what age can psoriasis present at? when does it most commonly occur?
psoriasis can present at any age, but it occurs most commonly in the third and sixth decades
what are the 5 main variants of psoriasis?
plaque type guttate pustular inverse erythrodermic psoriasis
What is the most common variant of psoriasis and describe the lesions associated with it
plaque-type psoriasis (90%) well-demarcated, erythematous plaques with an adherent, silver to white colored scale
where on the body do the plaques associated with plaque psoriasis most often occur
scalp, extensor surfaces of extremities (elbows and knees), and the periumbilical and sacral trunk RARELY occur on face, or on intertriginous areas of the body (crotch and armpit)
What is the Koebner phenomenon, what skin condition(s) is it associated with; what are some specific examples
it is where lesions arise at sites of trauma associated with plaque psoriasis. it occurs after scratching or areas of sunburn
- Also seen with Lichen Planus
What is inverse psoriasis, where does it occur
in the intertriginous areas of the body (gooch and pits) - compare to plaque psoriasis which rarely occurs here
do you see invovlement of flexor surfaces in plaque psoriasis?
no - popliteal fossa and antecubital fossa areas are commonly spared (diff from atopic dermatitis)
what is the Auspitz sign and what disease is it associated with?
plaque psoriasis - if you pick off a scale, will see bleeding - due to elongated dermal papillae being exposed after scratching off
what is the second most common variant of psoriasis?
Guttate psoriasis - who is more common in and how does it present (describe lesions)
more common in young adults multiple small "drop shaped" erythematous scaly palques diffusely on body - frequently on trunk
what usually precedes guttate psoriasis? how does this affect treatment?
guttate psoriasis is often preceded by streptococcal infxn, especially pharyngitis thus treatment usually includes ABX
describe the appearance and distribution of pustular psoriasis
superficial pustules - localized on palms and soles or can be generalized
what is the term for pustular psoriasis localized on palms and soles
characterize the erythrodermic variant of psoriasis
diffuse erythrodema with fine scaling i.e. total body redness
describe involvement of the tongue (mucosal) in psoriasis - appearance
geographic, annular white patches
describe psoriatic nail changes (4)
"oil spots," nail pitting, distal onycholysis, accumulation of subungual debris
what is distal onycholysis
lifting up of the nail at the distal portion
what is the major associated systemic manifestation of psoriasis and how does it present
psoriatic arthritis asymmetric oligoarthritis of small joints of hands and feet
what are 5 pathologies/ diseases that psoriatic patients are at increased risk for developing
obesity DM hyperlipidemia HTN CV disease
what joints are most commonly involved in psoriatic arthritis and what is the description of the appearance of these?
DIP joints most common "sausage fingers" termed dactylitis
what is the pathogenesis of psoriasis
T-cell mediated inflammatory disease
describe the genetics associated with psoriasis
about 1/3 of pts w/ psoriasis have a 1st degree relative with psoriasis genetics play a role
what factors contribute to flares seen in psoriasis
group A beta-hemolytic strep infxns, medications, and stress
what medications are associated with flares in psoriasis
beta blockers, ACE inhibitors, NSAIDs, lithium, interferon and antimalarials
what natural factor diminishes psoriasis
sunlight phototherapy is a potential form of therapy
when do you use topical treatment alone for psoriasis
when the psoriasis is localized
what topical treatments are used in psoriasis (5)
topical Vit D agents
topical tar products
what is the treatment regimen for patients with moderate to severe psoriasis?
systemic treatment in addition to topical therapy
what comprises the systemic treatment used in psoriasis
phototherapy, oral medications (retinoids, MTX) and biologics
what biologics comprise the systemic treatment of moderate to severe psoriasis
What is a key systemic treatment that you should not use in the treatment of moderate to sever psoriasis and why? this is $$
systemic steroids SHOULD NOT be used for tx of psoriasis the risk of disease flare upon discontinuation of the steroids is high
define Seborrheic dermatitis, including the bug associated with it
a very common inflammatory reaction to Malassezia (Pityrosporum ovale) yeast that thrives on seborrheic (oil-producing) skin
how does Seborrheic dermatitis present
erythematous scaling patches on the scalp, hairline, eyebrows, eyelids, central face and nasolabial folds, external auditory canals, or central chest all the oily areas
describe the presentation of seborrheic dermatitis in infants
"cradle cap" pink to yellow macules and patches with white greasy scales on the scalp, face, and diaper area
is what pt population is seborrheic dermatitis worse
does seborrheic dermatitis appear hyperpigemented or hypopigmented?
hypopigmented, especially in darker skin types
what part of chest does seborrheic dermatitis favor?
central chest where there is the greatest concentration of oil
what is the treatment for seborrheic dermatitis
ketaconazole cream or dandruff shampoos or low-potency steroid for flares
define Pityriasis Rosea, and who does it commonly occur in?
acute papulosquamous eruption that mainly occurs in young people
what virus may Pityriasis Rosea be associated with?
human herpes virus 6 or 7
how does Pityriasis Rosea present?
initially with a single herald patch, a pink-salmon colored, oval, 2-10 cm plaque with central fine collarette scale
what is the secondary phase of pityriasis rosea?
eruption in "christmas tree" pattern - numerous smaller similar lesions dispersed on trunk in Xas tree pattern
describe the course of pityriasis rosea
acute onset, lasts 6-8 weeks
what is the treatment for pityriasis rosea?
it is self-limiting, mean duration is 5 weeks, most resolve without treatment by 8 weeks some patients request treatment for pruritis
define lichen planus
idiopathic inflammatory dz of skin, hair, nails, and mucous membranes - seen most common in middle-aged adults
describe the lesions of lichen planus - this is $$ (Emily Thompson said this is on the test)
6Ps purple pruritic plaques papules polygonal planar - they are flat topped
besides the 6 Ps, what is another feature associated with Lichen Planus, name and describe
a fine reticulated network of white lines - Wickham's Striae
Lichen Planus - where are lesions found on body
flexor wrists, forearms, dorsl hands, lower legs, presacral area, neck, and glans of the penis (schlong is common site)
what phenomenon is associated with Lichen Planus
Koebner's phenomenon - lesions appear in areas of trauma
- also associated with plaque psoriasis
what are potential triggers for Lichen Planus
Hep C infection or medication (ACE-I, thiazide diuretics and antimalarials)
what is common finding of oral mucosa involvement in Lichen Planus
oral lesions present as net-like white streaks on buccal mucosa - Wickham's striae
what variant of lichen planus causes scarring alopecia
Lichen planopilaris (LPP), the follicular (hair) variant of lichen planus
what drugs are most commonly implicated in the cause of Lichen Planus
ACE inhibitors, thiazide diuretics, antimalarials, quinidine, and gold (gold all in my chain, gold all in my rang, gold all in my watch, don't believe me just watch)
what is a high $$ association for Lichen Planus i.e. what other disease is more prevalent in pts with LP vs controls
Hep C atypical presentations are also more likely to be associated with Hep c
what is pathogenesis of Lichen Planus
likely involves an autoimmune reaction against antigens on lesional keratinocytes
besides topical corticosteroids, how can we treat mucosal lichen planus
topical calcineurin inhibitors (tacrolimus)
what is the intitial treatment for Lichen Planus
topical and intralesional corticosteroids