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Dermatology > Lecture 9: Papulosquamous & Inflammatory Disorders > Flashcards

Lecture 9: Papulosquamous & Inflammatory Disorders Flashcards

1
Q

What is the most distinctive feature of pityriasis Rosea?

A

Herald patch on the trunk

or Christmas Tree Rash

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2
Q

What is the MCC of Pityriasis Rosea?

A

HHV6 & 7

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3
Q

Who is Pityriasis Rosea MC in?

A
  • 10-40
  • Spring/fall
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4
Q

After the herald patch, what is the usual pattern used to describe Pityriasis Rosea?

A

Christmas Tree Pattern

Almost always on the trunk!

Occurs 1-2 weeks after the herald patch

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5
Q

Describe the exanthem associated with Pityriasis Rosea

A
  • Fine scaling papules and patches
  • Dull pink, salmon red
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6
Q

What is used in the tx of Pityrasis Rosea? (4)

A
  • Oral antihistamines
  • Topical antipruritic lotions (Sarna)
  • Topical Triamcinolone BID x 4 weeks
  • Oral steroids
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7
Q

What is the MCC of Lichen Planus?

A

Idiopathic

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8
Q

What metals and infection are associated with Lichen Planus?

A
  • Gold & Mercury
  • Hep C
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9
Q

What kind of condition is Lichen Planus?

A

Inflammatory Dermatosis of the skin +/- mucuos membranes

Acute or chronic

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10
Q

What does Lichen Planus look like?

A
  • Flat topped papules
  • Annular, purple pruritic
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11
Q

Dermoscopy with oil of these small, flat-topped papule has white lines around it. What are these white lines and what condition is it?

A

Whickham striae seen in Lichen Planus

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12
Q

Where does Lichen Planus tend to occur?

A
  • Wrists (flexor)
  • Lumbar
  • Shins
  • Scalp
  • Penis
  • Mouth
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13
Q

Which Lichen Planus type involves cicatricial/scarring alopecia?

A

Follicular

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14
Q

Which Lichen Planus variant is associated with Bullous Pemphigoid?

A

Vesicular

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15
Q

Involvement of this area with Lichen Planus is concerning?

A

Mouth

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16
Q

If Lichen Planus occurs in the hair and nails, what may happen?

A
  • Scarring alopecia
  • Nail Bed destruction + longitudinal splintering
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17
Q

What is the most concerning variant type of Lichen Planus that we need to consider DDx for?

A

Papular

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18
Q

For cutaneous lesions of Lichen Planus, the preferred tx is…

A

Triamcinolone under occlusion BID x 4 weeks

Can also use ILK

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19
Q

For Lichen Planus in the mouth, the preferred tx is…

A

Cyclosporine and Tacrolimus MOUTHWASH

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20
Q

Systemic tx of Lichen Planus can use 3 drugs and 1 therapy, which are…

A
  • Cyclosporine
  • Prednisone
  • Retinoids (adjunctive)
  • PUVA therapy
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21
Q

Who is Granuloma Annulare MC in?

A

Female children/young adults

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22
Q

What condition can Granuloma Annulare mimic?

A

Tinea Corporis

But it has NO SCALING.

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23
Q

MC Etiology for Granuloma Annulare

A

Idiopathic

But seen in diabetics

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24
Q

How does Granuloma Annulare present?

A
  • Shiny beaded papules
  • ANNULAR arrangement
  • Skin colored/brownish red
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25
Q

Where does Granuloma Annulare MC appear?

A
  • Hands and feets
  • Elbows and Knees
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26
Q

A patient has been recently diagnosed with granuloma annulare. They have no other medical hx. You should refer them to…

A

PCP for a DM workup

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27
Q

How is granuloma annulare diagnosed?

A

Biopsy showing histiocytic infiltration or necrobiosis of CT.

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28
Q

If you do want to treat granuloma annulare, what can you give?

A

Topical Triamcinolone BID x 4 weeks

ILK if ^ under occlusion doesnt work.

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29
Q

What is the issue with using cryotherapy on granuloma annulare?

A

Hypopigmentation

Esp on darker skin

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30
Q

What layer is erythema nodosum inflammation of?

A

SQ fat

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31
Q

What is Erythema Nodosum the MC type of?

A

Panniculitis

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32
Q

A patient presents with indurated, tender red nodules up to 20cm in diameter on both their anterior legs that are only appreciable on palpation. The nodules are bilateral but not symmetrical. What condition should you be suspicious of that they may have?

A

Sarcoidosis, because this is erythema nodosum

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33
Q

MC area for arthralgia 2/2 Erythema Nodosum?

A

Ankle Joints

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34
Q

What labs would you consider ordering in someone presenting with Erythema Nodosum?

A
  • ESR/CRP (HIGH)
  • CBC (leukocytosis)

Sarcoidosis!

