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Senior - Derm 1 > 3 - Inflammatory Disorders > Flashcards

3 - Inflammatory Disorders Flashcards

1
Q

What physically and emotionally disabling skin condition starts in childhood, persists into adulthood, and is worse in winter?

A

Chronic plaque psoriasis

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2
Q

People with chronic plaque psoriasis are at increased risk for:

A

Psoriatic arthritis

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3
Q

Describe the morphology of chronic plaque psoriasis

A

Begins as red, discrete flat-topped scaling papules
that coalesce to form round to oval plaques

Thick, adherent, silvery-white scale

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4
Q

What is Auspitz sign?

A

Removal of scales of plaque psoriasis leading to pinpoint bleeding

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5
Q

Distribution of plaque psoriasis

A

Scalp
Extensor surfaces
Presacral and groin

Usually symmetric and bilateral
Diffuse or confluent

Pitting or “oil spots” on nails

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6
Q

Etiology of chronic plaque psoriasis

A

Hyperproliferation of the epidermis

7x faster transit than normal (4 days vs 30 days)

Cells pile up and cannot be released fast enough

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7
Q

Management of chronic plaque psoriasis

A

If over 5% BSA: systemic therapy (methotrexate, soriatane, cyclosporine, biologics, UVA)

If under 5% BSA: topical therapy

  • Class I or II and taper to triamcinolone as plaque thins
  • steroid vacation (take a break)
  • control stress
  • keratolytic (salicylic acid) can be used prior to steroid to remove scale
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8
Q

non steroid Topical meds for chronic plaque psoriasis

A

Topical Vit D - Calcitriol - very effective - even better when combined with steroid

Calcipotriene (Dovonex) - Vit D3 derivative

Tazarotene - topical retinoid

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9
Q

Txt of scalp plaque psoriasis?

A

Keratolytic gel, tar shampoo, triamcinolone

Diffuse and thick scale - calcipotriene and betamethasone dipropionate lotion

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10
Q

Slide 11

A

Meds

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11
Q

How will plaque psoriasis appear if it’s in the intertriginous areas?

A

Smooth, red plaques with a macerated surface

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12
Q

Pitting psoriasis of nail matrix results in loss of:

A

Parakeratotic cells from surface of nail plate

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13
Q

What is Guttate psoriasis?

A

Sudden appearance of scaling papules on the trunk / extremities (spares palms/soles), typically happens following a strep / viral URI

Indicates propensity to develop chronic plaque psoriasis

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14
Q

Describe the morphology of Guttate Psoriasis

A

Teardrop, diffuse, scattered

Multiple, tiny discrete red papules with thick white scale

May have classic plaques on elbows, knees

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15
Q

Guttate psoriasis distribution

A

Truncal and proximal extremities

May have nail pitting

May be on classic areas (knees / elbows)

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16
Q

Etiology of Guttate psoriasis

A

Genetic and environmental factors leading to an

aberrant immune response in the skin may contribute to disease development (Strep/Viral infxn)

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17
Q

Management of Guttate psoriasis

A

Throat cx to r/o strep

UVB 6-8 weeks = 1st line!

Topicals usually impractical due to diffuse area

Keep moist with emollients

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18
Q

What’s the deal with pustular psporiasis

A

Rare but sometime fatal

Toxic, febrile, leukocytosis

Middle age, usually

Painful

Smokers

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19
Q

Morphology of pustular psoriasis

A

Numerous tiny, sterile pustules evolve from an
erythematous base and coalesce into lakes of pus

Deep-seated pustules middle of palm or sole of foot) primary

Pustules don’t rupture - they dry up, harden, and fall off

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20
Q

Management of pustular psoriasis

A

Class I topical

NO ORAL STEROIDS

ABX for secondary infx

Emollients

Oral or topical PUVA

Retinoids

Cyclosporine

Methotrexate

Relapses common

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21
Q

Describe seborrheic dermatitis:

A

Common, chronic inflammatory dz

Peaks in infancy, maternity, teens (high hormonal periods)

Flares in dry winter, stress, change in hygiene

Severe in elderly

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22
Q

What is one of the MC cutaneous manifestations of AIDS?

A

Seborrheic dermatitis

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23
Q

Morphology of seborrheic dermatitis?

