091714 inflammatory disorders

Question 1

side effects of topical corticosteroids

Answer 1

mainly restricted to area of application

from chronic use: hypopigmentation, hypertrichosis, skin atrophy, telangiectasia. also striae. (if used on face, get acne or forms of rosacea) (if used around eyes, may increase risk of glaucoma and cataracts)

Question 2

ointment vs cream

Answer 2

ointments are preferred by many dermatologists (they allow for better penetration of active ingredient through stratum corneum)

Question 3

cons of ointment

Answer 3

greasy

patient non compliance

Question 4

cream pros

Answer 4

better pt compliance

Question 5

lotion and solution pros and cons

Answer 5

pros: good for scalp and places w hair
cons: stinging

Question 6

foam pros and cons

Answer 6

good for scalp and places w hair

cons: stinging

Question 7

gel pros and cons

Answer 7

pros: good for intraoral use
cons: drying, stinging

Question 8

psoriasis characteristic lesion

Answer 8

well demaracted erythematous papules and plaques, with overlying silvery scale

Question 9

clinical variants of psoraisis

Answer 9

plaque psoriasis (most common)
guttate psorasis (numermous smaller lesions, often triggered by strep)
erythrodermic (generalized erythema)
pustular (broad patches of erythema and overlying pustules)

Question 10

plaque psorasis

Answer 10

symmetric, with elbows and knees being commonly invovled

Question 11

tx of psoriasis

Answer 11

topical corticosteroids

others include: retinoids, coal tar, calcineurin inhibitors

topical vitamin D to induce terminal differentiation and inhibit proliferation of keratinocytes and to modulate the imune response

Question 12

atopic dermatitis

Answer 12

most common chronic inflam skin disease

often occurs in setting of other atopic disorders including allergic rhinoconjunctivitis and asthma

Question 13

pathogenesis of atopic dermatitis

Answer 13

multifactorial with genetics, epidermal barrier dysfxn and immunopathology all playing roles

major predisposing factor is mutations in profilaggrin gene

Question 14

appearance of atopic dermatitis

Answer 14

acute lesions are usually edematous, erythematous papules and plaques and may ooze

subacute: erythematous and scaly, may be crusted
chronic: thickened with lichenification

Question 15

diff btwn atopic dermatitis and psoriasis

Answer 15

AD lesions tend to be less well defined than those of psoriasis

Question 16

tx of atopic dermatitis

Answer 16

topical corticosteroids
education regarding skin care to minimize further disruption of skin barrier with use of non drying cleansers and frequent application of emollients

antihistamines for pruritis

Question 17

seborrheic dermatitis

Answer 17

mild inflammatory condition with variable presentation based on age

Question 18

pathogenesis of seborrheic dermatitis

Answer 18

not understood

Question 19

proposed contributing factors to seborrheic dermatitis

Answer 19

Malessezia furfur, sebum production, skin surface lipids

Question 20

infant signs of seborrheic dermatitis

Answer 20

greasy yellow scale (cradle cap)

Question 21

infantile seborrheic dermatitis lasts how long

Answer 21

it’s selflimited, with most having resolution by several months of age

Question 22

where does seborrheic dermatitis occur for adolescents and adults

Answer 22

areas of high sebum production

tends to be more diffuse on scalp and ill defined than psoriasis

Question 23

tx for seborrheic dermatitis

Answer 23

in infants, gentle skin care alone

adults-topical antifungal medications for chronic, or low potency topical croticosteroids for early stage

Question 24

lichen planus

Answer 24

idiopathic inflam disease of skin and mucous membranes (sometimes drug, infec, or vaccine)

most common in middle aged adults

Question 25

appearance of lichen planus

Answer 25

small, polygonal shaped violaceous flat topped papules

typically pruritic

fine white lines called Wickham’s striae

can affect orogenital mucosa

Question 26

tx for lichen planus

Answer 26

spontaenous remission may occur, or course may be prolonged

treat by eliminating any suspected medications
mild cases: topical croticosteroids and antihistamines

extensive cases: phototherapy and immunosuppressive drugs