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Dermatology > Psoriasis and dermatitis > Flashcards

Psoriasis and dermatitis Flashcards

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Dermatology Board Prep flashcards
1
Q

Two peaks of incidence in psoriasis?

histology?

A

20s and 50s
Absent granular layer and thick prickle cell layer
hyperkeratosis

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2
Q

Precipitating factors for psoriasis?

A

stress
trauma
alcohol/smoking
infection (strep throat - guttate)

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3
Q

what drugs can ppte psoriasis?

A 
B blockers
lithium
anti-malarials 
hydroxychloroquine
swift withdrawl of topical/systemic steroids
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4
Q

most common type of psoriasis - mildly itchy palpable scaly erythematous plaques??

A

chronic plaque psoriasis

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5
Q

is chronic plaque psoriasis symmetrical or asymmetrical?

A

often symmetrical - plaque scale may be silvery

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6
Q

whats auspitz sign??

A

removing scale causes pin point bleeding

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7
Q

where does chronic plaque psoriasis typically develop on body?

A

extensor aspects of knees elbows sacrum and scalp

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8
Q

where is scalp psoriasis m/c seen?

A

posterior aspect of the scalp, extending below the hairline and is ass with itch (no interruption to hair growth)

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9
Q

When plaques of psoriasis (very similar to chronic plaque) develop at a site of trauma 2-6 weeks after trauma has occurred - called?

A

Koebner phenomenom

ppte trauma - physical, sunlight or another skin condition

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10
Q

Younger patients (15-25) onset of well demarcated scaly erythematous plaques “pear drop” shaped and develop on trunk (typically 7-10 days post infection) - Dx?

A

guttate psoriasis

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11
Q

most common precipitating infection for guttate psoriasis is ?

A

strep throat infection

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12
Q

Flexural psoriasis (seen in groin, axilla and under breasts) usually seen in what patients ?

A

elderly

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13
Q

erythematous glazed well demarcated plaques with or without scale in flexural distribution?

A

Flexural psoriasis

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14
Q

Well demarcated plaques with absent scale and confluent full body erythema - onset ppte by removal of potent steroids - Dx?

A

Erythrodermic psoriasis

can develop de novo or in pts with deteriorating psoriasis

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15
Q

is erythrodermic psoriasis serious? if so why?

A

YES - can lead to complete failure of the skin

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16
Q

Sterile pustules within plaques of psoriasis and widespread erythema?

A

generalised pustular psoriasis

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17
Q

generalised pustular psoriasis - other symptoms?

A

skin often painful and associated fever and malaise

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18
Q

Multiple sterile yellow pustules that develop into brown macules that then develop a scale - on palms and soles - Dx??

A

Palmo-plantar pustulosis

distinct condition but related to psoriasis

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19
Q

Palmo-plantar pustulosis

a) typical in what patients - age/gender?
b) strong association with what risk factor?

A

a) women over 50

b) smoking

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20
Q

Psoriasis is also associated with what? (3)

A

nail disease (pitting, onchyolysis, subungual hyperkeratosis)

Psoriatic arthritis (pencil in cup on X ray)

CVS risk

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21
Q

Management of psoriasis:

treatment to be used regularly and liberally by all patients to reduce scale loss and itch??

A

emollients

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22
Q

1st line treatment for psoriasis?

duration of T initially ?

A

potent topical steroid (Betnovate) (applied OD)
+ potent vit D analogue (calcipotriol/calcitriol) (applied OD)

applied seperately - one in morning and one in evening

up to 4 weeks

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23
Q

when cant you use a vit D analogue ??

A

if pregnant

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24
Q

2nd line treatment for psoriasis considered if no improvement after how long ?

A

8 weeks

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25
Q

2nd line treatment for psoriasis?

A

Offer vit D analogue twice daily

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26
Q

3rd line treatment for psoriasis (if no improvement after 8-12 weeks) ???

A

Offer either:
potent corticosteroid twice daily for up to 4 weeks

or

coal tar preparation applied once or twice daily

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27
Q

another treatment of option for severe resistant psoriasis (only used in short term as burns/stains normal skin) ??

A

Dithranol

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28
Q

Treatment of scalp psoriasis ?

A

potent topical steroid lotion

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29
Q

Treatment of scalp psoriasis 2nd line (no improvement in 4 weeks) ??

A

Steroid in different form (eg shampoo) or topical agents to remove scale - salicylic acid before applying steroid

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30
Q

Shouldnt use potent steroids for more than how long ?

A

8 weeks

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31
Q

Shouldnt use very potent steroids for more than how long?

A

4 weeks

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32
Q

1st line topical T in psoriasis ?

A

Vit D analogue

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33
Q

smelly and messy T for psoriasis used if in hospital/severe?

A

coal tar

34
Q

mild steroids used in what types of psoriasis?

A

flexural disease and palmar plantar disease

35
Q

Treatment used to break down particularly hyper keratotic skin/ large scaly plaques ??

A

salicylate

36
Q

Secondary care treatment that can be used in more severe widespread disease/ as 1st line in guttate psoriasis ??

A

photodynamic therapy

UVB or PUVA

37
Q

SE’s of photodynamic therapy?

A

sunburn reactions, conjunctivits, exacerbation of HSV infection

38
Q

Very severe psoriasis/ non responsive disease to classic therapies - treatment option?

A

Systemic therapy:
Methotrexate 1st line
others =
ciclosporin, retinoids, biologics (infliximab)

39
Q

Itchy, ill defined erythematous rash, +/-scale, excoriations, papules, vesicles, ooze and crust - Dx?

