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Questions and Answers
What is the primary lesion found in psoriasis?
What is the primary lesion found in psoriasis?
Which of the following is NOT a common risk factor for psoriasis?
Which of the following is NOT a common risk factor for psoriasis?
Which characteristic is most typical of pityriasis rosea?
Which characteristic is most typical of pityriasis rosea?
What is a distinguishing feature of parapsoriasis as compared to psoriasis?
What is a distinguishing feature of parapsoriasis as compared to psoriasis?
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What type of complications can arise from seborrheic dermatitis?
What type of complications can arise from seborrheic dermatitis?
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Which statement regarding the etiology of pityriasis rubra pilaris (PRP) is accurate?
Which statement regarding the etiology of pityriasis rubra pilaris (PRP) is accurate?
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In terms of management, which is a hallmark treatment for psoriasis?
In terms of management, which is a hallmark treatment for psoriasis?
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What is a common histological finding in psoriasis?
What is a common histological finding in psoriasis?
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What is a common feature of the skin disorder described herein?
What is a common feature of the skin disorder described herein?
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In which location is this skin disorder least likely to occur?
In which location is this skin disorder least likely to occur?
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What age group has an increasing incidence of this skin condition?
What age group has an increasing incidence of this skin condition?
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Which environmental factor positively influences the severity of this skin disorder?
Which environmental factor positively influences the severity of this skin disorder?
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Which treatment option is indicated for severe cases associated with HIV/AIDS?
Which treatment option is indicated for severe cases associated with HIV/AIDS?
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What demographic shows a predominance in this condition?
What demographic shows a predominance in this condition?
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How does this skin condition typically respond to narrowband phototherapy?
How does this skin condition typically respond to narrowband phototherapy?
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What is the most common age for infantile seborrheic dermatitis to peak?
What is the most common age for infantile seborrheic dermatitis to peak?
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What is the first-line treatment for Pityriasis Lichenoides?
What is the first-line treatment for Pityriasis Lichenoides?
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Which condition is unlikely to be associated with Pityriasis Lichenoides?
Which condition is unlikely to be associated with Pityriasis Lichenoides?
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What is a common complication of PLEVA?
What is a common complication of PLEVA?
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In severe cases of Pityriasis Lichenoides, which systemic therapy is indicated?
In severe cases of Pityriasis Lichenoides, which systemic therapy is indicated?
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Which medication is considered a second-line treatment for Pityriasis Lichenoides?
Which medication is considered a second-line treatment for Pityriasis Lichenoides?
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What is characteristic of PLEVA compared to PLC?
What is characteristic of PLEVA compared to PLC?
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What is a common treatment for acute and severe cases of Pityriasis Lichenoides?
What is a common treatment for acute and severe cases of Pityriasis Lichenoides?
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Which antibiotic is frequently utilized for treating Pityriasis Lichenoides?
Which antibiotic is frequently utilized for treating Pityriasis Lichenoides?
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For which type of Pityriasis Lichenoides is ulceronecrosis and hyperthermia most likely to occur?
For which type of Pityriasis Lichenoides is ulceronecrosis and hyperthermia most likely to occur?
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What dose of Methotrexate is generally recommended for Pityriasis Lichenoides?
What dose of Methotrexate is generally recommended for Pityriasis Lichenoides?
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What is the predominant primary lesion identified in case #5?
What is the predominant primary lesion identified in case #5?
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Which systemic treatment is listed for erythrodermic psoriasis in case #5?
Which systemic treatment is listed for erythrodermic psoriasis in case #5?
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What is the highly associated condition with seborrheic dermatitis as described in case #2?
What is the highly associated condition with seborrheic dermatitis as described in case #2?
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In case #6, which nail finding is identified?
In case #6, which nail finding is identified?
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What is the first line of treatment for seborrheic dermatitis in case #2?
What is the first line of treatment for seborrheic dermatitis in case #2?
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Which prominent feature is noted in case #5?
Which prominent feature is noted in case #5?
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What specific diagnosis is made in case #3?
What specific diagnosis is made in case #3?
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What is the probable cause of nail pitting identified in case #6?
What is the probable cause of nail pitting identified in case #6?
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Which of the following treatments is considered a first-line management option for mycosis fungoides?
Which of the following treatments is considered a first-line management option for mycosis fungoides?
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In which location does inverse psoriasis typically manifest?
In which location does inverse psoriasis typically manifest?
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Which statement about plaque-type psoriasis is TRUE?
Which statement about plaque-type psoriasis is TRUE?
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Which of the following is NOT a second-line treatment option for mycosis fungoides?
Which of the following is NOT a second-line treatment option for mycosis fungoides?
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Which of the following complications is associated with Generalized Pustular Psoriasis (von Zumbusch type)?
