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Dermatology > Miscellaneous Skin Conditions > Flashcards

Miscellaneous Skin Conditions Flashcards

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1
Q

Epidemiology of Psoriasis

A

Men = Females
Hereditary
More prevalent further from the equator

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2
Q

Pathophysiology of Psoriasis

A

Cell turnover: 4 days
Normal cell keratinization does not take place
Subnormal blood vessel dilation
Autoimmune component: T lymphocytes

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3
Q

Psoriasis Risk Factors

A

Family Hx
Strep infection can trigger guttate psoriasis
Medications: beta blockers, lithium, anti-malaria
Smoking, obesity, & alcohol
Vitamin D deficiency?

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4
Q

Presentation of Psoriasis

A

Bimodal age distribution: 30-39, 50-69
Gradual or sudden in onset
Pruritus common
Hx of improvement with sun exposure

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5
Q

Associated Conditions with Psoriasis

A 
Psoriatic arthritis
CV disease
Malignancy
DM
Metabolic syndrome
HTN
IBD
Serious Infections
Ocular involvement: swollen lids, conjunctivitis, xerosis, uveitis
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6
Q

Types of Psoriasis

A 
Plaque
Inverse
Guttate
Erythrodermic
Pustular
Nails
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7
Q

Where does plaque psoriasis typically appear?

A 
Knees
Scalp
Elbows
Lower back
Can affect the nails
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8
Q

Plaque Psoriasis Presentation

A

Salmon pink papule & plaques
Sharply marginated with marked silvery-white scaling
Scales are loose, easily removed by scratching
Auspitz sign
Koebner’s phenomenon

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9
Q

Define Auspitz Sign

A

Pinpoint bleeding under the scale

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10
Q

Define Koebner’s Phenomenon

A

Psoriasis plaques that form at the site of a skin injury

Occurs 1-2 weeks after injury

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11
Q

What can Koebner’s phenomenon occur from?

A 
Bug bites
Bruises & scrapes
Poison ivy or poison oak
Burns (sun & chemical)
Constant pressure & rubbing
Injections or vaccinations
Skin blemishes from acne, herpes, or chickenpox
Acupuncture or tattoo needles
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12
Q

Distribution of Psoriatic Lesions

A

Symmetrical
Favors elbows, knees, intertriginous areas
Can be localized or all over the body
Extensor surfaces

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13
Q

Inverse Psoriasis Locations

A 
Axilla
Groin
Naval
Submammary region
Palms
Scalp
Soles
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14
Q

Inverse Psoriasis Characteristics

A

Common in overweight persons
No scales
Biopsy to differentiate from candidiasis

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15
Q

Define Guttate Psoriasis

A

Eruptive psoriasis

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16
Q

Characteristics of Guttate Psoriasis

A

Small teardrop shape erythematous papule

Scattered diffusely on proximal extremities & trunk

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17
Q

Treatment of Guttate Psoriasis

A

Self limiting (weeks to months)

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18
Q

Erythrodermic Psoriasis Presentation

A

Erythema & scaling head to toe
Inflammatory
Severe pruritis & pain as skin reddens & sheds

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19
Q

What is erythrodermic psoriasis have a high risk of?

A

Systemic infection

Electrolyte imbalances

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20
Q

Presentation of Pustular Psoriasis

A 
Acute onset
Widespread erythema, scaling, & sheets of pustules with erosions
Malaise
Fever
Diarrhea
Leukocytosis
Hypocalcemia
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21
Q

WHICH SKIN conditions can be life-threatening?

