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I.M DERMA > Papulosquamous Disorders > Flashcards

Papulosquamous Disorders Flashcards

1
Q

Leisons of psoriasis, lichen plants & pityrasis rosea

A

Raised, erythematous, scaly, well defined leisons

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2
Q

Ieison of psoriasis

A

Well defined erythematous papules and plaques covered by silvery laminated scales
Due to increase in epidermal cell proliferation up to 20 folds and vascular proliferation

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3
Q

Precipitating factors of psoriasis

A
  1. Trauma (Koebner phenomenon)
  2. Infection : streptococcal sore throat precipitate Guttate psoriasis
  3. Endocrine factors : Pregnancy improve psoriasis, occasionally
    provokes generalized pustular psoriasis
  4. Climate: High temperature, humidity and sunlight are generally
    beneficial
  5. Metabolic : Hypocalcaemia Cansing erythrodermic psoriasis
  6. Drugs: Antimalarials, beta-blockers and lithium exacerbate psoriasis
    Systemic steroids predispose for erythrodermic or pustular psoriasis.
  7. Psychogenic factors : Emotional stress
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4
Q

Primary lesion of psoriasis

A

Erythematous papule covered with laminated
silvery scales, which coalesce to form sharply defined plaques

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5
Q

Shapes of Chronic plaque Psoriasis

A

Psoriasis vulgaris is bilateral and symmetrical
1. Discoid or nummular psoriasis
2. Annular psoriasis: produced by peripheral extension oflesion with central involution
3. Linear psoriasis: presentation of koebner phenomenon
4. Geographic psoriasis: curved patterns on back & tongue

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6
Q

Leison of Guttate psoriasis

A

Mainly on trunk , rounded small leisons (drop like)
Preceded by acute Streptococcal infection

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7
Q

Describe psoriasis of nails

A

Nail pitting, transverse striations, subungual Hyperkeratosis or oncholysis

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8
Q

Characteristics of Flexural Psoriasis

A

Absent or decreased scales due to moisture and continuous friction

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9
Q

Leison in Napkin psoriasis

A

As a presentation of koebner phenomenon

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10
Q

Leison of erythrodermic psoriasis

A

Involving all the body with generalized erythema & scaliness
Precipitated by infection, hypovpcalcimia & drugs

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11
Q

The most sever form of psoriasis is

A

Pustular Psoriasis

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12
Q

DD of psoriasis

A

Plaque psoriasis &laquo_space;hyperkeratotic lichen planus
Guttate psoriasis &laquo_space;pityriasis rosea
Flexural psoriasis &laquo_space;flexural candidasis
Scalp psoriasis &laquo_space;seborrheic dermatitis
Onchomycosis &laquo_space;fungal infection of nails

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13
Q

TTT of Psoriasis

A
  • Topical therapy :
    1. Topical steroids avoided on face, flexures and in young patients
    Intralesional steroids in resistant nail leisons
    2. Vit D3 analogues as calcipotriol
    Inhibit cell proliferation, stimulate keratinocyte differentiation
    S.E irritation & hypercalcimia
    C.I in pregnancy, lactation & renal insufficiency
    3. Emollients as petrolatum
    4. Keratolytics as salicylic acid
    5. Tar preparation as crude coal ( antiproliferative )
    S.E unpleasant odour and staining of cloths
    combined with UVB as Goekerman technique
    6. Topical retinoids as Tazarotene gel
    7. Anthralin [Dithranol]: antimitotic, highly effective but irritant and stains skin.
  • Phototherapy : Narrow band UVB (NB-UVB) is the mainstay d
    treatment for moderate to severe psoriasis
  • Photochemotherapy: PUVA (psoralen + UVA)
  • Systemic therapy :
    1. Methotrexate
    Folic acid antagonist
    Indicated in erythrodermic, generalized pustular, arthropathic & sever psoriasis
    2. Acitretin
    derivative of vitamin A
    Indicated in generalized pustular and erythrodermic psoriasis
    3. Cyclosporin
    Selective immunosuppressive
    Indicated in severe psoriasis
    4. Combination : Re-PUVA [Acitretin and PUVA]
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14
Q

Side effects of Methotrexate

A

S.E hepatotoxicity and bone marrow suppression
C.I in pregnancy and liver disease

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15
Q

Side effects of Acitretin

A

Main side effects are teratogenicity & increase serum cholesterol
CI in children and pregnancy

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16
Q

Side effects of Cyclosporin

A

Main side effects are hypertension and nephrotoxicity

17
Q

Etiology of pityriasis rosea

A

Viral especially HHV 6,7 ( mainly 7)

18
Q

Leison of pityriasis rosea

A

First : Herald patch
Solitary papule enlarges to an oval or annular patch with a fine collarette of scales , center is clear & light brown
Then after 1-2 weeks
Generalized, symmetrical macules or maculopapules erythematous with fine scales (collarette of scales) , resembles a Christmas tree in back

19
Q

Herald patch not followed by 2ry rash

A

Abortive type of pityriasis rosea

20
Q

An inverted type of psoriasis………

A

Face and limbs affected sparing trunk

21
Q

DD of pityriasis rosea

A

Tinea circinata ( Herald patch )
Guttate psoriasis ( 2ry rash )
2ry syphalitic rash
Pityriasiform drug eruption

22
Q

TTT of P. Rosea

A

Reassurance
Avoid irritants
Calamine lotion
Moderate potent topical steroids ( relieve pruritus)

23
Q

Lichen planus is associated with……..

A

HCV , autoimmune diseases

24
Q

L. Planus preceded by trauma or sun exposure……..

A

Koebner phenomenon

25
Q

A marked symptom of L. Planus…….

A

Itching

26
Q

1ry leison of L. Planus

A

4P : pruritic, polygonal, purple, papules
Itchy flat topped polygonal papules showing whitish striations ( Wickham’s Striae )

27
Q

Healing of Lichen planus leaving ……..

A

Residual hyperpigmentation

28
Q

Lichen planopilaris affect ……

A

Hair follicles Causing Cicatricial alopecia

29
Q

Graham Little Syndrome a triad of……

A
  1. Multifocal scalp cicatricial alpociea
  2. Non scarring alopecia of axilla & groin
  3. Keratotic lichenoid follicular papules
30
Q

Hypertrophic L.planus affect …….

A

Shin of the tibia

31
Q

Leison of Lichen planus Actincus

A

Non itchy red brown annular macules on face
As a koebner phenomenon to sun

32
Q

White lines, streaks or patches may occur with ……..

A

Lichen planus of mucous membranes
May turn to squamous cell carcinoma

33
Q

Longitudinal ridging, pitting or Complete shedding of nails caused by…….

A

Lichen planus of nails

34
Q

Variants of lichen planus

A

Acute ( eruptive )
Atrophic
Annular
Linear
Bullous

35
Q

DD of Generalized lichen planus

A

Lichenoid drug eruption
Guttate psoriasis
Pityriasis rosea

36
Q

DD of Genital lichen planus

A

Psoriasis
Scabies

37
Q

TTT of Lichen planus

A
  • Local :
    Topical steroids, Intralesional steroids ( hypertrophic ), sun screens ( Actinic)
  • Systemic : for extensive involvement, lcerative m.m, scarring nail dystrophy
    Antihistamines, Systemic steroids, antimalarials ( Actinic )

I.M DERMA (8 decks)

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