A

Fine white or yellow greasy flakes

May have an inflamed base

Pruritic

Red papules

Annular with raised edge

Cradle cap

Secondary staph infx

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24
Q

Distribution of seborrheic dermatitis

A

Scalp and scalp margins

Eyebrows and base of eyelashes

Nasolabial folds

EAC’s

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25
Etiology of seborrheic dermatitis
Hereditary - flared by environment, possibly caused by yeast Hyperproliferation process (similar to psoriasis) Glandular problem (oily skin) Tends to persist in adults with periods of remission and exacerbation
26
Management of seborrheic dermatitis
OTC anti-dandruff shampoos Selenium sulfide Tar based Ketaconazole for yeast overgrowth Topical steroids Dicloxacillin for secondary infx Oral antifunfgals for bad cases
27
Atopic dermatitis
Chronic, pruritic eczematous disease Almost always begins in childhood Remitting/recurring course Improves with age FHX or allergies, atopy, asthma, sinusitis Flares with cold, dry weather, stress, illness, irritants
28
Morphology of atopic dermatitis
Erythema progressing to papules and plaques with: - flaking - xerosis - cracking - excoriations - fissures Patchy or confluent Lichenification over time Secondary staph with flares
29
Where would you see atopic dermatitis in adults on PE:
``` Bilateral flexor creases Hands Neck Waist Wrists and ankles Spares the face except the eyelids ```
30
Where would you see atopic dermatitis in kids?
2-12 ys - Flexural areas Face and scalp Patchy or generalized body eczema Infants - cheeks
31
Etiology of atopic dermatitis
The “itch that rashes” Dryness that causes cracking which causes itch which causes a rash (eczematous) Hereditary May flare with acute allergic situations
32
Management of atopic dermatitis (general)
Hydrate Wash less often (milder soap) Shorter bathing time, tepid water Moisturize immediately after washing
33
Meds for atopic dermatitis inflammation
Mid to high strength topical steroids Group V fluticasone proprionate cream safe in kids > 3 mos for severe
34
Important treatment aspect of atopic dermatitis management includes breaking the:
Itch-scratch cycle Use hydroxyzine or diphenhydramine
35
Use of pimecrolimus cream in atopic dermatitis
Apply thin layer to affected areas BID For immunocompetent patients older than 2 yrs No occlusive dressings NO burning sensation
36
Tacrolimus ointment for atopic dermatitis
Apply thin layer to affected areas BID For patients who have failed other topicals No occlusive dressings Burning sensation can happen
37
What is the MC inflammatory skin disease?
Eczema Characteristics include - erythema, scale, and vesicles
38
3 stages of eczema?
Can occur in any order 1. Acute 2. Subacute 3. Chronic
39
Etiology of acute eczema?
Contact allergy (Rhus) Acute nummular eczema Stasis derm Pompylox
40
Acute eczema presents with:
Intense erythema Intense itch Vesicles Bullae
41
Txt for acute eczema?
Cold wet compress PO or topical steroids Antihistamine ABX if secondarily infected
42
Subacute eczema will present how?
Erythema Scaling Fissuring Parched appearance Moderate itching, pain, burning
43
Etiologies of subacute eczema?
Contact allergy Irritant Atopic Nummular eczema Asteatotic eczema
44
Txt for subacute eczema?
Topical steroids (occlusion PRN) Emollients after Antihistamines ABX
45
Chronic eczema will present with:
Thickened skin Accentuated skin lines Excoriations Fissuring Moderate to intense itch
46
Etiologies of chronic eczema
Atopic Habitual scratching LSC Nummular eczema Asteatotic eczema
47
Treatment for chronic eczema?
Topical steroids with occlusion for best results Antihistamines ABX Emollients
48
What is dyshidtrotic eczema (pomphyolyx)?
Distinctive reaction pattern - symmetric vesicular hand and foot dermatitis Moderate to severe itching PRECEDES the appearance of vesicles Unknown etiology (maybe atopic, stress, irritants...) Most common in teens to middle age
49
Describe dyshidtrotic eczema (pompholyx)?
Multiple tiny deep seated vesicles (tapioca lesions) Palms and lateral aspects of fingers and hands or feet Palms may be red and wet with perspiration Surrounding erythema Very pruritic
50
Explain the progression of dyshidrotic eczema:
Vesicles slowly resolve in 3-4 weeks Replaces with scale...progresses to lichenification and cracking, peeling, and fissuring Pain then replaces pruritis Secondary infx can be problematic
51
Management of dyshidrotic eczema?
Lifestyle mods (avoid water, irritants, trauma) Use bland emollients Potent steroid then wean ABX if indicated Hydroxyine for pruritus Cool, wet compress Elimination diet (figure out a potential cause) IF ALL ELSE FAILS - low dose methotrexate
52
What is asteatotic eczema?
Occurs after excessive drying in the winter months and among the elderly Atopic patients more likely More of an itch than a rash
53
Describe the morphology of asteatotic eczema
