Papulosquamous and Inflammatory Dermatoses Flashcards

Question

GUTTATE PSORIASIS Differential diagnosis

Answer 1

- chronic plaque: seborrheic dermatitis, nummular eczema, tinea corporis, drug eruption - guttate: pityriasis rosea, secondary syphilis, drug eruption - inverse: candida, contact dermatitis, bacterial infection

Answer 2

- topical steroids/intralesional - tar preparations - salicylic acid (scalp) - vitamin D analogues - retinoid creams - anthralin - phototherapy UVB - systemic: methotrexate, cyclosporine, acitretin, PUVA, biologics - patient education

Answer 3

- acute, self-limiting skin eruption - etiology unclear, but thought to be viral in origin - sex: M = F

Answer 4

- age: >75% between 10-35 y.o.; rare in young and old - seasonal: more common in cooler months (spring/fall) - clustered in families/close contacts - higher incidence in immunocompromised

Answer 5

- mild URI prodrome - primary lesion: Herald patch - a solitary lesion, usually annular, 2-6 cm, round to oval, most common on trunk and neck but can occur anywhere - secondary lesions: 1-2 wks after 1ary; generalized eruption on trunk and proximal limbs; salmon pink; 0.5-1.5 cm macules or patches; Christmas tree distribution; collarette scale (inward facing cigarette paper-like appearance) - symmetrical eruption, but spares palms/soles - atypical presentations: small papules common in young and pregnancy

Answer 6

1. clinical appearance; biopsy not typically required 2. guttate psoriasis, viral exanthems (kids), tinea corporis (ring worm), nummular eczema, lichen planus, drug eruptions, seborrheic dermatitis, secondary syphilis

Answer 7

- no treatment (self-limiting) - emollients for scale - topical corticosteroids (class V) for itching - PO antihistamines, antipruritic lotions - NO topical lidocains or benadryl! - UVB phototherapy/direct sun

Answer 8

- inflammatory cutaneous and mucous membrane reaction pattern - unknown etiology

Answer 9

- sex: F > M - age: may occur at any age; adults most common 30-60; rare in kids under 5 - family history: 10% positive FHx - may be associated w/ chronic active hep C - lichen planus-like eurptions due to medications, chemical exposure, post bone marrow transplant

Answer 10

- location: skin, mucous membranes, genitalia, nails, scalp; flexor surfaces of wrist, forearms, legs just above ankles - pruritic - planar (flat top) - polyangular - purple (violaceous) - papules

Answer 11

- 1 mm - 1 cm - random clusters, discrete, linear, annular, or diffusely papular (guttate) - Koebner phenomenon: lesion in response to injury/scratch - Wickham striae: white, lacy reticular pattern of criss crossed lines - new lesions appear pink/white then become purple with waxy luster - heals w/ post inflammatory hyperpigmentation

Answer 12

- most common form - found on wrist, forearm, ankles and low back typically - often chronic - average 4 years

Answer 13

- 2nd most common - can be anywhere, but most common on shins and ankles - become confluent, rough red-brown thick - may have severe itching and last for avg 8 years - can develop vesicle/bullae

Answer 14

- localized to hair follicles - may occur with papular form - causes hair loss (can be permanent from scarring)

Answer 15

- mucosal membrane (oral, vulva, glans penis) - oral: can occur w/o cutaneous lesions - F>M, mean age onset 60 y.o - seen in greater than 50% with cutaneous lesions - most common form is non-erosive with white lacy pattern on buccal mucosa - erosive form more severe and painful; 0.5-3% develop into SCC

Answer 16

- longitudinal grooving, ridging, splitting, thinning and red streaks/dots, pterygium - tenting or pup tent = elevation of nail plate - 25% of pts with nail LP have LP at other sites before or after nail disease is noted - most common age 50s-60s

Answer 17

1. clinical appearance; biopsy for confirmation if needed; AST/ALT/alk phos (liver fx tests), HIV, Hep C tests 2. cutaneous: syphilis, lichen simplex chronicus, guttate vs plaque psoriasis mucosal: candida, SCC, leukoplakia

