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Flashcards in Papulosquamous Disorders Deck (11):
1

What is psoriasis?

A papulosquamous skin disorder
Chronic
Non infectious
Inflammatory autoimmune
Relapsing and remitting
Male=female

Well defined
Salmon pink plaques
Adherent silvery scales
Auspitz’s sign

2

What is the pathogenesis of psoriasis?

T cell mediated autoimmune response to keratinocytes

Hyper proliferation of keratinocytes

Accumulation of inflammatory cells

Shortened epidermal turnover time <10days

3

What are the precipitating factors of psoriasis?

Genetic, paternal imprint,
HLA CW6

Trauma (kobner phenomenon)

Infection (strep staph hiv)

Hormones (better in pregnancy, worse HYPOparathyoidism)

Sunlight 90%

Drugs (beta blockers, lithium, antimalarials, captopril)

Cigarette and alcohol

Emotion

4

What is the pathology of psoriasis?

Nucleated keratinocytes in corneum

Thick epidermis

Epidermal neutrophil infiltration

Dilated dermal capillary loops

Dermal T cell infiltration

5

What are the presentations of psoriasis?

Common
-chronic plaque
-guttate (children, adolescent)
-scalp
-nails (pitting, onycholysis, subungual hyperkeratosis)
-flexural (women . Elderly)
-palm and sole pustular

Less common
-pustular psoriasis
-erythrodermic
-arthritis mutilans
-enthesitis

6

What are the DDx for psoriasis?

Discoid eczema (itchy)

Seborrhoeic eczema

Pityriasis rosea

Secondary syphilis

Cutaneous T cell lymphoma

Tinea unguium

7

What are the treatments for psoriasis?

Non pharmacologic
-education and counseling

Pharmacologic

Local/topical
-vitamin d analogues
-local retinoids
-topical corticosteroids
-dithranol (anthralin)
-coal tar
-salicylic acid
-topical immunomodulators calcineurin

UVB Radiation

Systemic (if affecting >20% BSA)
-photochemotherapy psoralen+UVA
-retinoids
-methotrexate
-ciclosporin

Biological
-block T cell trafficking
-block cytokine
-block T cell activation


Combined
-Ingram regimen
-goeckerman regimen

8

What is pityriasis rosea?

Papulosquamous skin disorder
By reactivation of HHV 6,7
Not contagious
Herald plaques then fir clusters
Round erythematous scaly plaques

9

What are the DDx for pityriasis rosea?

Guttate psoriasis
Tinea corporis
Secondary syphilis
Captopril eruption
Pityriasis versicolor

10

What is lichen planus?

Violaceous
Itchy
Flat topped papules
On volar aspect of limbs
Wickham’s striae
Oral and genital striae
Kobner phenomena

11

What are the causes for exfoliating erythroderma?

Psoriasis
Eczema
Lymphoma
Scabies
Drug eruptions