Inflammatory Skin Conditions

Question 1

chronic disease that presents as largely symmetric erythematous well-defined plaques with overlying silvery scale; extensors (elbows, knees) and scalp, buttocks, sacrum, umbilicus are common locations; thought to be due to cytokines triggering a hyperproliferative state resulting in thick skin and excessive scale

Answer 1

Psoriasis

Question 2

MOST COMMON type of psoriasis

Answer 2

Plaque Psoriasis (silvery scale)

Question 3

type of psoriasis commonly seen in younger people; often seen after STREPTOCOCCAL pharyngitis

Answer 3

Guttate Psoriasis

Question 4

type of psoriasis morphology; lesions located in SKIN FOLDS (axilla,groin, etc.); may lack scale due to moistness of area

Answer 4

Inverse/Flexural psoriasis

Question 5

type of psoriasis; widespread, generalized erythema covering nearly ALL (>80%) of the body surface; hospitalization is sometimes needed

Answer 5

Erythrodermic psoriasis

Question 6

type of psoriasis morphology; pustules; triggered by corticosteroid withdrawal; generalized; can be LIFE-THREATENING

Answer 6

Pustular psoriasis

Question 7

indicates higher risk of psoriatic arthritis (90% have it); can involve pitting, onycholysis (separation of nail plate from nail bed) and hyperkeratosis

Answer 7

Nail Psoriasis

Question 8

Psoriasis is complicated ____ driven disease involving cytokines (TNFa and IL-23)

Answer 8

T-cell

Question 9

What cytokine stimulates Th17 cells to release IL-17 and IL-22 leading to proliferation of keratinocytes and dermal inflammation?

Answer 9

IL-23

Question 10

High levels of ____ correlate with psoriasis severity

Answer 10

IL-22

Question 11

What gene accounts for up to 50% psoriasis?

Answer 11

PSORS1

Question 12

Histopathology of psoriasis

Answer 12

1. Regular acanthosis with elongated rete ridges
2. Vessels in dermal papillae
3. Parakeratosis and lack of s. granulosum
4. munro microabscesses (neutrophils on top of parakeratosis)

Question 13

Treatment for Psoriasis

Answer 13

1. Topical steroids first for limited disease

2. Phototherapy, Biologic agents (TNF-a inhibitors) and Oral meds (Methotrexate) for systemic/widespread disease

Question 14

Acute red scaly rash that occurs in adolescents/young patients; starts as a HERALD patch (ring-shaped with clear center) and will progress to a CHRISTMAS TREE pattern along skin lines on trunk; unknown etiology but maybe associated with HHV6 infection; SELF-LIMITING in 6-8 weeks; no treatment needed

Answer 14

Pityriasis rosea

Question 15

Type I hypersensitivity reaction (Th2 cytokine predominance) that commonly impacts infants and young children; itchy (pruritus) rash; associated with other atopic diseases (seasonal allergy, asthma); commonly seen in flexural areas; increased serum IgE

Answer 15

Atopic Dermatitis

Question 16

Atopic dermatitis is caused by what mutation?

Answer 16

FLG (filaggrin) gene mutation –> epidermal barrier dysfunction –> transepidermal water loss

Question 17

Atopic dermatitis puts at risk for what secondary infections?

Answer 17

staph causing impetigo (crusting lesions)

Question 18

Treatment for atopic dermatitis

Answer 18

Repair epidermal barrier function (topical steroids first line tx & thick moisturizers to treat xerosis)

Question 19

What must be avoided as tx for Atopic Dermatitis?

Answer 19

systemic steroids (oral like prednisone) can cause rebound symptoms

Question 20

50-80% of children with Atopic Dermatitis will have another atopic disease, like Asthma or Allergic Rhinitis

Answer 20

Atopic Triad/March

Question 21

Eczema seen classically in lower legs in adults, very itchy and nummular (coin shaped)

Answer 21

Nummular Eczema

Question 22

Eczema described as “dry riverbed”, superficial fissuring from extreme dry skin leading to dermatitis; common in lower legs in winter months

Answer 22

Asteatotic Eczema

Question 23

Tx for Eczema (nummular and asteatotic)

Answer 23

moisturizer, topical steroids

Question 24

Skin disease seen in patients with lower extremity edema who then develop overlying dermatitis; DO NOT confuse with bilater lower extremity cellulitis; no fever, chills

Answer 24

Stasis dermatitis

Question 25

Tx for Stasis dermatitis

Answer 25

compression stockings, topical steroids

Question 26

T-cell mediated disease against keratinocytes triggered idiopathically; purple pruritic flat-topped papules; histology shows lichenoid pattern (dense band of lymphocytes in dermal papillae); commonly found in genitalia, lower legs, wrists; Wickham’s striae (white lines in papules)

Answer 26

Lichen planus

Question 27

Tx for lichen planus

Answer 27

Topical steroids, prednisone taper

Question 28

White atrophic plaques on genital skin caused by autoimmune reaction against extracellular matrix protein; very itchy; more common in women

Answer 28

Lichen sclerosus

Question 29

Lichen sclerosus must be treated because if left untreated..

Answer 29

1. scarring and loss of normal anatomy can occur

2. risk for scc

Question 30

Tx for Lichen sclerosus

Answer 30

Potent topical steroids for long term

Question 31

Recurrent nodules, abscesses, and draining at intertriginous sites (groin, axillae, buttocks) due to chronic inflammation of hair follicles; more common in women and black patients

Answer 31

Hidradenitis Suppurativa (HS)

Question 32

What factors worsen HS

Answer 32

Obesity, smoking, friction

Question 33

Tx for Hidradenitis Suppurativa (HS)

Answer 33

Weight loss, smoking cessation, oral antibiotics

Question 34

Targetoid appearance rash commonly seen on palms, soles, mouth; most frequent after infection (HSV and mycoplasma); self-limiting; treat underlying infection

Answer 34

Erythema multiforme