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Clinical Med I > Derm - Seborrheic Dermatitis, Lichen Planus, Pityriasis Rosea & Psoriasis - Exam 1 > Flashcards

Derm - Seborrheic Dermatitis, Lichen Planus, Pityriasis Rosea & Psoriasis - Exam 1 Flashcards

1
Q

What is the theory behind the etiology for Seborrheic Dermatitis?

A

Immune response to Malessezia furfur (yeast) or it’s metabolites

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2
Q

What typically causes Seborrheic Dermatitis to get worse?

A

Emotional stress and dry/cold winter months

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3
Q

What is the clinical presentation for infants with Seborrheic Dermatitis?

A

“Cradle Cap”: yellow, greasy adherent scales on the scalp

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4
Q

What is the clinical presentation for adults with Seborrheic Dermatitis?

A

Erythematous coalescing macules, patches, or plaques with yellow, greasy-looking scales

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5
Q

Where is Seborrheic Dermatitis typically found on the body?

A

Scalp, face, ears, pre-sternal skin, upper back

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6
Q

In which population is Seborrheic Dermatitis more severe and extensive?

A

HIV/AIDS and Parkinson’s

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7
Q

What is the clinical presentation for Seborrheic Blepharitis?

A

Eyelid edges are pink or irritated with yellow, greasy-appearing flakes that are adherent to lashes

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8
Q

What is the typical treatment for Seborrheic Blepharitis?

A

Warm compress and eyelid scrubs

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9
Q

What is the typical treatment for infants with Seborrheic Dermatitis?

A

Olive oil, baby shampoo, and warm water to loosen crusts

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10
Q

What is the typical treatment for adults with Seborrheic Dermatitis?

A

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

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11
Q

What population is Pityriasis Rosea most common in?

A

Teens and young adult females

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12
Q

What is a Herald patch and what skin disorder is it associated with?

A

A pink oval, slightly raised lesion with a marginal collarette scale.

Associated with Pityriasis Rosea

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13
Q

What is the clinical presentation of Pityriasis Rosea?

A

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.

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14
Q

How can you differentiate Pityriasis rosea from Tinea corporis?

A

Perform a KOH prep as the Herald patch is often mistaken for ringworm

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15
Q

What is the treatment for Pityriasis rosea?

A
  • Reassurance; rash is self-limiting
  • Oral antihistamines prn for pruritis
  • Medium strength topical corticosteroids
  • Sun exposure helps
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16
Q

How long does it take for the rash associated with Pityriasis rosea to resolve?

A

6-8 weeks

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17
Q

What are the “Four P’s” and what skin disorder are they associated with?

A
  • Pruritic
  • Purple
  • Polygonal
  • Papules (or Plaques)

Associated with Lichen Planus

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18
Q

What are common parts of the body affected by Lichen planus?

A
  • Wrists (very common)
  • Ankles
  • Shins
  • Back
  • Penis
  • Mouth (50%)
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19
Q

What is the papulosquamous eruption of Lichen planus characterized by?

A
  • Flat-topped violaceous papules

- Wickham’s striae (tiny white lines running through the papules)

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20
Q

Other than the known rash, what are other symptoms associated with Lichen planus?

A

Pruritus and pain (oral/genital)

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21
Q

What is the etiology of Lichen planus?

A

Immune-mediated response involving activated T cells

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22
Q

What population is most frequently affected by Lichen planus?

A

Adults 30-60 years old

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23
Q

What is Koebner phenomenon and what skin disorders is it associated with?

A

The development of lesions in the sites of trauma

Associated with Lichen planus and Psoriasis vulgaris

24
Q

What techniques can you use to confirm the diagnosis of Lichen planus?

A

Punch or shave biopsy

25
Q

Lichen planus is a self-limiting disorder, but how long does it typically take for it to resolve?

A

1-2 years

26
Q

What are the 1st line treatment options used to hasten resolution and manage pruritis associated with Lichen planus?

A

Topical steroids or Intralesional triamcinolone (high or super high potency on the trunk and extremities)

27
Q

What is Psoriasis?

A

A chronic, recurrent, hyperproliferative inflammatory skin disease often associated with systemic symptoms

28
Q

At what ages do Psoriasis patients typically see a peak in symptoms?

