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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
Topical tx for psoriasis:
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
25
use of topical steriods
decrease inflammation
26
calcipotriene/dovonex
vitamin D analog that binds to keratinocyte receptors to alter keratinocyte proliferation
27
tazarotene/tazorac
topical retinoid that causes peeling effect of skin to thin out plaque (like shingles on roof)
28
taclonex
combination of topical steroid and dovonex used to decrease both inflammation and keratinocyte proliferation
29
tar
inhibits DNA synthesis
30
phototherapy tx for psoriasis
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
list of systemic tx for psoriasis
1. Methotrexate (oral) 2. Soriatane (oral) 3. Cyclosporine (transplant drug) 4. Biologics (SQ injection/IV/infusion/oral)
32
systemic tx for psoriasis
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
methotrexate
``` 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
soriatane
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
cyclosporine
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
biologics
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
drug examples of biologics
humeria, enbrel,remicade,otezia | HERO
38
work up for psoriasis
CBC/BUN+Creatine levels/Liver function test/Hep Panel/TB screening
39
DDx for psoriasis
acute dermatitis tinea infections shingles
40
list of topical tx for psoriasis
``` topical steroids calcipotriene/dovonex tazarotene/tazorac taclonex tar ointment (TCTTTO) ```
41
Pityriasis Rosea looks like..
christmas tree with herald patch
42
pityriasis rosea presentation
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
pityriasis rosea etiology
unknown maybe viral maybe environmental younger people
44
pityriasis rosea work up
tests for syphilis if there are les then a few perfectly typical lesions or if there are any plantar, oral, or palmer lesions
45
pityriasis rosea DDx
tinea corporis (would have less lesions then p.r.) lichen planus psoriasis
46
pityriasis rosea tx
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
Lichen Planus presentation
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
lichen planus etiology
unknown | maybe associated with Hep C
49
lichen planus work up
biopsy Hep testing refer to oral surgeon if oral lesions
50
DDx lichen planus
drug eruptions that look "lichenoid" (looks like LP but is a drug rxn) psoriasis, lichen simplex chronicus, syphilis
51
Tx lichen planus
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
Drug Eruptions presentation
``` 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
Drug eruptions etiology
1. antibiotics -bactrim, penicillin, cephalosporins, sulfonamides* 2. diuretics- furosemide 3. NSAIDs (anti inflammatory) 4. blood products during transfucions
54
examples of antibiotics that cause drug eruptions
bactrim, penicillin, sulfonamides, cephalosporins
55
example of diuretic that causes drug eruption
furosemide
56
DDx drug eruptions
Lichen planus pityrisis rosea urticaria type 4? test for more Ig levels??
57
tx drug erruptions
-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
Fixed Drug Eruption presentation
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
fixed drug eruption etiology
as needed meds laxatives pain relievers antibiotics
60
fixed drug eruption work up
biopsy
61
drug eruption work up
biopsy- wont tell u specifically which drug tho
62
fixed drug eruption tx
- supportive tx for itch etc | - remove drug and it will resolve itself!
63
fixed drug eruption DDx
``` drug eruption lichen planus eczema pityriasis rosea psoriasis urticaria ```

clinical medicine (12 decks)

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