Psoriasis and Other Papulosquamous Disorders - Patel Flashcards Preview

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Flashcards in Psoriasis and Other Papulosquamous Disorders - Patel Deck (57):

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


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

palmoplantar pustulosis


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 steroids

topical retinoids

topical Vit D agents

topical keratolytics

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

TNF-a inhibitors

IL12/23 blocker

IL-17 blocker


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