Papulosquamous disease.txt

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Author:
kavinashah
ID:
85612
Filename:
Papulosquamous disease.txt
Updated:
2011-05-13 09:32:11
Tags:
psoriasis
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Description:
psoriasis
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  1. what is the incidence of psoriasis worldwide?
    2%
  2. where does psoriasis affect?
    • skin
    • joints
    • nails
  3. what is sex preponderance of psoriasis?
    f=m
  4. what is peak age onset of psoriasis?
    2nd and 3rd decade
  5. what is the main pathogenesis of psoriasis?
    • hyperproliferative disorder
    • production of keratinocytes is increased 28 fold!
  6. which WBC type mediates psoriasis?
    T cell - so its a Rx target
  7. what is parakeratosis?
    when keratin layer have NOT lost their nuclei
  8. what is acanthosis?
    thickening of epidermis
  9. what are the triggers of psoriasis? (8)
    • infection - strep (guttate), HIV
    • stress
    • childbirth
    • alcohol, smoking
    • trauma - koebner
    • drugs - steroids
    • endocrine - pregnancy, hypocalcaemia
    • sunburn
  10. what are the 5 types of psoriasis?
    • plaque
    • sebo-psoriasis (looks like seborrheic dermatitis)
    • guttate
    • erythrodermic
    • pustular - generalised/localised
  11. which 2 types of psoriasis are emergencies?
    • erythrodermic
    • pustular - generalised/localised
  12. how would you describe plaque psoriasis?
    • well defined plaque - FLAT, ELEVATED
    • on extensor surface
    • salmon pink
    • thick silvery whicte scale
  13. where are common sites for chronic plaque psoriasis?
    • symmetrical extensors
    • umbilicus
    • scalp
    • genital
  14. what are the 4 nail signs of psoriasis?
    • 1. onycholysis: lifting of nail plate off nailbed
    • 2. pitting: small depressions in nail plate
    • 3. longitudinal ridging
    • 4. subungal hyperkeratosis
  15. what are the 5 types of psoriatic arthropathy?
    • 1. asymmetric
    • 2. symmetric polyarthritis
    • 3. DIP
    • 4. destructive (arthritis mutilans)
    • 5. axial arthritis
  16. what causes guttate psoriasis?
    post strep throat infection
  17. who gets guttate psoriasis?
    young adults
  18. describe appearance of guttate psoriasis?
    • shower of scattered discrete lesions
    • up to 1cm
    • round or slight oval
    • small plaques on trunks/limbs
  19. what is Rx of guttate psoriasis?
    light therapy
  20. what are the 2 types of pustular psoriasis?
    • localised eg palmoplantar
    • generalised - life threatening!
  21. what are features of palmoplantar pustular psoriasis?
    palms and soles studded with sterile pustules on erythematous base
  22. what are features of generalised pustular psoriasis?
    • life threatening
    • abrupt onset
    • fever
    • very unwell
    • indicates severe, unstable psoriasis
  23. what can precipitate pustular psoriasis?
    use of steroids
  24. why is generalised pustular psoriasis an emergency?
    • dehydration
    • renal failure
    • death
  25. what is Rx of Gen pustular psoriasis? 3 aspects
    • 1. admit, ITU maybe needed
    • 2. greasy emollients, iv support, avoid/treat infection
    • 3. systemic therapy - acetretin or ciclosporin
  26. how would you describe erythrodermic psoriasis?
    skin becomes universally red with scaling
  27. what are symptoms of erythrodermic psoriasis?
    • malaise
    • shivering
    • skin hot and uncomfortable
  28. what are the complications of erythrodermic psoriasis?
    • fluid loss
    • heat loss - hypothermia
    • infection as barrier loss
    • hypercatablolic state
    • shock
  29. what is Rx for erythrodermic psoriasis?
    • admit ITU
    • iv supportive
    • greasy emollients
    • treat/avoid infection
    • systemic - acetretin/ciclosporin immunosupp
  30. what are the 5 step treatments for psoriasis?
    • 1. emollients
    • 2. topical agents
    • 3. phototherapy
    • 4. systemic agents
    • 5. biological agents
  31. what are the 4 different topical treatments for psoriasis?
    • vitamin D
    • tar
    • dithranol
    • steroids
  32. what are the 2 types of phototherapy, difference?
    • narrow band UVB
    • pUVA=UVA plus psoralen
  33. what is puva?
    • psoralen + UVA treatment
    • psoralen is taken orally to photosensitise skin then expose to UVA
    • P allows a lower dose of UVA to be used
  34. what are the systemic treatments for psoriasis based on?
    t cell suppression
  35. give 5 eg of systemic Rx for psoriasis?
    • retinoids: acetretin- reduce cell turnover
    • immunosupp: methotrexate, ciclosporin, hydroxyurea
    • fumaric acid
  36. what are the biological Rx for psoriasis?
    anti TNF - monoclonal antibody
  37. what is lichen planus? what does it affect?
    • inflammatory dermatosis
    • affects skin, mucous membranes, nail, hair
  38. what are the 5 Ps to describe lichen planus?
    • purple
    • planar
    • polished
    • papular
    • pruritic
  39. where does lichen planus tend to affect?
    • skin: flexor surfaces - wrist, forearm
    • genitals
    • mouth: white striae
  40. what does LP in the mouth look like?
    • reticulated lacy white patter
    • wickham's striae
    • leukoplakia
  41. what does LP in the mouth increase the risk of?
    oral cancer
  42. what is the topical Rx for LP?
    POTENT steroids
  43. what are the systemic Rx for LP? (4)
    • steroids
    • retinoids
    • PUVA
    • ciclosporin
  44. what is the natural history for LP?
    most resolve in 1-2 years
  45. what is the diagnosis for an asymptomatic man with a large patch on his trunk followed by a rash 1 week later?
    pityriasis rosea
  46. what is that patch called?
    herald patch
  47. who does pityriasis rosea affect and what is cause?
    • children/young adults
    • viral cause? seasonal variation
  48. what does the actual rash of PR look like?
    • oval erythematous papules
    • some scale in middle
    • t-shirt distribution
  49. what kind of pattern may PR form and why?
    • lesions follow lines of dermatomes
    • xmas tree pattern
  50. what is Rx of PR?
    • no Rx usually
    • if itchy then antihistamine (as the histamine is what makes itch)

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