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Dermatology > Papulosquamous Diseases- Alavian > Flashcards

Papulosquamous Diseases- Alavian Flashcards

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Dermatology Board Prep flashcards
1
Q

What is “Papulosquamous”?

A

Eruptions that consist of papules with Scaling

Note: Scaling is the abnormal shedding or accumulation of stratum corneum in perceptible flakes.

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2
Q

What are some of the Papulosquamous Disease?

A
  • Psoriasis
  • Seborrheic Dermatitis
  • Pityriasis Rosea
  • Lichen Planus
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3
Q

Describe the visible features of Psoriasis

A
  • Well defined red plaques with silvery scale (psoriasis vulgaris)
  • Extensor elbows, knees, scalp, hands, feet, genitals
  • Inverse Psoriasis may involve the flexures
  • Auspitz sign
  • Symptoms improved in the summertime sun.
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4
Q

What is the epidemiology of Psoriasis?

A

-2 peak age distribution:
20-30 and 50-60

-Guttate psoriasis is the most frequent in children.

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5
Q

What is the Psoriasis HLA association?

A

HLA-CW6 (PSORS1 locus)

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6
Q

Describe the pathogenesis of Psoriasis

A
  • TH1 (and some TH2) are the cause
  • Found in the epidermis and dermis.

Results in increased inflammatory mediators that stimulate:

  • epidermal proliferation
  • Differentiation
  • Angiogenesis
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7
Q

What are some triggers of Psoriasis?

A
  • Trauma
  • HIV
  • Infection (strep pharyngitis especially in Guttate form)
  • Smoking
  • Hypocalcemia
  • Alcohol
  • Drugs (Beta blockers, lithium, anti-malarials, interferon, rapid steroid taper)
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8
Q

Describe the clinical Psoriasis patterns

A
  1. Psoriasis Vulgaris
    - plaque type
  2. Guttate (drop like; children)
  3. Inverse (within the skin foldings; flexures)
  4. Palmoplantar
  5. Erythrodermic
  6. Pustular
  7. Psoriatic nail involvement
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9
Q

What is the most common Psoriasis variant?

A

-Chronic Plaque Psoriasis

  • Auspitz sign
  • Frequently itchy
  • sometimes painful
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10
Q

Describe Guttate Psoriasis

A
  • Guttate = drop
  • Common form in children and young adults

-Often preceded by a URI (group A hemolytic strep) 2-3wks prior to onset.

Note: Look for positive antistreptolysin

Note: Spontaneous remission in children; chronic in adults.

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11
Q

Psoriasis is better in the sun…but…

A

Guttate can erupt in photodistributed area. This is Koebner phenomenon.

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12
Q

What is Erythodermic Psoriasis?

A
  • Erythoderma is defined as redness/scaling involving greater than 90% of TBSA.
  • Often caused by withdrawal of Systemic steroids or Methotrexate.
  • Emergency

Manifestations:

  • Peripheral Edema
  • Tachycardia
  • Dehydration
  • High output CHF
  • Hypothermia
  • Protein loss
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13
Q

Describe Psoriasis nail involvement

A

Up to 50% of Psoriatics

  • Affects nail matrix and nailbed
  • Nail pitting
  • Oil Spots
  • Oncholysis
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14
Q

Describe Psoriatic Arthritis

A
  • Up to 30%
  • Erosive changes with negative Serologies (rules out RA)
  • Asymmetrical Oligoarthritis (DIP/PIPs)
  • Can have Sausage digits (arthritis mutilans)
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15
Q

What is the vulgar name for Arthritis Mutilans?

A

Sausage fingers

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16
Q

Name some Mild to Moderate Psoriasis treatment

A

Topical:

  • salicylic acid
  • corticosteroids
  • calcineurin inhibitors (tacrolimus)
  • urea preparations
  • retinoids
  • vitamin d3
17
Q

What is the topical for Psoriasis that starts with a “D”?

A

Dovonex

18
Q

What is the RX for Moderate to Severe Psoriasis?

