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Flashcards in Miscellaneous Deck (37):
1

Psoriasis

2-3% of pop
Cell turnover is reduced from 29 days to 4 days

2

Psoriasis triggers

Physical trauma (koebner's pnenominon)
Rubbing and scratching
Strep infxn
Meds
Smoking, obesity
Stress

3

Koebner's phenomenon

Psoriasis plaques that develop at site of skin injury.
1-2 wks after injury
50% will experience this

4

Psoriasis bimodal age distribution

30-40 then 50-70

5

Psoriasis rash

Salmon pink papules and plaques, sharply marginated w/ silvery white scaling.
Scales are loose and easily removed
Scale removal results in small blood droplets (auspitz sign)

6

Psoriasis distribution

Ogten symmetrical
Elbows, knees, intertriginous

7

Plaque psoriasis

Most common, 80% of cases
Slow forming, stable
Well-defined and symmetrical
Knees, scalp, elbows, lower back

8

Inverse psoriasis

Sharply demarcated plaques
Axilla, groin, naval, submammary, palms, soles
No scales like plaque psoriasis
More common in obese

9

Guttate psoriasis

AKA eruptive
Young adults and kids
Many small teardrop shaped erythematous papules scattered diffusely on proximal extremities and trunk

10

Erythrodermic psoriasis

Affects the whole body
Erythema and scaling from head to toe
Least common
Inflammatory
Itching, pain
High risk of infxn, electrolyte imbalance

11

Pustular psoriasis

Generalized on body
Severe form, acute onset
Pustules with erosions
Malaise, fever, diarrhea, hypocalcemia

12

Most common precipitating factor for erythrodermic and pustular psoriasis?

Withdrawl from systemic steroids

13

Emollients

Useful in all cases of psoriasis
Hydrate stratum corneum
Softens scales and plaques
Apply BID after bathing while skin is damp
Lubriderm, eucerin

14

Topical steroids for psoriasis

FIrst-line for mild/limited plaque psoriasis
Cannot use for extended periods in high dose

15

Coal-tar perparations

When used alone only as effective as mild to mid potency steroids
Generally used as add-on

16

Vitamin D Analogues

Calcipotriol (Dovonex)
Immune modulation
Mild to mod plaque psoriasis
Cannot use of face/groin

17

PUVA therapy

Psoralen and UV-A Light.
Generally has excellent results
Use after mild tx failure

18

Drugs that may exacerbate psoriasis

Beta blockers, NSAIDS, lithium, ACE, digoxin

19

Urticaria

Hives
immune-mediated skin eruption of well-circumscribed wheals on erythematous base.
IgE mediated

20

Angioedema

Hypersensitivity rxn involving deep layers of skin.
Swelling of lips, eyelids, palms, soles, genitals.

21

Urticaria and Angioedema prevelance

50% get both
40% only urticaria
10% only angioedema

22

Food and drug induced allergy

Tend to be brief
Usually do NOT cause chronic urticaria
May have angioedema

23

Cholinergic urticaria

Punctate hives triggered by exercise or hot shower

24

Urt and Angio tx

Antihistamines: H1 or H2
Steroids
Epi for anaphylaxis
Half of patients with chronic urticaria are free of lesions in one year

25

Vitaligo

Onset early in life, white patches, loss of pigment.
Lesions on face, upper trunk, fingertips, hands, armpits, genitals, perioral, body prominences.
White hair and skin in involved areas.

26

Vitaligo MOA

Autoimmune against melanocytes
Occurs in pernicious anemia, hashimotos like alopecia areata

27

Vitaligo tx

Topical steroids
Tacrolimus
UVA, UVB

28

Pemphigus

Rare, chronic, potentially fatal dz of mucous membranes.
Autoimmune intraepidermal blistering

29

Pemphigus lesion

Flaccid bullae that begin of oropharynx, then spread to scalp, face, chest, axillae, groin.
Tender and painful

30

Nikolsky sign

Slight rubbing of skin results in sloughing and blister formation.
Seen in Pemphigus

31

Pemphigus tx

May require admission for severe dz
Systemic steroids, immunosuppressives

32

Bullous Pemphigoid

Chronic, subepidermal blistering cause by autoimmune process.
Exclusively in elderly >60
WIdespread blistering eruption

33

Bullous Pemphigoid lesions

Associated urticarial plaques
Tense and fluid filled blisters

34

Bullous Pemphigoid tx

High dose oral steroids

35

Epidermoid cyst

Sevaceous cyst, infundibular cyst, epidermal cyst.
Most common cutaneous cyst.
Rupture is common, results in painful inflammatory mass.

36

Dermatofibroma

Very common, button like nodule
Lesion may be tender
Benign

37

Lipoma

Benign tumor of fat cells
Soft, rounded, moveable