Rash Clinical Cases

Question 1

what else can psoriasis affect as well as the skin?

Answer 1

nails - pitting, oncholysis, dystrophy, subungal hyperkeratosis
joints

Question 2

what causes psoriasis?

Answer 2

multifactorial

genetic predisposition and environmental trigger - stress, drugs, infection

Question 3

what is the most common form of psoriasis?

Answer 3

chronic plaque psoriasis (psoriasis vulgaris)

Question 4

what is the koebner phenomenon?

Answer 4

psoriasis develops in scar, wound or area of trauma

Question 5

what is auspitz sign?

Answer 5

removal of surface scale reveals tiny bleeding points due to capillaries in extended dermal papillae

Question 6

give 3 other types of psoriasis?

Answer 6

guttate (after throat infection)
palmoplantar pustular (hands and feet)
erythrodermic/ pustular (drug induced)

Question 7

how are inflammatory markers affected by psoriasis?

Answer 7

raised

Question 8

does psoriasis affect life expectancy?

Answer 8

yes, by about 4 years due to increased cardiovascular risk

Question 9

what are some comorbidities with psoriasis?

Answer 9

arthritis
metabolic syndrome
crohns
cancer
depression
uveitis

Question 10

what are 5 topical therapies for psoriasis?

Answer 10

Vit D analogues
- calcipotriol
- calcitriol
coal tar
dithranol
steroid ointment (used in conjunction with other treatments)
emollients (essential)

Question 11

what non-topical treatments are used for psoriasis?

Answer 11

UVB and PUVA
Immunosuppression (methotrexate)
immune modulation

Question 12

first line for acne?

Answer 12

topicals:
- benzoyl peroxide
- Vit A derivatives (retinoids)
- antibiotics
Systemic:
- antibiotics (doxy)

Question 13

second line for acne?

Answer 13

oral isotretinoin (systemic retinoid)

Question 14

what happens with isotretinoin treatment?

Answer 14

causes initial flare 2-3 weeks in then improves over 16 weeks

Question 15

pathogenesis of acne?

Answer 15

increases sebum production, pore occlusion, dermal inflammation, bacterial colonisation of duct

Question 16

how is acne vulgaris distributed?

Answer 16

related to sites with most sebaceous units (face, upper back, anterior chest)

Question 17

describe acne vulgaris morphology?

Answer 17

comedones (whiteheads/blackheads)
pustules/papules
cysts
erythema

Question 18

what types of scarring can occur in acne?

Answer 18

atrophic, ice pick, texture change, hypertrophic

Question 19

what are the 3 grades of acne?

Answer 19

mild (scattered)
moderate (numerous with mild scarring)
severe (cysts, nodules and significant scarring)

Question 20

how long does it take to see the effect of oral antibiotics in acne?

Answer 20

up to 6 months

Question 21

what are the features of rosacea?

Answer 21

papules, pustules and erythema with no comedones
prominent facial flushing aggrevated by temp change, alcohol, spicy foods, UV
rhinophyma
conjunctivitis

Question 22

what is the cause of rosacea?

Answer 22

unknown but could be to do with the larger amount of demodex mite found in people with rosacea
can run in families

Question 23

how is rosacea managed?

Answer 23

topical:
- metronidazole, ivermectin
oral:
- oral tetracycline (long term)
- isotretinoin if severe
vascular laser
surgery for nose

Question 24

what can lichen planus do to the nails?

Answer 24

ridges

Question 25

what drugs can cause a lichenoid drug eruption?

Answer 25

ACE inhibitors | statins

Question 26

where and who does lichen planus often affect?

Answer 26

middle aged | volar wrists/forearms, shins and ankles

Question 27

what is wickhams striae?

Answer 27

fine lace like pattern on surface of buccal mucosa

Question 28

how long does lichen planus last?

Answer 28

12-18 months

Question 29

how is lichen planus treated?

Answer 29

symptomatically topical steroids oral steroids if severe

Question 30

what can happen in untreated lichen planus?

Answer 30

hyperpigmentation | hypertrophic scars

Question 31

what is nikolsky's sign?

Answer 31

when the top layers of the skin slip away when slightly rubbed indicates pemphigus

Question 32

who is bullous pemphigoid common in?

Answer 32

elderly

Question 33

what are the features of bullous pemphigoid?

Answer 33

large tense, non-scarring bullae on normal skin with erythema which can burst to leave erosions itchy plaques and papules may also be present early on

Question 34

what are the features of pemphigus vulgaris?

Answer 34

flaccid, thin roofed vesicles/bullae on scalp, face, axillae, groin can rupture to leave erosions nikolsky sign positive

Question 35

what is the prognosis for pemphigus vulgaris?

Answer 35

self-limiting can last months to years but most get remission in a few months with treatment high mortality if untreated

Question 36

how is pemphigus/pemphigoid investigated?

Answer 36

skin biopsy with immunofluoroscence

Question 37

how is pemphigus and pemphigoid treated?

Answer 37

systemic steroids immunosuppressants topicals - emollients, steroids, antiseptics tetracycline in pemphygoid