the typical treatment for infants with Seborrheic Dermatitis?
Olive oil, baby shampoo, and warm water to loosen crusts
What is the typical treatment for adults with Seborrheic Dermatitis?
Scalp: Antifungal agents and topical corticosteroids (Ketoconazole shampoo or cream, Selenium sulfide, anti-dandruff shampoo)
Face: Low-potency topical corticosteroid cream, topical antifungal, or combination of both
What population is Pityriasis Rosea most common in?
Teens and young adult females
What is a Herald patch and what skin disorder is it associated with?
A pink oval, slightly raised lesion with a marginal collarette scale.
Associated with Pityriasis Rosea
What is the clinical presentation of Pityriasis Rosea?
Primary lesion is a Herald patch, typically on the trunk, followed by a secondary rash of pink papules and plaques 1-2 weeks later in a “Christmas tree” pattern.
How can you differentiate Pityriasis rosea from Tinea corporis?
Perform a KOH prep as the Herald patch is often mistaken for ringworm
What is the treatment for Pityriasis rosea?
- Reassurance; rash is self-limiting
- Oral antihistamines prn for pruritis
- Medium strength topical corticosteroids
- Sun exposure helps
How long does it take for the rash associated with Pityriasis rosea to resolve?
6-8 weeks
What are the “Four P’s” and what skin disorder are they associated with?
- Pruritic
- Purple
- Polygonal
- Papules (or Plaques)
Associated with Lichen Planus
What are common parts of the body affected by Lichen planus?
- Wrists (very common)
- Ankles
- Shins
- Back
- Penis
- Mouth (50%)
What is the papulosquamous eruption of Lichen planus characterized by?
- Flat-topped violaceous papules
- Wickham’s striae (tiny white lines running through the papules)
Other than the known rash, what are other symptoms associated with Lichen planus?
Pruritus and pain (oral/genital)
What is the etiology of Lichen planus?
Immune-mediated response involving activated T cells
What population is most frequently affected by Lichen planus?
Adults 30-60 years old
What is Koebner phenomenon and what skin disorders is it associated with?
The development of lesions in the sites of trauma
Associated with Lichen planus and Psoriasis vulgaris
What techniques can you use to confirm the diagnosis of Lichen planus?
Punch or shave biopsy
Lichen planus is a self-limiting disorder, but how long does it typically take for it to resolve?
1-2 years
What are the 1st line treatment options used to hasten resolution and manage pruritis associated with Lichen planus?
Topical steroids or Intralesional triamcinolone (high or super high potency on the trunk and extremities)
What is Psoriasis?
A chronic, recurrent, hyperproliferative inflammatory skin disease often associated with systemic symptoms
At what ages do Psoriasis patients typically see a peak in symptoms?
20-30 and then 50-60 years of age
What is the etiology behind Psoriasis?
Overactive T-cells trigger immune response causing decreased turn over time of the epidermis and skin cells to pile up on the surface of the skin
What are common characteristics of Psoriasis?
- Erythematous plaques often covered with a silvery-white scale
- Pruritis, skin pain or burning
What is the most common form of psoriasis?
Chronic plaque psoriasis (Psoriasis Vulgaris)
What two forms of psoriasis are the most severe and can be life-threatening?
- Pustular psoriasis
- Erythrodermic psoriasis
What is the typical clinical presentation of Psoriasis Vulgaris?
- Erythematous plaques with sharply defined margins and thick silvery scale
- Symmetrical lesions
- Smaller plaques join together to form larger ones
What areas of the body are most commonly affected by Psoriasis Vulgaris?
Elbows, knees, scalp, umbilicus, intergluteal cleft, genitalia and nails
Other than the typical rash that presents with Psoriasis vulgaris, what are other common clinical findings/distinctive features associated with it?
- Auspitz sign
- Koebner Phenomenon
What is Auspitz sign?
Removal of the plaque reveals a smooth, red, glossy membrane with tiny punctate bleeding.
What often precedes the onset of Guttate psoriasis?
Streptococcal infection
What is the typical clinical presentation of nail psoriasis?
Pitting and onycholysis of the fingernails with “oil spots”
Should you give oral steroids for psoriasis? Why or why not?
No!
While oral steroids will treat the psoriasis initially, psoriasis can worsen upon discontinuation and can be the primary cause of the life-threatening forms.
What is onycholysis?
Separation of the nail from nail bed
What are general measures for the treatment of psoriasis?
- Sunshine (Vitamin D, UVA, UVB light)
- Baths (moistens thick plaques)
- Emollients (reduces pruritis and tenderness)
- Occlusive dressings
- Rest
What are the topical therapies used for psoriasis?
Group I or II corticosteroids (high potency)
Steroid sparing agents:
- Synthetic Vitamin D
- Coal tar
- Topical retinoids- tararotene (Tazorac)
- Topical calicneurin inhibitors
What are some considerations to think about for treatment with topical steroids for psoriasis?
- Apply topical steroids after soaking
- Taper Group I steroids after 2-3 weeks to either a low-potency or to pulse therapy
- Occlusive therapy
What are options included in phototherapy for psoriasis?
- Broad or narrow band UVB light
- Excimer laser
- PUVA
What is PUVA?
The use of topical/oral psoralens (photosensitizers) plus UVA light
What are options included in systemic therapy for psoriasis?
- Immunosuppressants
- Biologic immunomodulators
- Phophodiesterase-4 inhibitors
What is the best course of treatment for moderate to severe psoriasis?
- Care by dermatologist
- Phototherapy or systemic therapies
What is excimer laser?
UVB light directed only at involved skin
What is the best course of treatment for psoriasis in which 5-20% TBSA is affected?
Vitamin D analogs +/- UV therapy
What is the best course of treatment for psoriasis in which >20% TBSA is affected?
Systemic therapy +/- UV therapy
What is Psoriatic Arthritis (PsA) characterized by?
- Pain and stiffness in affected joints
- Stiffness in morning that fades during the day
- Pain, joint line tenderness, and effusion are present (often in asymmetric distribution)
What joints are typically affected in Psoriatic arthritis?
Usually smaller joints (hands, feet, wrists, ankles)
DIP joints and spine in half of cases
Other than known joint pain, what are other symptoms that a patient may also have with Psoriatic arthritis?
- Tenosynovitis
- Enthesitis
- Dactylitis
- Nail lesions
- Ocular involvement
What is dactylitis?
Diffuse swelling of the digit; “Sausage digit”
What laboratory findings are typically elevated in psoriatic arthritis? What does this suggest?
Sedimentation rate (ESR) and WBC (leukocytosis)
Inflammation response
What specialists should be involved in the care of a patient with psoriatic arthritis?
- Rheumatologist
- Primary care
- Dermatologist