Which of the following complications is associated with Generalized Pustular Psoriasis (von Zumbusch type)?
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What is a characteristic feature of inverse psoriasis compared to other forms?
What is a characteristic feature of inverse psoriasis compared to other forms?
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What is the recommended follow-up frequency for a patient with mycosis fungoides after the initial examination period?
What is the recommended follow-up frequency for a patient with mycosis fungoides after the initial examination period?
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What is the role of Psoralen and UVA in the treatment of mycosis fungoides?
What is the role of Psoralen and UVA in the treatment of mycosis fungoides?
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Study Notes
Common Papulosquamous Skin Disorders
- Papulosquamous reaction pattern: A common pattern of inflammation in the skin characterized by both papules (small bumps/lesions) and scales.
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Psoriasis: A chronic inflammatory skin condition that affects the skin's growth cycle, leading to scaling, redness, and thickened plaques.
- Clinical Presentation: Typically, psoriasis presents with well-defined, raised, reddish plaques covered by silvery-white scales.
- Nail Changes: Nail pitting, onycholysis (nail separation from nail bed), and subungual hyperkeratosis (thickening of the nail bed) are commonly observed.
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Pathogenesis:
- T-helper cell (Th) 1 and Th17 immune cells play a crucial role in the development of psoriasis.
- Abnormal activation of keratinocytes, leading to rapid proliferation.
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Risk Factors:
- Genetics: Strong genetic component, with family history being a significant risk factor.
- Environmental triggers: Trauma, infections, medications, stress, extreme temperatures, and smoking can exacerbate the condition.
- Diagnosis: Typically based on clinical examination and a patient's history. Biopsy can be used to confirm the diagnosis in challenging cases.
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Treatment: Treatment primarily focuses on slowing down skin cell growth and reducing inflammation.
- Topical Treatments: Corticosteroids, calcineurin inhibitors, vitamin D analogs, and salicylic acid are commonly used.
- Phototherapy: Narrowband UVB phototherapy and PUVA (psoralen plus UVA) are effective treatment options.
- Systemic Therapy: Methotrexate, cyclosporine, biologics (adalimumab, etanercept, infliximab), and retinoids are used for more severe cases.
- Prognosis: While psoriasis is a chronic condition, with proper treatment, it can be effectively managed, and periods of remission can be achieved.
Seborrheic Dermatitis
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General Features:
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Chronic and relapsing skin condition that commonly affects individuals of all ages.
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Increased incidence in patients older than 50 years.
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Infantile seborrheic dermatitis peaks at 3 months of age.
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Male predominance.
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Seasonal variation: More severe in cold and dry climates, mitigated by sun exposure.
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Often found in:
- Nasolabial folds (area around the nose and mouth).
- Posterior auricle (behind the ear).
- Eyebrows.
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Associated with HIV/AIDS:
- More extensive and refractory patterns in up to 83% of HIV-positive individuals.
- Often observed in patients undergoing retroviral therapy.
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- Clinical Presentation: Characterized by greasy, yellowish-white scales that often appear on the scalp, eyebrows, eyelids, nasolabial folds, and chest.
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Etiology and Pathogenesis: The exact cause is unknown, but it is believed to be related to:
- Overgrowth of a yeast-like fungus (Malassezia globosa) on the skin.
- Abnormal immune response.
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Management: Treatment focuses on controlling the overgrowth of Malassezia and reducing inflammation.
- First-line treatments: Topical corticosteroids, calcineurin inhibitors (tacrolimus, pimecrolimus), antifungal drugs (ketoconazole, selenium sulfide), and keratolytics (salicylic acid).
- Second-line treatments: Oral antifungals (fluconazole, itraconazole) are used for systemic involvement or severe cases.
- Prognosis: Seborrheic dermatitis is a chronic condition, but with proper treatment, symptoms can be effectively managed, and remission is possible.
Pityriasis Rosea
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Clinical Features:
- Presents with an initial "herald patch" which is a larger, oval-shaped lesion often on the trunk.
- Development of multiple, smaller, oval-shaped lesions (papules) with scales along the lines of Langer (skin tension lines).
- Lesions often follow a Christmas tree pattern on the trunk.
- Diagnosis: Based on clinical presentation and characteristic features.
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Management: Treatments are focused on symptom relief.
- Topical corticosteroids (hydrocortisone, clobetasol) can be used for mild cases.
- Oral antihistamines (cetirizine, loratadine) may be used for itching.
- Phototherapy may also be used in severe cases.
Pityriasis Rubra Pilaris
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Clinical Characteristics: Chronic inflammatory skin disorder characterized by follicular (hair follicle) papules and scales, often diffusely distributed and associated with intense itching.
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Types of PRP: Different clinical presentations including:
- Classic Type: Most common type with widespread, follicular, and scaling papules.
