Papulosquamous Disorders Flashcards
Hypopigmented patches with a mild scale, slightly pruritic.
Symmetric, found on forehead, cheeks and neck, usually found in ages 3-16 years
Pityriasis Alba
When is pityriasis alba worse?
Summer, sun worsens condition
How should you treat Pityriasis Alba?
The condition is benign and self limiting, may relapse, unknown cause.
May use TCS or TCIs for symptoms
Salmon colored plaques with ISLANDS OF SPARING.
Waxy, diffuse orange keratoderma of palms and soles.
rare, chronic papulosquamous disorder
Pityriasis Rubra Pilaris
How to dx PRP
punch biopsy
1st and 2nd line treatments for Pityriasis Rubra Pilaris?
Symptomatic Treatment:
1st Isotret
2nd Methotrexate or Apremilast
Antihistamine, high potency TCS, urea/sa, tret
What should you educate patient on regarding treatment of Pityriasis Rubra Pilaris
It may take years to resolve.
Herald patch, salmon red colored patches with fine scale, acute benign exanthematous eruption
christmas tree pattern
proximal extremities and trunk
Pityriasis Rosea
How long does Pityriasis Rosea hang around? when is it at its worst?
6-12 weeks
Spring/Fall
How to treat Pityriasis Rosea
antihistamines
tcs
sun/heat avoidance
Recurring crops of erythematous papules w/ a central scale, present on trunk and extremities
Pityriasis Lichenoides
Treatment for Pityriasis Lichenoides
TCS, TCI, azithromycin, erythromycin
- does not require treatment
Education for Pityriasis Lichenoides
Rare, response to infection, may last months to years, will need biopsy.
Pityriasis Lichenoides et Varioliform
Prolonged course of Pityriasis Lichenoides, lasting 1-3 years, if prolonged may progress to mycosis fungoides or ctcl
PLV is also known as
MuchaHabermann
Acute onset of 2-3 mm macules and papules with a rapid progression to vesicles, ulceration and necrosis, emergency
PLV
how to treat PLV
TCS
TCI
Doxycycline
Dapsone
Acetretin
Pruritic urticarial papules
3rd trimester
no risk to fetus
most common in primagravida
SPARES UMBILICUS
Occurs on abdomen, lower back, buttock, upper/inner arms
PEP
How to treat PEP?
TCS
Prednisone
Antihistamines
When does PEP resolve
after delivery
When is seb derm at its worst?
Better in summer, worse in winter
Cracked riverbed, most common in lower extremities, trunk and dorsal hands
xerosis cutis
how to treat xerosis cutis
check tsh, t4, cmp, lft
bathe in lukewarm water
SOAK AND SEAL
Use humidifier
urea
lactic acid
ammonium lactat
What triggers psoriasis
weather
medications- BB, lithium, antimalarials
Group A strep
Most common form of psoriasis
plaque psoriasis
Micaceous scale
+ Auspitz sign
Most common in flexural areas, umbilicus, upper gluteal cleft
Plaque psoriasis
“Dew Drop”
R/t Group A strep
younger patients
normally on trunk
(ask about a sore throat recently)
Guttate psoriasis
Thin, shiny, erythematous skin found in folds, not moist
Inverse psoriasis
Sterile, noninfectious pustules on palms and soles
palmopustular psoriasis
RED Man syndrome
generalized psoriasis
dysregulation in IL-36 pathway
malaise, fever, leukocystosis
Spreads over the body in hours
ERYTHRODERMA
Associated with more severe forms of psoriasis, most commonly psoriatic arthritis, oil spots, onycholysis, dystrophy
Nail psoriasis
History components important when interviewing a psoriasis patient?
family hx
arthritis hx
trauma-koebner phenomenom
recent strep infections
BB? antimalarial? lithium?
Grade psoriasis using palm?
Mild- less than 3%
Moderate 3-10
Sever > 10
Palm print= 1 %
psoriasis treatment guidelines
reduce burden to 1% or less within 3 months, 3% BSA or less
How long do you perform ULtraviolet B light therapy for psoriasis
3 months then need to take a break.
adalimumab
certolizumab
etanercept
infliximab
TNF alpha inhibitors
Brodalumab
ixekizumab
secukinumab
il-17 inhibitor
ustekinumab
il12/23 inhibitor
guselkumab
tildrakizumab
rizankizumab
il-23 inhibitor
Which biologic best for pregnancy?
certolizumab does not cross barrier
Labwork for biologics
baseline and annual tb
hep b&c
hiv
cbc
cmp
Rems program biologic for suicidal ideation
brodalimumab
Caution w/ IBD patients and depressoin
apremilast
psoriasis rescue drug, clears skin quickly, weigh based dosing 2.5mg/kg
Cyclosporine
labs to check with cyclosporine
blood pressure
cbc
bun/creat
lft
lipid
uric acid
mg and potassium
pregnany test
how long can you stay on cyclosporine
no longer than 1 year, usually 6months of treatment.
