Y2S1B1 - Cs - Papulosquamous, Vesiculobullous Diseases, And Common Skin Neoplasms

Front 1

What skin disorder is a chronic disease, characterized by recurrent exacerbations and remissions?

Back 1

Psoriasis

Front 2

What is the most definitive HLA association with psoriasis?

Back 2

HLA-Cw6

Front 3

What is the term to describe that any area of trauma to the skin can cause a psoriatic plaque?

Back 3

Koebner's reaction

Front 4

50% of children get exacerbation of PSA after what?

Back 4

2-3 weeks of URI

Front 5

Guttate PSA is an example that can follow what type of infection?

Back 5

Acute streptococcal infection

Front 6

What is a possible medication trigger for psoriasis?

Back 6

Lithium

Front 7

What might be confusing about sunlight with psoriasis?

Back 7

Sunlight is reported to be beneficial, but TOO much exposure can trigger an exacerbation d/t trauma!

Front 8

Persistent TH1 activation is a/w which skin disorder?

Back 8

Psoriasis

Front 9

What are the clinical features of psoriasis?

Back 9

-sharply demarcated, erythematous plaques, papules and patches
-thick silvery-white scale!
-Auspitz sign (pinpoint bleeds)
-Koebner's phenomenon (20% pts)
-Woronoff ring

Front 10

What is the most common form of psoriasis?

Back 10

Psoriasis Vulgaris (erythematous plaques w/ silver)

Front 11

Which form of psoriasis has a sudden appearance of small red/pink scaly papules on skin (almost like small drops of PSA on skin) diffusely over trunk and extremities?

Back 11

Guttate Psoriasis

Clue: look for recent strep throat. preceeds eruption by 1-2 weeks in 50% of cases!

Front 12

Which (more serious) form of psoriasis has an abrupt eruption of numerous sterile pustules on highly erythematous skin?

Back 12

Generalized Pustular Psoriasis (of Von Zumbusch)

Can coalesce into "lakes of pus!"

Front 13

Which form of psoriasis begans as pustules on the distal fingers and is VERY tender?

Back 13

Acrodermatitis continua of Hallopeau

Front 14

Which types of nail changes can occur usually after Psoriasis Vulgaris (10-20% pts)?

Back 14

Nail matrix: pitting/ crumbling/thickening

Proximal bed: salmon or “oil spots”, splinter hemorrhages (focal onycholysis)

Distal bed: distal onycholysis (lifting of the nail plate from the nail bed)

Front 15

What are some possible trigger factors for generalized pustular psoriasis (of Von Zumbusch)?

Back 15

infections, rapid tapering of corticosteroids, hypocalcemia, pregnancy

Front 16

What are possible treatments for Psoriasis?

Back 16

Topical agents (corticosteroids, corticosteroid sparing agents, Vitamin D3 analogues)
UV light
Systemic drugs (conventional or biologic agents)

Front 17

Which form of treatment is usually used alone for psoriasis if the extent is limited?

Back 17

Topical agents (corticosteroids, corticosteroid sparing agents, Vitamin D3 analogues)

Front 18

How effective is PUVA?

Back 18

85%, but with risk of skin CA. It's stronger than UVB light boxes.

Front 19

What conventional systemic drugs can be used to treat psoriasis, and what is their MOA?

Back 19

Methotrexate or Cyclosporine

They are immunosuppressive

Front 20

What labs must you monitor with Methotrexate treatment in psoriasis, and why?

Back 20

liver function test, renal function, and CBC, due to the hematologic changes that can be a/w methotrexate

Front 21

What biologic agents can be used to treat psoriasis?

Back 21

Adilmumab, etanercept, infliximab

All TNF-alpha inhibitors- last resort

*Etanercept is associated with an aggravation of CHF and all of these can be associated with Tb

Front 22

What are the clinical features of Pityriasis Rosea?

Back 22

-Pink/salmon colored, oval in shape w/ a “collarette” of fine scale around lesion.*
-Favors trunk and extremities
-Initial lesion (common first on abdomen) is referred to as the “herald patch”* --- plaque that is LARGER than the subsequent lesions
-“Christmas tree” distribution on back*

Pityriasis Rosea is a benign, self-limiting skin eruption that abruptly appears.

Front 23

What disorder is an idiopathic inflammatory disease that affects the skin, hair, nails and mucous membranes? (flat topped papule)

Back 23

Lichen Planus

Front 24

What are the clinical features of Lichen Planus?

Back 24

-5 P's*: Pruritic, Planar, Polyangular (irregular angular borders), Purple, Papules
-Favors flexor surfaces of the wrist *(especially wrist), arms and legs. Also see in the genitalia and oral mucosa.*
-Wickham’s striae *may be present- lacy white lines over the plaque.
-Very pruritic*

Front 25

Autoimmune Blistering Diseases (AIBDs) result from the production of what?