Answer 18

- refer to derm: generalized or mucosal disease, scarring alopecia, and refractory cases - topical corticosteroids: initial Tx of localized disease - intralesional corticosteroids sometimes used for hypertrophic lesions - anti-histamines for pruritus - topical corticosteroids in orabase for oral lesions

Answer 19

- benign, inflammatory/reactive dermatosis; self-limited - unknown pathophysiology - several clinical variants; localized GA is most common

Answer 20

- sex: 2F:M - age: localized GA most common in kids and adults <10 or adults 30-60 - seasonal: worse in summer, better in winter

Answer 21

- primary lesion: firm, 1-2 mm, skin colored to erythematous papules; slowly progressing; grouped lesion expand to arcuate or annular plaques; central depression; smooth and non-scaling - dorsal surface of hands/feet/fingers; extensor of arms and legs; rare on face, scalp, genitals - asymptomatic or mild pruritus - duration: variable; weeks to decades; spontaneous involution w/in 2 years in 50%

Answer 22

- diabetes - TB - insect bites/trauma - sun exposure - thyroid disease - viral infections: HIV, Epstein Barr, herpes zoster

Answer 23

1. clinical appearance, maybe a biopsy, KOH (- to r/o ringworm) 2. tinea, annular lichen planus, basal cell carcinoma, erythema migrans (Lyme), sarcoidosis, nummular eczema

Answer 24

- asymptomatic localized lesion can be left untreated - topical corticosteroids not very effective (class I or II under occlusion, use in intervals) - intralesional Kenalog at the elevated border - cryotherapy - other generalized variants may need systemic treatment

Answer 25

- reactive immunologic/inflammatory process - also referred to as hives or wheals - prevalence: may occur at any age; up to 20% of pop will have one episode; may be more common in atopic pts - cause undetermined in most causes - acute or chronic

Answer 26

- mast cell releases histamine in response to immunologic, non-immunologic, physical and chemical stimuli - H1 receptors: triple response of Lewis (vasodilation-ereythema, axon reflex-pruritus, and wheal) - H2 receptors: vasodilation, increased gastric secretion

Answer 27

- acute: less than 6 weeks; majority of cases; lasts few hours to few weeks; more common in kids and young adults; cause usually undetermined - chronic: more common in young adults and middle age women; cause determined in 5-20% of cases

Answer 28

- raised, red, transitory area of edema - various sizes and shapes: papules, plaques, annular, arcuate, polycyclic - newest lesions are reddest - no scale - pruritus varies in severity - sudden onset; each lesion last <24 hours - occur on any skin surface

Answer 29

- ordinary: 4-36 hours - contact: 1-2 hrs, biological or chemical - urticarial vasculitis: 1-7 days - physical: 30 min-6 hrs; aquagenic, cholinergic (stress), cold, delayed pressure, dermatographism, exercise induced, localized heat, solar, vibratory

Answer 30

- "skin writing" - minor trauma/scratch = hive - lasts < 30 minutes

Answer 31

- recent infection: viral, bacterial - medications: ACE inhibitors, aspirin, NSAIDs, penicillins, diuretics, opioids - food and food additives: nuts, fish, shellfish, eggs, chocolate, strawberries, tomatoes, cheese, etc - chemical/contact: latex, ammonium, persulfate, perfumes, plants, cosmetics, textiles - other misc: parasites, arthropod bites, malignancy, hormones, autoimmune

Answer 32

- detailed H&P - 5 Is: infections, ingestants, inhalants, injectants, internal disease - contact/chemical - allergen testing - stool cultures/sinus xray - autoimmune/CT work up - malignancy work up - thyroid disease

Answer 33

- acute: drug eruption, viral exanthem, insect bites, angioedema, urticaria vasculitis, pityriasis rosea - chronic: erythema multiforme, bullous pemphigoid, Lyme disease, urticarial vasculitis

Answer 34

- refer to derm if recurrent or chronic - treat underlying condition - antihistamines preferred initial Tx: 1st generation (sedate) = hydroxyzine and diphenhydramine (benadryl); 2nd generation (low sedating) = fexofenadine (allegra), certrizine (zyrtec), loratadine (claritin) - topicals: tepid or oatmeal bath - for difficult cases: H2 receptor antagonists, corticosteroids, tricyclic H1 and H2

