PAPULOSQUAMOUS AND BULLOUS DISEASES

Question 1

describes conditions with papules and scale, or scaly plaques and scaly papules

Answer 1

Papulosquamous

Question 2

erythema and vesicles -> scale; exudations of serous matter; weeping (Latin – to
boil over)

Answer 2

Eczema

Question 3

inflammation of the skin

Answer 3

Dermatitis

Question 4

“fish,” group of disorders of

cornification- resulting in scale of varying thickness

Answer 4

Ichthyosis

Question 5

main finding of atopic dermatitis?

Answer 5

pruritis

Question 6

Atopic triad?

Other findings suggestive of AD

Answer 6

asthma, allergic rhinitis, atopic dermatitis

keratosis pilaris, hyperlinear palms, ichthyosis vulgaris

Question 7

down regulation of cornfield envelope genes (filaggrin and loricrin)

Reduced ceramide levels

Increased levels of endogenous proteolytic enzymes

Exogenous proteases causing damage from staph aureus, dust mite

Enhanced transepidermal water loss

Answer 7

Decreased Skin Barrier

Function due to atopic dermatitis

Question 8

main topical therapies for atopic dermatitis?

for what severity of atopic dermatitis?

Answer 8

corticosteroids
calcineurin inhibitors
crisaborale

mild to moderate

Question 9

main systemic therapies for moderate to severe atopic dermatitis?

Answer 9

phototherapy
immunosuppressants
-MTX
-cyclosporine
-prednisone
duplimab (releases IL-4)

Question 10

what are the two types of contact dermatitis?

Answer 10

allergic contact dermatitis

irritant contact dermatitis

Question 11

allergic contact dermatitis can be tested using?

Answer 11

patch testing

Question 12

what is this?

• Infancy: usually scalp involvement (cradle cap), variable skin involvement (flexures, neck, chest)

• Adults: usually scalp, eyebrows, nasolabial folds, sternum; can occur in genitals or intertriginous
folds

• Morphology: Erythematous plaques with loose, greasy scale
• Linked to overgrowth of natural yeasts (malassezia furfur) and increased sebum production, exacerbated in HIV and Parkinson’s disease

Answer 12

Seborrheic Dermatitis

Question 13

how is seborrheic dermatitis treated?

Answer 13

shampoos salicylic acid
scalp therapy
topical corticosteroids
calcineurin inhibitors

Question 14

what is this?

• Sharply demarcated erythematous, silver-scaled
plaques of the scalp, elbows, and knees.
• Any site can be involved
• Can be associated with psoriatic arthritis
• Koebner phenomenon
• Auzpits sign

Answer 14

Psoriasis

Question 15

what is this?

• “Eczema craquele”
• “Winter itch”
• Aging is the most common
cause
• Shins are the most common
location

• Treatment
• Topical steroids
• Emollient (urea, lactic acid)
• Bathoils

Answer 15

Asteatotic Eczema

Question 16

what is this?

• “Nummular eczema”
• Pruritic coin shaped eczematous
lesions
• Chronic
• Usually on the extremities
• Features of atopy absent

• Treatment – topical steroids,
tacrolimus, emollients, phototherapy

Answer 16

Nummular Dermatitis

Question 17

what is this?

• “Tapioca like” vesicles
• Pruritic
• Usually hands, can be
feet

• Treat with topical
steroids

Answer 17

Dyshidrotic Eczema

Question 18

what is this?

• Idiopathic
• Pruritic, flat-topped pink to purple papules
• 4 Ps: Purple, polygonal, pruritic papules
• Commonly on volar wrists, shins, pre sacral area and hands
• White reticulated patches on buccal mucosa - Wickham’s striae
• Thickened, ridged nails with loss of nail plate; dorsal pterygium

major treatment?

Answer 18

Lichen Planus

topical corticosteroid
topical calcineurin inhibitors

Question 19

what is this?

• Self-limited cutaneous eruption
• Herald patch - solitary, scaly pink or flesh-colored plaque appears first, often on trunk, days to weeks
before eruption
• Christmas tree pattern
• Morphology: multiple discrete oval, erythematous and scaly plaques and platches oriented along skin
cleavage lines; typically trunk and upper extremities; face, palms and soles typically spared
• HHV-6 & 7

Answer 19

Pityriasis Rosea

Question 20

what is this?

• Lesions begin as flat white plaques surrounded by a red, purple or violet border
• Over time, lesions become sclerotic and atrophied with shiny porcelain, wrinkly
appearance
• Dry, tender and severely pruritic
• Over 85% found on anogenital skin
• Squamous cell carcinoma can arise in untreated lesions
• Females: clitoris, clitoral hood, labia minora, perineum
• Males: glans and prepice
• Extragenital: most commonly on buttocks, thighs, breast, submammary skin, neck, back and chest, shoulders, axillae and wrists

Answer 20

Lichen Sclerosus

Question 21

lichen nitidus?

Answer 21

• Chronic, cutaneous eruption often in children
and young adults

• Small, discrete, uniform, skin-colored papules
that present in clusters or linear arrays

Question 22

what is this?

• Most commonly occurs in men ages 20-40

• 1-4 weeks post infection with specific bacteria: Chlamydia trachomatis, Shigella,
Salmonella , Yersinia, Campylobacter

• Can’t pee (urethritis), can’t see (uveitis), can’t climb a tree (arthritis)

• Painful oligoarthritis (fewer than 5 joints), dactylitis (sausage digits), lower back stiffness,
fevers, uveitis, weight loss

Derm:
circinate balanitis
keratoderma blenorrhagicum
nail involvement: paronychia, onycholysis, ridging, splitting, elkonyxis (loss of nail plate)

Answer 22

reactive arthritis

Question 23

what is this?

• Most commonly idiopathic, but also associated with
drugs, lymphoproliferative disorders and systemic
diseases, tinea pedis, blue cheese

• Single or multiple erythematous papules that advance peripherally millimeters per day to form annular or arcuate plaques with central clearing, faint brownish
pigmentation and trailing scale

• Sites of predilection include the trunk and proximal
extremities, especially the buttocks, hips, and upper
legs

Answer 23

Erythema Annulare

Centrifugum