Lower legs - dry and scaly with accentuation of the skin lines (xerosis) Red plaques with thin, long, horizontal superficial fissures - resembles cracked porcelain Minimal erythema Excoriations without other lesions
54
Etiology of asteatotic eczema
Cold, dry weather and long, hot showers
55
Management of asteatotic eczema?
Shower less, and not with hot water, mild soap Emollients immediately after bath Steroids if bad enugh If oozing, crusts, infx - wet compress, ABX
56
Who gets nummular eczema?
Middle age to elderly
57
What’s nummular eczema all about?
Intense itching, recurs in the same spot every winter, excessive scratching leads to lichenification
58
Describe the morphology of nummular eczema:
Discrete, round, coin-shaped red plaque 1-5cm in diameter Intensely erythematous plaques Thin, sparse scale that may flake May become thicker with vesicles on the surface
59
MC location of nummular eczema?
Back of the hand Also found on lower legs, forearms, flanks, hips
60
How do we manage nummular eczema?
Potent steroids for 4-6 weeks (group III-IV) Correct dryness of skin and environment Antipruritic PRN
61
What is lichen simplex chronicus? (LSC)
Basically the end result of chronic scratching over time - possibly a defense mechanism against recurrent trauma (scratching) Any age
62
Morphology of LSC?
Red papules coalesce to a red, scaly, thick plaque with accentuation of skin lines Excoriations Cracks and fissures possible Hyperpigmentation Nodules (prurigo nodularis)
63
Management of lichen simplex chronicus
Long-term therapy to soften and break down lichenified skin Stop the itch-scratch cycle Behavior modification Temovate or Diprolene ointment Possibly intralesional steroids Emollients for dryness 1st gen antihistamines for night-time scratching
64
Who gets pityriasis rosea?
Young adults (10-35 yrs old)
65
What causes pityriasis rosea?
Possible viral origin - some association with HHV 6 Hx of proceeding URI
66
Morphology of pityriasis rosea?
Have have herald patch (first and largest lesion, patients may think they have ringworm) Then eruptive phase - round to oval 1-2cm plaques (salmon pink in white people, hyperpigmented in darker-skinned people) “Christmas Tree” distribution Trunk and proximal extremities
67
Management of pityriasis rosea?
Patient reassurance, most do not require treatment Group V topical steroids and antihistamines for the itch If severe: oral steroids, UVB, oral acyclovir
68
What should be considered in the differential of pityriasis rosea?
Syphilis
69
What is lichen planus?
A unique inflammatory cutaneous and mucocutaneous membrane reaction Can happen at any age (avg 20-60yrs) Can be without cause or caused by meds, chemicals, transplants Can be part of a Koebner phenomenon (lesion associated with trauma)
70
Describe the morphology of lichen planus
The 5 P’s: 1. Pruritic 2. Planar (flat-topped) 3. Polygonal 4. Purple 5. Papules / plaques Also, “persistent”...so it’s really six P’s? These slides are terrible...
71
What is Wickham’s Striae?
White lacy pattern of crisscrossed lines on lesion (increase visualization with immersion oil) Seen in lichen planus
72
Where is lichen planus found?
Basically anywhere Acral - hands and feel, ankles and wrists Oral lesions (white lacy pattern, erosive and painful) Nail splitting and dystrophy Scarring hair loss on scalp Genital lesions
73
What confirms the dx of lichen planus?
Bx
74
Etiology of lichen planus
Like most of this crap, we don’t know But we say.. Maybe associated with liver disease Maybe associated with Hep C
75
Management of cutaneous lichen planus
Control the itching with Hydroxyzine Topical I or II - may need occlusion Intralesional steroid injection every 3 to 4 weeks
76
Management of mucous membranous lichen planus
Challenging Steroids in an adhesive base Azathioprine in resistant cases
77
Management of generalized lichen planus
PO steroids for about 3 weeks
78
What are the two main types of contact dermatitis?
Irritant (damages barrier, non-immunologic) Allergic (absorption of antigen - sensitization - with subsequent exposure eruption)
79
MC types of irritant dermatitis?
Occupational - hand dermatitis Diaper dermatitis
80
Morphology of irritant dermatitis ?
Damage to the stratum corneum Inflamed, cracked, fissured skin When acute, could be exudative and/or vesicular If chronic - scaly, flaky, lichenified with less erythema
81
Management of irritant dermatitis?
Avoid the irritant (duh) Use emollients Cool compress for acute inflammation Topical steroids if severe
82
What is the MC allergic contact derm?
Nickel | Poison ivy is 2nd MC
83
Morphology of allergic contact derm?
Very red Inflamed, swollen, vesicular to bullous, exudative and crusty, intensely pruritic Can be linear (poison ivy) or shaped (ring, watch)
84
Management of allergic contact derm
Minimize topical products Wet compress Potent topical or PO steroid for 2-3 weeks Antihistamines Triamcinolone spray
85
Kim kardashian was diagnosed with psoriasis
He doctor assured her it wouldn’t affect her ability to do nothing

Senior - Derm 1 (7 decks)

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