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Dermatology > 23: Papulosquamous Diseases - Frush > Flashcards

23: Papulosquamous Diseases - Frush Flashcards

1
Q

define papulosquamous disease

A

a heterogeneous group of disorders characterized by scaling papules or plaques

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2
Q

define papule

A

Small elevated, firm skin lesions under 0.5cm in diameter that are above, rather than within, the surrounding skin

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3
Q

define plaque

A

Elevated, plateau-like confluence of papules

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4
Q

define scale

A

Thickened stratum corneum that exfoliates. Accumulated debris of dead epidermal cells resulting in flakes that lift off of the skin

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5
Q

Flat topped, polygonal, violaceous papules of unknown cause

A

lichen planus

Individual lesions 1-2 mm in diameter
Coalesced lesions 4-5 mm in diameter

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6
Q

6 Ps of lichen planus

A 
Planar (flat topped)
Purple
Polygonal 
Pruritic
Papules
Plaques
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7
Q

good ROS questions lichen planus

A

Oral lesions found in up to 1/3 of patients
Nails are involved in 10% of patients
Usually affects ages 20-60: Children and elderly less commonly affected

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8
Q

wickham’s striae

A

Delicate white lace-like pattern of lichen planus

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9
Q

acute v. chronic lichen planus

A
  • acute up to 18 mo
  • extremely pruritic
  • anterior legs, ankles, feet

-chronic more likely to have oral lesions which can lead to squamous cell carcinoma

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10
Q

koebner’s phenomenon

A

Lesions will develop in areas of mild trauma - follow scratch lines

occurs in lichen planus

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11
Q

nails of lichen planus

A

10%
atrophy, RIDGING, grooving or splitting
- pterygium may be seen
- can be confused with onychomycosis

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12
Q

define pterygium

A

forward growth of cuticle over nail plate

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13
Q

describe actinic lichen planus

A
  • Mildly pruritic
  • Sun exposed areas or sunburned skin
  • Similar in appearance to granuloma annulare
  • Pigmented and/or dyschromic
  • Koebnerization present
  • Scalp and nails usually not involved
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14
Q

describe annular lichen planus

A
  • Lesions form in annular pattern
  • Ring of small confluent papules with central clearing and peripheral spreading
  • Lower extremities and penis
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15
Q

describe atrophic lichen planus

A
  • When active lesion go into remission
  • Often on mucosal surfaces
  • Has scaly white crust with “melting” edges
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16
Q

describe bullous lichen planus

A
  • Tense bullous lesions
  • Unaffected skin or
    Preexisting lichen planus
  • Common on lower extremities and feet **
  • Changes to characteristic appearance after blister eruption
17
Q

describe follicular lichen planus

A
  • Lichen planus of hair follicles
  • Scalp and lower extremity prevalence
  • Sharp pointed, keratotic, follicular papules
  • Occasional concurrent skin atrophy and alopecia
    • May become permanent
18
Q

describe hypertrophic lichen planus

A
  • Highly pruritic
  • Confluent, firm, lichenified, scaly, and violaceous or hyperpigmented plaques
  • Location: Anterior shins, ankles and soles
  • Often becomes chronic
  • More likely to become malignant ***
  • Skin becomes heavily pigmented
  • Often permanent
  • Skin feels rough or “warty”
19
Q

describe lichen amyloidosu

A
  • Predilection for Dark skinned middle aged people of Central or South America
  • Pruritic papules on anterior shins and ankles
  • May coalesce into plaques
20
Q

describe lichen planus erythematous

A
  • Soft, nonpruritic, round, erythematous papules
  • Forearms and ankles
  • Older women
21
Q

describe lichen nitidus

A
  • Mildly pruritic
  • Flesh colored to erythematous, tiny, discrete, sharply demarcated, round or flat-topped, shiny papules
  • Penis, arms, legs, ankles, back and abdomen
  • Occasionally found on palms, soles and toes
  • Hyperkeratotic scale commonly present
  • Koebner phenomenon
  • Nail changes present: Pitting, ridging, thickening and brittleness
22
Q

lichen dermatitis

A

Caused by medications or chemical exposure

Color changes from bright red to violaceous to rust brown

Lesions resolve with removal of cause

23
Q

describe vesicular lichen planus

A

Precursor or variant of bullous

Mildly to moderately pruritic

Violaceous vesicles

Often found with other forms of lichen planus

24
Q

treatment lichen planus

A

Self limiting disease with 60-80% spontaneous clearance in 1 year

Remove questionable offending agents if medically possible

Treat patient’s symptoms (pruritus)

Severe cases: Dapsone or PUVA (8-methoxypsoralen photochemotherapy)

25
Q

describe pityriasis rosea

A

Self-limiting, asymptomatic skin eruption

Found most frequently on the trunk or proximal extremities

Starts as solitary round to oval lesion 2 to 10 cm termed herald patch

Eruptive phase begins with spread of smaller lesions

20% of patients have recent history of infection with fever, fatigue, sore throat, and lymphadentitis

Lesions typically resolve in 1 to 3 months

26
Q

describe pityriasis rubra pilaris

A

Progressive yet self-limiting

Thick scaling with red follicular papules that can spread into a generalized eruption

Difficult to distinguish from psoriasis

Initial lesion is a small, smooth, red, scaling plaque that slowly enlarges

Soles and palms start to thicken

Eruption can last for months to years: 80% of patients clear within 3 years

27
Q

what makes psoriasis better? worse?

A

stress and illness make worse

rest and sunshine make better

28
Q

Red to brown, slightly raised patches with silvery scales

Affects extensor surfaces primarily

A

psoriasis

  • Small papules to large plaques
  • Heal centrally during treatment, giving ring like appearance
  • Koebnerization present
  • Nail involvement common (similar to onycomycosis )
  • 10-15% of patients will have arthritic changes
29
Q

auspitz sign

A

removal of psoriasis scales cause pinpoint bleeding

30
Q

nails of psoriasis

A 
Pitting - 25%
Yellow macules
Oil spots
Distal lysis
Dystrophy
Resembles onychomycosis
31
Q

most stable form of psoriasis

A

psoriasis vulgaris

Patches well defined
Raised
Red base with uniform silvery scale

32
Q

psoriasis following strep throat

A

guttate psoriasis

Small, erythematous papules
Appears suddenly
Trunk, lower legs, and feet
Usually resolves after 2-3 months

33
Q

describe pustular psoriasis

A
  • Located on palms and soles (Usually centrally )
  • Can involve just toes
  • Acrodermatitis perstans
  • Yellow pustules often on erythematous base
  • Dries to brown crusts
  • Symmetrical and bilateral
  • Difficult to treat
34
Q

what is acrodermatits perstans?

A

Crusts scale over nails and they fall off

found with pustular psoriasis affecting the toes

35
Q

distinguishing features…

excoriations and lichenification of skin, often on flexor surfaces

one or more plaques with lichenification in an are that is easily scratched

herald patch preceding annular plaques with collarette scale

pruritic nodules, often on extremities

plaques with thick scale on extensor surfaces

A

eczema

lichen simplex chronicus

pityriasis rosea

prurigo nodularis

psoriasis

Dermatology (24 decks)

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