Derma Flashcards
Examples of Papulosquamous Diseases
- Psoriasis
- Lichen Planus
- DLE
Def of Psoriasis
- Psoriasis is a genetically determined common skin disease characterized by: chronic relapsing nature and variable clinical features.
Etiology of Psoriasis
Pathology of Psoriasis
Clinical types of Psoriasis
1- Psoriasis vulgaris.
2- Erythrodermic psoriasis
3- Pustular psoriasis.
4- Arthropathic psoriasis.
Koebner Phenomenon in Psoriasis Vulgaris
- Trauma to the apparently normal skin may elicit new psoriatic lesions.
Auspitz Sign in Psoriasis Vulgaris
- Removal of scales by scraping gives rise to small bleeding points which is pathognomonic for psoriasis
what is the most comn form of Psoriasis Vulgaris?
Plaque Psoriasis
Shape of Plaque Psoriasis
Color of Plaque Psoriasis
Salmon Pink Erythema
Covering of Plaque Psoriasis
Silvery white scales
Specific Charaters of Plaque Psoriasis
+ve Koebner phenomenon
+ve Auspitz sign
Site of Plaque Psoriasis
- Elbows, knees and lower sacrum.
- However, any site may be affected
Shape of Scalp Psoriasis
Specific Characters of Scalp Psoriasis
No hair loss
Sites of Scalp Psoriasis
Scalp
Shape of Palms & Soles Psoriasis
Color of Palms & Soles Psoriasis
Red
Covering of Color of Palms & Soles Psoriasis
Fine silvery scales
Sites of Palms & Soles Psoriasis
Palms & Soles
Shape of Psoriasis of Nails
Site of Psoriasis of Nails
Nails
Lesion in Intertriginous Psoriasis
Specific Characters of Intertriginous Psoriasis
- Itching is common & fissuring is often seen in the gluteal crease
Site of Intertriginous Psoriasis
Localized to groins, gluteal crease, axillae and sub-mammary areas
Lesion in Mucosal Psoriasis
Lesion in Guttate Psoriasis
Site of Guttate Psoriasis
trunk and proximal extremities
Incidence of Guttate Psoriasis
- Usually occurs in children and young adults following acute streptococcal infection
Course of Guttate Psoriasis
- The lesions may subside after about 6 weeks without treatment or change to plaque type
Erythrodermic Psoriasis
- The entire skin is red and covered with scales.
Pustular psoriasis
Macroscopic sterile pustules appear.
- Localized to palms and soles.
- Generalized pustular psoriasis.
Arthropathic psoriasis
Psoriasis associated with arthropathy.
Course of Psoriasis
The disease is usually chronic with remission and relapse.
TTT of Psoriasis
- Topical
- Phototherapy
- Systemic
Topical TTT of Psoriasis
- Steroids
- Salicylic Acid
- Tar
- Calcipotriol (vitamin D analogue)
Steroids In TTT of Psoriasis
- Antimitotic & anti-inflammatory. (Topical, intralesional)
- They are applied alone or in combination with salicylic acid.
- Intralesional injection of steroid is used in localized small resistant lesion.
- Also, it is used for nail psoriasis by injection in the nail fold. However.
Salicylic acid in TTT of Psoriasis
- Keratolytic agent which is used to remove the scales. It is usually used in combination with steroid, tar or anthralin.
Tar in TTT of Psoriasis
Antimitotic 2-5% tar ointment is applied at night, and then removed in the next day by mineral oil before exposure to UVB. (goekerman technique)
when is Tar Contraindicated in Psoriasis?
- Application on face, flexures & genitals.
- Erythroderrnic and generalized pustular psoriasis.
- Severe acne & folliculitis.
Calcipotriol in TTT of Psoriasis
(vitamin D analogue)
- It inhibits proliferation of keratinocytes.
- It is applied twice daily with maximum dose of 100 gm weekly for 6 week
- This drug may increase serum calcium.
Phototherapy in TTT of Psoriasis
- UVB (broad band or narrow band) exposure 3 times weekly in mildly erythemogenic dose.
Systemic Therapy in TTT of Psoriasis
- Methotrexate. (given once weekly, hepatotoxic and myelotoxic)
- PUVA (psoralen+ UVA).
- Retinoids (acitretin), etretinate: teratogenic.
- Cyclosporine: nephrotoxic.
- Biologic therapy as TNFa blockers (as adalimumab, etanercept) and IL-17 antagonists (as sekicinumab)
Indications of Systemic Therspy in TTT of Psoriasis
should be used only by specialist in:
- Extensive psoriasis vulgaris not responding to topical therapy.
- Erythrodermic psoriasis.
- Pustular psoriasis.
- Arthropathic psoriasis
Why are Systemic corticosteroids absolutely contraindicated in psoriasis vulgaris?
Cause flare at withdrawl
Def of Lichen Planus
- a chronic sometimes acute disease of the skin and mucous membranes, with distinctive clinical and pathological features.
Etiology of Lichen Planus
- Psychic stress is a predisposing factor.
- Lichen planus may be more common among patients suffering from HCV.
Pathology of Lichen Planus
CP of Lichen Planus
what is the clsssic 1ry lesion of Lichen Planus?
- itchy flat topped, polygonal violaceous papules.
Wickham’s striae
The surface of the papule may show white fine dots and lines known as (Wickham’s striae).
Lichen Planus Lesions in oral mucosa
Lichen Planus lesion in nail
Lichen Planus lesions in palms & soles
Sites of Lichen Planus
Clinical Varieties of Lichen Planus
Course of Lichen Planus
TTT of Lichen Planus
7 Characters starting with P for Lichen Planus
Papules
Purple
Polygonal (flat topped)
Pruritic
Peripheral extremities + oral
Positive Koebner
Pterygium in nail
Def of Discoid lupus erythematosus (DLE)
- Localized inflammatory skin disease characterized by plaques of erythema, scaling and atrophic scar.
what is the most common type of chronic cutaneous lupus?
Discoid lupus erythematosus (DLE)
Types of Lupus erythematosus (LE)
DLE & SLE
Predisposing factors for Discoid lupus erythematosus (DLE)
CP of Discoid lupus erythematosus (DLE)
Age & sex of Discoid lupus erythematosus (DLE)
adults 20-40 years. (4 decade)
{Female: male = 2:1}
Lesions of DLE
Sites of Discoid lupus erythematosus (DLE)
- Face especially the butterfly area, scalp, arms, legs, dorsum of hands and retro-auricular areas.
- However, any site may be affected including oral mucosa.
- Lesions on the scalp cause scarring alopecia.
Course of Discoid lupus erythematosus (DLE)
- Spontaneous regression may occur with or without scar.
- Calcification
- Spread to other area
- In 6-6.5% of DLE patients they may change to SLE.
TTT of Discoid lupus erythematosus (DLE)
Systemic TTT of Discoid lupus erythematosus (DLE)
- Antimalarial drugs as hydroxychloroquine in cases not responding to topical steroid.
- Prednisone 15 mg/d.
- Etretinate