Inflammatory Skin Conditions Flashcards
chronic disease that presents as largely symmetric erythematous well-defined plaques with overlying silvery scale; extensors (elbows, knees) and scalp, buttocks, sacrum, umbilicus are common locations; thought to be due to cytokines triggering a hyperproliferative state resulting in thick skin and excessive scale
Psoriasis
MOST COMMON type of psoriasis
Plaque Psoriasis (silvery scale)
type of psoriasis commonly seen in younger people; often seen after STREPTOCOCCAL pharyngitis
Guttate Psoriasis
type of psoriasis morphology; lesions located in SKIN FOLDS (axilla,groin, etc.); may lack scale due to moistness of area
Inverse/Flexural psoriasis
type of psoriasis; widespread, generalized erythema covering nearly ALL (>80%) of the body surface; hospitalization is sometimes needed
Erythrodermic psoriasis
type of psoriasis morphology; pustules; triggered by corticosteroid withdrawal; generalized; can be LIFE-THREATENING
Pustular psoriasis
indicates higher risk of psoriatic arthritis (90% have it); can involve pitting, onycholysis (separation of nail plate from nail bed) and hyperkeratosis
Nail Psoriasis
Psoriasis is complicated ____ driven disease involving cytokines (TNFa and IL-23)
T-cell
What cytokine stimulates Th17 cells to release IL-17 and IL-22 leading to proliferation of keratinocytes and dermal inflammation?
IL-23
High levels of ____ correlate with psoriasis severity
IL-22
What gene accounts for up to 50% psoriasis?
PSORS1
Histopathology of psoriasis
- Regular acanthosis with elongated rete ridges
- Vessels in dermal papillae
- Parakeratosis and lack of s. granulosum
- munro microabscesses (neutrophils on top of parakeratosis)
Treatment for Psoriasis
- Topical steroids first for limited disease
2. Phototherapy, Biologic agents (TNF-a inhibitors) and Oral meds (Methotrexate) for systemic/widespread disease
Acute red scaly rash that occurs in adolescents/young patients; starts as a HERALD patch (ring-shaped with clear center) and will progress to a CHRISTMAS TREE pattern along skin lines on trunk; unknown etiology but maybe associated with HHV6 infection; SELF-LIMITING in 6-8 weeks; no treatment needed
Pityriasis rosea
Type I hypersensitivity reaction (Th2 cytokine predominance) that commonly impacts infants and young children; itchy (pruritus) rash; associated with other atopic diseases (seasonal allergy, asthma); commonly seen in flexural areas; increased serum IgE
Atopic Dermatitis
Atopic dermatitis is caused by what mutation?
FLG (filaggrin) gene mutation –> epidermal barrier dysfunction –> transepidermal water loss
Atopic dermatitis puts at risk for what secondary infections?
staph causing impetigo (crusting lesions)
Treatment for atopic dermatitis
Repair epidermal barrier function (topical steroids first line tx & thick moisturizers to treat xerosis)
What must be avoided as tx for Atopic Dermatitis?
systemic steroids (oral like prednisone) can cause rebound symptoms
50-80% of children with Atopic Dermatitis will have another atopic disease, like Asthma or Allergic Rhinitis
Atopic Triad/March
Eczema seen classically in lower legs in adults, very itchy and nummular (coin shaped)
Nummular Eczema
Eczema described as “dry riverbed”, superficial fissuring from extreme dry skin leading to dermatitis; common in lower legs in winter months
Asteatotic Eczema
Tx for Eczema (nummular and asteatotic)
moisturizer, topical steroids
Skin disease seen in patients with lower extremity edema who then develop overlying dermatitis; DO NOT confuse with bilater lower extremity cellulitis; no fever, chills
Stasis dermatitis
Tx for Stasis dermatitis
compression stockings, topical steroids
T-cell mediated disease against keratinocytes triggered idiopathically; purple pruritic flat-topped papules; histology shows lichenoid pattern (dense band of lymphocytes in dermal papillae); commonly found in genitalia, lower legs, wrists; Wickham’s striae (white lines in papules)
Lichen planus
Tx for lichen planus
Topical steroids, prednisone taper
White atrophic plaques on genital skin caused by autoimmune reaction against extracellular matrix protein; very itchy; more common in women
Lichen sclerosus
Lichen sclerosus must be treated because if left untreated..
- scarring and loss of normal anatomy can occur
2. risk for scc
Tx for Lichen sclerosus
Potent topical steroids for long term
Recurrent nodules, abscesses, and draining at intertriginous sites (groin, axillae, buttocks) due to chronic inflammation of hair follicles; more common in women and black patients
Hidradenitis Suppurativa (HS)
What factors worsen HS
Obesity, smoking, friction
Tx for Hidradenitis Suppurativa (HS)
Weight loss, smoking cessation, oral antibiotics
Targetoid appearance rash commonly seen on palms, soles, mouth; most frequent after infection (HSV and mycoplasma); self-limiting; treat underlying infection
Erythema multiforme
