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SMS Week 3 > Chronic Inflammatory Dermatoses > Flashcards

Chronic Inflammatory Dermatoses Flashcards

1
Q

What are the five chronic inflammatory dermatoses we discussed?

A
  1. psoriasis
  2. lichen planus
  3. systemic lupus erythematosis
  4. seborrheic dermatitis
  5. acne vulagris
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2
Q

About psoriasis…

  1. what’s the prevalence?
  2. During what generations does it peak?
  3. What is the genetics behind it?
A
  1. about 4%
  2. 30s and 60a
  3. presumed autosomal dominance with modifying features and environmental triggers
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3
Q

What are the clinical features of psoriasis?

A

sharply demarcated erythema usually with a thick micaceous scale

Auspitz sign (you scratch and it bleeds under the surface)

Koebner sign (happens in areas that had previous trauma)

Nail disease is common in up to 50%

Rarely pustular

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4
Q

What is the pathogenesis of psoriasis?

A

A T-CELL MEDIATED AUTOIMMUNE DISORDER

  1. envrionmental factor triggers T cells to produce cytokines
  2. The cytokines stimulate keratinocye proliferation and the production of antigenic adhesion molecules in the dermal blood vessles
  3. The adhesion molecules further stimulate T cells to produce cytokines
  4. cycles until you get the rash
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5
Q

What are 5 risk factors associated with psoriasis?

A
  1. genetics
  2. psychological stress
  3. medications
  4. infection
  5. chronic HIV
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6
Q

What are some precipitating agents of psoriasis outbreaks?

A

infection, trauma, stress, ETOH, systemic steroids (esp on withdrawal), beta blockers, lithium, antimalarials, Indomethacin

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7
Q

What should be in your diagnosis when you see psoriasis. How woul dyou tell for sure?

A

DD: lichem simplex chronicus, nummular eczema, seborrheic dermatitis, and tinea corporis

You have to use a punch biopsy to be sure.

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8
Q

What are the four types of psoriasis?

A
  1. chronic plaque (most common)
  2. inverse
  3. guttate
  4. pustular
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9
Q

Where does the chronic plaque psoriasis occur on the body?

A

scalp

extensor surfaces like elbow, knees, presacral and nails

palms and soles (esp thick scale of the arch of the foot and thenar hypothenar palms)

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10
Q

Where does inverse psoriasis usually occur on the body?

A

the intertriginous areas (fold areas) like the gluteal fold, axillae, and glans of the penis

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11
Q

What characteristic of plaque psoriasis is lackin gin inverse psoriasis?

A

the scale may not appear in the inverse

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12
Q

WHat are the chraacteristics of guttate psoriasis?

A

eruptive trunkal dermatosis

it’s a sudden onset of tear drop shaped (2 to 5 mm) scaled spots of the tunk and proximal extremities

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13
Q

When does guttate psoriasis almost always occur?

A

usually childhoold or young adulthoods POST STREP INFECTION

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14
Q

Describe pustular psoriasis?

A

It starts as small pustules on the palms and soles (pustular psoriasis of barber)

they generalize with fever and can be life threatening

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15
Q

What are complications of psoriasis?

A
  1. mental health issues - depression, anxiety, etc.
  2. increased risk of non-melanoma skin cancers and lmphoma
  3. psoriatic arthritis
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16
Q

WHat are two nail deformities that are associated with psoriasis?

A

onycolysis - the separation of the nail plate from the nail bed

pitting of the nail plate itself

17
Q

In general, what is lichen planus?

A

a chronic inflammatory autoimmune disease

18
Q

What is the prevalence of lichen planus and who does it usually effect?

A

.1 to 4 % of the pop

usually perimenopausal females (30-60)

19
Q

What virus is lichen planus associated with?

A

Hep C

20
Q

Where do lichen planus rashes usually occur?

A

WRISTS, chins, mucous membranes

21
Q

What is the clinical hallmark of lichen planus?

A

Wickham’s striae = whitish lines visible in the stria of papeuls of lichen planus

22
Q

What are the “6 Ps” of lichen planus?

A

planar (flat topped)

purple

polygonal (not round)

pruritic

papules

plaque

23
Q

What are the 6 forms of lichen planus?

A

linear (classic)

annular

atrophic

jypertrophic

vesiculbullous

erosive/ilcerative

24
Q

What happens in hypertrophic lichen planus?

A

you get very thick plaques of scale of the lichen planus, esp over the extremities and extensor surfaces

25
Q

What happens in bullous lichen planus?

A

you get blisters occuring under the lichen planus due to the severe interface dermatitis

26
Q

What does oral lichen planus look like?

A

It’s tendr red patches on the buccal mucosa with a surface covered in Wickham’s striae - which does NOT wipe off like thrush would.

27
Q

What is the treatment for lichen planus?

A

It may resolve sponantouely sin 1-2 years, but often relapses

Use topical or oral steroids

phototherapy

stop the drug is it was drug induced

28
Q

What are the three forms of systemic lupus erythematosus?

A

acute

subacute

chronic cutaneous (discoid)

29
Q

What group of people are at higher risk for systemic lupus erythematosus?

A

more common in women

most diagnosed between 14-40

more common in african americans, hispanics and asians

30
Q

What lab tests should you run to check for SLE?

A

CBC

Sed rate

Kidney/Liver tests

UA

ANA - checking for antinuclear antibody

31
Q

What are the symptoms of acute lupus erythematosus?

A

You get an acute photosensitivity pattern of erythema in a butterfly rash across the nose and cheeks

You can also get a red rash of the sun exposed upper chest and extensor areas (may become bulolous here)

Many have non-specific features like digital infarcts/ulcers associated with Raynaud’s Syndrome

32
Q

What sort of rash forms in subacute cutaneous lupus?

A

erythematous and usually scaling rash of the upper traunk and extensor surfaces

it looks like a psoriasis plaque ,but it isn’t

It’s due to the SSA or SSB antibody

33
Q

What happens in chronic cutaneous lupus (discoid)?

A

You get scarring lesions of the skin (especialy the outer ear)

34
Q

There are three other rarer forms of SLE called tumid lupus, lupus panniculitis, and verrucous lupus. WHat are their hallmarks?

A

tumid - you get indurated plaques in sun exposed areas

panniculitis - infiltration and destruction of adipose tissue on the upper extremities

verrucuous - very thick, hyperkeratotic discoid-like lesions usually on extensor and sun exposed areas

35
Q

What are some treatment options for SLE?

A

NSAIDS

Antimalarials

COrticosteroids

Immunosuppressants

36
Q

What are some triggers for SLE?

A

sunlight

meds (antiseizure, ABx, BP)

37
Q

What are some other non-specific skin lesions/symptoms of lupus?

A

telangiectasia, vasculitis, thrombophlebitis, raynaud’s, ulcers, gangrene, alopecia, urticaria, mucous membrane pigment changes, livedo reticularis

38
Q
A

SMS Week 3 (11 decks)

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