Papulosquamous Disorders Flashcards
define Psoriasis
Common Chronic inflammatory and hyperproliferative skin disease affecting skin, nails and joints (5-10%).
What is the morphological appearance of psoriasis?
chronic well-demarcated dull-red plaques with silvery scale found on extensor surfaces.
What specific signs are seen during the clinical exam?
- Auspitz Sign
- Koebner’s Phenomenon
- Classic Nail findings (oil staining, pitting, onycholysis
What is the etiology of psoriasis?
- Generally considered to ge genetically determined
- Incidence is highest among W. Europe and Scandinavia
- Less common among African, Oriental, Native American
- Often seen with strong Family History
- Guttate psoriasis often seen associated with strep. Pharyngitis
- Drugs that precipitate psoriasis: Beta Blx, Antimalarials, Lithium, Systemic Steroids
When are topical medications used for psoriasis?
- Used for limited disease
A. <20% Body surface area
What are the drawbacks to topical steroids?
- Tedious and often hard to apply
- Temporary relief
- Tachyphalaxis/Tolerance or compliance issues
What are the topical medication options for psoriasis?
1. Topical Steroids A. First line of therapy (Med/High) B. Monitor for Side effects 2. Topical Retinoids A. Tazarotene (Tazorac) 3. Calcipotriene (Dovonex) A. Vitamin D3 derivative B. Use < 100gm/wk (200 ftu’s) 4. Coal Tar Preparations
When is systemic therapy indicated for psoriasis?
- For specific cases once risk & benefits have been reviewed
A. Generalized (>20% BSA)
B. Severe (Erythrodermic, Pustular)
C. Resistant cases
What phototherapy is used for psoriasis?
UVB, PUVA, nbUVB
What systemic medications are used for psoriasis?
Retinoids, Methotrexate, Cyclosporine
What biologics are used for psoriasis?
- Enbrel, Humira, Remicade, Amevive, etc.
2. Ease of dosing and safety vs. $$$Cost$$$
What are the morphologic variants of psoriasis?
Chronic plaque psoriasis
Guttate psoriasis
Pustular psoriasis
Erythrodermic psoriasis
What are the locational variants of psoriasis?
Scalp psoriasis Palmoplantar psoriasis Inverse psoriasis Nail psoriasis Psoriatic arthritis
What is the most common form of psoriasis?
Chronic plaque psoriasis
What are the characteristics of chronic plaque psoriasis?
1. Symmetrical Distribution Involving A. Extensor surfaces B. Sacral area C. Genitalia D. Spares palms/soles/face 2. Classic Findings A. Nail Changes B. Auspitz’s sign C. Koegner phenom D. Silvery White Scale on Eryth base
What demographic group is guttate psoriasis seen in?
Seen in adolescents and young adults
What psoriasis is asst with strep. Pharyngitis?
guttate psoriasis
What are the characteristics of pustular psoriasis?
- Rare, unstable variant
- Severe Psor. disease
- Superficial sterile pustules replace scaling plaques
- Need Systemic Tx to keep under control
What are the characteristics of erythrodermic psoriasis?
- Presents as total body redness
2. Is serious and requires systemic therapy to control.
Define scalp psoriasis
Pruritic well-demarcated scaling eruption of scalp (must stop itch/rub!)
How is scalp psoriasis differentiated from tinea and seb derm?
- No Hair loss with Psoriasis vs Tinea
- No Occipital LN’s with Psoriasis vs Tinea
- Isolated areas with Psoriasis vs Seb Derm
Why is scalp psoriasis difficult to treat?
Scale, trapped by hair, acts as sponge
Must 1st remove scale
Then apply Topical Medicated Solutions
Define palmoplantar psoriasis
Only areas involved are palms and soles
Why is palmoplantar psoriasis difficult to treat? How is it treated?
- Difficult to treat such thick skin
- TCS with occlusion
- +/- Keratolytics
- Intralesional Steroids
- PUVA with hand/foot box
- Systemic tx with retinoids (etretinate = Soriataine)
define inverse psoriasis
1. Psoriasis involving intertriginous and flexural areas A. Axillae B. Groin C. Umbilicus D. Inframamary
How is inverse psoriasis treated?
- TCS - low potency
- Dovonex
- Tar Preparations
What are the characteristics of nail psoriasis?
Found in 25-50% of psoriatics Nail pitting Discoloration – Oil Staining Onycholysis Subungual Hyperkeratosis
What are the characteristics of psoriatic arthritis?
- 5-10% of pt’s with psor.
- May precede, accompany, or MC follow skin disease
- MC form - Asymmetric
What is pityriasis rosea
acute, benign, self limiting rash
Usually seen in spring
Who does pityriasis rosea affect?
Adolescents and young Adults
What is the etiology of pityriasis rosea?
Viral etiology suspected
What are the sxs of pityriasis rosea?
- Asymtomatic
A. Occasional prodromal sx’s and +/- mild pruritis with rash - Herald Patch
A. ¾ of cases start with a single 2-10cm plaque
seen 1-2wks before rash - Distributed to trunk and proximal extremities
A. Spares face, palms, soles (if present here, check RPR to r/o 2nd Syphilis) - Christmas Tree pattern
A. Lesions run parallel to the lines on skin cleavage (+/- Inverted) - Lesions seen with a trailing edge of scale
A. A “collarette” of scale, does not extend to the lesions border
Define Seborrheic dermatitis
common chronic dermatitis, dandruff
Where is seborrheic dermatitis distributed?
- Distributed over “seborrheic areas” (rich supply of sebacous glands)
- Scalp – universal, visible desquamation = dandruff
- Face – very common, seen at ocular/auditory areas too
- Central chest and intertriginous areas
What is the presentation of seborrheic dermatitis in infants?
- Seen in infants, resolves spontaneously at 6-8mo
A. Cradle cap, Diaper dermatitis
What is the presentation of seborrheic dermatitis in Children?
Usually not seen in children
Due to lack of sebacous gland activity
Think Tinea!!!
What is the etiology on seborrheic dermatitis?
- Hypersensitivity response to the common skin yeast Pityrosporum ovale.
A. Flares with external influences – Stress, fatigue, sunlight
True/false: seborrheic dermatitis doesn’t affect adults
False: Seen in Adolescents and Adults too
What are the clinical signs of seborrheic dermatitis?
1. +/- Asymptomatic or with A. Mild pruritis to scalp 2. Erythematous 3. Well-demarcated 4. Patch’s/Plaues 5. With yellow, greasy scale 6. In “seborrheic areas”
What is the treatment for seborrheic dermatitis on the scalp?
Medicated Shampoo’s 5min
Selenium sulfide, Tea Tree, Zinc pyrithione, or Tar
What is the treatment for seborrheic dermatitis on the face/scalp/body?
TCS Med – High for scalp
TCS Low potency for face
Topical antifungals
Ketoconazole, Ciclopirox,