A
  • Phototherapy (psoralen +UVA) = PUVA
  • Systemic retinoids
  • PUVA + sys retinoids
  • Methotrexate
  • Cyclosporin
  • Biological agents
19
Q

Name the biological agents used to treat Psoriasis

A

Infliximab (binds TNF-a)
K
Etanercept (binds TNF-a)
Adalimumad (binds TNF-a)

20
Q

What is Seborrheic Dermatitis?

A

Inflammatory skin disorder involving the skin areas rich in sebaceous glands.

21
Q

The skin manifestations in seborrheic dermatitis are different from psoriasis in that they are…

A
  • not well demarcated
  • appear as light red plaques with white to Greasy yellow scale
  • Flexures
  • Sebaceous skin regions
22
Q

Describe the Epidemiology of SD

A

Bimodal
- 1-3 months and 40s-60s.

  • M>F
  • Common in Parkinson’s and HIV disease
23
Q

Describe leading hypothesis for SD pathogenesis

A
  • Skin overgrowth of the yeast Malassezia furfur.
  • Metabolic products and antigens of the yeast cause inflammation.

-Increased colonies in patients with SD.

24
Q

What is the mildest form of seb derm?

A

Dandruff.

25
Q

What is a major differential for Seb derm vs Lupus when the rash appears on the face?

A

SD will involve the nasolabial folds. Lupus will not.

In addition, there will be erythema with scale on the chest where there is abundant chest hair in SD (example).

26
Q

What is the major risk factor we should screen for in a patient with SD?

A

HIV infection.

27
Q

What’s the name of the yeast involved with Seborrheic Dermatitis?

A

Malassezia furfur

28
Q

What is a central Rx for Seborrheic Dermatitis?

A

Ketoconazole and steroids

Head and shoulders shampoo for dandruff.

29
Q

Describe the etiology of Pityriasis Rosea

A
  • Viral etiology- Associated with HHV-7

- Immunologic Factors

30
Q

Describe the presentation of Pytriasis Rosea

A
  • Herald patch appears on trunk (misdiagnosed often as tinea corporis)
  • Papular eruption appears days/weeks later on the trunk. (Christmas tree distribution). Lesions follow the Langer lines of Cleavage.

Note: Prodromal URI symptoms may precede the Herald patch.

  • Pruritic
  • Spontaneous remission.

RX:

  • Topical steroids
  • antihistamines
  • UV light therapy (if severe)
31
Q

What differentials should we consider for Pytiriasis rosea? What test should we do?

A
  1. Secondary Syphilis (perform RPR to rule out)
  2. Drug induced Pityriasis Rosea (GABAMIB)
    - Gold
    - Arsenic
    - Beta blockers
    - ACE inhibitors
    - Metronidazole
    - Isotretinoin
    - Barbituates
  3. Nummular eczema
  4. Guttate Psoriasis
32
Q

Describe the pathological cause of Lichen Planus

A
  • Autoimmune reaction

- Directed against epitopes on lesional keratinocytes, which have been modified by viral or drug antigens.

33
Q

Describe the epidemiology of Lichen Planus

A
  • No racial predilection.

- Typical onset between 5th and 6th decade

34
Q

Name the 4 Ps associated with LP followed by the general appearance.

A

Purple
Pruritic
Polygonal
Papules

  1. Wickham’s striae
  2. Koebner phenomenon
  3. Flexure wrist/forearms
  4. Dorsal hands
  5. Anterior lower legs
  6. Genitals
  7. ORAL membranes
35
Q

75% of patients with LP also have what other manifestation?

A

-Mucosal Lichen Planus

  1. Reticular pattern in the Buccal mucosa.
  2. Annular pattern on the glans penis.
36
Q

10% have this manifestation in Lichen Planus

A

Nail Lichen Planus

Presents with either/and:

  • Lateral thickening
  • Longitudinal ridges
  • Pterygium (skin growing over the nails)
37
Q

What virus is most associated with LP? And which type?

A
  • Hep C

- Oral Lichen Planus

38
Q

What are the Rx options for LP?

A

MC(a)TTPASS

Topical steroids
Topical immunomodulators
Phototherapy
Antimalarials
Systemic retinoids
Systemic steroids
Methotrexate
Cyclosporin

Dermatology (7 decks)

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