- Generalized Type: More severe form with extensive involvement, including the palms and soles.
- Palms and Soles Type: Only the palms and soles are affected.
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Etiology and Pathogenesis: The exact cause is unknown, but it is believed to involve:
- Dysregulation of the immune system, leading to inflammation.
- Abnormal proliferation of keratinocytes around hair follicles.
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Diagnosis: Diagnosis is based on the characteristic clinical presentation.
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Management: Treatment aims to control inflammation and relieve symptoms.
- Topical corticosteroids (clobetasol, betamethasone) are used to reduce inflammation.
- Oral retinoids (acitretin, etretinate) are often effective, but they have potential side effects.
- Phototherapy (narrowband UVB or PUVA) can be beneficial.
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Prognosis: PRP can be challenging to treat and often causes chronic flare-ups.
Parapsoriasis
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Clinical Features: Characterized by scaly, reddish patches (plaques) that can be small or large.
- Large plaque parapsoriasis (LPP): Presents with larger, well-defined plaques that frequently involve the trunk and limbs.
- Small plaque parapsoriasis (SPP): Characterized by numerous, smaller plaques often found on the trunk, legs, and arms.
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Etiology and Pathogenesis: Cause is still unclear.
- Possible factors include:
- Abnormal T-cell response.
- Viral infection.
- Environmental triggers.
- Possible factors include:
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Management: Treatment focuses on symptom management and reducing inflammation.
- Topical corticosteroids are often used, but their effectiveness is variable.
- Phototherapy (UVB or PUVA) may be helpful in some cases.
- Systemic therapy with cyclosporine or methotrexate is considered for severe cases.
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Prognosis: SPP is typically benign, but LPP can be more aggressive and may progress to a more serious form of skin cancer called mycosis fungoides in rare cases.
Pityriasis Lichenoides
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Clinical Features: Characterized by small, red papules (bumps) with scales.
- Clinical Presentation: - Usually, a chronic, recurrent condition. - Can be divided into three varieties: - Pityriasis lichenoides et varioliformis acuta (PLEVA):* Acute phase with rapid development of lesions. (See figure 51) ** - Pityriasis lichenoides chronica (PLC): Chronic phase with more slowly developing lesions. - Pityriasis lichenoides with ulceronecrosis and hyperthermia (PLUH): Rare and more severe form with ulcerating lesions and fever.
- Epidemiology: Can affect individuals at various ages, but more commonly in adolescents and young adults.
- Diagnosis: Diagnosis is based on clinical examination. Biopsies are used to rule out other conditions.
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Management: Treatment focuses on reducing inflammation and controlling symptoms.
- First-line treatment: Topical corticosteroids, phototherapy, and oral antibiotics (erythromycin, tetracycline, minocycline, azithromycin).
- Second-line treatment: Oral medications (prednisone, methotrexate), cyclosporine, and retinoids are used for more severe cases.
- Prognosis: Pityriasis lichenoides is often a chronic condition, but with proper treatment, most individuals can achieve significant symptom improvement and remission.
Mycosis Fungoides
- A type of cutaneous T-cell lymphoma that is characterized by slow-growing, itchy patches of skin.
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Clinical Presentation:
- Patch stage: Scaly, reddish patches, often on the trunk, limbs, and face.
- Plaque stage: Similar to patch stage, but the lesions become thicker and more raised.
- Tumor stage: Lesions are often nodular and can be ulcerated, with a high risk of spreading beyond the skin.
- Diagnosis: Diagnosis is based on skin biopsies, laboratory tests to evaluate the T-cell subtype, and imaging studies to check for spread to other areas of the body.
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Management: Treatment is dependent on the stage and progression of the disease.
- Early stages: Topical medications (corticosteroids, imiquimod, bexarotene) and phototherapy.
- Advanced stages: Systemic therapies (methotrexate, cyclosporine, biologic therapies) and radiation therapy.
- Prognosis: Prognosis is variable depending on the stage and type of treatment. Early diagnosis and treatment significantly improve outcomes.
Review Questions
- A known complication of **Generalized Pustular Psoriasis** is **hypocalcemia**.
(Hypocalcemia refers to abnormally low levels of calcium in the blood.)
- **Inverse psoriasis** is characterized by minimal or absent scaling, and it often presents in major skin folds with impaired sweating in those areas.
- **Plaque-type psoriasis** exhibits pin-point bleeding after forcible removal of the outer scales, referred to as the **Auspitz sign**. The lesions commonly affect the extensor surfaces of the extremities.
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Description
This quiz covers key concepts related to common papulosquamous skin disorders, particularly psoriasis. Explore the clinical presentation, pathogenesis, and genetic risk factors associated with this chronic inflammatory condition. Test your understanding of the characteristics and implications of these skin disorders.
