Papulosquamous Diseases

Question 1

Psoriasis pathophysiology

Answer 1

genetic & immune-mediated components
increased cytokine production; elevated TNF-a correlate with flares
higher cell turnover rate, (3-5 days instead of 23) and improper cell maturation - no stratum granulosum b/c cells keep nuclei
don’t release enough lipids, and skin flakes & forms plaque

Question 2

Psoriasis

Answer 2

chronic
erythematous
lesions increased on traumatized areas
thick skinned plaque

Question 3

plaque-type (discoid) psoriasis

Answer 3

stable
unchanged for long time
symmetrical

Question 4

Inverse psoriasis

Answer 4

affects axilla, groin, submammary, navel, scalp, palms, soles (intertriginous regions)

lesions plaques, sometimes moist w/o flaking (due to location)

Question 5

guttate (eruptive) psoriasis

Answer 5

follows infection w/ hemolytic strep, withdrawal from steroids, and antimalarial use

small erythematous scaling papules

Question 6

pustular psoriasis

Answer 6

pamls or soles

pustules and variable scale; erythematous

Question 7

erythrodermic psoriasis

Answer 7

sterile pustules with intense erythema background
systemic
glucocorticoid withdrawal
treated w/ oral retinoids in non-pregnant ptns (teratenogenic)

Question 8

Nail psoriasis

Answer 8

punctate pitting (visible with otoscope)

Question 9

psoriatic arthritis

Answer 9

hands and feet

stiffness pain and progressive joint dammage

Question 10

oral psoriasis

Answer 10

white lesions on oral mucosa, change from day to day
geographic tongue
can cross vermillion border

Question 11

psoriasis treatment

Answer 11

hydration (ointments/crisco)

avoid excess drying or irritation

Question 12

localized, plaque psoriasis treatment

Answer 12

mid-potency topical (in combo with occlusion)

topical vitamin D analogue

Question 13

mild/moderate widespread psoriasis treatment

Answer 13

UV light

• skin cancer
• contraindicated in ptns taking cyclosporine
• be careful with immunocompromised ptns

Question 14

sever, widespread psoriasis

Answer 14

methotrexate (esp arthritic patients)
synthetic retinoid acitretin - limited by teratogenicity)
NOT oral glucocorticoids (can trigger pustular psoriasis)

Question 15

psoriasis treatment - immunological mediated

Answer 15

no immunosuppressants if ptn has severe infection
check for TB routinely
multifocal leukoencephalopathy can occur
look out for malignancies

cyclosporin and other immunosuppressives
biologics

Question 16

Lichen Planus appearance

Answer 16

skin, scalp, and nails
wrist, shins, lower back, genitalia
4 Ps: purple, polygonal, pruritic papule
Wickham's striae - gray network
mucous membrane involvement

Question 17

Lichen Planus associations and treatment

Answer 17

can lead to perm hair/nail loss
associated w/ some drugs, grat-versus-host, hep C
spontaneous remission
treat with topical glucorcorticoids

Question 18

Pityriasis Rosea presentation

Answer 18

initially 2-6 cm annular lesion
often missed as ringwork or nummular eczema
then several smaller lesions on trunk
3-8 weeks
Christmas Tree Rash Distribution (follow derm lines of back)

Question 19

Pityriasis Complications

Answer 19

similar to 2nd syphilis
hyper-/hypopigmentation
risk of miscarriage

Question 20

Pityriasis treatments

Answer 20

mid-potency topical corticosteroids

oral anti histamines