Answer 35

- abrupt and evanescent swelling of the skin, mucous membranes, resp/GI tracts - deeper rxn: more diffuse swelling than hives; deeper form of urticaria that involves deep dermis and subQ tissue - caused by increased vascular permeability

Answer 36

- sex: F >M | - may be with or w/o family history, urticaria, systemic symptoms

Answer 37

- subQ tissue: face including lips, hands, arms, legs, genitals - GI organs: stomach, intestines, bladder; nausea, vomiting, diarrhea - upper airway: dyspnea and dysphagia - non-pitting swelling - may have pain or burning - pruritus typically absent - marked periorbital/perioral swelling

Answer 38

- detailed H&P - possible biopsy - immunologic studies deferred to allergy or derm - some recommend CBC/diff, basic metabolic panel, thyroid

Answer 39

- anaphylaxis - urticaria - cellulitis - erysipelas - contact dermatitis

Answer 40

- acute severe attacks: epinephrine and antihistamines - refer to derm/allergist - ID bracelets w/ Dx - Epi Pen - hereditary angioedema: replacement with C1 inhibitor concentrate; fresh frozen plasma - intense support may be necessary depending on Sxs

Answer 41

- common, acute, might be recurrent, inflammatory, hypersensitivity disease - EM minor: localized skin eruption with no mucosal involvement - EM major: more severe mucosal and skin (eg SJS or TEN - potentially life threatening disorders, derm emergencies)

Answer 42

- M>F slightly | - 20-40 y.o; 20% in adolescents

Answer 43

- most common is herpes simplex virus, Mycoplasma pneumoniae, acute URI - medications - other infection (bacterial/viral/fungal) - contact allergens - flavoring, preservative, food - immunologic disorders; connective tissue diseases - mechanical (tattoos)

Answer 44

- prodrome: malaise, fever, itching, burning, couch - numerous lesions: target lesions, erythematous macules and papules, urticarial-like, vesicles, bullae - primary lesion: small dull red macule with central papule/vesicle that may flatten and clear - symmetrical on palms, soles, extensor surfaces of forearms/legs - with or w/o burning, Koebner phenomenon - mucosal lesions - heal w/o scarring

Answer 45

- detailed H&P - biopsy - helpful if dx uncertain - HSV PCR if lesions suggestive - more systemic work-up in severe cases

Answer 46

- urticaria - Stevens Johnson syndrome - toxic epidermal necrolysis - drug eruption - bullous pemphigoid

Answer 47

- most mild cases don't require Tx - antiviral therapy - antihistamines for pruritus - systemic steroids for widespread disease - soothing mouthwashes - symptomatic for wounds - topical antibiotics - supportive care: IV fluids w/ electrolytes if severe - refer to derm

Answer 48

- hypersensitivity reaction to various triggers - inflammatory reaction in the panniculus - self limiting - 55% cases are idiopathic

Answer 49

- age 18-34 years - 5F:M in adults; kids affected equally - bacterial: strep infections, TV, yersinia, salmonella, shigella - fungal: coccidiomyosis - viruses: hep B, HSV, Epstein Barr - parasitic: giardiasis, ascariasis - drugs: sulfonamids, oral contraceptives, penicillin - inflammatory conditions - malignancy: lymphoma, leukemia, renal cell carcinoma - pregnancy

Answer 50

- lesions start as poorly defined, red, firm, tender subQ nodules, 2-6cm that fade over 1-3 weeks, do not scar - extensor surfaces, bilateral but not symmetric, most common on pretibial surfaces - new lesions appear for 3-6 weeks - ankle edema and leg pain are common - may have prodrome of flu-like Sxs, fever, myalgias a few weeks before or with onset of lesions - arthralgia > 50%

Answer 51

- detailed H&P - biopsy if atypical and include fat - throat culture/rapid strep - complete CBC - CXR - PPD - ESR - stool culture with GI sxs

Answer 52

- erysipelas - cellulitis/thrombophlebitis - acute urticaria - physical abuse - Henoch Schonlein purpura

Answer 53

- treat underlying condition and stop offending medication - NSAIDs - rest - cool wet compresses - potassium iodide or corticosteroids (only if severe or recurrent)

Papulosquamous and Inflammatory Dermatoses Flashcards

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