Inflammatory Skin Dz

Question 1

Primary lesion: flat, <1cm

Answer 1

macule

Question 2

Primary lesion: flat, >1cm

Answer 2

patch

Question 3

Primary lesion: violaceous patch, > 1cm

Answer 3

purpura

Question 4

Primary lesion: violaceous patch, <1cm

Answer 4

petechiae

Question 5

Primary lesion: raised, <1cm

Answer 5

papule

Question 6

Primary lesion: raised, >1cm

Answer 6

plaque

Question 7

Primary lesion: raised, <1cm, filled with fluid

Answer 7

vesicle

Question 8

Primary lesion: raised, >1cm, filled with fluid

Answer 8

bulla

Question 9

Which class of corticosteroids has the highest potency?

Answer 9

Class I

Question 10

List the SE of topical corticosteroids on the skin, eyes, and face

Answer 10

skin: hypopigmentation, hypertrichosis, skin atrophy, telangiectasia, striae
face: acne, perioral dermatitis/rosacea
Eyes: glaucoma, cataracts

Question 11

What is hypertrichosis

Answer 11

abnormal amount of hair growth on body

Question 12

a fingertip unit of topical medicine will cover how much area?

Answer 12

two palms (or one palm, two applications)

Question 13

Name the idiopathic inflammatory disease of skin and mucous membranes that is associated with HepC (and HBV vaccine) exposure

Answer 13

Lichen planus

Question 14

In what age-range is lichen planus most commonly seen?

Answer 14

middle-aged adults

Question 15

which disease presents with polygonal, purple, pruritic, planar papules and plaques with wickham’s striae?

Answer 15

lichen planus

Question 16

Where on the body is lichen planus seen?

Answer 16

flexures, tops of hands, shins, orogenital mucosa (reticular white patches or erosions)

Question 17

How do should you treat lichens planus?

Answer 17

spontaneous remission may occur, so eliminate any suspect medications
mild - topical corticosteroids and anti-His
severe - phototherapy and immunosuppression

Question 18

Name the AI polygenic skin condition that is triggered by trauma, infections, meds, etc. in predisposed people

Answer 18

Psoriasis

Question 19

what other comorbidities are associated with psoriasis?

Answer 19

psoriatic arthritis (20-30%) and increased risk of metabolic disease and atherosclerotic CV disease

Question 20

what is the most common clinical variant of psoriasis and how does it present?

Answer 20

plaque psoriasis

• symmetric (elbows and knees)
• nail changes - yellow and pitting

Question 21

Which clinical variant of psoriasis is often triggered by Strep infection? how does it present?

Answer 21

Guttate psoriasis - numerous small erythematous lesions with overlying silvery scale, well demarcated

Question 22

a pt with psoriasis has generalized erythema. which clinical variant does she have?

Answer 22

erythrodermic psoriasis

Question 23

Pt with psoriasis presents with broad patches of erythema an overlying pustules. which clinical variant does she have?

Answer 23

pustular psoriasis

Question 24

How do you treat mild and severe psoriasis?

Answer 24

Mild - topical corticosteroids (also, retinoids, coal tar derivatives, calcineurin inhibitors)
severe - systemic meds, phototherapy and topical (immune suppressors - oral corticosteroids should be avoided)

Question 25

vitD derivatives and retinoids work by...

Answer 25

inhibiting keratinocyte proliferation

Question 26

salicylic and lactic acids work by....

Answer 26

keratolysis

Question 27

coal tar works by...

Answer 27

anti-inflammatory, inhibits keratinocyte proliferation

Question 28

calcineurin inhibitors work by...

Answer 28

anti-inflammatory (prevents T-cell activation)

Question 29

what light waves are used in phototherapy

Answer 29

narrowband UVB

Question 30

What is the name of the phenomenon in which psoriatic skin lesions develop at sights of injury (scratching, sunburn)

Answer 30

Koebner

Question 31

Pinpoint bleeding points seen when psoriatic scale is removed

Answer 31

Auspitz sign, d/t capillaries at papillary dermis

Question 32

Name the mild, self-limited inflammatory condition often d/t Malessezia furfur and high sebum production...

Answer 32

Seborrheic Dermatitis

Question 33

How does Seborrheic dermatitis USUALLY present in infants?

Answer 33

cradle cap: yellow, greasy adherent scale on the scalp

Question 34

In infants, describe the 3 extensions of seborrheic dermatitis

Answer 34

Face - small pink papules intertriginous areas - moist pink patches; secondary infxn with candida and strep trunk/extermities - thin oval pink scaly patches (may be difficult to distinguish from atopic dermatitis)

Question 35

How can you distinguish between psoriasis and seborrheic dermatitis in adolescents/adults

Answer 35

SD is more diffuse and ill-defined (SD presents at areas of high sebum production: face, ears, eyebrows, upper chest, intertriginous area)

Question 36

how do you typically treat seborrheic dermatitis in infants?

Answer 36

gentle cleansers with use of emollients (moisturizers)

Question 37

how do you typically treat seborrheic dermatitis in adults (relapse is common)

Answer 37

topical anti-fungals for chronic therapy | low potency topical steroid for acute therapy

Question 38

Name a derm condition that is associated with other allergic conditions and is the most common chronic inflammatory skin disease

Answer 38

Atopic dermatitis/eczema

Question 39

Explain the pathogenesis of atopic dermatitis

Answer 39

multifactorial: - impaired barrier d/t mut of profilaggrin gene - immune dysregulation - acute (Th2), chronic (Th1) - allergens/infections: S. aureus 2/2 AD is common and can aggravate AD by stimulating inflammatory cascade

Question 40

rapid dissemination of HSV with areas of eczema, a complication of atopic dermatitis, is called

Answer 40

eczema herpeticum

Question 41

what is xerosis?

Answer 41

dry skin

Question 42

describe the appearance of acute atopic dermatitis

Answer 42

dedematous, erythematous papules/plaques, may ooze

Question 43

describe the appearance of sub-acute atopic dermatitis

Answer 43

erythematous, scaly, may be crusted, LESS WELL DEFINED THAN PSORIASIS

Question 44

describe the appearance of chronic atopic dermatitis

Answer 44

thickened, with lichenification

Question 45

what is lichenification

Answer 45

exaggerated skin lines

Question 46

In infants, how does atopic dermatitis present?

Answer 46

cheeks, primarily, lesions are often exudative with oozing and crusting - associated with Staph, poor sleep (pruritis), and FTT

Question 47

In the childhood phase of atopic dermatitis, what is the typical presentation?

Answer 47

flexural involvement, lesions are less exudative, lichenification may be seen

Question 48

what are the different outcomes/presentations of atopic dermatitis in adult hood?

Answer 48

75% outgrow - or, more chronic and severe, with evidence of scratching/rubbing leading to chronic papules - may be more resistant to treatment - limited to hands or more generalized

Question 49

how do you treat actively inflamed atopic dermatitis

Answer 49

education to minimize further skin disruption - gentle skin care (daily baths, gentle cleansers, thick emollients 2x/day, avoid irritants) - topical corticosteroids or calcineurin inhibitors

Question 50

how do you treat severe/recalcitrant atopic dermatitis?

Answer 50

phototherapy and immunosuppressants - anti-His to releive pruritis (H1-blockers are sedative) - bleach baths to tx secondary infections