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58 Cards in this Set
- Front
- Back
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What is the list of diseases that can be considered to be papulosquamous diseases?
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Psoriasis
Seborrheic Dermatitis Pityriasis Rosea Lichen Planus Secondary Syphilis Tinea versicolor/corporis CTCL Drug eruptions Saml and large plaque parapsoriasis PLEVA/Pityriasis lichenoides chronica Pityriasis rubra pilaris |
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What percentage of people have psoriasis?
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0.5-2%
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Psoriasis: age distribution
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two peaks
20-30 50-60 |
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Psoriasis: gender distribution
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M=F
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Psoriasis: most common form in children
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guttate
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Psoriasis: pathogenesis
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unclear, assoc w HLA-cw6 (PSORS1 locus).
T cells are a driving force (Th1>Th2). Significant numbers of T cell in epidermis and dermis. |
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Psoriasis: environmental triggers
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- trauma --> Koebner's phenomenon
- Infections (strep pharyngitis) - HIV - Hypocalcemia - Stress - Drugs: lithium, beta-blockers, anti-malarials, interferons, rapid taper of steroids - Alcohol - Smoking |
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Psoriasis: drug triggers
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Lithum, beta-blockers, anti-malarials, interferons, rapid taper of steroids.
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Psoriasis: types
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- Psoriasis vulgaris
- Guttate (drop-like) - Inverse - Palmoplantar - Erythrodermic - Pustular (generalized or localized) - Psoriatic nail involvement |
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Psoriasis: clinical presentation
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extensors
well-demarcated plaques erythemetous scaly plaques Face rarely involved Auspitz sign: bleeding upon removal of scale Better in summer, worse in winter. Frequently itch Occasionally painful |
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Guttate psoriasis: general
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most common form in children
Often preceded by a Group A hemolytic strep URI 2-3 weeks before onset. Antistreptolysin may be positive Tx of active strep infection or carrier state with ABX may hasten remission |
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Psoriasis: what is it called if seen in intertriginous areas?
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Inverse psoriasis
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Psoriasis: erythrodermic type
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redness/scaling involving over 90% of TBSA
Can be caused by withdrawl of MTX or systemic steroids Systemic manifestations: tachycardia, peripheral edema, dehydration, high output CHF, hypothermia, protein loss |
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Generalized pustular psoriasis
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Von Zumbusch
- Disseminated erythematous areas with pustules - Systemic symptoms - Quick onset High fever, joint aches |
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Acrodermatitis continua of Hallopeau
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Associated with onychodystrophy
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Psoriasis: nail involvement
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25-50% of patients with psoriasis have nail involvement
oil spots onycholysis nail pits subungual hyperkeratosis |
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Nail pitting: DDx
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1. Psoriasis
2. Alopecia areata |
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Psoriatic arthritis: attributes
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5-30% of patients with psoriasis have psoriatic arthritis
- Asymmetrical oligoarthritis - DIPs/PIPs - Exclusively DIP involvement - Symmetric (like RA) - Arthritis mutilans (sausage digits) - Spondylitis/sacroilitis |
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Psoriasis: tx of mild to moderate
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Topical:
- corticosteroids - tar, salicyclic acid, urea preparations - calcineurin inhibitors (tacrolimus) - anthralin - retinoids (tazarotene) - Excemer laser (308 nm) - UVB phototherapy |
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Psoriasis: adverse effects of topical steroids
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atrophy, telangiectasias, striae, adrenal suppression.
Tachyphylaxis (tolerance develops to steroids) |
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Psoriasis: tx of moderate to severe
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- Phototherapy
- Systemic retinoids - Systemic retinoids plus phototherapy - Methotrexate - Cyclosporine - Biological agents |
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Psoriasis: biologics used for tx
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infliximab
etanercept adalimumab alefecept: blocks CD2-LFA3 interaction --> depletion of memory effector T cells efalizumab: blocks the interaction of LFA-1 with intracellular adhesion molecule-1 --> inhibition of T cell activation and movement of T cells from circulation into the dermis |
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Seborrheic dermatitis: definition
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A common inflammatory skin disorder characterized by erythematous scaly plaques, primarily involving areas of skin rich in sebaceous glands.
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Seborrheic dermatitis: clinical presentation
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pink to light red plaques (not as well demarcated as psoriasis), with fine white to greasy yellow scale. May be pruritic
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Seborrheic dermatitis: distribution
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scalp, flexural and diaper areas in children.
beard area, eyebrows, central face, chest, axillae, pubic areas in adults |
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Seborrheic dermatitis: what percentage of population has it?
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2-5%
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Seborrheic dermatitis: age distribution
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Bimodal
Under 1 y.o. 40-60 |
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Seborrheic dermatitis: gender distribution
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M>F
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Seborrheic dermatitis: association with other diseases
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higher rates in Parkinson's and HIV patients
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Seborrheic dermatitis: sudden onset may signal the presence of what disease?
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HIV!
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Seborrheic dermatitis: pathogenesis
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Overgrowth on the skin of the yeast Malassezia furfur (Pityrosporum ovale), a lipophilic yeast.
