2.1 Cs Exam5: Papulosquamous & Vesiculobulbous

Front 1

What skin disorder is a chronic disease, characterized by recurrent exacerbations and remissions of scaly papules & plaques?

Back 1

Psoriasis

Front 2

What is the most definitive HLA association with psoriasis?

Back 2

HLA-Cw6

Front 3

What is the term to describe that any area of trauma to the skin can cause a psoriatic plaque?

Back 3

Koebner's reaction

Front 4

50% of children get exacerbation of psoriasis after what?

Back 4

2-3 weeks of URI

Front 5

Guttate psoriasis is an example that can follow what type of infection?

Back 5

Acute streptococcal infection

Front 6

What is a possible medication trigger for psoriasis?

Back 6

Lithium or beta-blockers

Front 7

What might be confusing about sunlight with psoriasis?

Back 7

Sunlight is reported to be beneficial

Front 8

Persistent TH1 activation is a/w which skin disorder?

Back 8

Psoriasis

Front 9

What are the clinical features of psoriasis?

Back 9

-sharply demarcated, erythematous plaques, papules and patches
-thick silvery-white scale!
-Auspitz sign (pinpoint bleeds when pick scales)
-Koebner's phenomenon (20% pts)
-Woronoff ring

Front 10

What is the most common form of psoriasis?

Where does it commonly occur?

Back 10

Psoriasis Vulgaris (erythematous plaques w/ silver)

(SNAKES)- Scalp, nails, anogenital, knees, elbows, sacrum

Front 11

Which form of psoriasis has a sudden appearance of small red/pink scaly papules on skin (almost like small drops of PSA on skin) diffusely over trunk and extremities?

Back 11

Guttate Psoriasis

Clue: look for recent strep throat. preceeds eruption by 1-2 weeks in 50% of cases!

Front 12

Which (more serious) form of psoriasis has an abrupt eruption of numerous sterile pustules on highly erythematous skin?

Back 12

Generalized Pustular Psoriasis (of Von Zumbusch)

Can coalesce into "lakes of pus!"

Front 13

Which form of psoriasis begans as pustules on the distal fingers and is VERY tender?

Back 13

Acrodermatitis continua of Hallopeau

Front 14

Which types of nail changes can occur usually after Psoriasis Vulgaris (10-20% pts)?

Back 14

Nail matrix: pitting/ crumbling/thickening

Proximal bed: salmon or “oil spots”, splinter hemorrhages (focal onycholysis)

Distal bed: distal onycholysis (lifting of the nail plate from the nail bed)

Front 15

What are some possible trigger factors for generalized pustular psoriasis (of Von Zumbusch)?

Back 15

infections, rapid tapering of corticosteroids, hypocalcemia, pregnancy

Front 16

What are possible treatments for Psoriasis?

Back 16

Topical agents (corticosteroids, corticosteroid sparing agents, Vitamin D3 analogues)
UV light
Systemic drugs (MTX, cyclosporins, TNF-alpha inhibitor)

Front 17

Which topical agent should be used AFTER UV light therapy?

What is the neg SE of PUVA?

Back 17

Vit D3 analogues

risk of developing squamous cell carcinoma

Front 18

What are the clinical features of Pityriasis Rosea?

Back 18

-Pink/salmon colored, oval in shape w/ inner central “collarette” of fine scale around lesion.*
-Favors trunk and extremities
-Initial lesion (common first on abdomen) is referred to as the “herald patch”* --- plaque that is LARGER than the subsequent lesions
-“Christmas tree” distribution on back*

Pityriasis Rosea is a benign, self-limiting skin eruption that abruptly appears. Tx: topical corticosteroids

Front 19

What disorder is an idiopathic inflammatory disease that affects the skin, hair, nails and mucous membranes (genitals & mouth)? (flat topped papule)

Back 19

Lichen Planus

Front 20

What are the clinical features of Lichen Planus?

Back 20

-5 P's*: Pruritic**, Planar, Polyangular (irregular angular borders), Purple, Papules
-Favors flexor surfaces of the wrist *(especially wrist), arms and legs. Also esp mouth & glans penis
-Wickham’s striae *may be present- lacy white lines over the plaque.

-Pterygium= triangular nail scar= angel wing, trachyonychia= distal nail splitting

-Koebner Phenomenon may occur

(assoc w HCV)

Front 21

Autoimmune Blistering Diseases (AIBDs) result from the production of what?

Back 21

autoantibodies that attack a specific adhesion protein in the skin that is responsible for either:

Holding the cells of the epidermis together (desmosomes)= ankantholysis (intraepidermal FLACCID blister) - Nikolsky sign
OR
Holding the epidermis to the dermis at the dermal epidermal junction (hemidesmosomes)= bulla (subepidermal TENSE blister) - Asboe-Hanson sign

Front 22

Pemphigus causes intraepidermal blisters. Is rupture more common in PV or PF (types)?