Cat X
slow onset, titrate slowly
liver contraindications
do not give to patients who consume alcohol
hair loss common
monitor cbc q 3m
methotrexate
Waxes and wanes
improves in summer, worsens in winter
Thick, waxy scaling
Seb derm
Treatment for seb derm
keto shampoo 2%
Ciclopirox 1%
Seleniumsulfide 2.5%
Stop oily makeup
IF SEVERE: tx with oral antifungals
Mirrored skin image with erythema, sometimes violaceous, maceration, superficial fissures present
intertrigo
Treatment for intertrigo
Aluminum acetate, burrow’s solution 1;40, dilute vinegar or wet tea bags
zinc/a&D ointment, dimethicone, lanolin
topical antifungals; nystatin, miconazole, and econazole
diflucan 200 mg if severe
Weight loss
Avoid tight fitting clothes, reduce skin on skin friction, use ph balanced soaps, avoid alkaline, dry skin folds completely, glycemic control
What are the 7 P’s of lichen planus
planar (flat topped)
pruritic
purple
polygonal
papules
penile
prolonged course
- occurs on flexor aspect of wrist/hands
- extensor surgaces of forearms and legs
- Koebner phenomenon
- thinning, ridging, splitting, pterygium
- If photodistributed think drug related
Lichen planus
All patient’s with LP should be screened regularly for….
oral and perineal disease as it is linked to SCC
Hepatitis C
How to treat LP
Cutaneous; topicals (TCIs, TCS, & oral antihistamines)
Genital; (high potency TCS, tacrolimus)
Polymorphic vesicles, pustules or erosions, erthematous scaly brown red papules which flatten over time, patient may complain of burning or pruritus
Spontaneous regression
Pityriasis Lichenoides
Treatment for pityriasis lichenoides
topical corticosteroids
Doxy
Azithromycin
Erythromycin
Does Pityriasis Lichenoides scar?
Yes and leaves PIH
Precedes URI symptoms, mild fever
Herald patch
Usually followed by Christmas tree pattern rash
How would you treat?
Pityriasis Rosea
Topical steroids, anti-itch therapies, oral acyclovir 400mg 5x/day x 1 week (initiate within 1st two weeks)
Erythematous papules, vesicles, and often hyperkeratotic/scaly papules, wax and wane, pruritus present
How would you treat?
Grover’s
- Avoid exacerbations from sunlight, heat, friction, or sweat
-TCS short course
Rare and sporadic; RAPID PROGRESSION
salmon colored hyperkeratotic papules on the trunk/extremities (nutmeg grater, gooseflesh, islands of sparing)
Sandal like palmoplantar keratoderma RED ORANGE PLAQUES, yellow brown hyperpigmentation of nails BUT NO INVOLVEMENT OF PROXIMAL NAIL MATRIX AND NAIL BED
How do you treat?
PRP
Self limited, resolves within 3 years of onset
EMOLLIENTS
KERATOLYTIC AGENT
UREA
SALICYCLIC ACID
TOPICAL STEROIDS
TAZAROTENE
TCI
SYSTEMIC
1ST LINE ISOTRETINON
METHOTREXATE
TNF ALPHA INHIBITORS
Il 17 INHIBITORS
typically develops in the third trimester-
polymorphous and urticarial papules
STARTS ON ABDOMEN BUT SPARES THE UMBILLICUS,
severe pruritus
How do you treat?
Polymorphic eruption of pregnancy (pep or puppp)
topical steroids
antihistamines
what should be a clue for intrahepatic cholestasis in pregnancy
The presence of severe pruritus with no lesions.
What drugs commonly cause erythroderma?
carbamazepine, phenytoin, allopurinol, ace inhibitors, PPIs, oral retinoids, bactrim, PCN, dapsone, hydroxychloroquine
What are common causes of erythroderma in adults
psoriasis
atopic dermatitis
drug eruptions
idiopathic
What are systemic symptoms of erythroderma?
peripher lymphadenopathy
f/e shift
pretibial pedal edema
vasodilation
temp dysregulation
hepatosplenomegaly
Loss of functional melanocytes
Vitiligo
What are two types of vitiligo?
1st line therapy?
non-segmental (both sides of body) and segmental (one side)
TCS/TCIs
Nonsegmental- opzelura BID
non-scaly hypopigmented macules/patches involving the trunk, (orange-red follicular fluorescence on Wood’s lamp)
Progressive macular hypomelanosis
BPO w/ clindamycin
oral isotretinoin
Explain reoccurence is very common.
acroderma where pigment is absent form the skin
leukoderma, once remove the causative agent will repigment over many months.
Causes of leukoderma
hydroquinone
ADHD patches
TCS
ILK
EGFR inhibitors
azelaic acid
imiquimod
phenols
sulfhydryls
mercury
arsenic
fragrance
Median age of onset 20-30 years old, most common in Caucasians, increased keratinocyte proliferation/turnover and erythema of the skin, triggers- environmental, stress, infection, excessive body weight, cigarettes, medications, alcohol, weather/climate
psoriasis
abnormal hyperproliferation and differentiation leading to epidermal hyperplasia, dermal infiltration by various immune cells, increase capillary permeability in the dermis
pathogenesis of plaque psoriasis
White adherent micaceous scale on erythematous base
arms/legs elbows/knees, + auspitz, koebnerization
plaque psoriasis
oil spots, onycholysis, itching around fingernails
nail psoriasis
smooth erythematous plaques, that are often macerated and fissured, found in intertriginous areas of skin including inguinal, inframammary, axillary or abdominal folds
inverse psoriasis
often triggered by strep, small spots or rain drop like scaly papules or plaques
guttate psoriasis
scaly papules and plaques on erthematous bases favoiring extensor aspects, umbilicus, genitals, and postauricular sulcus. ITCH is very important in determining the severity of hte disease,
plaque psoriasis
how to score psoriasis
mild <3% bsa
moderate 3%-10% BSA
severe >10% BSA
