PAPULOSQUAMOUS AND BULLOUS DISEASES Flashcards
describes conditions with papules and scale, or scaly plaques and scaly papules
Papulosquamous
erythema and vesicles -> scale; exudations of serous matter; weeping (Latin – to
boil over)
Eczema
inflammation of the skin
Dermatitis
“fish,” group of disorders of
cornification- resulting in scale of varying thickness
Ichthyosis
main finding of atopic dermatitis?
pruritis
Atopic triad?
Other findings suggestive of AD
asthma, allergic rhinitis, atopic dermatitis
keratosis pilaris, hyperlinear palms, ichthyosis vulgaris
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
Decreased Skin Barrier
Function due to atopic dermatitis
main topical therapies for atopic dermatitis?
for what severity of atopic dermatitis?
corticosteroids
calcineurin inhibitors
crisaborale
mild to moderate
main systemic therapies for moderate to severe atopic dermatitis?
phototherapy immunosuppressants -MTX -cyclosporine -prednisone duplimab (releases IL-4)
what are the two types of contact dermatitis?
allergic contact dermatitis
irritant contact dermatitis
allergic contact dermatitis can be tested using?
patch testing
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
Seborrheic Dermatitis
how is seborrheic dermatitis treated?
shampoos salicylic acid
scalp therapy
topical corticosteroids
calcineurin inhibitors
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
Psoriasis
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
Asteatotic Eczema
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
Nummular Dermatitis
what is this?
• “Tapioca like” vesicles
• Pruritic
• Usually hands, can be
feet
• Treat with topical
steroids
Dyshidrotic Eczema
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?
Lichen Planus
topical corticosteroid
topical calcineurin inhibitors
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
Pityriasis Rosea
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
Lichen Sclerosus
lichen nitidus?
• Chronic, cutaneous eruption often in children
and young adults
• Small, discrete, uniform, skin-colored papules
that present in clusters or linear arrays
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)
reactive arthritis
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
Erythema Annulare
Centrifugum
