Papulosquamous Diseases- Alavian Flashcards
What is “Papulosquamous”?
Eruptions that consist of papules with Scaling
Note: Scaling is the abnormal shedding or accumulation of stratum corneum in perceptible flakes.
What are some of the Papulosquamous Disease?
- Psoriasis
- Seborrheic Dermatitis
- Pityriasis Rosea
- Lichen Planus
Describe the visible features of Psoriasis
- 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.
What is the epidemiology of Psoriasis?
-2 peak age distribution:
20-30 and 50-60
-Guttate psoriasis is the most frequent in children.
What is the Psoriasis HLA association?
HLA-CW6 (PSORS1 locus)
Describe the pathogenesis of Psoriasis
- TH1 (and some TH2) are the cause
- Found in the epidermis and dermis.
Results in increased inflammatory mediators that stimulate:
- epidermal proliferation
- Differentiation
- Angiogenesis
What are some triggers of Psoriasis?
- Trauma
- HIV
- Infection (strep pharyngitis especially in Guttate form)
- Smoking
- Hypocalcemia
- Alcohol
- Drugs (Beta blockers, lithium, anti-malarials, interferon, rapid steroid taper)
Describe the clinical Psoriasis patterns
- Psoriasis Vulgaris
- plaque type - Guttate (drop like; children)
- Inverse (within the skin foldings; flexures)
- Palmoplantar
- Erythrodermic
- Pustular
- Psoriatic nail involvement
What is the most common Psoriasis variant?
-Chronic Plaque Psoriasis
- Auspitz sign
- Frequently itchy
- sometimes painful
Describe Guttate Psoriasis
- 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.
Psoriasis is better in the sun…but…
Guttate can erupt in photodistributed area. This is Koebner phenomenon.
What is Erythodermic Psoriasis?
- 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
Describe Psoriasis nail involvement
Up to 50% of Psoriatics
- Affects nail matrix and nailbed
- Nail pitting
- Oil Spots
- Oncholysis
Describe Psoriatic Arthritis
- Up to 30%
- Erosive changes with negative Serologies (rules out RA)
- Asymmetrical Oligoarthritis (DIP/PIPs)
- Can have Sausage digits (arthritis mutilans)
What is the vulgar name for Arthritis Mutilans?
Sausage fingers
Name some Mild to Moderate Psoriasis treatment
Topical:
- salicylic acid
- corticosteroids
- calcineurin inhibitors (tacrolimus)
- urea preparations
- retinoids
- vitamin d3
What is the topical for Psoriasis that starts with a “D”?
Dovonex
What is the RX for Moderate to Severe Psoriasis?
- Phototherapy (psoralen +UVA) = PUVA
- Systemic retinoids
- PUVA + sys retinoids
- Methotrexate
- Cyclosporin
- Biological agents
Name the biological agents used to treat Psoriasis
Infliximab (binds TNF-a)
K
Etanercept (binds TNF-a)
Adalimumad (binds TNF-a)
What is Seborrheic Dermatitis?
Inflammatory skin disorder involving the skin areas rich in sebaceous glands.
The skin manifestations in seborrheic dermatitis are different from psoriasis in that they are…
- not well demarcated
- appear as light red plaques with white to Greasy yellow scale
- Flexures
- Sebaceous skin regions
Describe the Epidemiology of SD
Bimodal
- 1-3 months and 40s-60s.
- M>F
- Common in Parkinson’s and HIV disease
Describe leading hypothesis for SD pathogenesis
- Skin overgrowth of the yeast Malassezia furfur.
- Metabolic products and antigens of the yeast cause inflammation.
-Increased colonies in patients with SD.
What is the mildest form of seb derm?
Dandruff.
