2/18 Psoriasis (Papulosquamous Disease)

Question 1

What are some of the features and physical findings of psoriasis?

Answer 1

Features: ham-colored plaques with loosely adherent silvery scales; present on extensor surfaces (knees, elbows, groin, scalp)

Physical findings

• well demarcated plaques and papules
• symmetrical distribution
• itchy, painful
• nails: **pitting
• Auspitz sign:**pinpoint bleeding that occurs when scales are removed; occurs due to dilated capillaries and thin epidermal layer over papillae

Question 2

Where does psoriasis usually affect?

Answer 2

extensor surfaces (knees, elbows, groin, scalp)

Question 3

What is Auspitz sign?

Answer 3

pinpoint bleeding that occurs when scales are removed; occurs due to dilated capillaries and thin epidermal layer over papillae

Question 4

What is the immunological cause of Psoriasis?

What are some common cytokines involved in its pathogenesis?

Answer 4

T cell mediated disease

IL17, IL23 - there are now drug therapies that target these two cytokines

Question 5

What are some triggers of Psoriasis?

Answer 5

Trauma
Friction
Changes in skin homeostasis (xs humidity, temp, UV)
Allergens (contact dermatitis)
Drugs
Infections

Question 6

What is the usual onset of Psoriasis?

Answer 6

BIMODAL

late 20s and early 50s

Question 7

What are the 4 variants of Psoriasis?

Answer 7

1. Guttate - lots of dots all over the body; occurs in children; due to post-strep pharyngitis
2. Pustular - localized on palm and soles
3. Intertriginious (inverse psoriasis) - affects skin folds (axilla, gluteal cleft, post-auricular)
4. Erythrodermic - total body redness

Question 8

What type of psoriasis is this?

What causes it?

Answer 8

GUTTATE

• caused by strep pharyngitis - bacterial antigens acts as superantigens that cause T cell activation, resulting in lots of dots all over the body.

Question 9

What type of psoriasis is this?

Where else would you find it?

Answer 9

PUSTULAR

occurs on palms and soles

Question 10

What type of psoriasis is this?

Where are these normally located?

Answer 10

Inverse psoriasis “intertriginous”

affects areas where there are skin folds (overlapping skin):

• *- axilla
• gluteal cleft
• post-auricular
• butt
• penis**

Question 11

What type of psoriasis is this?

What causes it?

Answer 11

ERYTHRODERMIC

total body redness; often presents with systemic symptoms

Question 12

How do you treat psoriasis?

Answer 12

**Topicals Rx: **mild-moderate psoriasis

Phototherapy - moderate-severe psoriasis

Systemics - oral or injected Rx

Question 13

What are the common causes of death in patients with psoriasis?

Answer 13

1. CVD (34%)
2. Infection (22%)
3. Cancer (21%)

Question 14

What are some of the topical therapies for psoriasis?

Answer 14

topical steroids
coal tar
UVB phototherapy
Anthraline
Vitamin D analogs (Calcipotriene, Calcipotriol)
Tazarotene (synthetic retinoid)

Question 15

What are the side effects of using retinoids, such as Tazarotene?

Answer 15

liver toxicities
alopecia
dry skin
nail loss

Question 16

What are some systemic therapies for psoriasis?

psoriasis “camp”

What are some of the ADRs and contraindications?

Answer 16

MTX - contraindicated in persons on bactram

PUVA - increase risk of melanoma and squamous cell carcinoma

Acitretin - synthetic retinoid ; long half-life; can cause liver toxicities, alopecia, dry skin, and nail loss

Cyclosporins - nephrotoxicity

Biologics: TNFa, antibodies against T cells

Question 17

What is the PASI score?

Answer 17

measures efficicacy of psoriasis treatment using a composite score of

• erythema
• induration
• desquamation

>75% = great because it means the psoriasis improved by 75%

Question 18

What does this person have?

How do you tell?

Answer 18

Seborrheic Dermatitis

presence of yellow, greasy scaling papules among red patches

plaques in areas that contain the greatest concentration of sebaceous glands (scalp, face, parasternal)

Question 19

What does Pityrosporum yeast cause?