A

Erythrodermic psoriasis
Pustular psoriasis
Pemphigus
Bullous Pemphigoid

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22
Q

Nail Psoriasis

A

Associated with psoriatic arthritis

Appear before onset of cutaneous psoriasis

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23
Q

Presentation of Nail Psoriasis

A

Nail pitting
Oil drop sign
Subungual hyperkeratosis

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24
Q

Treatment of Plaque Psoriasis

A

Exacerbating factors
Topical therapy
Systemic therapy

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25
Drugs That May Exacerbate Psoriasis
``` Beta-blockers NSAIDs Lithium ACEi Digoxin ```
26
Topical Therapy for Plaque Psoriasis
``` Emollients Steroids Vitamin D analogues Topical retinoids Calcineurin inhibitors Coal tar preparations Phototherapy: UVA, UVB ```
27
MOA of Emollients
Hydrate stratum corneum Decrease water evaporation Soften the scales
28
Examples of Emollients
Eucerin Lubriderm Moisturel
29
Education of Emollients
Apply after bathing while skin is still damp
30
What is first line for plaque psoriasis?
Topical steroids
31
What are topical steroids used in conjunction with?
Topical vitamin D analoge Topical retinoid UVB therapy
32
When do you use Calcipotriol (Dovonex), a vitamin D analogues?
Mild to moderate plaque psoriasis
33
SE of Calcipotriol (Dovonex)
Hypercalcemia | Hypercalcuria
34
Where can you not use Calcipotriol (Dovonex)?
Face | Groin
35
Example of a Vitamin D Analogue
Calcipotriol
36
Example of a Vitamin A Derivative
Tazarotene (Tazorac)
37
MOA of Tazarotene (Tazorac)
Modulates differentiation & proliferation of epithelial tissue Exerts some degree of anti-inflammatory & immunological activity
38
Examples of Topical Calcineurin Inhibitors
Tacrolimus (Protopic) | Pimecrolimus (Elidel)
39
MOA of Topical Calcineurin Inhibitors
Inhibt T-lymphocyte activation by binding to an intracellular protein & complex with calcineurin dependent proteins to inhibit calcineurin phosphatase activity
40
Coal Tar Topical Preparations
Enhance effects of UVB therapy OTC Stains clothes & odor Add-od therapy
41
MOA Phototherapy
Anti-proliferative effects by slowing keratinization & anti-inflammatory effects by inducing apoptosis of pathogenic T-cells
42
Systemic therapy for psoriasis
``` Methotrexate Acetretin: Psoriatane Systemic calcineurin inhibitor: cyclosporine Infliximab (Remicade) Hydroxyurea Azathiprine ```
43
Define Urticaria
Hives | Immune mediated skin eruption of well-circumscribed wheals on an erythematous base
44
Define Angioedema
Hypersensitivity reaction involving the deep layers of the skin
45
Where does angioedema usually occur?
``` Lips Eyelids Palms Soles Genitalia ```
46
Pathophysiology of Urticaria & Angioedema
Allergen IgE antibody attached to mast cell Sudden release of immunologic mediators Inflammation
47
Presentation of Urticaria
Characteristic edematous, erythematous, well-circumscribed blanching wheals Serpiginous borders
48
Define Dermatographism
Gentle stroking of the skin produces immediate wheal & far response
49
Define Pressure Urticaria
Pressure to skin at right angle results in red swelling after latent period of up to 4 hours
50
Define Cold Urticaria
Eruptions within minutes following application of cold
51
Define Cholinergic Urticaria
Punctate hives triggered by exercise or hot shower
52
Define Aquagenic Urticaria
Hives after contact with water
53
Define Solar Urticaria
Hives develop following exposure to UV light
54
Management of Urticaria & Angioedema
Avoidance of etiologic agents | Avoidance of substances that may aggravate: ASA, NSAIDs, ETOH, ACEi
55
Symptomatic Relief for Urticaria & Angioedema
Antihistamines: H1-blockers, H2-blockers, Doxepin (Sinequan) Steroids: systemic or local SubQ Epinephrine: anaphylaxis
56
Important Principles of Urticaria & Angioedema
``` Chronic urticaria can be frustrating EDUCATION Investigate for thyroid or H. pylori Epipen Referral to allergist ```
57
Where do vitiligo lesions occur?
``` Face Upper trunk Finger tips Hands Arm pits Genitalia Bony prominences Perioral region ```
58
Define Vitiligo
Destruction of melanocytes
59
Pathophysiology of Vitligo
Autoimmune: antibodies to melanocytes | Occurs with pernicious anemia & Hashimoto's thyroiditis
60
Treatment of Vitiligo
Some regimentation with topical steroids, tacrolimus, psoralens, UVA, UVB, surgical skin grafting Need psychological support
61
Describe Pemphigus
INTRA-epidermal blistering secondary to an autoimmune process
62
Define Pamphigus
Chronic, potentially fatal disease of the mucous membranes & skin
63
Clinical Presentation of Pemphigus
Flaccid bullae Bullae tender & painful Nikolsky's sign Skip biopsy
64
Where are the bullae most present?
``` Oropharynx Scalp Face Chest Axillae Groin ```
65
Treatment of Pemphigus
Recognize & refer Hospital admission Systemic steroids & immunosuppressives
66
Define Bullous Pemphigoid
Chronic, SUB-epidermal blistering autoimmune disease
67
Common Presentation of Bullous Pemphigoid
Widespread blistering eruption
68
Epidemiology of Bullous Pemphigoid
Triggered by drug reaction or infection Exclusively in the elderly (>60) Increased mortality
69
Describe Blisters of Bullous Pemphigoid
Tense | Fluid filled
70
Treatment of Bullous Pemphigoid
Recognize & refer 1st: topical high dose or oral steroids Immunosuppressants (maybe)
71
Synonyms of Epidermoid Cyst
Sebaceous cyst Infundibular cyst Epidermal cyst Cutaneous cyst
72
Describe Epidermoid Cyst
Cystic enclosure of epithelium Cysts filled with keratin & lipid-rich debris Rupture common: painful inflammatory mass May be secondarily infected
73
Define Dermatofibroma
Button-like dermal nodule | Lesion may be tender
74
Define Lipoma
Soft, rounded, & movable against the overlying skin | Composed of fat cells

Dermatology (13 decks)

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