A

Dermatitis (eczema)

40
Q

chronic features of dermatitis rash?

A

scale, skin thickening, pigment changes and lichenification

41
Q

Atopic dermatitis - risk factors?

A 
higher socio-economic class
family or personal Hx atopy (eczema asthma hayfever)
42
Q

what is the atopic march?

A

clinical progression of atopy =
eczema in infancy,
asthma around age of 2 and then hay fever around the age of 7

43
Q

normal age presentation of eczema?

A

6 mths - 5 years but really any age

44
Q

rash distribution in infants? (eczema)

A

face, scalp (cradle cap) extensor surfaces involved, flexor surfaces and napkin area spared

45
Q

rash distribution in children and adults?

A

flexor surfaces esp wrist, cubital fossa, popliteal fossa and ankles

46
Q

triggers for eczema?

A

stress
non compliance with treatment
allergens - pets new skin products, temperature

47
Q

Dx criteria for eczema = itch + 3 or more of:

Histology?

A 
visible flexural rash
Hx of flexural rash
PHx of atopy
Dry skin in the past year
Onset before age 2

Spongiosis, acanthosis, hyperkertosis (mutation in fliagrin)

48
Q

Pt with eczema - develops yellow weeping crust over their rash - Dx?

A

Bacterial infection with staph A

49
Q

Viral infection of eczema which presents with monomorphic punched out lesions?

A

Eczema herpeticum (infection with herpes simplex)

50
Q

Management of eczema herpeticum?

A

Emergency - require admission for IV aciclovir

51
Q

Treatment for eczema - everyone should get ?

A

emoillients (constantly even when eczema not there)

52
Q

For itch in eczema - T?

A

anti histamines

53
Q

To treat a flare of eczema - T?

A

topical steroids

54
Q

Mild eczema - T?

A

mild topical steroids (hydrocortisone, eumovate)

55
Q

moderate eczema - T?

A

moderate topical steroids (eumovate/betnovate)

56
Q

severe - T?

A

potent/very potent topical steroids (dermovate)

UV light therapy

Systemic i/s

57
Q

Potent steroids must use ST.

Steroid sparing agents that can be used in pts relying on continual steroid use ? (Moderate- severe eczema)

A

Calinurin inhibitors (Topical tacrolimus)

58
Q

If eczema not responding to potent topical steroids - T options? (2)

A

Light therapy (UVB or PUVA)

Systemic i/s

59
Q

Dermatitis caused by overgrowth of commensal yeast on the skin?

A

Seborrhoeic dermatitis

60
Q

Development of seborrhoeic dermatitis associated with what risk factor?

A

immunosupression

HIV or drugs like ciclosporin

61
Q

Itchy erythematous and scaly rash on the forehead nasolabial folds behind the ear and anterior chest in an adult?

A

Seborrhoeic dermatitis

stressed student at exam type

62
Q

Presentation if seborrhoeic dermatitis in a newborn?

A

Cradle cap, flexural surfaces and napkin area. might not be itchy.

63
Q

Treatment of infantile seborrhoeic dermatitis (cradle cap)?

A

emollients (on their own first)

and topical steroids

64
Q

Treatment of seborrhoeic dermatitis in an adult?

A

emollients + topical steroids + topical antifungal (ketoconazole)

65
Q

If seborrhoeic dermatitis unresponsive to initial treatment or very widespread - T?

A

Oral ketoconazole

66
Q

Erythematous rash with intensly itchy vesicles that burst to produce superficial erosions ? (Eczema on palms of hands and soles of feet)

A

Pompholyx

67
Q

Type of eczema seen in elderly patients - dry skin with polygonal fissures - “crazy paving pattern” seen on the lower limbs ?

A

Azteototic eczema

Treat - emollients

68
Q

Eczema seen in elderly in lower limbs - dry scaly skin with a red/brown colour due to haemosiderin deposition?

A

venous eczema

69
Q

why does venous eczema develop?

T?

A

due to venous insufficiency in the lower limbs

Compression to T venous insufficiency

70
Q

Type of eczema/dermatitis that develops as a consequence of chronic itch?

A

Discoid eczema

71
Q

Discoid eczema - morphology?

A

widespread, disc shaped intensly itchy lesions

ass with atopic eczema and renal failure which causes itch

72
Q

Contact dermatitis:

Dermatitis caused by repeated exposure to substance that abrades irritates and aggrevates the skin?

A

Irritant contact dermatitis

73
Q

Is irritant contact dermatitis immune mediated?

A

NO

It does not require a previous exposure to have occured like with contact allergic

74
Q

Common irritants in irritant contact dermatitis?

A

Soap/detergents, urine (nappy rash)

75
Q

Occupations in which common to get irritant contact dermatitis?

A

Hairdressers
Cleaners
Hospital workers

76
Q

Contact allergic dermatitis - type of reaction?

A

Type 4 T cell mediated hypersensitivity reaction in response to an antigen there has been previous exposure to. 1st exposure - sensitized and 2nd - reaction

77
Q

Rash and skin changes typically occur how long after exposure to the antigen?

A

48-96 hours after exposure to the antigen

78
Q

Common allergens in contact allergic dermatitis?

A

Rubber
Nickel (belts and jewellery)
Deodarants

79
Q

Allergic dermatitis seen in what occupations?

A

those exposed to allergens
builders
mechanics
hairdressers

80
Q

Dx Ix for contact allergic ?

A

Patch testing

81
Q

T for contact allergic dermatitis?

A

Allergen avoidance
Regular emollients
Topical steroids during flares

Dermatology (9 decks)

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