Papillosquamous Disorders Flashcards
Psoriasis
Occurs in 2-3% of Americans and 3% worldview
Chronic disorder with multifactorial epidemiology
Always shows erthematous scaly papules and plaques (can pustular)
- most common site is scalp/elbows/knees/feet.hands/trunk
- may or may not show fever
Pathology = uniform elongation of rete ridges with dilated blood vessels, thinking of suprapapiillary plate and intermittent parakeratosis
10-25% of cases = psoriatic arthritis
- possess a fever and arthralgia as well as the rash
Treatment of psoriasis
Depends on severity
1) mild/moderate (<5% surface area)
- intermittent therapy = topical steroids, vitamin D analogs and tazarotene
- continuous therapy = calcineurin inhibitors (really only reserved for face and groin regions)
2) severe (>5% surface area)
- less than 20% total = vitamin D analogs and phototherapy
- more than 20% = systemic therapy and phototherapy
* * in both cases refer to dermatologist
3) if arthritis symptoms are also present (psoriatic arthritis)
- biological therapy (especially TNF inhibtors)
What are the safest long term topical treatment for psoriasis
Vitamin D derivatives
Guttate psoriasis
A unique form of psoriasis that involves the thigh, hands and back
- often leads to chronic plaque psoriasis if not treated
Looks kind of like pityriasis rosea but plaque like psoriatic-lesions instead.
Common symptoms of psoriatic arthritis
Pitting, brown oncholysis of the nail beds
Swollen finger joints
Pencil in cup apperance of fingers and toes on imaging
Swollen heel at Achilles’ tendon
Arthralgia and myalgia throughout
must have active psoriasis
Pityriasis rubra pilaris (PRP)
A rare inflammatory skin disease seen in juveniles usually but can onset in adults
- most is self limiting within a few years and goes away
Can be hereditary or acquired
- **hereditary = CARD14 gain-of-function mutations
Symptoms
- hyperkeratosis papules that coalesce into scaly reddish organs plaques
- often looks “checkerboard pattern” of parakaertosis and orthokeratosis in early stages
- **Must always rule out
- HIV infections
- cutaneous T-cell lymphoma
Treatment = TNF blockers and Ustekolukein
Treatment of non self limiting PRP
Retinoids
Methotrexate
Photochemotherapy
biologics that block TNF-a and IL-12
Lichen planus
Idiopathic T-cell mediated process without clear autoantigen
1% of population
Symmmetrical and grouped lesions that almost always occur at the flexure levels aspects of the arms and legs
Histology shows stratum basale keratinocyte damage w/ excess lymphocytes
What are the 6 P’s that describe lichen planus lesions
Planar
Purple
Polygonal
Pruritic
Papules
Plaques
What tests must you get for lichen planus?
CBC
Patch testing
Lipid panel
Thyroid tests
Antithyroid peroxidase antibiodies
Antithyroglobulin antibodies
Hep C virus test
Treatment of non genital cutenous lichen planus
1 = high does topical corticosteroids
#1 oral corticosteroids - reserved for severe widespread version
Phototherapy can also be used but usually reserved for severe cases
Treatment of oral lichen planus
1 high dose topical corticosteroids
- clobetasol
- flucinonide are usually the 2 most used
- tacrolimus
- *only refractory cases
- prednisone
- only for severe widespread cases
Lichen sclerosus
Infrequent chronic inflammatory dermatosis with anogenital and extra genital manifestations
- affects primarily women in 50-60s and children less than 10 yrs
Shows antibodies to extracellular matrix protein-1 and predominance of TH1 mediated autoimmunity
vulvar lichen sclerosus = increased risk of squamous cell carcinoma
Most cases = potent topical corticosteroids and calcineurin inhibtors work
What are common pitfalls associated with lichen sclerosus
Wrong/incomplete diagnosis in the case of SCC
Lichen sclerosus can be confused with child abuse
High dose steroids requires ample observation for ADRs
Can immitate irritant dermatitis
What can be used to treat severe cases of pityriasis rosea?
Acyclovir
