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