Misc Skin Conditions Flashcards
Psoriasis
- normal cell turnover vs cell turnover in psoriasis
- what is this
- cause
- MC age
- onset
- MC sx
-normal cell turnover is about 27 days, but in posriasis, cell turnover is reduced to about 4 days
What
- massive increase in the number of cells produced and normal cell keratinization does not take place
- subdermal blood vessel dilation (erythema)
Cause:
- autoimmune component: multiple T cells are present in psoriatic lesions, therapies that suppress T cells are very effective
- strep infection can trigger guttate psoriasis
Age
-Early 30-39 years or late 50-69 years
Onset
-gradual or sudden
MC sx
-pruritus
Psoriasis
- associated conditions
- types
- MC type
Associated conditions
- psoriatic arthritis
- CV disease, malignancy, DM, metabolic syndrome, HTN, IBD
- ocular involvement: swollen lids, conjunctivitis, xerosis, uveitis
Types
- plaque (MC)
- inverse
- guttate
- erythrodermic
- pustular
- nails
Plaque psoriasis
- onset
- distribution
- presentation
Onset
-slow-forming, stable
Distribution
- appears on the knees, scalp, elbows, lower back and can affect the nails
- symmetrical
- uncommon on the face
- can be a single lesion, can be localized, can be widespread
presentation
- well defined and symmetrical
- salmon pink papules and plaques, sharply marginated with marked silvery-white scaling
- scales are loose and easily removed by scratching
- removal of scales results in small blood droplets (Auspitz sign)
- plaques at sites of former skin injury (Koebner’s phenomenon
What is Auspitz sign?
what is Koebner’s phenomenon?
Auspitz sign=pinpoint bleeding under the scale
Koebner’s phenomenon= psoriasis plaques that form at the site of skin injury (from bug bites, bruises or scrapes, burns, poison ivy)
Inverse psoriasis
- distribution
- MC in who
- presentation
Distribution
- found in axilla, groin, naval, submammary region, palms, scalp, soles
- sharply demarcated plaques
MC in overweight people
Presentation
- No scales (unlike plaque psoriasis)
- difficult to distinguish from candidiasis without bx
Guttate psoriasis
- AKA
- onset
- MC in who
- strong association with what?
- presentation
- distribution
- prognosis
- AKA
- -eruptive psoriasis
- onset
- -abrupt onset
- MC in who
- -young adults and children
- strong association with what?
- -recent strepococcal infection (usually pharyngitis) in the preceding 2-3 weeks
- presentation
- -multiple small teardrop shaped erythematous papules
- may have scale
- distribution
- -scattered diffusely on the proximal extremities and trunk
- prognosis
- self limiting in a few weeks to months
Erythrodermic psoriasis
- distribution
- presentation
- high risk of what
- management
Distribution
-generalized, affects most or all of the bodys surface
Presentation
- erythema and saling from head to toe
- inflammatory
- severe itching and pain as skin reddens and sheds
High risk of systemic infection and electrolyte imbalances
- difficult to distinguish from SJS, history will help.
- you don’t have to have psoriasis to get this
- LIFE THREATENING****
Management
-inpatient
Pustulat psorisasis
- distribution
- onset
- presentation
- associations
Distribution
-generalized
Onset
-acute
Presentation
- severe form of psoriasis with LIFE THREATENING complications
- widespread erythema, scaling, and sheets of superifical pustules with erosions
Associations with
-malaise, fever, diarrhea, leukocytosis, hypocalcemia
MC precipitating factor for erythrodermic and pustular psoriasis?
Withdrawal of systemic corticosteroids :/ :/ ;(
Nail psoriasis
- closely associated with?
- may appear before the onset of?
- what is the oil drop sign?
- closely associated with psoriatic arthritis
- may appear before the onset of cutaneous psoriasis
- oil drop sign=translucent discoloration in the nail bed that resembles a drop of oil beneath the nail plate
Treatment of plaque psoriasis
-exacerbating factors (what can you do to help with these)
- Some drugs may exacerbate psoriasis, such as: beta blockers, NSAIDs, lithium, ACEI, digoxin
- consider switching med if possible
Treatment of plaque psoriasis
-topical therapy options and ex of each
Emollients
- hydrate stratum corneum
- decrease water evaporation
- soften scales on plaques
- ex. eucerin, lubriderm, moisturel
Steroids(topical)
- first line***
- use as long as pt has thick active lesions
- ex. betamethasone 0.05%, clobetasol propionate 0.05%
Vitamin D analogues
- Calcipotriol (Dovonex)
- causes immune modulation
- too irritating for face or groin
- SE=hypercalcemia/uria
Topical retinoids
- Tazarotene (Tazorac)
- modulates differentiation and proliferation of epithelial tissue and exerts some degree of anti-inflammatory and immunological activity
Calcineurin inhibitors
- ex. Tacrolimus (Protopic) or Pimecrolimus (Elidel)
- inhibits T lymphocyte activation
- good for intertriginous areas and the face (where steroid use should be limited)
Coal tar preparations
- when used alone only as effective as mild to midpotency topical steroids
- OTC, shampoos beneficial for scalp lesions in combination with topical steroid solutions
- use is limited d/t odor and staining of clothes
Phototherapy (UVA, UVB)
-has antiproliferative effects by slowing keratinization and anti-inflammatory effects by inducing apoptosis of pathogenic T-cells
Treatment of plaque psoriasis
-systemic therapy
*use only for severe cases resistant to topical tx
- methotrexate
- acetretin (systemic retinoid)
- -psoriatane
- systemic calcineurin inhibitor
- -cyclosporine
- biologic agents
- -infliximab (remicade)
- other immunosuppressants
- -hydroxyurea
Urticaria
- what is this?
- presentation
Angioedema
-what is this
Pathophysiology of both
Urticaria
- immune mediated skin eruption of well-circumscribed wheals on an erythematous base, IgE mediated
- presentation: edematous, erythematous, well circumscribed blanching wheals
Angioedema
-hypersensitivity reaction involving the deep layers of the skin. Swelling of the lips, eyelids, palms, soles, genitals
Patho
- allergen…IgE antibody attached to mast cell…sudden release of immunologic mediators…inflammation
- principle mediator released by mast cells is histamine
*idiopathic chronic urticaria thought to be caused by autoimmune process
Types of physical urticarias
- dermatographism: gentle stroking of the skin produces immediate wheal and flare response
- pressure urticaria: pressure to skin at right angle result in red swelling after latent period of up to 4 hours
- cold urticaria: eruptions within minutes following application of cold
- cholinergic urticaria: punctate hives triggered by exercise or hot shower
- aquagenic urticaria: hives after contact with water
- solar urticaria: hive develop following exposure to UV light
