Term
| What are the characteristic traits of papulosquamous disorders? |
|
Definition
| Scaly papules and plaques |
|
|
Term
| What are the different types of papulosquamous disorders? |
|
Definition
| Psoriasis, Pityreasis Rosea, Lichen Planus, Seborrheic Dermatitis |
|
|
Term
|
Definition
| Chronic disease marked by recurrent exacerbations and remissions throughout life, incurable, can be emotionally and physically disabling |
|
|
Term
|
Definition
| Precise etiology unknown, likely a combination of genetic factors and external triggers |
|
|
Term
| What human leukocyte antigen (HLA) is most definitively associated with psoarias? |
|
Definition
| HLA-Cw6 (HLA-B17 has earlier onset and is more severe) |
|
|
Term
| What can trigger Psoriasis? |
|
Definition
| Physical trauma, infections, HIV, alcohol consumption, smoking, obesity |
|
|
Term
| How does a psoriasis plaque form? |
|
Definition
| Immune dysregulation due a trigger activating inflammation. Persistent Th1 activation releases Th1 based cytokines (THF-alpha and IL-2), cytokines cause keratinocyte proliferation |
|
|
Term
| What are some of the more important consequences of TNF over-activity such as in psoarias? |
|
Definition
| Increased inflammation, angiogenesis, articular cartilage degeneration, skin thickening |
|
|
Term
| What are the clinical features of Psoriasis? |
|
Definition
| Sharply demarcated erythematous plaques with thick silvery white scales |
|
|
Term
| What are some associated findings with Psoriasis? |
|
Definition
| Auspitz sign, Koebner's phenomenon, Wornoff ring |
|
|
Term
|
Definition
| Small pinpoint bleeding appears when a scale is peeled off (as in Psoriasis) |
|
|
Term
| What is Koebner's phenomenon? |
|
Definition
| Non-specific trauma leads to formation of psoriasis in area of irritation |
|
|
Term
|
Definition
| Area of blanching around a psoriatic patch |
|
|
Term
| What is Psoriasis Vulgaris? |
|
Definition
| Vulgaris means common, characteristic and common Psorias manifestation |
|
|
Term
| What is Guttate Psoriasis? |
|
Definition
| Sudden "drops" develop small red/pink scaly papules, almost like small drops of PSA on skin, also known as acute eruptive psoriasis. Primary association is Strep throat: precedes eruption in 1/2 of cases |
|
|
Term
| What is Acrodermatitis Continua Hallopeau? |
|
Definition
| Psoriasis that occurs on distant portion of fingers, very tender, nail can be shed |
|
|
Term
| What are the areas of predilection in Psorias Vulgaris? |
|
Definition
| SNAKES: Scalp, Nails, Anogenital area, Knees, Elbows, Sacrum |
|
|
Term
| What is generalized pustular psoriasis? |
|
Definition
| More serious form of PSA, patient often febrile w/ leukocytosis, abrupt skin lesions as numerous sterile pustules on highly erythematous skin |
|
|
Term
| What can trigger generalized pustular psoriasis? |
|
Definition
| Infection, rapid tapering of corticosteroids, hypocalcemia, infection |
|
|
Term
| What kind of nail changes are seen with psoriasis? |
|
Definition
| Involves 10-20% of patients, can cause pitting, thickening, salmon/"oil" spots, splinter hemorrhages, distal oncholysis. Effects depend on part of nail effected - nail matrix, proximal bed, or distal bed |
|
|
Term
| How is psoriasis treated? |
|
Definition
| Topical - Corticosteroids, Vit D analogues, Lightbox - UV-B, UV-A, Systemic - Methotrexate, Cyclosporin, Acitretin |
|
|
Term
| What are the different classes of topical corticosteroids? |
|
Definition
| Ranges from 1 (super-potent) to 7 (mild) |
|
|
Term
| What is the mechanism of Vit D3 analogues (calcipotriene and calcitrol) in Psoriasis treatment? |
|
Definition
| Inhibits keratinocyte proliferation and has anti-inflammatory effects, can be coupled with other treatments, should be used AFTER UV light therapy |
|
|
Term
| Describe UVB lightbox treatment of psoriasis |
|
Definition
| Broad and narrow band treatments, narrow is more effective |
|
|
Term
|
Definition
| An oral ingestion of potent photosensitizer, not used very often anymore to treat Psoriasis due to risk of developing squamous cell carcinoma |
|
|
Term
| What is methotrexate and how is it used to treat Psoriasis? |
|
Definition
| Folic acid antagonists, inhibits dihydrofolate reductase (inhibits S phase of cell cycle): Immunosuppressive |
|
|
Term
| What are the potential adverse side effects of methotrexate when used as a systemic agent to treat Psoriasis? |
|
Definition
| Hematologic changes, hepatotoxicity, pulmonary fibrosis. Liver observation is recommended |
|
|
Term
| What is Cyclosporin and how is it used to treat Psoriasis? |
|
Definition
Systemic agent, inhibits release of cytokines, specifically IL-2,
by binding and deactivating calcineurin, is immunosuppressive |
|
|
Term
| What are some potential adverse effects of Cyclosporin? |
|
Definition
| Renal impairment, hypertension, elevated triglycerides, hyperkalemia, several drug-drug interactions, hypomagnesia, hepatotoxicity, hypertrichosis (common), long term risk of malignancy due to chronic immunosuppression |
|
|
Term
| What biologic agents are used to treat Psoriasis? |
|
Definition
| Adalimumab (IM), Etanercept (IM), Infliximab (IV) - all are TNF-alpha inhibitors and immunosuppressive |
|
|
Term
| What is Pityriasis Rosea? |
|
Definition
Benign, self-limiting, skin eruptions that abruptly appear, lesions are pink/salmon colored, oval, w/ an inner central “collarette” of fine scale
around papule/plaque lesion, oriented along skin lines on the back to form "christmas-tree" lesion |
|
|
Term
| An initial lesion of Pityriasis Rosea is known as what? |
|
Definition
| Herald patch, is much larger than subsequent lesions |
|
|
Term
| How is Pityriasis Rosea contracted? |
|
Definition
| Unknown etiology though may possibly be viral, spontaneously resolves after 6-8 weeks |
|
|
Term
| What other pathologies should you consider in your differential diagnosis of Pityriasis Rosea? |
|
Definition
| Secondary syphilis (great imitator), drug eruptions, Tinea corporis, Tinea versicolor, Nummular eczema, Guttate psoriasis |
|
|
Term
| How is Pityriasis Rosea treated? |
|
Definition
| Patient education and reassurance, topical corticosteroids for itching |
|
|
Term
| What are the clinical manifestations of Lichen Planus? |
|
Definition
| Know the 5 P's: Pruritic, Planar, Polyangular, Purple, Papules. Favors flexor surfaces, can also be in genitalia or oral so make sure to check buccal mucosa, check for Wickham's striae and Koebner phenomenon |
|
|
Term
| What other pathology is associated with Lichen Planus? |
|
Definition
| Hep C has been implicated in triggering Lichen Planus |
|
|
Term
| How does Lichen Planus appear in the mouth? |
|
Definition
| White lacy network pattern on buccal mucosa, pink/whitish papules on tongue |
|
|
Term
| How might Lichen Planus effect nails? |
|
Definition
| Can result in Pterygium where scar bridge between nail matrix and proximal nail fold forms a V-shaped "angel wing" - Classic finding. Trachyonychia (loss of luster, roughness) also may occur |
|
|