Back 25

autoantibodies that attack a specific adhesion protein in the skin that is responsible for either:

Holding the cells of the epidermis together (desmosomes)
OR
Holding the epidermis to the dermis at the dermal epidermal junction (hemidesmosomes)

Front 26

Is mucosal involvement more common in PV or BP?

Back 26

PV

Front 27

What are the clinical features for PV?

Back 27

-Oral mucosal lesions, usually before skin lesions (intact bullae are rarely found in the mouth, usually only find painful erosions and pain can interfere with eating)

-Characteristic skin lesion: FLACCID, thin walled bullae that are easily ruptured

Front 28

What 3 ways can you tell Pemphigous Foliaceous/Superficial Foliaceous (PF) from PV?

Back 28

-Blister occurs higher in epidermis
-Different antibodies involved (desmoglein 1 only)
-does NOT involve mucosal membranes

Front 29

What are the clinical features of BP?

Back 29

-Widespread TENSE blisters with good structural integrity
-Can be intensely pruritic (itchy)
-May start initially as pruritic urticarial (hives) plaques and then develop widespread blisters
-Rupture of blisters leads to well-demarcated areas of denuded skin
-Tends to heal rapidly (unlike in PV)
-Nikolsky sign negative
-Most common sites of involvement: abdomen, groin, flexor surfaces of arms and legs, and mucous membrane involvement is more uncommon (~ 20%)

Front 30

An 83 year old man (or woman) presents with tense blisters that itch. This is most likely...

Back 30

BP

Front 31

What is the treatment for BP?

Back 31

Corticosteroids and immunosuppressants

– Oral steroids
– Azathioprine
– Mycophenolate mofetil
– Nicotinamide
– Tetracycline

Front 32

What are the main clues to BP?

Back 32

-Skin itchy
-TENSE blisters
-Elderly patient
-Subepidermal blister with eosinophils
-Antigen against: BP230 and BP180

Front 33

Which skin disease is almost ALWAYS a/w gluten sensitivity?

Back 33

Dermatitis Herpetiformis

Front 34

What are the clinical features of Dermatitis Herpetiformis?

Back 34

-SEVERELY PRURITIC grouped vesicles*
-Eruption may be PRECEDED by burning or itching
-Lesions tend to commonly be symmetric and occur first on extensor surfaces * (Like on elbows and knees *)
-HOWEVER, often won’t see vesicles b/c patients scratch at lesions* (often times just see non-specific crust and excoriated/scratched areas; may make you consider scabies as a DDx)

Front 35

How is DH treated?

Back 35

Gluten free diet*
Dapsone*
Sulfasalazine
Sulfapyridone

Front 36

Why is it important to consider the location of the lesion in Allergic Contact Dermatitis?

Back 36

The ACD reaction is typically LOCALIZED to the area of skin that comes in contact with the allergen

Front 37

What are the top 2 allergens for ACD?

Back 37

1. Nickel sulfate 16.7% * (nickel ranked as top allergen by NACDG)
2. Neomycin sulfate 11.6%* (found in OTC topical antibiotic Neosporin*)

Front 38

T/F

Latex is a common allergen for ACD.

Back 38

True!

This is found in surgical gloves. Alternatives are vinyl or blue nitrile gloves.

Front 39

What type of ACD is caused by Poison Ivy, Poison Oak, or Poison Sumac?

Back 39

Rhus Dermatitis

Front 40

Describe lesions of Rhus Dermatitis.

Back 40

Often pruritic*
Streaky or linear**
Also may be marked by hives or blisters*

Front 41

What is the name of a phototoxic reaction that is caused by plant contact with skin that is THEN exposed to light (light activates the photosensitive chemical)?

Back 41

Phytophotodermatitis

Front 42

Describe the lesions of phytophotodermatitis.

Back 42

-Lesions typically appear several hours after exposure followed by burning erythema and development of vesicles/bullae*
-Lesions are asymmetric, of atypical shape and can be streaky
-Later, a residual hyperpigmentation occurs

Front 43

The most common areas for skin tags are where?

Back 43

the axilla (48%) followed by the neck (35%)

Front 44

What is a cutaneous horn?

Back 44

A hard, keratin projection

Front 45

Describe dermatofibromas.

Back 45

Benign, hard nodule

Front 46

Name for a painful (can be exquisitely tender), red, inflamed lesion on helix of ear.

Back 46

Chondrodermatitis Nodularis Helicis

Front 47

What is the best treatment for keratoacanthomas?

Back 47

Surgical removal! also helps rule out SCC, since they are difficult to distinguish

Front 48

Describe a pyogenic granuloma.

Back 48

Fragile and bleed easily
Glistening, moist-to-scaly surface

Front 49

What is the difference between a hypertrophic scar and a keloid?

Back 49

Hypertrophic scars are inappropriately large, but they are CONFINED to the wound site and REGRESS with time.

Keloids EXTEND beyond the margins of injury.