Papulosquamous Disorders Flashcards by C P

Hypopigmented patches with a mild scale, slightly pruritic.
Symmetric, found on forehead, cheeks and neck, usually found in ages 3-16 years

Pityriasis Alba

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When is pityriasis alba worse?

Summer, sun worsens condition

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How should you treat Pityriasis Alba?

The condition is benign and self limiting, may relapse, unknown cause.

May use TCS or TCIs for symptoms

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Salmon colored plaques with ISLANDS OF SPARING.
Waxy, diffuse orange keratoderma of palms and soles.

rare, chronic papulosquamous disorder

Pityriasis Rubra Pilaris

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How to dx PRP

punch biopsy

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1st and 2nd line treatments for Pityriasis Rubra Pilaris?

Symptomatic Treatment:

1st Isotret
2nd Methotrexate or Apremilast

Antihistamine, high potency TCS, urea/sa, tret

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What should you educate patient on regarding treatment of Pityriasis Rubra Pilaris

It may take years to resolve.

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Herald patch, salmon red colored patches with fine scale, acute benign exanthematous eruption
christmas tree pattern
proximal extremities and trunk

Pityriasis Rosea

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How long does Pityriasis Rosea hang around? when is it at its worst?

6-12 weeks

Spring/Fall

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How to treat Pityriasis Rosea

antihistamines
tcs
sun/heat avoidance

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Recurring crops of erythematous papules w/ a central scale, present on trunk and extremities

Pityriasis Lichenoides

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Treatment for Pityriasis Lichenoides

TCS, TCI, azithromycin, erythromycin

does not require treatment

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Education for Pityriasis Lichenoides

Rare, response to infection, may last months to years, will need biopsy.

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Pityriasis Lichenoides et Varioliform

Prolonged course of Pityriasis Lichenoides, lasting 1-3 years, if prolonged may progress to mycosis fungoides or ctcl

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PLV is also known as

MuchaHabermann

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Acute onset of 2-3 mm macules and papules with a rapid progression to vesicles, ulceration and necrosis, emergency

PLV

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how to treat PLV

TCS
TCI
Doxycycline
Dapsone
Acetretin

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Pruritic urticarial papules
3rd trimester
no risk to fetus
most common in primagravida
SPARES UMBILICUS
Occurs on abdomen, lower back, buttock, upper/inner arms

PEP

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How to treat PEP?

TCS
Prednisone
Antihistamines

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When does PEP resolve

after delivery

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When is seb derm at its worst?

Better in summer, worse in winter

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Cracked riverbed, most common in lower extremities, trunk and dorsal hands

xerosis cutis

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how to treat xerosis cutis

check tsh, t4, cmp, lft
bathe in lukewarm water
SOAK AND SEAL
Use humidifier
urea
lactic acid
ammonium lactat

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What triggers psoriasis

weather
medications- BB, lithium, antimalarials
Group A strep

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Most common form of psoriasis

plaque psoriasis

Micaceous scale + Auspitz sign Most common in flexural areas, umbilicus, upper gluteal cleft

Plaque psoriasis

"Dew Drop" R/t Group A strep younger patients normally on trunk (ask about a sore throat recently)

Guttate psoriasis

Thin, shiny, erythematous skin found in folds, not moist

Inverse psoriasis

Sterile, noninfectious pustules on palms and soles

palmopustular psoriasis

RED Man syndrome generalized psoriasis dysregulation in IL-36 pathway malaise, fever, leukocystosis Spreads over the body in hours

ERYTHRODERMA

Associated with more severe forms of psoriasis, most commonly psoriatic arthritis, oil spots, onycholysis, dystrophy

Nail psoriasis

History components important when interviewing a psoriasis patient?

family hx arthritis hx trauma-koebner phenomenom recent strep infections BB? antimalarial? lithium?

Grade psoriasis using palm?

Mild- less than 3% Moderate 3-10 Sever > 10 Palm print= 1 %

psoriasis treatment guidelines

reduce burden to 1% or less within 3 months, 3% BSA or less

How long do you perform ULtraviolet B light therapy for psoriasis

3 months then need to take a break.

adalimumab certolizumab etanercept infliximab

TNF alpha inhibitors

Brodalumab ixekizumab secukinumab

il-17 inhibitor

ustekinumab

il12/23 inhibitor

guselkumab tildrakizumab rizankizumab

il-23 inhibitor

Which biologic best for pregnancy?

certolizumab does not cross barrier

Labwork for biologics

baseline and annual tb hep b&c hiv cbc cmp

Rems program biologic for suicidal ideation

brodalimumab

Caution w/ IBD patients and depressoin

apremilast

psoriasis rescue drug, clears skin quickly, weigh based dosing 2.5mg/kg

Cyclosporine

labs to check with cyclosporine

blood pressure cbc bun/creat lft lipid uric acid mg and potassium pregnany test

how long can you stay on cyclosporine

no longer than 1 year, usually 6months of treatment.

