Papulosquamous Diseases Questions Flashcards
What is psoriasis?
A chronic inflammatory condition caused by epidermal proliferation resulting in thickened stratum corneum (outer layer)
What can contribute to the flaring of psoriasis?
Emotional stress, skin trauma (koebner phenomenon), certain drugs like lithium/beta blockers/NSAIDS, and obesity
What is the pathophysiology of psoriasis?
An immune system trigger causes hyperproliferation (epidermal skin cells do not shed, build up as a plauque)
The cause for this is unknown, yet could be T-cell mediated autoimmune disease
These immune system components then cause itching/inflammation, burning/cracking/bleeding
**can be genetic/hereditary
What does psoriasis treatment depend on?
Severity, location, symptoms, insurance, patient preference
What are the signs/symptoms of plaque psoriasis?
Hallmark sign: well demarcated erythematous plaque with silvery scale
Commonly on elbows, knees, scalp but can be anywhere
Plaques fissure/bleed
Pruritis, pain
**may have joint pain
What is nail psoriasis? What are the common symptoms? Is it easy to treat?
Pitting/inflammation in the nail bed causing changes in the nail plate
Subungal (beneath nail plate) discoloration - no vascularization = no color
Can happen in fingernails&toenails but most commonly fingernails
Hard to treat: hard to penetrate nail
What is guttate psoriasis? What is it usually triggered by?
Multiple small plaques that are peppered throughout the body
can be triggered by strep infection
**may predispose you to developing plaque psoriasis
**may be mistaken for tinea
What is pustular psoriasis?
Small pustules, common on hands/feet
Can have generalized pustulosis: emergent because it can cause electrolyte imbalance when these burst all over the body
What is palmar/plantar psoriasis?
Red, flaky, cracked skin confined to palms and soles
What is inverse psoriasis?
Psoriasis that occurs in skin folds (under breasts, ect.)
**Commonly mistaken for candidal infection
What are the systemic effects of psoriasis?
Psoriatic arthritis: inflammatory process may affect joints (~30%)
Underlying inflammation: increased risk of cancer, cardiovascular disease, obesity
Depression/Anxiety: because condition is so visible can cause mental health struggles, make sure to screen for these things
What are the topical treatments for psoriasis?
Topical steroids: decrease inflammation
Calcipotriene: slows down proliferation, Vitamin D analog binds to keratinocyte
Tazarotene: topical retinoid, helps peel/thin plaque “peeling shingles off the roof”
Tar (baths): inhibits DNA synthesis/anti-inflammatory (messy and smelly)
Ointments: sit on skin, help medication penetrate (messy,greasy, can use saran wrap to help penetrate thick plaques)
Emolients: gentle skincare
What is light therapy for psoriasis? Why are the advantages/disadvantages of light therapy?
UVA and UVB wavelengths penetrate skin for a photochemical reaction
Advantages: if used correctly (small amount of time/sunscreen) good for widespread disease, target specific areas
Disadvantages: time consuming, expensive, not long after completion psoriasis will return, risk of skin cancer/burns
What’s a Ddx for psoriasis symptoms?
-candidiasis (inverse)
-atopic derm
-tinea
-seb derm
-nummular eczema
What’s the first line treatment preferred for moderate to severe psoriasis?
SubQ injection/IV infusion to suppress inflammation, good for joints and skin
IMMUNE SYSTEM INTERFERENCE
-puts pt. at a higher risk for infection (like lymphoma)
-very expensive
What are the systemic treatments for psoriasis?
Methotrexate: oral med, inhibits proliferation/immunosuppressant (can be used for arthritic symptoms.
common: nausea
HEPATOTOXIC: blood tests/lab work required to check liver function
Soriatane: oral med, Vitamin A derivative (inhibits keratinization), pill form of “peeling shingles off of a roof”, used with phototherapy, good for palmo/plantar
common: dryness
NO PREGNANCY: must be continued 3 years prior
Otezla (Apremilast): PD4 inhibitor that reduces cytokine production, expensive, good for skin&joints
common: diarrhea/mood changes
START AT LOW DOSE/WORK WAY UP
What is pityriasis rosea?
An acute, self limited eruption (no known cause, maybe viral etiology) one patch usually blossoms into a rash
(Usually occurs in younger populations in the spring/fall)
What are the clinical features of pityriasis rosea?
Blossoming red/pink/brown scaly patches that begin at trunk and extend to proximal extremities (christmas tree rash!)
Usually begins as one herald patch (pink/isolated) before the rest of the rash blossoms a few days/week later
Intense pruritis
Ddx: Guttate psoriasis, tinea, secondary syphillis, nummular eczema
Usually wont, but can reoccur
What are the treatments available for pityriasis rosea?
Will resolve on its own (6-12 weeks)
To alleviate associated pruritis: topical steroids, oral antihistamines, phototherapy
(relieving pruritis reduces chance of secondary infection)
What is lichen planus?
An uncommon inflammatory condition with unknown cause
A raised eruption that can be seen on the skin, mouth, buccal mucosa, hair follicle (may disrupt hair growth)
What are the four P’s of lichen planus?
Pruritic
Purple
Polygonal
Papules or plaques
What are the clinical features of lichen planus?
Possible pruritis, skin lesions (flat topped/raised) on ankles, wrists, scalp, nails, mucous membranes
Can have oral erosions/lacy white patches, sloughing
Scarring alopecia
Nail deformity
**Wickham’s Striae: fine white streaks/grey lines in lesions
What are the diagnostic practices used in the diagnosis of lichen planus?
Biopsy
Hep C testing
Referral to oral surgeon if any oral lesions
What associated diagnosis is sometimes related to lichen planus?
Hepatitis (good to test for it as well- Hep C panel)
What are the treatments for lichen planus?
Will spontaneously resolve (6mos-2yrs), but commonly recurs at any time
Topical steroid/IL steroids, systemic steroids if severe, phototherapy
What is a drug eruption?
A sudden systemic onset reaction (rash/hives) in response to a medication
What are common medications associated with a drug eruption?
Antibiotics (bactrim, penicillins, cephalosporins)
Diuretics (Furosemide)
NSAIDS
Blood products
What are the characteristics of a drug eruption?
Hives or bright/generalized papular rash
Starts proximally and proceeds distally
Usually begins within 1 week of new med, but can happen at any time
What can diagnose a drug eruption, but CANNOT tell you which drug the patient is allergic to?
Biopsy
What are the treatments available for drug eruptions?
Discontinue suspecting drug (make sure you collaborate with providers when replacing a drug)
Supportive care for any rash/itching (topical/oral steroids, baths, etc.)
What is a fixed drug eruption?
One or more annular/oval/dusky/erythematous patches that form when exposed to a systemic drug
When re-exposed to the drug, same spot as original reaction occurs, and new spots may form as well
What are the clinical features of a fixed drug eruption?
Plaques that are round/oval, sharply demarcated, dusky, erythematous/edematous
Commonly found on lip, hip, sacrum, genitalia
Symptoms include pruritis, burning, pain
*center of plaque can blister/become necrotic
What is the treatment for a fixed drug eruption?
Avoid the offending drug, self resolves
Other supportive treatment for symptoms
Plaques will fade gradually/may leave residual hyperpigmentation
What medications are commonly associated with a FIXED drug eruption?
Medications taken episodically (once a week, once a month, PRN)
Examples: pain relievers, antibiotics, laxatives
