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clinical medicine > Papulosquamous Disease > Flashcards

Papulosquamous Disease Flashcards

0
Q

what is the most common papulosquamous disease?

A

psoriasis

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1
Q

Name four papulosquamous diseases

A

psoriasis, lichen planus, pityriasis rosea, drug eruptions

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2
Q

psoriasis presentation

A

raised plaques, large, rough, silvery/white scales, redness, inflammation, fissure might crack and bleed, demarcated, thickened stratum corneum, pitting of nail bed, nail doesnt stick to nail bed, subungal discoloration-whitish, various itching, pain, arthralgias, depression

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3
Q

location psoriasis presents

A

elbows, knees, scalp are most common *extensor surfaces

also hands and feet

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4
Q

possible condition presenting with psoriasis

A

psoriatic arthritis- same signal from immune system attacks skin (1st) and joints (2nd)

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5
Q

define “pitting nails”

A

ice pick makes small dots on nail

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6
Q

tx and work up for pitting and discoloration of nail in psoriasis

A

steroid under bed of nail

send clipping of nail to test for fungus

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7
Q

DDx psoriasis vs atopic dermatits

A

location! atopic dermatitis is in flexural regions, psoriasis is extensor regions

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8
Q

DDx psoriasis vs shingles

A

pattern! shingles follows dermatomal pattern, psoriasis does not

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9
Q

psoriasis has __ _ times its normal production

A

epidermal thickening 7

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10
Q

psoriasis etiology

A

unknown
possibly Tcell mediated auto immune disease,
possibly genetic predisposition,
flares can be caused by drugs: lithium, beta blockers, NSAIDs,

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11
Q

psoriasis increases risks of..

A
  1. CV disease
  2. Lymphoma
  3. Metabolic disorders
  4. Cancer
  5. Obesity (also worsened by obesity)
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12
Q

most common type of psoriasis

A

plaque psoriasis

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13
Q

drugs that cause a flare in psoriasis

A

lithium, beta blockers, NSAIDs

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14
Q

what age group does psoriasis target?

A

all ages, commonly around 30 years

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15
Q

define koebnar phenomenon

A

appearance of lesions in areas of trauma

ex. psoriasis in scar or abrasion
ex. lichen planus in scar or abrasion

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16
Q

onset of psoriasis

A

gradual onset usually but can be sudden

-sudden onset occurs after streptococcal infection

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17
Q

this infection leads to guttate psoriasis or worsens current type

A

steptococcal infection

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18
Q

Describe guttate psoriasis

A

flare caused by strep or upper respiratory infections
tiny pink perfect circles with scaly lesions on trunk/extremities
tx: uv light but this can go away on its own

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19
Q

Describe pustular psoriasis

A

small pustules on hand and feet (raised small white fluid filled bumps)
painful and can break open
-generalized pustulosis- whole body is covered; this is emergent and treated like a burn in hospital

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20
Q

Describe palmar/plantar psoriasis

A

lesions found only on palms and soles
thick, scaly plaques
very painful if crack- will bleed

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21
Q

Describe inverse psoriasis

A 
found in skin folds
red with or without scales
thick, flat small scales
uncomfortable
rule out tinea infections
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22
Q

name 5 types of psoriasis

A
  1. plaque
  2. guttate
  3. pustular
  4. palmar/plantar
  5. inverse
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23
Q

general tx for psoriasis

A

no cure!!! want to control symptoms- topical/phototherapy/systemic: depends on location severity, symptoms, and insurance
NEVER GIVE ORAL STEROIDS risk of rebound flare once pt is off them

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24
Q

Topical tx for psoriasis:

A
  1. topical steroid - decrease inflammation
  2. calcipotriene (dovonex) - vitamin D analog that binds to keratinocyte receptors to alter keratinocyte proliferation
  3. Tazarotene (Tazorac) - topical retinoid that causes peeling effect of skin to thin out plaque (like shingles on a roof)
  4. Taclonex - combo of topical steroid and dovonex - decrease inflammation and keratinocyte proliferation
  5. Tar -inhibits DNA synthesis but is smelly and orange staining
  6. Ointments -with saran wrap occlusion
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25
Q

use of topical steriods

A

decrease inflammation

26
Q

calcipotriene/dovonex

A

vitamin D analog that binds to keratinocyte receptors to alter keratinocyte proliferation