Also due to active sebaceous glands. Increased sebum production? Lipid composition? |
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Seborrheic dermatitis: complication
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secondary bacterial infection
belpharoconjunctivitis secondary eczematization from prutitus and scratching |
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Seborrheic dermatitis: DDx
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Scalp - psoriasis, xerosis, dermatomyositis
Face - rosacea, SLE, tinea Trunk - pityriasis rosea, psoriasis, SCLE, tinea Intertriginous areas - eythrasma, inverse psoriasis, candidiasis, tinea cruris |
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Seborrheic dermatitis: mildest form is called what?
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dandruff! Just scales, no erythema.
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Seborrheic dermatitis: tx for sd on scalp
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Anti-seborrheic shampoos: zinc pyrithione, selenium sulfate, salicyclic acid, ketoconazole 2%, ciclopirox
Removal of heavy scale with keratolytic agents: mineral oil, 6% salicyclic acid gel, Baker's P&S solution Anti-inflammatory: low to mid potency topical steroid solutions, gel, or foams |
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Seborrheic dermatitis: tx for sd on face, ears, skin folds
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Topical anti-yeast: ketoconazole adn ciclopirox creams
low/mid potency steroids Anti-seborrheic shampoos |
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If you suspect pityriasis rosea, what other disease should you rule out?
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Secondary syphilis (get an RPR)
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Pityriasis rosea: epidemiology
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Tends to affect young, healthy indivs (10-35 y.o.)
All races, worldwide F:M, 2:1 "comes in little epidemics" |
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Pityriasis rosea: pathogenesis
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HHV-7 suspected
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Pityriasis rosea: clinical features
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A solitary lesion appears on trunk and enlarges (Herald patch)
Pink/tan/salmon plaque with slightly raised advancing margin. Trailing collarette of scale with free edge pointing inwards (vs. tinea corporis, which points outwards) Prodromal URI may be noted Within days more lesions on trunk and prox ext Follow Langer lines of cleavage --> this accounts for the Christmas tree pattern Face, palms, soles are typically spared. 25% experience pruritus. Can look like psoriasis |
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Pityriasis rosea: DDx
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Secondary syphilis (check RPR, VDRL)
Drug induced Pityriasis rosea (Gold, ACEi, Metronidazole, isotretinoin, arsenic, beta-blockers, barbituates) Nummular eczema Guttate psoriasis |
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Pityriasis rosea: treatment
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Self-limited (6-8 weeks, but can persist for > 5 mo)
Topical steroids for symptomatic relief Oral antihistamines for itching Phototherapy if severe sx Some evidence that patients may respond well to erythromycin |
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Lichen planus: associated with what disease?
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Hep C!
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Lichen planus: epidemiology
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< 1% of pop
any race 50-60s |
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Lichen planus: pathogenesis
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Autoimmue reaction against epitopes on lesional keratinocytes which have been modified by viral or drug antigens.
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Lichen planus: Clincal features
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Pruritic
Polygonal Purple flat topped Papules Wickham's striae (fine white lines) See Koebner's phenomenon |
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Lichen planus: distribution
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Flexor wrists
forearms dorsal hand anterior lower leg genitals oral mucous membranes nails "very itchy, but people don't scratch it that much" |
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Lichen planus: mucosal type
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Seen in up to 75% of those with cutaneous disease
in 25% of cases is the only manifestation of the disease reticular pattern in the buccal mucosa is most common atrophic or erosive lesions may occur annular appearance common on the glands penis "a miserable disease" |
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Lichen planus: nail involvement
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involved in 10% of cases
lateral thinning, longitudinal ridges, pterygium. Can lead to scarring |
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Lichen planus: tx
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corticosteroids (decadron)
topical immunosuppressants phototherapy antimalarials systemic retinoids systemic steroids MTX Cyclosporine |
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Psoriasis vulgaris: histo
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Psoriasiform epidermal hyperplasia
- regular elongation of rete ridges - thickening (clubbing) of lower portions of rete ridges - Parakeratosis - Hypogranulosis (fast turnover of skin) - Intracorneal neutrophils (microabscesses of Munro) - Intraspinous neutrophils (spongiform pustules of Kogoj) |
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Pustular psoriasis: histo
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subcorneal pustules
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Geographic tongue: histo
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Irregular psoriasiform hyperplasia with spongiform pustule
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What diseases exhibit psoriasiform dermatitis?
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Psoriasis and variants
Reiter's syndrome Lichen simplex chronicus Mycosis fungoides Pityriasis rosea |
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Lichen planus: histo
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- hyperkeratosis
- saw tooth hyperplasia of rete ridges - band-like infiltrate - hypergranulosis - interface changes - Civatte bodies (apoptosis) |
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Which diseases exhibit lichenoid dermatitis?
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Lichen planus and variants
Fixed drug eruption Erythema multiforme SLE and variants Dermatomycosis Lichen sclerous et atrophicus |
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Erythema multiforme: histo
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vacuolar alteration of basal cells
Several necrotic keratinocytes Mild inflammatory reaction |
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Lupus erythematosus: histo
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Pronounced vacuolar degeneration of basal cells
Perivascular lymphoid cell infiltrate |
