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Derm Rheum > Psoriasis and Other Papulosquamous Disorders - Patel > Flashcards

Psoriasis and Other Papulosquamous Disorders - Patel Flashcards

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Dermatology Board Prep flashcards
1
Q

what age can psoriasis present at? when does it most commonly occur?

A

psoriasis can present at any age, but it occurs most commonly in the third and sixth decades

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2
Q

what are the 5 main variants of psoriasis?

A

plaque type guttate pustular inverse erythrodermic psoriasis

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3
Q

What is the most common variant of psoriasis and describe the lesions associated with it

A

plaque-type psoriasis (90%) well-demarcated, erythematous plaques with an adherent, silver to white colored scale

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4
Q

where on the body do the plaques associated with plaque psoriasis most often occur

A

scalp, extensor surfaces of extremities (elbows and knees), and the periumbilical and sacral trunk RARELY occur on face, or on intertriginous areas of the body (crotch and armpit)

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5
Q

What is the Koebner phenomenon, what skin condition(s) is it associated with; what are some specific examples

A

it is where lesions arise at sites of trauma associated with plaque psoriasis. it occurs after scratching or areas of sunburn

  • Also seen with Lichen Planus
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6
Q

What is inverse psoriasis, where does it occur

A

in the intertriginous areas of the body (gooch and pits) - compare to plaque psoriasis which rarely occurs here

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7
Q

do you see invovlement of flexor surfaces in plaque psoriasis?

A

no - popliteal fossa and antecubital fossa areas are commonly spared (diff from atopic dermatitis)

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8
Q

what is the Auspitz sign and what disease is it associated with?

A

plaque psoriasis - if you pick off a scale, will see bleeding - due to elongated dermal papillae being exposed after scratching off

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9
Q

what is the second most common variant of psoriasis?

A

Guttate psoriasis

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10
Q

Guttate psoriasis - who is more common in and how does it present (describe lesions)

A

more common in young adults multiple small “drop shaped” erythematous scaly palques diffusely on body - frequently on trunk

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11
Q

what usually precedes guttate psoriasis? how does this affect treatment?

A

guttate psoriasis is often preceded by streptococcal infxn, especially pharyngitis thus treatment usually includes ABX

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12
Q

describe the appearance and distribution of pustular psoriasis

A

superficial pustules - localized on palms and soles or can be generalized

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13
Q

what is the term for pustular psoriasis localized on palms and soles

A

palmoplantar pustulosis

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14
Q

characterize the erythrodermic variant of psoriasis

A

diffuse erythrodema with fine scaling i.e. total body redness

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15
Q

describe involvement of the tongue (mucosal) in psoriasis - appearance

A

geographic, annular white patches

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16
Q

describe psoriatic nail changes (4)

A

“oil spots,” nail pitting, distal onycholysis, accumulation of subungual debris

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17
Q

what is distal onycholysis

A

lifting up of the nail at the distal portion

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18
Q

what is the major associated systemic manifestation of psoriasis and how does it present

A

psoriatic arthritis asymmetric oligoarthritis of small joints of hands and feet

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19
Q

what are 5 pathologies/ diseases that psoriatic patients are at increased risk for developing

A

obesity DM hyperlipidemia HTN CV disease

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20
Q

what joints are most commonly involved in psoriatic arthritis and what is the description of the appearance of these?

A

DIP joints most common “sausage fingers” termed dactylitis

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21
Q

what is the pathogenesis of psoriasis

A

T-cell mediated inflammatory disease

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22
Q

describe the genetics associated with psoriasis

A

about 1/3 of pts w/ psoriasis have a 1st degree relative with psoriasis genetics play a role

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23
Q

what factors contribute to flares seen in psoriasis

A

group A beta-hemolytic strep infxns, medications, and stress

24
Q

what medications are associated with flares in psoriasis

A

beta blockers, ACE inhibitors, NSAIDs, lithium, interferon and antimalarials

25
Q

what natural factor diminishes psoriasis

A

sunlight phototherapy is a potential form of therapy

26
Q

when do you use topical treatment alone for psoriasis

A

when the psoriasis is localized

27
Q

what topical treatments are used in psoriasis (5)

A

topical steroids

topical retinoids

topical Vit D agents

topical keratolytics

topical tar products

28
Q

what is the treatment regimen for patients with moderate to severe psoriasis?

