Matthys: Papulosquamous Diseases 2 Flashcards
Pityriasis Rubra Pilaris
-reddish-orang scaling plaques of unkown etiology with palmoplantar keratoderma nd follicular keratotic papules
Path of PRP
- auto dominant inheritance
- has many features of vit A deficiency
- cause unkown
Clinical classification of PRP
- Type 1 classic adult type is most common: red brown plaques with islands of sparing
- Type 2: icthyosiform
- type 3 is juvenile… same as 1 but before age 2
- type 4: circumscribed juvenile
- type5: atypical juvenile
In what important disease can PRP pop up in?
- Type 6 HIV
- orange red plaques with follicular hyperkeratosis and islands of sparing
- skin, mucous membranes, nails, eyes
ddx for PRP
- Cutaneous T cell lymphoma
- erythroderma
- psoriasis
- exfoliative dermatitis
Cutaneous T cell Lymphoma
- T cell lymphoma affecting the CD4 helper cells
- Lymph nodes and organs become involved during the disease proces
- > 50 y/o
- males get this a lot more
pathophys of CTL
- HTLV
- Unknown
- CD8
- B cells
Clinical features of CTL
- Scaling plaques which mimic eczema
- itchy
- multiple different shades of red-brown
- round, oval annular or bizarre shape
- Check for LAD!!!
- Patch, plaque, tumor
- Mycosis Fungoides
- Hypopigmented variants
- Sezary’s syndrome
ddx of CTL
- psoriasis
- eczema
- parapsoriasis
dx and tx of CTL
- bx, CXR, CBC w/ buffy coat
- Imaging
- Topical steroids, puva, topical nitrogen mustard
Discoid Lupus Erythematosus
- Scarring atrophic photosensitizing dermatosis
- 20-40 y/o
path of DLE
-Heat shock ptn induced by UV light
clinical findings for discoid lupus erythematosus
- mild itching of lesions; most asymptomatic
- be aware of SLE sx; Pericarditics, neuro sx
- Malignant transformations (SCC) can occur in chronic lesions
- Psoriasis, LP,
- erythematous papule or plaque with modest amount of scale
- hypopigmented or hyperpigmented
- scarred
- mucosal, palms and soles
Dx and tx for DLE
- ANA and bx
- sunscreen
- topical steroid
- IL steroids
- Surgery
- Antimalarials
Drug eruption
- wide spectrum of clinical findings and causes
- papulosquamous, pustular, bullous, EM-like, TEN
- NSAIDS, ATB, psycotropic agents, anticonvulsants
Path of Drug eruption
- overdose: purpura with coumadin
- accumulation: argyria with silver nitrate
- Phototoxic: doxycycline
- Imbalance of normal flora: candidiasis with ATB
- Jarish HErsheimer: rxn to killing of bacterial or fungal by appropriate agents…. normal
Which ppl are at increased risk for drug eruption?
-immunocompromise
type one hypersensitivity?
-classic, immediate (urticaria)
Type 2
-cytotoxic
-Type 3
-cell mediated immune complex deposition
type 4
-delayed hypersensitivity
Clinical findings with drug eruption
- morbilliform, erythematous macular papular eruption with minimal scale until progressed or cleared
- 2 weeks after new meds
- review ALL meds of prior 2 months
ddx for frug eruption
- PR
- contact dermatitis
- erythroderma
- all other variants
- lichen planus
DX and Tx of drug eruption
- blood work
- bx
- hx
- clinical exam
- antihistamines
- steroids
