Miscellaneous Flashcards
Psoriasis
2-3% of pop
Cell turnover is reduced from 29 days to 4 days
Psoriasis triggers
Physical trauma (koebner's pnenominon) Rubbing and scratching Strep infxn Meds Smoking, obesity Stress
Koebner’s phenomenon
Psoriasis plaques that develop at site of skin injury.
1-2 wks after injury
50% will experience this
Psoriasis bimodal age distribution
30-40 then 50-70
Psoriasis rash
Salmon pink papules and plaques, sharply marginated w/ silvery white scaling.
Scales are loose and easily removed
Scale removal results in small blood droplets (auspitz sign)
Psoriasis distribution
Ogten symmetrical
Elbows, knees, intertriginous
Plaque psoriasis
Most common, 80% of cases
Slow forming, stable
Well-defined and symmetrical
Knees, scalp, elbows, lower back
Inverse psoriasis
Sharply demarcated plaques
Axilla, groin, naval, submammary, palms, soles
No scales like plaque psoriasis
More common in obese
Guttate psoriasis
AKA eruptive
Young adults and kids
Many small teardrop shaped erythematous papules scattered diffusely on proximal extremities and trunk
Erythrodermic psoriasis
Affects the whole body Erythema and scaling from head to toe Least common Inflammatory Itching, pain High risk of infxn, electrolyte imbalance
Pustular psoriasis
Generalized on body
Severe form, acute onset
Pustules with erosions
Malaise, fever, diarrhea, hypocalcemia
Most common precipitating factor for erythrodermic and pustular psoriasis?
Withdrawl from systemic steroids
Emollients
Useful in all cases of psoriasis Hydrate stratum corneum Softens scales and plaques Apply BID after bathing while skin is damp Lubriderm, eucerin
Topical steroids for psoriasis
FIrst-line for mild/limited plaque psoriasis
Cannot use for extended periods in high dose
Coal-tar perparations
When used alone only as effective as mild to mid potency steroids
Generally used as add-on
Vitamin D Analogues
Calcipotriol (Dovonex)
Immune modulation
Mild to mod plaque psoriasis
Cannot use of face/groin
PUVA therapy
Psoralen and UV-A Light.
Generally has excellent results
Use after mild tx failure
Drugs that may exacerbate psoriasis
Beta blockers, NSAIDS, lithium, ACE, digoxin
Urticaria
Hives
immune-mediated skin eruption of well-circumscribed wheals on erythematous base.
IgE mediated
Angioedema
Hypersensitivity rxn involving deep layers of skin.
Swelling of lips, eyelids, palms, soles, genitals.
Urticaria and Angioedema prevelance
50% get both
40% only urticaria
10% only angioedema
Food and drug induced allergy
Tend to be brief
Usually do NOT cause chronic urticaria
May have angioedema
Cholinergic urticaria
Punctate hives triggered by exercise or hot shower
Urt and Angio tx
Antihistamines: H1 or H2
Steroids
Epi for anaphylaxis
Half of patients with chronic urticaria are free of lesions in one year
Vitaligo
Onset early in life, white patches, loss of pigment.
Lesions on face, upper trunk, fingertips, hands, armpits, genitals, perioral, body prominences.
White hair and skin in involved areas.
Vitaligo MOA
Autoimmune against melanocytes
Occurs in pernicious anemia, hashimotos like alopecia areata
Vitaligo tx
Topical steroids
Tacrolimus
UVA, UVB
Pemphigus
Rare, chronic, potentially fatal dz of mucous membranes.
Autoimmune intraepidermal blistering
Pemphigus lesion
Flaccid bullae that begin of oropharynx, then spread to scalp, face, chest, axillae, groin.
Tender and painful
Nikolsky sign
Slight rubbing of skin results in sloughing and blister formation.
Seen in Pemphigus
Pemphigus tx
May require admission for severe dz
Systemic steroids, immunosuppressives
Bullous Pemphigoid
Chronic, subepidermal blistering cause by autoimmune process.
Exclusively in elderly >60
WIdespread blistering eruption
Bullous Pemphigoid lesions
Associated urticarial plaques
Tense and fluid filled blisters
Bullous Pemphigoid tx
High dose oral steroids
Epidermoid cyst
Sevaceous cyst, infundibular cyst, epidermal cyst.
Most common cutaneous cyst.
Rupture is common, results in painful inflammatory mass.
Dermatofibroma
Very common, button like nodule
Lesion may be tender
Benign
Lipoma
Benign tumor of fat cells
Soft, rounded, moveable
