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sdnp exam > Papulosquamous Disorders > Flashcards

Papulosquamous Disorders Flashcards

1
Q

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

A

Pityriasis Alba

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2
Q

When is pityriasis alba worse?

A

Summer, sun worsens condition

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3
Q

How should you treat Pityriasis Alba?

A

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

May use TCS or TCIs for symptoms

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4
Q

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

rare, chronic papulosquamous disorder

A

Pityriasis Rubra Pilaris

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5
Q

How to dx PRP

A

punch biopsy

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6
Q

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

Symptomatic Treatment:

A

1st Isotret
2nd Methotrexate or Apremilast

Antihistamine, high potency TCS, urea/sa, tret

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7
Q

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

A

It may take years to resolve.

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8
Q

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

A

Pityriasis Rosea

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9
Q

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

A

6-12 weeks

Spring/Fall

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10
Q

How to treat Pityriasis Rosea

A

antihistamines
tcs
sun/heat avoidance

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11
Q

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

A

Pityriasis Lichenoides

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12
Q

Treatment for Pityriasis Lichenoides

A

TCS, TCI, azithromycin, erythromycin

  • does not require treatment
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13
Q

Education for Pityriasis Lichenoides

A

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

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14
Q

Pityriasis Lichenoides et Varioliform

A

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

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15
Q

PLV is also known as

A

MuchaHabermann

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16
Q

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

A

PLV

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17
Q

how to treat PLV

A

TCS
TCI
Doxycycline
Dapsone
Acetretin

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18
Q

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

A

PEP

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19
Q

How to treat PEP?

A

TCS
Prednisone
Antihistamines

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20
Q

When does PEP resolve

A

after delivery

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21
Q

When is seb derm at its worst?

A

Better in summer, worse in winter

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22
Q

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

A

xerosis cutis

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23
Q

how to treat xerosis cutis

A

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

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24
Q

What triggers psoriasis

A

weather
medications- BB, lithium, antimalarials
Group A strep

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25
Q

Most common form of psoriasis

A

plaque psoriasis

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26
Q

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

A

Plaque psoriasis

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27
Q

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

A

Guttate psoriasis

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28
Q

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

A

Inverse psoriasis

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29
Q

Sterile, noninfectious pustules on palms and soles

A

palmopustular psoriasis

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30
Q

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

A

ERYTHRODERMA

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31
Q

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

A

Nail psoriasis

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32
Q

History components important when interviewing a psoriasis patient?

A

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

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33
Q

Grade psoriasis using palm?

A

Mild- less than 3%
Moderate 3-10
Sever > 10

Palm print= 1 %

34
Q

psoriasis treatment guidelines

A

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

35
Q

How long do you perform ULtraviolet B light therapy for psoriasis

A

3 months then need to take a break.

36
Q

adalimumab
certolizumab
etanercept
infliximab

A

TNF alpha inhibitors

37
Q

Brodalumab
ixekizumab
secukinumab

A

il-17 inhibitor

38
Q

ustekinumab

A

il12/23 inhibitor

39
Q

guselkumab
tildrakizumab
rizankizumab

A

il-23 inhibitor

40
Q

Which biologic best for pregnancy?

A

certolizumab does not cross barrier

41
Q

Labwork for biologics

A

baseline and annual tb
hep b&c
hiv
cbc
cmp

42
Q

Rems program biologic for suicidal ideation

A

brodalimumab

43
Q

Caution w/ IBD patients and depressoin

A

apremilast

44
Q

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

A

Cyclosporine

45
Q

labs to check with cyclosporine

A

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

46
Q

how long can you stay on cyclosporine

A

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

47
Q

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

A

methotrexate

48
Q

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

A

Seb derm

49
Q

Treatment for seb derm

A

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

50
Q

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

A

intertrigo

51
Q

Treatment for intertrigo

A

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

52
Q

What are the 7 P’s of lichen planus

A

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

53
Q
  • occurs on flexor aspect of wrist/hands
  • extensor surgaces of forearms and legs
  • Koebner phenomenon
  • thinning, ridging, splitting, pterygium
  • If photodistributed think drug related
A

Lichen planus

54
Q

All patient’s with LP should be screened regularly for….

A

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

55
Q

How to treat LP

A

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

56
Q

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

A

Pityriasis Lichenoides

57
Q

Treatment for pityriasis lichenoides

A

topical corticosteroids
Doxy
Azithromycin
Erythromycin

58
Q

Does Pityriasis Lichenoides scar?

A

Yes and leaves PIH

59
Q

Precedes URI symptoms, mild fever
Herald patch
Usually followed by Christmas tree pattern rash

How would you treat?

A

Pityriasis Rosea

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

60
Q

Erythematous papules, vesicles, and often hyperkeratotic/scaly papules, wax and wane, pruritus present

How would you treat?

A

Grover’s

  • Avoid exacerbations from sunlight, heat, friction, or sweat
    -TCS short course
61
Q

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?

A

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

62
Q

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

How do you treat?

A

Polymorphic eruption of pregnancy (pep or puppp)

topical steroids
antihistamines

63
Q

what should be a clue for intrahepatic cholestasis in pregnancy

A

The presence of severe pruritus with no lesions.

64
Q

What drugs commonly cause erythroderma?

A

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

65
Q

What are common causes of erythroderma in adults

A

psoriasis
atopic dermatitis
drug eruptions
idiopathic

66
Q

What are systemic symptoms of erythroderma?

A

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

67
Q

Loss of functional melanocytes

A

Vitiligo

68
Q

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

A

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

Nonsegmental- opzelura BID

69
Q

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

A

Progressive macular hypomelanosis

BPO w/ clindamycin
oral isotretinoin

Explain reoccurence is very common.

70
Q

acroderma where pigment is absent form the skin

A

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

71
Q

Causes of leukoderma

A

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

72
Q

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

A

psoriasis

73
Q

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

A

pathogenesis of plaque psoriasis

74
Q

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

A

plaque psoriasis

75
Q

oil spots, onycholysis, itching around fingernails

A

nail psoriasis

76
Q

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

A

inverse psoriasis

77
Q

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

A

guttate psoriasis

78
Q

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,

A

plaque psoriasis

79
Q

how to score psoriasis

A

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

80
Q
A

sdnp exam (14 decks)

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