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35
Q

What is the expected course of erythema nodosum?

A

Self-resolving in 6 weeks.

No scarring either.

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36
Q

What can you treat erythema nodosum with if the patient really wanted you to?

A
  • NSAIDs
  • Steroids

Inflammatory condition

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37
Q

Say you decided to biopsy erythema nodosum because you were really curious. How would you do it?

A

Lots of punches to get into the FAT

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38
Q

What is the pathophysiology of psoriasis?

A

Hyperproliferation of keratinocytes in the EPIdermis

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39
Q

What are the bimodal peaks for psoriasis?

A
  • 20-30
  • 50-60
40
Q

What characterizes psoriatic skin WITHOUT active lesion?

A
  • Minor capillary dilation
  • Minor epidermal thickness
41
Q

What happens as psoriasis progresses on a pathophys level?

A
  • Increased capillary dilation + tortuosity
  • Increased mast cell degranulation
  • Increased epidermal thickness
42
Q

How much thicker is a fully developed psoriatic lesion?

A
  • 10x thicker
  • 10x blood flow

Also has neutrophils now in stratum corneum (Munro’s microabscesses)

43
Q

What is Koebnerization?

A

Stressor induces something like psoriasis at that location

Trauma, stress, infection

44
Q

Guttate/nummular/eruptive, inflammatory psoriasis is often precipitated by…

A

Streptococcal infection

Strep pharyngitis

45
Q

What is the MC subtype of psoriasis?

A

Chronic, stable plaque psoriasis

Little change.

46
Q

What is an auspitz sign?

A

Removal of scale leaves a small blood droplet

This screams PSORIASIS

47
Q

What does the classic lesion of psoriasis look like?

A
  • Erythematous papule/patch/plaque with sharp margins
  • Silvery-white scales that fall with scratching
  • Itchy
48
Q

Where does eruptive inflammatory psoriasis tend to occur?

A

Trunk

Usually will become chronic stable afterwards.

49
Q

How does chronic stable psoriasis tend to look?

A
  • Sharp margins
  • Dull-red
  • Loose silver-white scales
  • Waxes and wanes
50
Q

If you had one place to check a person’s body for psoriasis, you should choose…

A

sacral/gluteal region

51
Q

When is psoriasis seen on the face?

A

Refractory cases

Very rare

52
Q

Is Psoriasis on the hair scarring?

A

Nope, causes no hair loss

But v itchy

53
Q

How does psoriasis in the intertrignous areas differ from the regular sites?

A
  • Macerated due to warm moist
  • Fissured
54
Q

How does psoriasis on the nails present?

A
  • Yellow-brown oil spots
  • Subungal hyperkeratosis or onycholysis

25% of the time

55
Q

What often precipiates a pustular psoriasis breakout?

A

CS withdrawal

56
Q

Describe pustular psoriasis

A

Lots of sterile pustules

It looks so GROSS

57
Q

What are the two ways pustular psoriasis present?

A
  • Palmoplantar (turns dusky-red and persists)
  • Generalized von Zumbusch, which turns into lakes of pus.
58
Q

What is the concern with generalized/von zumbusch pustular psoriasis?

A
  • LIFE THREATENING
  • (+) nikolsky sign

but can also just evolve into regular stable

59
Q

When would you expect to see leukocytosis with a left shift in psoriasis?

A

Generalized pustular psoriasis

Von Zumbusch

60
Q

How do you manage localized psoriasis?

A
  • PCP with high-potency topical CS under occlusion overnight and Vit D.
  • Topical retinioids + CS/UVB phototherapy (THICK)
  • Coal Tar + SA (THICK)
  • Emollients in between
61
Q

How do you manage generalized psoriasis?

A

Send to derm.

62
Q

What vehicle for carrying Vit D analogs is best for scalp psoriasis?

63
Q

What are the topical Vit D analog options for psoriasis?

A
  • Calcipotriene (solution for scalp)
  • Calcitriol (good for allergic to above^^)
64
Q

A patient has localized psoriasis on their scalp and on their palms/soles. You would recommend BLAH for their scalp and BLAH for their palms and soles.

A
  • Scalp: Tar shampoo + lotion
  • Palms/Soles: High-potency CS with occlusive dressing or PUVA soaks.
  • Last resort: Oral retinoids for thick, hyperkeratotic lesions that are unresponsive.
65
Q

A patient presents with palmoplantar PUSTULOSIS psoriasis. You recommend…

A
  • PUVA soaks
  • MTX or Cyclosporine for unresponsive
66
Q

A patient is having psoriasis under in their groin areas. You recommend treatment with…

A
  • Short-term topical steroids for 2 weeks
  • Vit D analog, topical retinoid, or topical calcineurin inhibitors
67
Q

A patient is having localized psoriasis in their nails, you recommend…

A
  • PUVA phototherapy
  • Oral retinoids
  • Immunosuppressants if unresponsive.