Back 22

PV

-bc blister above the basal layer of epidermis, easier rupture = more serious

Front 23

What are the clinical features for Pemphigues Vulgaris (PV)?

Back 23

-Mainly affects adults, life-threatening

-Characteristic skin lesion: Oral mucosal lesions, FLACCID, thin walled bullae that are easily ruptured

-Healing: brown hyperpigmentation WITHOUT scarring

-Histology: intraepidermal, suprabasilar "tombstoning"

-AutoAbs: desmoglein 1 & 3

Front 24

What 3 ways can you tell Pemphigous Foliaceous/Superficial Foliaceous (PF) from PV?

Back 24

-Blister occurs higher in epidermis
-Different antibodies involved (desmoglein 1 only)
-does NOT involve mucosal membranes

Front 25

What are the clinical features of Bullous Pemphigoid?

Back 25

-Elderly pt

-Widespread TENSE subepiderimal bullae
-Can be intensely pruritic (itchy)
-Nikolsky sign negative

-AutoAb's: BP Ag 1 (BP230) & BP 2 (BP180)

-Eosinophils

Front 26

An 83 year old man (or woman) taking LASIX & SULFA drugs, presents with tense blisters that itch. This is most likely...

Back 26

Bullous Pemphigoid

Front 27

What is the treatment for BP?

Back 27

Corticosteroids and immunosuppressants

– Oral steroids
– Azathioprine
– Mycophenolate mofetil
– Nicotinamide
– Tetracycline

Front 28

Which skin disease is almost ALWAYS a/w gluten sensitivity?

Back 28

Dermatitis Herpetiformis

(clinical manifestation of celiacs dz)

Front 29

What are the clinical features of Dermatitis Herpetiformis?

Back 29

-SEVERELY PRURITIC grouped subepidermal blisters* w. neutrophils & eosinophils in upper dermis
-Lesions tend to commonly be symmetric and occur first on extensor surfaces * (Like on elbows and knees *)
-AutoAbs: transglutaminase 3

Front 30

How is DH treated?

Back 30

Gluten free diet*
Dapsone*
Sulfasalazine
Sulfapyridone

Front 31

Why is it important to consider the location of the lesion in Allergic Contact Dermatitis?

Back 31

The ACD reaction is typically LOCALIZED to the area of skin that comes in contact with the allergen

Front 32

What are the top 2 allergens for ACD?

Back 32

1. Nickel sulfate 16.7% * (nickel ranked as top allergen by NACDG)
2. Neomycin sulfate 11.6%* (found in OTC topical antibiotic Neosporin*)

Front 33

T/F

Latex is a common allergen for ACD.

Back 33

True!

This is found in surgical gloves. Alternatives are vinyl or blue nitrile gloves.

Front 34

What type of ACD is caused by Poison Ivy, Poison Oak, or Poison Sumac?

Back 34

Rhus Dermatitis

Front 35

Describe lesions of Rhus Dermatitis.

Back 35

Often pruritic*
Streaky or linear**
Also may be marked by hives or blisters*

Front 36

What is the name of a phototoxic reaction that is caused by plant contact with skin that is THEN exposed to light (light activates the photosensitive chemical)?

Back 36

Phytophotodermatitis

Front 37

Describe the lesions of phytophotodermatitis.

Back 37

-Lesions typically appear several hours after exposure followed by burning erythema and development of vesicles/bullae*
-Lesions are asymmetric, of atypical shape and can be streaky
-Later, a residual hyperpigmentation occurs

Front 38

The most common areas for skin tags are where?

Back 38

the axilla (48%) followed by the neck (35%)

Front 39

What is a cutaneous horn?

Back 39

A hard, keratin projection

Front 40

Describe dermatofibromas.

Back 40

Benign, hard nodule

Front 41

Name for a painful (can be exquisitely tender), red, inflamed lesion on helix of ear.

Back 41

Chondrodermatitis Nodularis Helicis

Front 42

What is the best treatment for keratoacanthomas?

Back 42

Surgical removal! also helps rule out SCC, since they are difficult to distinguish

Front 43

Describe a pyogenic granuloma.

Back 43

Fragile and bleed easily
Glistening, moist-to-scaly surface

Front 44

What is the difference between a hypertrophic scar and a keloid?

Back 44

Hypertrophic scars are inappropriately large, but they are CONFINED to the wound site and REGRESS with time.

Keloids EXTEND beyond the margins of injury.