Pance pearls Flashcards
Triggers of Dishydrosis
Sweating, emotional stress, warm weather, metals
Pruritus “tapioca pudding” tense vesicles on palms, soles and fingers
Dishydrosis
Management of Dishydrosis
Topical steroids (high strength)- ointments preferred
What is atopic dermatitis linked with?
Hay fever, allergy, allergic rhinitis, asthma, & other atopic dx
Altered immune reaction in genetically susceptible population when exposed to triggers –> T-cell mediated immune activation with increase in IgE production
Atopic dermatitis
Triggers of atopic dermatitis?
heat, perspiration, allergens, and contact irritants
What is the hallmark clinical manifestation of atopic dermatitis?
Pruritus- “itch-scratch cycle”
Tiny, erythematous, edematous ill-defined blisters –> dries/crusts over and scales. MC in flexor creases (anticubital & popliteal folds)
atopic dermatitis
Sharply defined coin-shaped lesions on dorsal hand, feet extensor surface
Nummular eczema
Management of atopic dermatitis
High strength topical steroids & antihistamines for itching
Skin thickening in patients with eczema secondary to repetitive rubbing/scratching
Lichen simplex chronicus
Scaly, well-demarcated rough plaques with exaggerated skin lines
Lichen simplex chronicus
Management of LSC?
Topical steroids (high strength) and avoid scratching
Where does lichen planus develop?
Flexor surfaces of extremities, mucous membranes on skin mouth, scalp, genitals, or nails
In which disease do you see lichen planus more often?
HCV infection
What are the 5 P’s for lichen planus?
Purple, polygonal, planar, pruritic papules with fine scales
What type of lesions can be seen in the oral mucosa with lichen planus?
Lacy lesions (Wickham striae)
Management of lichen planus?
Topical steroid ointment and antihistamines
Herald patch (solitary salmon-colored macule) on trunk –> general exanthem 1-2 weeks later with smaller, round/oval salmon-colored papules with white circular (collarette) scaling along cleavage lines. VERY PRURITIC
Pityriasis rosea
What rash pattern is seen with Pityriasis rosea?
Christmas tree
Management for Pityriasis rosea
None needed
What is the pathophysiology of psoriasis?
Keratin hyperplasia (proliferating cells in the stratum basale and stratum spinosum due to T-cell activation & cytokine release). Leads to epidermal thickening and continuous turnover of the dermis
Plaques seen in Psoriasis?
- MC type
- raised dark red plaques/papules with thick silver/white scales
- found on extensor surfaces and scalp
- Nail pitting in 25%
What signs/phenomenon are seen with Psoriasis?
Auspitz sigmn and Koebner’s phenomenon
Clinical manifestations of Pustular psoriasis?
Deep, yellow non-infected pustules –> red macules on palms/soles
Clinical manifestations of Guttate psoriasis?
- small, erythematous papules with fine scales, discrete lesions, and confluent plaques
What inflammatory condition is seen with psoriasis?
Psoriatic arthritis
Sx of psoriatic arthritis?
- Stiffness >30mins relived with activity
- Sausage digits
- X-ray: pencil in cup deformity
Management of psoriasis?
- Topical steroids, tar-based anthralin, Vit. D analnogs & retinoid
- UBV light therapy , immune agents
Occurs in areas of high sebaceous glands over secretion (scalp, face, eyebrows, body folds)
Seborrheic dermatitis
What do you have a hypersensitivity too in seborrheic dermatitis?
Pityrosporum ovale
What does seborrheic dermatitis present as in infants?
Cradle cap
Erythematous plaques with fine white scales common on the scalp (dandruff)
Seborrheic dermatitis
Management of seborrheic dermatitis?
Selenium sulfide, sodium sulfacetamide, ketoconazole (shampoo or cream), steroids, zinc pyrithione
Type I HSN (IgE) reaction of dermis or SQ tissues
Urticaria (Hives)
Triggers of Urticaria (Hives)?
- foods
- meds
- infections
- insect bites
- drugs
- environmental
What is the pathophys of Urticaria (Hives)?
Mast cells release histamine causing vasodilation of venules –> edema of dermis and SQ tissues
Blanchable, edematous pink papules, wheals, or plaques that are oval, linear, or irregular
Urticaria (Hives)
What is Darier’s sign?
Localized urticaria appearing where skin is rubbed (histamine induced)
What is the tx of choice for Urticaria (Hives)?
oral antihistamines
Acute, self-limiting type IV HSN rxn most common in adults 20-40 y/o
Erythema multiforme
What infections are assoicated with erythema multiforme?
- HSV most common
- mycoplasma
- s. pneumo
What meds are associated with erythema multiforme?
- sulfa drugs
- beta-lactams
- phenytoin
- phenobarbital
What type of lesion is pathognomonic of erythema multiforme?
TARGET (iris) lesions
Dull, “dusty-violet” red, purpuric macule/vesicle or bullae in center surrounded by pale edematous rim & peropheral halo. Patient often FEBRILE
Erythema multiforme
What are the guidelines for erythema multiforme minor?
- target lesions distributed acrally
- no mucosal membrane lesions
What are the guidelines for erythema multiforme major?
- target lesions with involvement of >1 mucous membranes (oral, genital, ocular mucosa)
- <10% BSA acrally –> centrally
- no epidermal detachment
Management of erythema multiforme?
- Symptomatic: discontinue drug causing rash
- can also use steroid mouthwashes for oral lesions
What most commonly causes SJS and TEN?
Drug eruptions esp. Sulfa and antioconvulsant meds and infections like Mycoplasma, HSV, HIV, malignancy
What % of sloughing of BSA is seen in SJS and TEN?
- SJS: <10%
- TEN: >30%