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Psoriasis mainfests as a result of what pathological mechanisms? (2)
  • Cutaneous inflammation
  • Epidermal hyperproliferation
What is the class of disease is psoriasis, generally speaking?
  • What cell type mediates the inflammation?
Immunologic
  • Th1 cells
Is the exact cause of psoriasis known?
No
Psoriasis can be exacerbated by what environmental factors? (4)
  • Koebner phenomenon (lesions along lines of trauma)
  • Infections (e.g. GAS, HIV)
  • Stress
  • Alcohol & Drugs (e.g. after prednisone)
What are physical complications of psoriasis? (3)
  • Pruritus
  • Fissuring
  • Bleeding of lesions
What are systemic complications of psoriasis? (1)
Increased risk of cardiovascular events and risk factors
  • Myocardial infarction
  • Metabolic syndrome
  • Hyperlipidemia
  • Obesity
  • Smoking
  • Diabetes mellitus
What are emotional complications of psoriasis? (2)
  • Social isolation
  • Low self-esteem
What are economic complications or psoriasis? (2)
  • Stigmatization and social isolation
  • Time away from work
Name and describe an extracutaneous disease associated with psoriasis? (1)
Psoriatic arthritis
  • 5-10% of patients
  • Seronegative (RF)
  • HLA-B27
  • Usually asymmetrical peripheral joint arthritis 
What are the 5 cardinal signs of psoriasis?
  • Plaque (raised lesion)
  • Well-circumscribed
  • Bright salmon red colour
  • Silver micaceous scale
  • Symmetric distribution
Name common sites for psoriasis? (8)
  • Extensor surfaces over bony prominence (elbows, knees)
  • Scalp
  • On and behind ears
  • Palms and soles
  • Umbilicus
  • Penis (glans)
  • Lumbar
  • Shins
  • Nails
Name variant forms of psoriasis (4)
  • Guttate
  • Inverse
  • Pustular
  • Erythrodermic
Describe guttate psoriasis
  • What lesions?
  • Where?
  • Associated with? 
  • Acute eruption of small papules on trunk and proximal extremities
  • Associated with GAS infection
Describe inverse psoriasis
  • Where?
  • Appearance? 
  • Within flexural sites (axillae, groin, gluteal fold)
  • Bright red, moist, macerated appearance
Describe pustular psoriasis
  • Localization?
  • Associated with? 
  • Systemic or localized to palms or soles
  • Associated with fever, leukocytosis (can be life-threatening)
Describe erythrodermic psoriasis
  • What is affected?
  • Appearance?
  • Complications?
  • Entire body affected
  • Red and scaly appearance
  • Prominent systemic complications
What are classes of treatment for psoriasis? (3)
  • Topical creams, ointments, gels, lotions
  • Phototherapy
  • Systemic therapy
What are the topical treatments for psoriasis? (6)
  • Glucocorticoids
  • Calcipotriol (Vitamin D derivative)
  • Tar
  • Anthralin
  • Tazarotene (Retinoid, Vitamin A)
  • Salicyclic acid
Describe phototherapy for psoriasis
  • UVB light
  • or, UVA light combined with psoralens (PUVA)
Describe systemic therapy for psoriasis (4)
  • Methotrexate
  • Acitretin
  • Cyclosporine
  • Biologics
For pathophysiology of atopic dermatitis, describe where the inflammation occurs?
  • What type of cells cause it? 
Cutaneous inflammation
  • Th2 cells
For atopic dermatitis, what can be seen in blood test?
Increased levels of IgE
For pathophysiology of atopic dermatitis, what causes dry skin?
Impaired cutaneous barrier function
  • Allows water loss
How important are dietary factors when it comes to influencing atopic dermatitis?
Rarely important
For pathophysiology of atopic dermatitis, what may colonize the skin and worsen the condition?
Staphylococcus aureus
What is the primary symptom of atopic dermatitis?
VERY ITCHY!!!!!!!!

(Pruritus)
What are other symptoms of atopic dermatitis? (6)
  • Xerosis (dry)
  • Ill-defined erythema
  • Tiny coalescing edematous papules or papulovesicles
  • Lichenification
  • Excoriations
  • Crusting (if infected)
Can the basic morphology of atopic dermatitis be easily described?
No
What are the 3 clinical phases of atopic dermatitis?
  • Infantile
    -Facial and extensor distribution 
     
  • Childhood
    -Greater tendency to xerosis
    -Flexural distribution
    -More lichenification and excoriations 
     
  • Adult
    -Atopic dermatitis improves with age
    -In adults, primarily affects hands 
What are 2 other forms of dermatitis caused by allergy or irritant?
  • Allergic contact dermatitis
  • Irritant contact dermatitis
List treatment options for atopic dermatitis (8)
  • Avoid irritating factors
  • Aggressive restoration of cutaneous permeability barrier with emollients/moisturizers
  • Topical glucocorticoids
  • Topical immunomodulators
  • Topical anti-staphylococcal antibiotics
  • Oral antihistamines
  • Phototherapy
  • Oral glucocorticoids
What is another name for atopic dermatitis?
Eczema
For seborrheic dermatitis describe the basic pathology
  • What organism is involved?
  • Generally speaking, where does it occur? 
Pathology probably involves sebum production  lipophilic fungus feeds off of sebum
  • Involves malassezia fungus
  • Occurs at sites of increased sebaceous gland density and activity 
In seborrheic dermatitis, the scaling and inflammation are the result of what?
Results from increased numbers of malassezia on skin
  • Anti-fungals are helpful treatment 
In seborrheic dermatitis, what is the presentation in adults?
  • Describe the lesions 
Dandruff
  • Ill-defined areas of erythema with greasy-appearing scale (looks like chunky, greasy dandruff) 
Where on the body does seborrheic dermatitis occur in adults?
  • Face: glabella, eyelids, eyebrows, nasolabial folds, nose, msutache/beard, ears
  • Trunk: presternal, umbilicus
Where on the body does seborrheic dermatitis occur in children? (2)
  • Cradle cap
  • Diaper region 
What disorders is seborrheic dermatitis associated with? (2)
  • Parkinson's disease
  • HIV
For pityriasis rosea, describe the lesion and its progression

Occurs over 6-8 weeks:
  • Herald pat: Solitary 2-6cm scaly plaque
     
  • Eruption of multiple 1-2cm oval annular papules with fine "collarette" scaling along rim of individual lesions
How is pityriasis rosea distributed?
T-shirt and shorts distribution
What causes pityriasis rosea?
Unknown, may be due to a human herpesvirus infection
Is treatment necessary for pityriasis rosea?
No
What 2 conditions can mimick pityriasis rosea?
  • Secondary syphilis
  • Drug eruptions: ACE inhibitors, gold
Describe the clinical features of lichen planus (i.e. the 5 P's)?
  • Papules (usually 2-5mm size)
  • Pruritus (intense)
  • Purple
  • Polygonal
  • Planar (flat-topped)
Lichen planus lesions may have white lines which are known as what?
Wickham's striae
Lichen planus lesions are usually distributed where? (6)
  • Flexor surface of wrists and forearms
  • Neck
  • Thighs
  • Shins
  • Lumbar back
  • Genitalia
What is another place that is extremely common for lichen planus?
  • Describe these lesions in more detail 
Mouth
  • Lacy white reticular lesions on the buccal mucosa (most common pattern)
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