Papulosquamous Disorders Flashcards
1
Q
Psoriasis Overview (6)
A
- Chronic Recurrent Inflammatory Disorder
- Many Cases (37%) start in childhood or Adolescence
- Plaques are Circumscribed, Erythematous, and Covered with Micaceous Scale
- Most Common Sites: Elbow, Knee, Buttocks, Scalp, and Nails
- Koebner Phenomenon is Common
- Bleed as you scratch = psoriasis
- Positive Auschpitz sign
2
Q
Different forms of psoriasis (6)
A
- Napkin Psoriasis
- Guttate Psoriasis one or two Weeks after Strep
- Classic tear drop lesions
- Easily treatable - Scalp Psoriasis
- Responds very well to steroids, usually given in liquid form - Erythrodermic Psoriasis
- Pustular Psoriasis
- Psoriatic Arthritis (gets treated by derm)
3
Q
Clinical Characteristics of Psoriasis Guttata (7)
A
- Annular, localized erythematous to salmon colored plaques with hyperkeratosis
- Little tiny tear-drop shaped; seen all over
- Frequently occurs after strep throat & when family has history of psoriasis
- Commonly noted on trunk, abdomen, and back
- Recent pharyngitis may precipate
- Treat infection and it can clear it up
- Herald of further psoriasis
4
Q
Clinical characteristics of nail psoriasis
A
- Nail pitting, oil spots, subungual hyperkeratosis
- Extensive pitting and subungal hyperkeratosis
- Gets confused with fungal infection
5
Q
Inverse Psoriasis (3)
A
- Founds in folds
- Thick plaques in axillae and groin
- Secondary infection with candida
6
Q
Topical psoriasis treatments (4)
A
- Anthralin cream 1%
- Topical steroids
- Tar
- Topical calcineurin inhibitors twice a day (off label)
7
Q
Systemic agents to treat psoriasis (4)
A
- Cyclosporine
- Oral antibiotics
- Methotrexate
- Retinoids (oral Accutane)
8
Q
Biological agents to treat psoriasis (3)
A
- Etanercept (subcut), adalimumab (subcut) and infliximab (IV)
- Not approved for this use
- Used for severe psoriasis
9
Q
Alternative psoriasis treatments (3)
A
- phototherapy
- Omega-3-fatty acids
- Indigo naturalis (a traditional Chinese medicine)
10
Q
Pityariasis Versicolor (7)
A
- Widespread, hypopigmented, minimally scaly plaque (Tinea pityriasis)
- Superficial yeast infection resulting from Malassezia furfur
- Superficial scaling hypopigmented or hyperpigmented macules or flat papules on the upper trunk, arms, neck and face
- Common in Spring and Summer due to heat and humidity factors
- May present as Folliculitis
- Most commonly in high humidity and temperatures
- SC, NC, Florida, etc. - Low grade yeast infection
11
Q
Pityariasis Rosea (7)
A
- Begins with a herald patch
- Goes to generalized, non-pruritic eruption within 2 weeks
- Characterized by oval, erythematous lesions with long axis in lines of skin cleavage
- Clears spontaneously within 6 weeks
- Frequently confused with secondary syphilis and generalized tinea corporis
- Spares the hands; it is a trunkal rash
- Will have a classic herald patch
-Christmas tree like pattern but not on the hands
Secondary sphyillis is all over and will be on the hands and feet
12
Q
Vitiligo (4)
A
- Autoimmune disorder due to melanocyte destruction or damage
- Reduced or absent pigmentation of the skin, hair and Mucous membranes.
- .5 to 2% of the world population
- Genetic propensity paired with environmental triggers melanocyte destruction
- Because there is a genetic propencity to autoimmunity
13
Q
overview of vitiligo (3)
A
- Associated with deficiencies of vitamins—lack of antioxidants, Lack of Vitamin D
- Teens with vitiligo or a family history of vitiligo should avoid hair dyes
- Tan and hazel/green eyes are associated with vitiligo
14
Q
Co-morbidity of vitiligo (2)
A
- Vitiligo is associated with other autoimmune illnesses such as alopecia areata, psoriasis, rheumatoid arthritis
- Non segmental vitiligo has a higher incidence of autoimmune thyroid disease
15
Q
Prognosis of vitiligo (4)
A
- Segmental vitiligo spread over month or years in the skin segment involved
- Can be along lines of Blaschko
- More common in children
- Nonsegmental vitiligo spreads slow and steadily
16
Q
Management of Vitiligo (4)
A
- While young children may not want therapy early medical treatment is more likely to work in the first 2-5 years of the disease
- Need thyroid screen and vitamin D level (25-hydroxyvitamin D)
- Celiac disease screening should be done if there are symptoms of abdominal pain and bloating
- Joint complaints screen for idiopathic juvenile arthritis
17
Q
Treatment of Vitiligo (7)
A
All topicals used are off label
- Topical corticosteroids (class 2-mometosone)
- Topical calcineurin inhibitors (pimecrolimus, tacrolimus (elidel and protopic)
- Topical vitamin D analogues (Calcipotriene) use of topical for 3-4 month on face and 6-8 months on the body
- Photochemotherapy with psoralens and UVA
- Excimer laser for focal disease or poor response to topical agents
- Grafting
- Treatable!Treated with steroids and lychs
18
Q
How to prevent vitiligo worsening (4)
A
- Avoid food that are hydroquinone rich and phenol rich such as blueberries and pears and mushroom that contain melanin
- Hair dyes
- Take a B complex and antioxidant vitamin
- Vitamin D supplement
19
Q
Alopecia Areata (11)
A
- Sudden loss of hair
- Hair comes out in clumps
- May be reaction to stress
- Patient may have thyroid disease
- Patient may complain of tingling or burning
- Well circumscribed annular patches of alopecia
- May see exclamation point hairs
- Sparing of white hairs
- May affect non scalp hair
- Nail pitting in 10%
- Cannot work on grey hair
20
Q
Treatment of alopecia areata (5)
A
- Topical Class 1 steroids
- Intralesional steroid
- Topical irritant therapy
- Immunotherapy
- Outcome of treatment - Hair regrowth: more common with single patches; Can be recurrent
21
Q
Hair pull test (2)
A
- Grab about 60 hairs and tug at them from proximal to distal end
- Removal of more than six hairs indicates a positive pull test and active hair loss
22
Q
Telogen Effluvium (7)
A
- Generalized hair loss
- Abrupt onset with trigger factor— Blood loss, iron deficiency, thyroid imbalance, initiation of drugs
- Hair thinning but no bare patches
- Prominent shedding
- Any age but not common in childhood
- Positive pull test
- Previous major illness or stress