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Pediatric Primary Care Exam 2 > Papulosquamous Disorders > Flashcards

Papulosquamous Disorders Flashcards

1
Q

Psoriasis Overview (6)

A
  1. Chronic Recurrent Inflammatory Disorder
  2. Many Cases (37%) start in childhood or Adolescence
  3. Plaques are Circumscribed, Erythematous, and Covered with Micaceous Scale
  4. Most Common Sites: Elbow, Knee, Buttocks, Scalp, and Nails
  5. Koebner Phenomenon is Common
  6. Bleed as you scratch = psoriasis
    - Positive Auschpitz sign
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2
Q

Different forms of psoriasis (6)

A
  1. Napkin Psoriasis
  2. Guttate Psoriasis one or two Weeks after Strep
    - Classic tear drop lesions
    - Easily treatable
  3. Scalp Psoriasis
    - Responds very well to steroids, usually given in liquid form
  4. Erythrodermic Psoriasis
  5. Pustular Psoriasis
  6. Psoriatic Arthritis (gets treated by derm)
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3
Q

Clinical Characteristics of Psoriasis Guttata (7)

A
  1. Annular, localized erythematous to salmon colored plaques with hyperkeratosis
  2. Little tiny tear-drop shaped; seen all over
  3. Frequently occurs after strep throat & when family has history of psoriasis
  4. Commonly noted on trunk, abdomen, and back
  5. Recent pharyngitis may precipate
  6. Treat infection and it can clear it up
  7. Herald of further psoriasis
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4
Q

Clinical characteristics of nail psoriasis

A
  1. Nail pitting, oil spots, subungual hyperkeratosis
  2. Extensive pitting and subungal hyperkeratosis
  3. Gets confused with fungal infection
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5
Q

Inverse Psoriasis (3)

A
  1. Founds in folds
  2. Thick plaques in axillae and groin
  3. Secondary infection with candida
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6
Q

Topical psoriasis treatments (4)

A
  1. Anthralin cream 1%
  2. Topical steroids
  3. Tar
  4. Topical calcineurin inhibitors twice a day (off label)
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7
Q

Systemic agents to treat psoriasis (4)

A
  1. Cyclosporine
  2. Oral antibiotics
  3. Methotrexate
  4. Retinoids (oral Accutane)
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8
Q

Biological agents to treat psoriasis (3)

A
  1. Etanercept (subcut), adalimumab (subcut) and infliximab (IV)
  2. Not approved for this use
  3. Used for severe psoriasis
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9
Q

Alternative psoriasis treatments (3)

A
  1. phototherapy
  2. Omega-3-fatty acids
  3. Indigo naturalis (a traditional Chinese medicine)
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10
Q

Pityariasis Versicolor (7)

A
  1. Widespread, hypopigmented, minimally scaly plaque (Tinea pityriasis)
  2. Superficial yeast infection resulting from Malassezia furfur
  3. Superficial scaling hypopigmented or hyperpigmented macules or flat papules on the upper trunk, arms, neck and face
  4. Common in Spring and Summer due to heat and humidity factors
  5. May present as Folliculitis
  6. Most commonly in high humidity and temperatures
    - SC, NC, Florida, etc.
  7. Low grade yeast infection
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11
Q

Pityariasis Rosea (7)

A
  1. Begins with a herald patch
  2. Goes to generalized, non-pruritic eruption within 2 weeks
  3. Characterized by oval, erythematous lesions with long axis in lines of skin cleavage
  4. Clears spontaneously within 6 weeks
  5. Frequently confused with secondary syphilis and generalized tinea corporis
  6. Spares the hands; it is a trunkal rash
  7. 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
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12
Q

Vitiligo (4)

A
  1. Autoimmune disorder due to melanocyte destruction or damage
  2. Reduced or absent pigmentation of the skin, hair and Mucous membranes.
  3. .5 to 2% of the world population
  4. Genetic propensity paired with environmental triggers melanocyte destruction
    - Because there is a genetic propencity to autoimmunity
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13
Q

overview of vitiligo (3)

A
  1. Associated with deficiencies of vitamins—lack of antioxidants, Lack of Vitamin D
  2. Teens with vitiligo or a family history of vitiligo should avoid hair dyes
  3. Tan and hazel/green eyes are associated with vitiligo
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14
Q

Co-morbidity of vitiligo (2)

A
  1. Vitiligo is associated with other autoimmune illnesses such as alopecia areata, psoriasis, rheumatoid arthritis
  2. Non segmental vitiligo has a higher incidence of autoimmune thyroid disease
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15
Q

Prognosis of vitiligo (4)

A
  1. Segmental vitiligo spread over month or years in the skin segment involved
  2. Can be along lines of Blaschko
  3. More common in children
  4. Nonsegmental vitiligo spreads slow and steadily
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16
Q

Management of Vitiligo (4)

A
  1. While young children may not want therapy early medical treatment is more likely to work in the first 2-5 years of the disease
  2. Need thyroid screen and vitamin D level (25-hydroxyvitamin D)
  3. Celiac disease screening should be done if there are symptoms of abdominal pain and bloating
  4. Joint complaints screen for idiopathic juvenile arthritis
17
Q

Treatment of Vitiligo (7)

A

All topicals used are off label

  1. Topical corticosteroids (class 2-mometosone)
  2. Topical calcineurin inhibitors (pimecrolimus, tacrolimus (elidel and protopic)
  3. Topical vitamin D analogues (Calcipotriene) use of topical for 3-4 month on face and 6-8 months on the body
  4. Photochemotherapy with psoralens and UVA
  5. Excimer laser for focal disease or poor response to topical agents
  6. Grafting
  7. Treatable!Treated with steroids and lychs
18
Q

How to prevent vitiligo worsening (4)

A
  1. Avoid food that are hydroquinone rich and phenol rich such as blueberries and pears and mushroom that contain melanin
  2. Hair dyes
  3. Take a B complex and antioxidant vitamin
  4. Vitamin D supplement
19
Q

Alopecia Areata (11)

A
  1. Sudden loss of hair
  2. Hair comes out in clumps
  3. May be reaction to stress
  4. Patient may have thyroid disease
  5. Patient may complain of tingling or burning
  6. Well circumscribed annular patches of alopecia
  7. May see exclamation point hairs
  8. Sparing of white hairs
  9. May affect non scalp hair
  10. Nail pitting in 10%
  11. Cannot work on grey hair
20
Q

Treatment of alopecia areata (5)

A
  1. Topical Class 1 steroids
  2. Intralesional steroid
  3. Topical irritant therapy
  4. Immunotherapy
  5. Outcome of treatment - Hair regrowth: more common with single patches; Can be recurrent
21
Q

Hair pull test (2)

A
  1. Grab about 60 hairs and tug at them from proximal to distal end
  2. Removal of more than six hairs indicates a positive pull test and active hair loss
22
Q

Telogen Effluvium (7)

A
  1. Generalized hair loss
  2. Abrupt onset with trigger factor— Blood loss, iron deficiency, thyroid imbalance, initiation of drugs
  3. Hair thinning but no bare patches
  4. Prominent shedding
  5. Any age but not common in childhood
  6. Positive pull test
  7. Previous major illness or stress

Pediatric Primary Care Exam 2 (12 decks)

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