A

20-30 and then 50-60 years of age

29
Q

What is the etiology behind Psoriasis?

A

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

30
Q

What are common characteristics of Psoriasis?

A
  • Erythematous plaques often covered with a silvery-white scale
  • Pruritis, skin pain or burning
31
Q

What is the most common form of psoriasis?

A

Chronic plaque psoriasis (Psoriasis Vulgaris)

32
Q

What two forms of psoriasis are the most severe and can be life-threatening?

A
  • Pustular psoriasis

- Erythrodermic psoriasis

33
Q

What is the typical clinical presentation of Psoriasis Vulgaris?

A
  • Erythematous plaques with sharply defined margins and thick silvery scale
  • Symmetrical lesions
  • Smaller plaques join together to form larger ones
34
Q

What areas of the body are most commonly affected by Psoriasis Vulgaris?

A

Elbows, knees, scalp, umbilicus, intergluteal cleft, genitalia and nails

35
Q

Other than the typical rash that presents with Psoriasis vulgaris, what are other common clinical findings/distinctive features associated with it?

A
  • Auspitz sign

- Koebner Phenomenon

36
Q

What is Auspitz sign?

A

Removal of the plaque reveals a smooth, red, glossy membrane with tiny punctate bleeding.

37
Q

What often precedes the onset of Guttate psoriasis?

A

Streptococcal infection

38
Q

What is the typical clinical presentation of nail psoriasis?

A

Pitting and onycholysis of the fingernails with “oil spots”

39
Q

Should you give oral steroids for psoriasis? Why or why not?

A

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.

40
Q

What is onycholysis?

A

Separation of the nail from nail bed

41
Q

What are general measures for the treatment of psoriasis?

A
  • Sunshine (Vitamin D, UVA, UVB light)
  • Baths (moistens thick plaques)
  • Emollients (reduces pruritis and tenderness)
  • Occlusive dressings
  • Rest
42
Q

What are the topical therapies used for psoriasis?

A

Group I or II corticosteroids (high potency)

Steroid sparing agents:

  • Synthetic Vitamin D
  • Coal tar
  • Topical retinoids- tararotene (Tazorac)
  • Topical calicneurin inhibitors
43
Q

What are some considerations to think about for treatment with topical steroids for psoriasis?

A
  • Apply topical steroids after soaking
  • Taper Group I steroids after 2-3 weeks to either a low-potency or to pulse therapy
  • Occlusive therapy
44
Q

What are options included in phototherapy for psoriasis?

A
  • Broad or narrow band UVB light
  • Excimer laser
  • PUVA
45
Q

What is PUVA?

A

The use of topical/oral psoralens (photosensitizers) plus UVA light

46
Q

What are options included in systemic therapy for psoriasis?

A
  • Immunosuppressants
  • Biologic immunomodulators
  • Phophodiesterase-4 inhibitors
47
Q

What is the best course of treatment for moderate to severe psoriasis?

A
  • Care by dermatologist

- Phototherapy or systemic therapies

48
Q

What is excimer laser?

A

UVB light directed only at involved skin

49
Q

What is the best course of treatment for psoriasis in which 5-20% TBSA is affected?

A

Vitamin D analogs +/- UV therapy

50
Q

What is the best course of treatment for psoriasis in which >20% TBSA is affected?

A

Systemic therapy +/- UV therapy

51
Q

What is Psoriatic Arthritis (PsA) characterized by?

A
  • 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)
52
Q

What joints are typically affected in Psoriatic arthritis?

A

Usually smaller joints (hands, feet, wrists, ankles)

DIP joints and spine in half of cases

53
Q

Other than known joint pain, what are other symptoms that a patient may also have with Psoriatic arthritis?

A
  • Tenosynovitis
  • Enthesitis
  • Dactylitis
  • Nail lesions
  • Ocular involvement
54
Q

What is dactylitis?

A

Diffuse swelling of the digit; “Sausage digit”

55
Q

What laboratory findings are typically elevated in psoriatic arthritis? What does this suggest?

A

Sedimentation rate (ESR) and WBC (leukocytosis)

Inflammation response

56
Q

What specialists should be involved in the care of a patient with psoriatic arthritis?

A
  • Rheumatologist
  • Primary care
  • Dermatologist

Clinical Med I (24 decks)

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