Must tailor depending on nail growth.

68
Q

Which psoriasis drug is ABSOLUTELY CONTRAINDICATED IN PREGNANCY

A

Tazarotene

Topical retinoid, but still a NONO

69
Q

What two psoriasis treatments are specifically for plaque psoriasis?

A
  • Tazarotene (topical ret)
  • Coal tar (scalp)
70
Q

For a generalized, acute inflammatory psoriasis, the recommended management is…

A

Refer to derm for UVB irradiation or oral PUVA chemo.

71
Q

For generalized PUSTULAR psoriasis, you should…

A
  • Admit
  • Refer to derm
  • Give IVF and IV ABX and Oral rets
72
Q

For generalized chronic plaque psoriasis, you would…

A

Refer to derm for UVB, PUVA chemo, Oral rets, or immunosuppressants.

73
Q

Overall, if you have generalized psoriasis, you should…

A

refer to derm

74
Q

What is the MOST IMPORTANT piece of historical information regarding adverse cutaneous drug reactions?

75
Q

What are the unique RFs for adverse cutaneous drug reactions?

A
  • Female
  • EBV and CMV with PCN
  • HIV with sulfonamides
76
Q

How quickly does an immediate adverse cutaneous drug reaction have to occur within to be considered immediate?

A

Less than ONE HOUR prior to last dose.

Urticaria, angioedema, anaphylaxis

77
Q

How quickly do delayed adverse cutaneous drug reactions tend to occur within?

A

1-6 hours

Occasionally weeks-months after.

Exanthematous eruptions
Fixed drug rxns
Systemic rxns

78
Q

What is the MC type of adverse cutaneous drug rxn?

A

Exanthematous drug reactions

79
Q

Classic viruses that produce exanthematous drug reactions when given this drug class…

A

EBV and CMV with PCNs

80
Q

Exanthematous drug reactions can be immediate or delayed. When does an immediate one occur? Delayed?

A
  • Immediate: 2-3 days after starting the drug (but you were previously sensitized)
  • Delayed: 7-10 days after, due to sensitization requirement.
81
Q

Top 4 drug classes for exanthematous reaction probability

A
  • PCNs
  • Carbamazepine
  • Allopurinol
  • Gold salts
82
Q

Mainstays of treating exanthematous drug reactions (2)

A
  • DC drug
  • Topical steroids/antihistamines for symptoms
83
Q

What characterizes a fixed drug eruption?

A

Location is always fixed!

Solitary erythematous patch/plaque

84
Q

T/F Hyperpigmentation can occur after a fixed drug reaction resolves

85
Q

How does a fixed drug eruption present early on color wise? Later?

A
  • Early: Erythematous
  • Later: Dusky red-violaceous
86
Q

MC sites of fixed drug eruptions

A
  • Genitals
  • Pubic/crural region
  • Perioral
  • Periorbital
  • Conjunctiva
  • Oropharynx
87
Q

Tx of a non-eroded lesion 2/2 fixed drug eruption

A

Topical steroid ointment

88
Q

Tx of an eroded lesion in a fixed drug eruption

A

Topical antimicrobial ointment

89
Q

2 MC drug classes that can cause drug-induced hypersensitivity syndrome

A
  • Antiepileptics (phenytoin, carbamazepine, phenobarbital)
  • Sulfonamides (antimicrobials, dapsone, sulfasalazine)
90
Q

A patient presents with widespread maculopapular rash that first began on their face and trunk. They have a fever, feel tired, and look like their face is swollen. Their physical exam is positive for LAN and hepatosplenomegaly. They recently started on phenytoin for seizure tx about 3 weeks ago. What is most likely occurring?

A

Drug-induced hypersensitivity syndrome

Check the rest of the organs.

91
Q

What would CBC show for a drug-induced hypersensitivity syndrome?

A
  • Leukocytosis
  • Eosinophilia
92
Q

What is the Diagnostic criteria for a drug-induced hypersensitivity syndrome?

3 must be present

A
  • Cutaneous drug eruption
  • Hematologic abnormalities
  • Systemic involvement (LAN > 2 cm, elevated LFTs, and elevated BUN/Cr)
93
Q

For a mild-moderate drug-induced hypersensitivity syndrome, the first-line tx is…

A

Topical steroids

Also stop any suspected meds

94
Q

For just symptom relief of drug-induced hypersensitivity syndrome, we would recommend

A

Oral antihistamines

95
Q

A patient started taking a new medication and developed a fever shortly after. They also have associated leukocytosis and lots of wide specks on their forehead. It began about 1 week ago. This is most likely a ????? drug eruption

A

Pustular drug eruption.

2-3 days if they were already sensitized to the drug.

96
Q

Where do pustular drug eruptions typically begin?

A
  • Intertriginous folds
  • Face

Dermatology (12 decks)

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