A

systemic treatment in addition to topical therapy

29
Q

what comprises the systemic treatment used in psoriasis

A

phototherapy, oral medications (retinoids, MTX) and biologics

30
Q

what biologics comprise the systemic treatment of moderate to severe psoriasis

A

TNF-a inhibitors

IL12/23 blocker

IL-17 blocker

31
Q

What is a key systemic treatment that you should not use in the treatment of moderate to sever psoriasis and why? this is $$

A

systemic steroids SHOULD NOT be used for tx of psoriasis the risk of disease flare upon discontinuation of the steroids is high

32
Q

define Seborrheic dermatitis, including the bug associated with it

A

a very common inflammatory reaction to Malassezia (Pityrosporum ovale) yeast that thrives on seborrheic (oil-producing) skin

33
Q

how does Seborrheic dermatitis present

A

erythematous scaling patches on the scalp, hairline, eyebrows, eyelids, central face and nasolabial folds, external auditory canals, or central chest all the oily areas

34
Q

describe the presentation of seborrheic dermatitis in infants

A

“cradle cap” pink to yellow macules and patches with white greasy scales on the scalp, face, and diaper area

35
Q

is what pt population is seborrheic dermatitis worse

A

HIV

36
Q

does seborrheic dermatitis appear hyperpigemented or hypopigmented?

A

hypopigmented, especially in darker skin types

37
Q

what part of chest does seborrheic dermatitis favor?

A

central chest where there is the greatest concentration of oil

38
Q

what is the treatment for seborrheic dermatitis

A

ketaconazole cream or dandruff shampoos or low-potency steroid for flares

39
Q

define Pityriasis Rosea, and who does it commonly occur in?

A

acute papulosquamous eruption that mainly occurs in young people

40
Q

what virus may Pityriasis Rosea be associated with?

A

human herpes virus 6 or 7

41
Q

how does Pityriasis Rosea present?

A

initially with a single herald patch, a pink-salmon colored, oval, 2-10 cm plaque with central fine collarette scale

42
Q

what is the secondary phase of pityriasis rosea?

A

eruption in “christmas tree” pattern - numerous smaller similar lesions dispersed on trunk in Xas tree pattern

43
Q

describe the course of pityriasis rosea

A

acute onset, lasts 6-8 weeks

44
Q

what is the treatment for pityriasis rosea?

A

it is self-limiting, mean duration is 5 weeks, most resolve without treatment by 8 weeks some patients request treatment for pruritis

45
Q

define lichen planus

A

idiopathic inflammatory dz of skin, hair, nails, and mucous membranes - seen most common in middle-aged adults

46
Q

describe the lesions of lichen planus - this is $$ (Emily Thompson said this is on the test)

A

6Ps purple pruritic plaques papules polygonal planar - they are flat topped

47
Q

besides the 6 Ps, what is another feature associated with Lichen Planus, name and describe

A

a fine reticulated network of white lines - Wickham’s Striae

48
Q

Lichen Planus - where are lesions found on body

A

flexor wrists, forearms, dorsl hands, lower legs, presacral area, neck, and glans of the penis (schlong is common site)

49
Q

what phenomenon is associated with Lichen Planus

A

Koebner’s phenomenon - lesions appear in areas of trauma

  • also associated with plaque psoriasis
50
Q

what are potential triggers for Lichen Planus

A

Hep C infection or medication (ACE-I, thiazide diuretics and antimalarials)

51
Q

what is common finding of oral mucosa involvement in Lichen Planus

A

oral lesions present as net-like white streaks on buccal mucosa - Wickham’s striae

52
Q

what variant of lichen planus causes scarring alopecia

A

Lichen planopilaris (LPP), the follicular (hair) variant of lichen planus

53
Q

what drugs are most commonly implicated in the cause of Lichen Planus

A

ACE inhibitors, thiazide diuretics, antimalarials, quinidine, and gold (gold all in my chain, gold all in my rang, gold all in my watch, don’t believe me just watch)

54
Q

what is a high $$ association for Lichen Planus i.e. what other disease is more prevalent in pts with LP vs controls

A

Hep C atypical presentations are also more likely to be associated with Hep c

55
Q

what is pathogenesis of Lichen Planus

A

likely involves an autoimmune reaction against antigens on lesional keratinocytes

56
Q

besides topical corticosteroids, how can we treat mucosal lichen planus

A

topical calcineurin inhibitors (tacrolimus)

57
Q

what is the intitial treatment for Lichen Planus

A

topical and intralesional corticosteroids

Derm Rheum (39 decks)

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