27
Q

tazarotene/tazorac

A

topical retinoid that causes peeling effect of skin to thin out plaque (like shingles on roof)

28
Q

taclonex

A

combination of topical steroid and dovonex used to decrease both inflammation and keratinocyte proliferation

29
Q

tar

A

inhibits DNA synthesis

30
Q

phototherapy tx for psoriasis

A

good for widespread lesions; if lesions are small use Excimer Laser
light penetrates deep and causes a reaction- clearing up psoriasis
expensive and time consuming, burning, increase risk for skin cancer, photo aging, return of disease

31
Q

list of systemic tx for psoriasis

A
  1. Methotrexate (oral)
  2. Soriatane (oral)
  3. Cyclosporine (transplant drug)
  4. Biologics (SQ injection/IV/infusion/oral)
32
Q

systemic tx for psoriasis

A
  1. Methotrexate (oral)-inhibit cell proliferation (also helps with arthritis symptoms); liver toxic can not drink alcohol, nausea, liver biopsy every 2 weeks and blood work often (CBC/HFP/BUN/Creat)
  2. Soriatane (oral)-vitamin A derivative effects keratinization and causes peeling of plaque; used with phototherapy and in palmar psoriasis; teratogenic, cant donate blood or get pregnant for 3 years after use, dryness of lips, check cholesterol and triglycerides in blood work often (CBC/HFP/CHOL/Triglycerides)
  3. Cyclosporine (transplant drug)-inhibits T cell production; used in super severe ppl!!!! ; dont use for more then 1 year and taper dose; monitor BP and do labs this can effect kidney (CBC/HFP/Lytes/Chol/Triglycerides
  4. Biologics (SQ injection/IV/infusion/oral)-common now; suppress inflammation thru T cell interference; good for arthritis and skin; PPD/Labs needed because increased risk of infection due to lowering immune system (TB & HEP screening); costly. Ex: Enbrel, Humira, Remicade, Otezla

NEVER GIVE ORAL STEROIDS in psoriasis

33
Q

methotrexate

A 
oral, inhibits cell proliferation
also good to treat psoriatic arthritis
problems with drug:
liver toxic-get blood work done often
causes nausea
cant drink any alcohol
needs liver biopsy every 2 weeks
labs (CBC/HFP/BUN/Creat)
34
Q

soriatane

A

used with phototherapy
common use with palmar psoriasis
vitamin A derivate causes peeling effect by effecting keratinization
teratogenic (causes birth defects) - wait three years to have babies
cant donate blood until off it for 3 years
effects cholesterol and triglycerides
dryness of lips
get blood work done often: CBC/HFP/Chol/Triglycerides

35
Q

cyclosporine

A

used for severe cases of acute flare
transplant drug that inhibits t cell production
cant use for more then one year and need to taper dose
effect on kidneys-monitor BP and do labs often
CBC/HFP/Chol/Triglycerides/Lytes

36
Q

biologics

A

newer tx that suppresses inflammation thru T cell interference
used for arthritis and skin
costly
increased risk of infection because lowering immune system so get PPD/TB test/HEP screening

examples:humira,enbrel,remicade,otezia

37
Q

drug examples of biologics

A

humeria, enbrel,remicade,otezia

HERO

38
Q

work up for psoriasis

A

CBC/BUN+Creatine levels/Liver function test/Hep Panel/TB screening

39
Q

DDx for psoriasis

A

acute dermatitis
tinea infections
shingles

40
Q

list of topical tx for psoriasis

A 
topical steroids
calcipotriene/dovonex
tazarotene/tazorac
taclonex
tar
ointment
(TCTTTO)
41
Q

Pityriasis Rosea looks like..

