Other Papulosquamous disorders Flashcards

Question

Pityriasis rosea is an acute, self limited papulosquamous eruption that favors otherwise healthy adolescents/ young adults, is self resolving, is thought to have a viral etiology. What are some other epidemiological facts, typical length of time? Which virus is implicated?

Answer 1

most commonly seen between 10-35 yo, female predominant, lasts 6-8 weeks (can last as much as 5 months) Virus implicated is HHV7, sometimes 6

Answer 2

Solitary lesion appears on trunk and enlarges over several days (herald patch) The herald patch is pink-salmon-brown colored and is either a patch or plaque, slightly raised advancing margin, ranging from 2-4 cm but can be as large as 10 cm Center has small fine scales, the long axis of lesions follows langer cleavage lines, on the back the lesion orientation follows a “christmas tree patterns”, occasional minute pustules can be seen *In dark skinned individuals : lesions tend to be more papular and hyperpigmented*

Answer 3

Small mounds of parakeratosis, spongiosis and mild lymphohistiocytic perivascular interstitial papillary dermal infiltrate, sometimes mild erythrocyte extravasation and sometimes epidermal pustules Bonus: Mounded parakeratosis differential **Pityriasis rosea-like eruptions**: Triggered by medications or vaccinations **Guttate / eruptive psoriasis:** May be very similar clinically and histopathologically *Herald patch is usually not present in psoriasis* Histopathologically: neutrophils present in the parakeratosis; dilated vessels in the papillary plates are more common **with psoriasis** **Secondary syphilis:** Clinically, may be similar but no herald patch seen Histopathologically: psoriasiform and lichenoid dermatitis with perivascular and interstitial infiltrate with lymphocytes, histocytes and plasma cells, the infiltrate may be granulomatous Swollen, prominent endothelial cells are common ' **Other eczematous eruptions** **(contact dermatitis, nummular dermatitis, seborrheic dermatitis**): May be indistinguishable histopathologically and clinical correlation is required, Although a few eosinophils may be present in pityriasis rosea, large numbers are uncommon **Drug eruptions:** Variable clinical presentation Histopathology is variable; combination of interface pattern with spongiosis and eosinophil rich infiltrates are common **Pityriasis lichenoides:** Clinically, may have similar features; however, tends to have a chronic course, no herald patch present Histopathologically*_: an interface dermatitis and perivascular lymphocytic infiltrate is present with erythrocyte extravasates_* Presence of neutrophils in the parakeratosis

Answer 4

if presence of split papules/ condyloma → syphilis (also confirm hx of primary chancre) 2ndry syph patients have more complaints, peripheral LAD Drug eruptions can mimic PR (ACE inhibitors, b-blockers, metronidazole, isotretinoin, barbiturates, NSAIDs, vaccines The herald patch can resemble tinea corporis, versicolor, nummular dermatitis

Answer 5

Type 1 is seen primarily in blacks/ asians and appears as large \>10cm scaly, annular plaques/patch and is a/w internal malignancy (particularly hepatocellular/ gastric cancer) but no family history Type 2 is seen in caucasians and is typically \>30 smaller lesions with no fam history or a/w internal malignancy Both are seen in adults 24-45 yo and there is slight female predominance Most common in Mediterranean *May be a/w malnutrition, genetics* ***Path:*** **looks like ichthyosis vulgaris, absent granular layer, moderate hyperkeratosis without parakeratosis, increased pigmentation of basal layer, epidermal atrophy**

Answer 6

yes pruritic involves all intertriginous sites female exclusively in adult forms Thoughts on pathogenesis: *potential failure to degrade keratohyalin granules and keratin filaments leading to hyperkeratosis* ***Lesion:*** **keratotic, brown-red papules (some with cone shape), some coalescing into larger, well-demarcated plaques with maceration/ fissures causing pain/ pruritus** Path: *stratum corneum is thickened with increased eosinophilic staining, retained nuclei in the keratin layer (parakeratosis), retained keratohyalin granules*

Answer 7

seb derm candidiasis inverse psoriasis erythrasma - Erythrasma is **a bacterial infection of the skin typically caused by Corynebacterium minutissimum**

Answer 8

Onset age 40ish Males:Females 3:1

Answer 9

Eosinophils

Answer 10

100% (possibly) Retiform parapsoriasis - variant of large plaque para *widespread, ill-defined patches in net-like pattern*

Answer 11

- Upper left- more common in children, often leaves behind PI hypopigmentation - upper right- itchy!! more common in older population - lower left- sudden onset of rash - middle lower: pink, scaly papules and small plaques - lower right- great mimicker, may have palm/sole involvement

Answer 12

Widespread papules with crust, some ulcerated, sometimes vesicles/ pustules

Answer 13

CARD14 (PSORS2) ## Footnote **autosomal dominant**

Answer 14

first and second decade and again in 6th decade

Answer 15

NO Retinoids

Answer 16

HCV Most common sites of involvement ionclude tongue, labial mucosa, gingiva

Answer 17

The characteristic nail abnormalities include lateral thinning (Fig. 11.15A), longitudinal ridging, and fissuring

Answer 18

Oral and cutaneous ## Footnote **in the Cutaneous we think of Hypertrophic and vulvovaginal LP**

Answer 19

Granuloma annulare (except LP has scale) Porokeratosis Tinea

Answer 20

- usually appears suddenly, develops fully over days to weeks, and after several months to a year or more, undergoes spontaneous resolution. - usually does not recur - Treatment of lichen striatus is usually not needed because it is self-limited, usually resolving within 1 to 2 years. Topical corticosteroids under occlusion can be used to hasten spontaneous resolution. - Left: **can have nail involvement** - Right: appearance on less pigmented skin types, where it appears more pink

Answer 21

drug eruptions, viral exanthems, 2ndry syphillis, arthropod bite rxn, polymorphous light eruption, connective tissue disease, erythema multiforme *drug eruptions/ viral exanthem → **not as much keratinocyte necrosis/ less inflammation*** ***PLEVA/ PLC*** Do not contain eosinophils

Answer 22

Perakeratosis, mild basal layer vacuolization, predominantly superficial perivascular infiltrate , extravasated RBCs (less than pleva)

Answer 23

Small plaque Parapsoriasis, LP, Pr, drug eruptions, PRP, early MF, subacute spongiotic dermatitis, guttate psoriasis, 2ndry syphilis

Answer 24

Parakeratosis (focal) Lichenoid interface dermatitis Extravasation of rBCS Vasculitis \**lymphocytic* *Apoptotic keratinocytes* Top-heavy wedge shaped infiltrate , rbcs, scale crust, focal epidermal cell death, vasculitis?, Infiltrate = T cell often monoclonal

Other Papulosquamous disorders Flashcards

(51 cards)