Rashes Clinical Cases Flashcards
Causes of psoriasis?
Multifactorial
- environment- stress, drugs, infection
- Genetic
Commonest form of psoriasis?
Psoriasis Vulgaris
Distribution of psoriasis?
Symettrical
Common sites: extensors (elbows/knees), scalp, sacrum, hands, feet, tree, trunk
Other psoriasis signs?
Koebner phenomenon- psoriasis develops in area of skin trauma
Auspitz sign: removal of surface scale reveals tiny bleeding points
Psoriatic nail disease?
Onycholysis
Nail pitting
Dystrophy
Subungal hyperkeratosis
Life psoriasis does not reduce life expectancy. True or false?
FALSE
reduced by about 4 years in patients with severe psoriasis primarily oweing to increased CVD
Managing psoraisis?
- Aim to control chronic disease
- Recognize psychological impact
- Recognize co-morbidities
Topical therapies for psoraisis?
Vitamin D analogues:
- Calcipotriol (localized plaques rather than flexures)
- Calcitriol (less rritatings, better for flexures
Coal tar
Dithranol - if few localized plaques and patient complies
Steroid ointments
Emollients for everyone
Other treatments for psoriasis?
Phototherapy
Systemic treatments
Initial management of acne?
Oral AB: doxycycline, topical retinoid
Second line management of acne?
Oral isotretinoin
(usually causes initial flare 2-3 weeks then steady improvement over 16 weeks) (Causes congenital defects and has many side effects)
-Patient counselled on side effects
What is acne vulgaris?
Chronic inflammatory disease of pilosebaceous unit
What is an open comedone?
Blackhead
White head is a ——— comedone?
Closed
Secondary features of acne vulgaris?
Scars
Atrophic, ice pick
Texture changes
Hypertrophic
Acne treatment?
- Avoid oily substance, triggers
- Topical treatment
- Systemic treatment (AB’s for atleast 6 months)
- Isotretinoin (oral retinoid)
Example of topical acne treatments?
Benzoyl peroxide
Topical Vitamin A derivatives
Topical AB
Symptoms of rosacea?
Nose, chin, cheeks and forehead redness
- Papules, pustules and erythema with no comedones
- Prominent facial flushing exacerbated by sudden change in temp, alcohol & spicy food
- Enlarged, unshapely nose
- Conjunctivitis/gritty eyes
Rosacea management?
Reduce aggravating factors
-Dietary triggers, sun exposure, avoid topical steroids
Topical therapies: metronidazole
Oral therapy:
oral tetracycline
isotretinoin
What are lichenoid eruptions characterized by?
Damage and infiltration between epidermis and dermis
Pathophysiology of lichen planus?
T cell mediated inflammation targeting an unknown protein within the skin and mucosal keratinocytes
What is Wickham’s striae?
Fine lace-like pattern on surface of papules and buccal mucosa
Management of lichen planus?
Emollients
Treat symptomatically -topical steroids, oral steroids
UVB phototherapy or PUVA
What is pathophysiology of bullous disorders?
Autoimmune diseases where damage to adhesion mechanisms in the skin results in blistering at various levels