A

christmas tree with herald patch

42
Q

pityriasis rosea presentation

A

herald patch (1 pinkish scaly patch 2-6 cm appears for 1 week) then rash blossoms into pink/red/brown scaly patches
very itchy, trunk and proximal extremeties
6-12 weeks after blossom it will be cleared
occurs during spring and fall usually

43
Q

pityriasis rosea etiology

A

unknown
maybe viral
maybe environmental
younger people

44
Q

pityriasis rosea work up

A

tests for syphilis if there are les then a few perfectly typical lesions or if there are any plantar, oral, or palmer lesions

45
Q

pityriasis rosea DDx

A

tinea corporis (would have less lesions then p.r.)
lichen planus
psoriasis

46
Q

pityriasis rosea tx

A

IF NO SYMPTOMS DO NOT TREAT!! it will go away in time
alleviate itch
topical steroids and oral antihistamines (clariton, benedril, zertec)
sunlight/phototherapy

47
Q

Lichen Planus presentation

A

varying itch, flat topped, purple (violalceous) papules with white/gray fine streaks within lesions “wickham’s striae”
nail deformity, scarring alopecia
can occur on skin, scalp, nails, mucous membranes (check for oral lesions which are lacey white patches/network on buccal mucosa)
follows koebner phenomenon (occurs in areas of trauma)

48
Q

lichen planus etiology

A

unknown

maybe associated with Hep C

49
Q

lichen planus work up

A

biopsy
Hep testing
refer to oral surgeon if oral lesions

50
Q

DDx lichen planus

A

drug eruptions that look “lichenoid” (looks like LP but is a drug rxn)
psoriasis, lichen simplex chronicus, syphilis

51
Q

Tx lichen planus

A

can go away on its own 6mo-2 yrs but come back if stressed

  1. topical steroids -to alleviate itch and slow skin eruption
  2. systemic steroids if severe
  3. phototherapy
  4. plaquenil- antimalarial med-anti-inflammatory with few side effects
52
Q

Drug Eruptions presentation

A 
symmetric!!!!
hives or bright papular rash
starts proximally and moves distally
occurs within 1 week of new medication
discomfort/joint pain/fever/headache can occur
53
Q

Drug eruptions etiology

A
  1. antibiotics -bactrim, penicillin, cephalosporins, sulfonamides*
  2. diuretics- furosemide
  3. NSAIDs (anti inflammatory)
  4. blood products during transfucions
54
Q

examples of antibiotics that cause drug eruptions

A

bactrim, penicillin, sulfonamides, cephalosporins

55
Q

example of diuretic that causes drug eruption

A

furosemide

56
Q

DDx drug eruptions

A

Lichen planus
pityrisis rosea
urticaria
type 4? test for more Ig levels??

57
Q

tx drug erruptions

A

-D/C (remove) suspected drug and it should clear after about 4 weeks
make sure replacement rx is not needed with the prescribing dr
-topical steroids / supportive care

58
Q

Fixed Drug Eruption presentation

A

1 or more oval/annular red isolated patch that has a blister or necrotic tissue in center
itching, burning, pain
demarcated
common on lips hips sacrum genitals
took med PRN by mouth -exposure to drug causes lesion
lesion will come back to same spot if taken again, over time tho it will move somewhere else and the old lesion will lighten up
delayed about 2 weeks after drug taken
will last days-weeks and fade slowly but will leave hyperpigmented patch
if reexposed to meds it will appear 30 min -16 hrs

59
Q

fixed drug eruption etiology

A

as needed meds
laxatives
pain relievers
antibiotics

60
Q

fixed drug eruption work up

A

biopsy

61
Q

drug eruption work up

A

biopsy- wont tell u specifically which drug tho

62
Q

fixed drug eruption tx

A
  • supportive tx for itch etc

- remove drug and it will resolve itself!

63
Q

fixed drug eruption DDx

A 
drug eruption
lichen planus
eczema
pityriasis rosea
psoriasis
urticaria

clinical medicine (12 decks)

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