Dermatphatology part 4

Question 1

pitryiasis rosea etiology and demographic

Answer 1

subacute spongiotic dermatitis

not contagious but possibly related to HHV type 7

affects older children and young adults

most common in winter

Question 2

Pitryiasis rosea clinical and gross Description

Answer 2

“herald patch” resmebles ringworm

progresses to generalized oval, sightly elevated, scaling papules that resemble the herald patch but are smaller

the lesions are pink with scaling near the border

described as classically having a “christmas tree” pattern

the patient feels well

Question 3

Pitryriasis rosea location and tx and histology

Answer 3

common on trunk, upper arms, and thigs usually not found on the face

pruritis often present and varies in severity

histologic: spongiosis with erythrocyte extravasation

spontaneously remits in 6-8 weeks without treatment

Treat itching with antihistamines

recurrence is rare

Question 4

Venous insufficiency

Answer 4

venous incompetence causes increased hydrostatic pressure and capillary damage leading to extravasation of RBCs and serum

disease of middle age and older adults

starts as edema and hyper pigmentation and leads to pruritic erythema and stasis dermatitis

Question 5

Stasis dermatitis histology

Answer 5

this is a subacute spongiotic dermatitis

chornic intracellular epidermal edema

erythrocyte extravasation causes hemosiderin to collect which givs skin a thickened, rough, brown appearance

Question 6

venous insufficiency TX

Answer 6

avoid trauma to the area

compression stockings

topical steroids for stasis dermatitis

wound care for ulcers debridement and Unna boot

Question 7

psoriasis

Answer 7

accelerated prolifertion of skin cells resulting in scaling

chronic condition with exacerbations and remissions

can occur at any age, average is 35 years

pathogenesis: genetic and environemnta; 1/3 have family history

impact on quality of life and self esteem can be enormous

Question 8

Psoriasis clinical

Answer 8

well demarcated erythematous plaques and papules with silver scalling

auspitiz sign: pinpoint bleed on removal of scale

symmertical elbows, knees, buttocks, scalp, gluteal cleft, trunk, face

trauma to the skin and stress can cause exacrbations (koebner phenomenon)

Question 9

Psoriasis histo

Answer 9

downard elongation fo rete ridges

thinning of overylying stratum granulsom with parakeratosis above

aggregates of neutrophils with surrounding spongiosis

cappaleries in derm papilla are brought close to the surface

Question 10

Psoriasis other types

Answer 10

erythrodermic: involves entire skin very serious
guttate: scattered drop like, pink, scaly plaques may follow strep infection
pustular: pusutules on erythematous skin can be on palsm/soles or generalized

Question 11

Psoriasis on nails

Answer 11

50% have nail involvement

oil spotting: focal brown discoloration of nail plate

oncycholysis: distal separation of plate from bed

subungual hyperkeratosis

pitting

Question 12

Psoriatic arthritis

Answer 12

5%

most is mild with asymmetric small and medium join involvement

arthritis mutilans is very destrive form of psoriatic arthritis with significant periarticular bone resorption

erosions cause a penicl in cup deformity where one articular surface is erodied creating a pointed appearance. Articulating bone is concave resmembling an upside down cup

Question 13

Psoriasis TX

Answer 13

Topical

corticosteroid

calcipotriene: vitamin D deriviative
tars: compliance very low

also treat systemic

Question 14

Seborrheic dermatitis

Answer 14

dandruff

chronic inflammatory process affecting areas rich in sebaceous glands

peaks in infancy and adulthood

thought to be caused by yeast malassezia furfur which is normal flora on skin

Question 15

Seborrheic dermatitis caveats

Answer 15

may be more common in parkinson and HIV

mild cases manifest as dandruff

yellow, greasy, scaly patches with surrounding erythema

asymptomatic but may be itchy

in babies condition will remit after 6-8 moths. The course is chronic in adults

Question 16

seborrheic dermatitis histo

Answer 16

features of both spongiotic dermatitis and psoriasis later

mounds of parakeratosis with neutrophils and serum at the ostia of hair follicules

perivascular infiltrate of lymphocytes and neutrophils

etiology unkonwn

Question 17

Seborrheic dermatitis TX

Answer 17

sunight helps

dandruff shampoo
ketoconazole

mild topical steroids fro more severe cases

may only need to use dandruff shampoo and ketoconazole 2-3 per week

Question 18

Lichen planus

Answer 18

idopathic inflammatory disorder

5 P: pruritic purple, polygonal, planar, papules, plaques

uncommon but not rare

Question 19

Lichenen planus clinical

Answer 19

history: severe intching

most common on wrists and ankles

wickham’s striae: fine reticulated white lines

mucous membrane involvement is common

koebner phenomenon (trauma to the skin and stress can cuse exacerbations)

Question 20

Lichenplanus assocaitions

Answer 20

hepatitis C

Question 21

lichenplanus histo

Answer 21

dense chornic infiltrate

Question 22

Lichen planus TX and diagnosis

Answer 22

biopsy if dianosis is in doubt

strong topical steroids are mainstay of treatment

usually self limited, most commonly resolves 1-2 years after onset. Recurrences uncommon

patients with mucous membrane involvement have longer course

Question 23

Systemic lupus erythematousus

Answer 23

multisystem autoimmune disease involving connective tissues and blood vessels

incidence is 40-200/100000

more common in african americans

female to male ratio 9 to 1

age of onset is 30-40

Question 24

Systemic lupus erythematosus clinical presentation

Answer 24

history: 36% have skin lesions. Sunlight exacerbates rash. Skin lesions may burn or itch

also present with fatigeu, fever, wt loss, malaise, arthralgias, CNS symptoms

Malar rash “butterfly rash” erythematous confluent, macular eruption with clear borders

multisysteme involvement: oral ulcers, renal disease, pericarditis, pneumonitis, peritonitis, hepatosplenomegaly, myopathy, neuropathy, lymphadenopathy, seizures

Question 25

Systemic lupus erythematosus TX

Answer 25

oral steroids and immunosuppressants (methotrexate and azathioprine, etc)

Question 26

Systemic lupus erythematosus causes and false positives

Answer 26

all due to immune complex deposition

false positive on RPR and VDRL

five year survival is 93%

Question 27

Systemic lupus erythematosus histoogy

Answer 27

lichenoid interface dermatitis

epidermal atrophy

thickening of basal membrane