Cat X slow onset, titrate slowly liver contraindications do not give to patients who consume alcohol hair loss common monitor cbc q 3m

methotrexate

Waxes and wanes improves in summer, worsens in winter Thick, waxy scaling

Seb derm

Treatment for seb derm

keto shampoo 2% Ciclopirox 1% Seleniumsulfide 2.5% Stop oily makeup IF SEVERE: tx with oral antifungals

Mirrored skin image with erythema, sometimes violaceous, maceration, superficial fissures present

intertrigo

Treatment for intertrigo

Aluminum acetate, burrow's solution 1;40, dilute vinegar or wet tea bags zinc/a&D ointment, dimethicone, lanolin topical antifungals; nystatin, miconazole, and econazole diflucan 200 mg if severe Weight loss Avoid tight fitting clothes, reduce skin on skin friction, use ph balanced soaps, avoid alkaline, dry skin folds completely, glycemic control

What are the 7 P's of lichen planus

planar (flat topped) pruritic purple polygonal papules penile prolonged course

- occurs on flexor aspect of wrist/hands - extensor surgaces of forearms and legs - Koebner phenomenon - thinning, ridging, splitting, pterygium - If photodistributed think drug related

Lichen planus

All patient's with LP should be screened regularly for....

oral and perineal disease as it is linked to SCC Hepatitis C

How to treat LP

Cutaneous; topicals (TCIs, TCS, & oral antihistamines) Genital; (high potency TCS, tacrolimus)

Polymorphic vesicles, pustules or erosions, erthematous scaly brown red papules which flatten over time, patient may complain of burning or pruritus Spontaneous regression

Pityriasis Lichenoides

Treatment for pityriasis lichenoides

topical corticosteroids Doxy Azithromycin Erythromycin

Does Pityriasis Lichenoides scar?

Yes and leaves PIH

Precedes URI symptoms, mild fever Herald patch Usually followed by Christmas tree pattern rash How would you treat?

Pityriasis Rosea Topical steroids, anti-itch therapies, oral acyclovir 400mg 5x/day x 1 week (initiate within 1st two weeks)

Erythematous papules, vesicles, and often hyperkeratotic/scaly papules, wax and wane, pruritus present How would you treat?

Grover's - Avoid exacerbations from sunlight, heat, friction, or sweat -TCS short course

Rare and sporadic; RAPID PROGRESSION salmon colored hyperkeratotic papules on the trunk/extremities (nutmeg grater, gooseflesh, islands of sparing) Sandal like palmoplantar keratoderma RED ORANGE PLAQUES, yellow brown hyperpigmentation of nails BUT NO INVOLVEMENT OF PROXIMAL NAIL MATRIX AND NAIL BED How do you treat?

PRP Self limited, resolves within 3 years of onset EMOLLIENTS KERATOLYTIC AGENT UREA SALICYCLIC ACID TOPICAL STEROIDS TAZAROTENE TCI SYSTEMIC 1ST LINE ISOTRETINON METHOTREXATE TNF ALPHA INHIBITORS Il 17 INHIBITORS

typically develops in the third trimester- polymorphous and urticarial papules STARTS ON ABDOMEN BUT SPARES THE UMBILLICUS, severe pruritus How do you treat?

Polymorphic eruption of pregnancy (pep or puppp) topical steroids antihistamines

what should be a clue for intrahepatic cholestasis in pregnancy

The presence of severe pruritus with no lesions.

What drugs commonly cause erythroderma?

carbamazepine, phenytoin, allopurinol, ace inhibitors, PPIs, oral retinoids, bactrim, PCN, dapsone, hydroxychloroquine

What are common causes of erythroderma in adults

psoriasis atopic dermatitis drug eruptions idiopathic

What are systemic symptoms of erythroderma?

peripher lymphadenopathy f/e shift pretibial pedal edema vasodilation temp dysregulation hepatosplenomegaly

Loss of functional melanocytes

Vitiligo

What are two types of vitiligo? 1st line therapy?

non-segmental (both sides of body) and segmental (one side) TCS/TCIs Nonsegmental- opzelura BID

non-scaly hypopigmented macules/patches involving the trunk, (orange-red follicular fluorescence on Wood's lamp)

Progressive macular hypomelanosis BPO w/ clindamycin oral isotretinoin Explain reoccurence is very common.

acroderma where pigment is absent form the skin

leukoderma, once remove the causative agent will repigment over many months.

Causes of leukoderma

hydroquinone ADHD patches TCS ILK EGFR inhibitors azelaic acid imiquimod phenols sulfhydryls mercury arsenic fragrance

Median age of onset 20-30 years old, most common in Caucasians, increased keratinocyte proliferation/turnover and erythema of the skin, triggers- environmental, stress, infection, excessive body weight, cigarettes, medications, alcohol, weather/climate

psoriasis

abnormal hyperproliferation and differentiation leading to epidermal hyperplasia, dermal infiltration by various immune cells, increase capillary permeability in the dermis

pathogenesis of plaque psoriasis

White adherent micaceous scale on erythematous base arms/legs elbows/knees, + auspitz, koebnerization

plaque psoriasis

oil spots, onycholysis, itching around fingernails

nail psoriasis

smooth erythematous plaques, that are often macerated and fissured, found in intertriginous areas of skin including inguinal, inframammary, axillary or abdominal folds

inverse psoriasis

often triggered by strep, small spots or rain drop like scaly papules or plaques

guttate psoriasis

scaly papules and plaques on erthematous bases favoiring extensor aspects, umbilicus, genitals, and postauricular sulcus. ITCH is very important in determining the severity of hte disease,

plaque psoriasis

how to score psoriasis

mild <3% bsa moderate 3%-10% BSA severe >10% BSA