Answer 19

Seborrheic dermatitis “dandruff”

Question 20

What does this person have?

how can you tell?

Answer 20

Seborrheic dermatitis

there are yellow, greasy scaling papules among red patches

Question 21

What does this patient have?

how do you treat it?

Answer 21

Seborrheic dermatitis

treatment:
remove the scale
low dose corticosteroids
topical antifungal (caused by Pityrosporum yeast)

Question 22

What is Seborrheic dermatitis?

What is it caused by?

How does it present in adults? children?

How is it treated?

Answer 22

Dandruff

caused by: Pityrosporum yeast

Adults: yellow, greasy scaling papules among red patches + plaques in areas that contain the greatest concentration of sebaceous glands (scalp, face, parasternal)

children: yellow, greasy adherent scale on scalp with minimal erythema;“cradle cap”

Question 23

What does this person have?

How can you tell?

Answer 23

Pityriasis Rosea

• *Oval** plaque, salmon colored with a
• *thin collar of residual scale** inside the border

Question 24

What does this person have?

Answer 24

Pityriasis Rosea

Oval plaque, salmon colored with a
thin collar of residual scale inside the border

distribution in a “christmas tree pattern”

Question 25

What is Pityriasis Rosea? What is the clinical presentation of it? What other disease does this resemble and how do you tell them apart?

Answer 25

self-limited disease (possibly of viral etiology) **Clinical Presentation** * **HERALD** patch appears on trunk (pval plaque, salmon colored with a thin collar of residual scale inside the border) * 1-2 weeks later, numerous lesions appear with a **christmas tree pattern** * clears spontaneously within 4-6 weeks, but hyperpigmentation may take months to resolve looks like **syphillis** but does not show up on palms and soles like syphillis

Question 26

What does this person have? How can you tell?

Answer 26

Lichen Planus 5 P'S **Purple polygonal Pruritic Papules Plaques Sharply defined** surface contains a lacy reticulated pattern

Question 27

What are the 5 P'S of lichen planus?

Answer 27

Purple polygonal Pruritic Papules Plaques Sharply defined

Question 28

What is lichen planus? Where does it normally affect? What is the characteristics of it? What patients is it common in?

Answer 28

itchy rash on the skin or in the mouth affects: skin, nails, mucous membranes (mouth, penis) 5P'S - purple, polygonal, pruritic, papules, plaques, sharply defined lacy, reticulated pattern Koebner Phenomenon - new lesions that may develop in areas of injury common in HepC, woman, + family history

Question 29

What is the Koebner phenomenon? What disease does it happen in?

Answer 29

new lesions that may develop in areas of injury happens in Lichen Planus

Question 30

What disease does this patient have? How can you tell?

Answer 30

Lichen Planus 5P'S - purple, polygonal, pruritic, papules, plaques, sharply defined lacy, reticulated pattern

Question 31

What does this patient have? How can you tell?

Answer 31

Lichen Planus lesions commonly develop in the mucus membranes and skin

Question 32

This is characteristic of what disease?

Answer 32

Lichen Sclerosis ivory white papules with a faint pink rim with dark brown keratotic follicular plugs can coalesce to form a smooth, white atrophic surface with a dull or glistening appearance

Question 33

You're an OBGYN resident and a patient comes in, wanting to know what's up with their jizz. What do you tell them? How do you tell?

Answer 33

Lichen Sclerosis - a disease of unknown cause that results in white patches on the skin, which may cause scarring on and around genital skin if its not treated. Features: ivory white papules with a faint pink rim with that can coalesce to form a smooth, white atrophic surface with a dull or glistening appearance

Question 34

What is Lichen Sclerosis? Where does it normally affect? Who does it normally affect? What are some characteristic features of it? What are some of the clinical features on it?

Answer 34

It's a disease of unknown etiology affects skin + mucosal surfaces with a predilection for **anogential skin** **Females** skin lesons can be asymptomatic, but it can be **pruritiic** if it's not treated, it can lead to **irrversible scarring** can develop to **squamous cell carcinoma**

Question 35

dx?

Answer 35

lichen sclerosis

Question 36

dx?

Answer 36

lichen sclerosis

Question 37

dx?

Answer 37

pustular psoraisis