Matthys: Papulosquamous Diseases 2

Question 1

Pityriasis Rubra Pilaris

Answer 1

-reddish-orang scaling plaques of unkown etiology with palmoplantar keratoderma nd follicular keratotic papules

Question 2

Path of PRP

Answer 2

• auto dominant inheritance
• has many features of vit A deficiency
• cause unkown

Question 3

Clinical classification of PRP

Answer 3

• 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

Question 4

In what important disease can PRP pop up in?

Answer 4

• Type 6 HIV
• orange red plaques with follicular hyperkeratosis and islands of sparing
• skin, mucous membranes, nails, eyes

Question 5

ddx for PRP

Answer 5

• Cutaneous T cell lymphoma
• erythroderma
• psoriasis
• exfoliative dermatitis

Question 6

Cutaneous T cell Lymphoma

Answer 6

• 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

Question 7

pathophys of CTL

Answer 7

• HTLV
• Unknown
• CD8
• B cells

Question 8

Clinical features of CTL

Answer 8

• 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

Question 9

ddx of CTL

Answer 9

• psoriasis
• eczema
• parapsoriasis

Question 10

dx and tx of CTL

Answer 10

• bx, CXR, CBC w/ buffy coat
• Imaging
• Topical steroids, puva, topical nitrogen mustard

Question 11

Discoid Lupus Erythematosus

Answer 11

• Scarring atrophic photosensitizing dermatosis

- 20-40 y/o

Question 12

path of DLE

Answer 12

-Heat shock ptn induced by UV light

Question 13

clinical findings for discoid lupus erythematosus

Answer 13

• 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

Question 14

Dx and tx for DLE

Answer 14

• ANA and bx
• sunscreen
• topical steroid
• IL steroids
• Surgery
• Antimalarials

Question 15

Drug eruption

Answer 15

• wide spectrum of clinical findings and causes
• papulosquamous, pustular, bullous, EM-like, TEN
• NSAIDS, ATB, psycotropic agents, anticonvulsants

Question 16

Path of Drug eruption

Answer 16

• 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

Question 17

Which ppl are at increased risk for drug eruption?

Answer 17

-immunocompromise

Question 18

type one hypersensitivity?

Answer 18

-classic, immediate (urticaria)

Question 19

Type 2

Answer 19

-cytotoxic

Question 20

-Type 3

Answer 20

-cell mediated immune complex deposition

Question 21

type 4

Answer 21

-delayed hypersensitivity

Question 22

Clinical findings with drug eruption

Answer 22

• morbilliform, erythematous macular papular eruption with minimal scale until progressed or cleared
• 2 weeks after new meds
• review ALL meds of prior 2 months

Question 23

ddx for frug eruption

Answer 23

• PR
• contact dermatitis
• erythroderma
• all other variants
• lichen planus

Question 24

DX and Tx of drug eruption

Answer 24

• blood work
• bx
• hx
• clinical exam
• antihistamines
• steroids