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B1-2 Papulosquamous disorders
n/a
39
Medical
Graduate
09/05/2012

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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
Describe Psoriasis
Definition
Chronic disease marked by recurrent exacerbations and remissions throughout life, incurable, can be emotionally and physically disabling
Term
What causes Psoriasis?
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
What is an Auspitz sign?
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
What is a Woronoff ring?
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
What is PUVA?
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
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