Scaling Rashes Flashcards
Atopic derm etiology, barrier dysfunction, enivornment
Downregulation of cornified epithelium gene for fillagrin, prtoein contained in granules of outer layer of SC that is needed to make tough outer layer of the skin…recued amounts of ceramides (waxy lipids)…brick and mortar system fails
Barrier compormised by drying and harsh cleansers whcih activate proteases that further destroy…penetration can trigger hyperimmune response
Impaired immune response and epi of atpoic dermatits
T-helper 2 cells present in largr number which stimulate B cells to produce IgE…inflmation from cytokines
Enahnced transepidermal water loss as well
Most develop by 3-6 months…most resolve by adulthood
Atopic dermatitis
Apperance
Distribtuion
Sx
Erythematous papules becomes plaques
Infants and toddlers on face, trunk, and extensors
Children and adults on flexural creases…adults may get lichenification
Pruritic and xerotic…part of allergic triad of atopic dermatitis, allergic rhinitis and asthma
Tx of atopic derm
Adequate hydration with an emollient is important
Inflammation recued by topical CSs…less potent in face and gen
Severe may need steroid sparing agent like a topical calcineurin inhibitor that inhibits T cells
ANtihystemines acan help
Psoriasis etiology of 1st 2 stages
Normal helathy skin contains Langerhan cells and dnedirtic cells in epidermis and T cells in dermis
Normal appearing skin from a psoriatic pt has increased mononuclear and mast cells and slight curvature of capillaries…mild increase in thickness of epidermis
Psoriasis 2nd 2 stages
Trnasition zone - increased monoculaer cells mast cells…dilation of caps…epidermis thicker…parakeratosis present - keratinization where they retain nucleus in SC…spotty loss of granular layer of epidermis…increased cell tunrover…Langerhands leave and replacedby T cells
Fully developed - 10 fold increase in blood flow…increased macros and dermal T cells…compaction of SC and increased T cells and nuetros in SC
Psoriasis epi
Plaque like appearance and dist
Guttate appearance and dist
Uncommon under 10…mostly 20-30
Strep pharyngitis has been associated with guttate,,,meds, infections
Most common,..demaracted, raised, erythematous, plquaes…symmetric over extensor
Small “drop like” scaly plaquyes…upper trunk and proximal extemeities
Associated nail findings and why
Onycholysis - spearation of nail plate from nail bed and oil drop spotting…red yellow spot at distal
Nail bitting - defective keratinization
Subungal hyperkeratosis - abnormal keratinzaiton of distal nail bed
Onychodystrophy - loss of nails
Auspitz sign
Koebner phenomenon
Blleding after sclae remove
Trauma to skin reuslting in psorias…skin biosy or sunburn
Topical steroids
Vit D derivs
Topical retinoids
Clobetasol, mometasone, fluocinolide - anti inflam
Calcipotriene - normalizes keratinocyte prolif
Tazarotene - normalizes keratino prolif
Topical immunosuppresives
Anthralines
Coal tar
Tracolimus, pimecrolimjus…inhibit T cell act
Antrahlin - antiprolif on keratinocyte
Coat tar keratinolytic
Other tx
Lmited plauqe controlled with topical agents
Mod to severe may need systemic
Phtotherapy can reduce T cell apoptosis and slows ketainozation
Methotrexate has antiprolif on DNA ynstheis in epidermal cells and immunosuppresive
TNF-alpha inhibitos are monoclonal ABs that decrease immune response
Pityriasis orsea
Etiology/app, appearance distribtuion, tx
HHV 7?…childre nad young adults
80% intitially have a hearld pathc that is a oround to oval erthematous patch with a scaling border and central clearing
2 weeks later, pruritic eruption on the trunk that looks like a Christmas tree,..resolves in 4-8 weeks
Most do not ned tx
Seborrheic dermatitis eti/epi, appearance (infantile vs adult) and tx
Chornic dermatitis releated to malassezie furfur
Infalantile - yellow greasy scale on scalp (cradle cap)…erythematous patches with greaay scale with predilection to face and flexural areas
Adult - dandrugg…scaling patches on ears, borws, nasolabial folds and beard
Antifungal that inhiibts triglycerides and phopholipids production
Topical corticosteroids
Selenurm shampoo
Tinea etio/epi diagnosis
Superficial fungal infection impacting keratinized tissue cuased by dermatophytis…trichophyton most ocmmon in US
Clinical
KOH prep shoudl see branching hyphae
Culture not needed
Wood’s lamp can be used to looks at scalp
