Upgrade to remove ads
3.2: Papulosquamous, Lichenoid, and Eczematous dermatoses
Terms in this set (55)
Psoriasis Vulgaris Etiology
1. Abnormal T cell activation. Specifically Th17
2. abnormla keratinocytes
-mitotic activity increase.
- increase in human b defensin, increase involucrin
-secretes inflammatory cytokines
-B13, DR7, B17. B57 early onset
-13 and 17 as above for guttate psoriasis
Description-acute onset rain drop like scaly paules on trunk and extremities. Commonly after strep infection
Locations that are special-palms and soles(palmoplantar), intertrigenous(inverse psoriasis)
Psoriatic nails findings
pitting, onychodystrophy, oil spots, onycholysis, splinter hemmorages
Erythrodermal of psoriasis
generalized erythema na skailing, can be sudden or stable.
Treatment of psoriasis
Topical agents-VD3 analogues, steroids, calcineurin inhibitors, coal tar
Oral-acitretin, methotrexane, cyclosporine,
other-biologics, PUVA, NBUVB
Distinct from psoriasis vulgaris in features and clinical course
Association: HLA b27
Two types. Generalized and Localized(palmoplantar, acrodermatitis continua of hallpeau)
1. Generalized- Presents with malaise+ fever and onset of erythematous macules with sterile pustules. Initially in intertrigenous areas, but quickly sreads to trunk, extremities and nails, skin feels painful.(rest on other cards)
Risk factors and treatment of generalized pustular psoriasis
Risk factors: oral steroid taper, infection, hypocalcemia, pregnancy
treatment: correct electrolyte and protein inbalance, methotrexate, or cyclosporineavoid steroids
Tense sterile pustules over palmoplantar surface with yellow macules. Might be associated with SAPHO syndrome. Ack about sternoclaicular tenderness or back pain
Treatment: acitretin, topical corticosteroid
Acrodermatitiscontinua of Hallopeau
Variant of pustular psoriasis limite to finger tip or digit. Same association of HLA b27
Description-steile pustules on erythematous base at tip of finger forming lakes of pus with associated pain. Can have nail damage
Tx-topical calciptriene, topical corticosteroid, acitretin
Arthritis-30 percent with skin findings have arthritis will develpop years later.
Association: HLA b27, nail changes
Treatment-TNF alphas, methotrexate
Forms of psoriatir arthrits
1. Asymmetric oligoarthritis-most common
2. Asymmetrical DIP arthritis-ONly DIP
3. Symmetrical polyarthritis. Bassically seronegative RA
4. Spondylitis and sarcoillitis- this is ankylosing spondylitis
5. ARtritis mutilans-digits become shorter, wider, and softer. Results in telescoping otin of digits
Reiter's disease or Reactive arthritis
- Cant see , cant pee, cant clime a tree.
Worse in HIV patients
duration is usually longer than one month and can follow a GI or gu infection
-pathopnomonic finding is circinate erythematous lesions on glans of the penis
treatment-treat underlying infection ie doxycycline for 14 days. can consider psoriasis type treatments as well
Pityriasis Rubra Pilaris
Cause- disorder of keratinization with bimodaldistribution ie children and adults.
1. Hyperkeratotic follicular papules on erythematous base, which coalesce into large orange red to red patches with characteristic islands of sparing
-palms and soles with waxy orange red keratoderma
- can evolve into erythroderma
-nail changes can occur with subungual hyperkeratosis and nail plate thickening
5 types of pityriasis rubra pilaris
Type 1. -over half of cases with sudden onset with duration of 2-5 years-adults
type2-atypical with slow onset allopecia, localized lesions and chronic course
type 3-5 are pediatric
Tx- high dose topical corticosteroid, systemic retinoid, methotrexate
Cause- Cell mediated autoimmune reaction toward basal layer keratinocytes. May be idiopathic, drug related or infectin(HCV) cause
Lesions: 4ps: Purple, papular, polygonal, pruritis. Can last for 1-2 years, but oral and hypertrophic can last longer
-Intense pruritis, smooth flat topped papules and plaques with fine skale
Histology- increase granular layer, band like lymphycytic infiltrate
Treatment-superpotent topical steroids
Cause-inflammation of lentigo, AKs, or seb keratosis
Description-brown to red scaly papule on sun exposed extremity, solicatry lesion mimicking lichen planus histologically
Graft Versus Host Disease
Casue-donor lymphocytes recognize the receipient as foreign and mount an attack.
Can occur after transplant or unirradiated blood products
2 types, chronic and acute.
Timeframe- 100 days following transplantation, but usually 1-3 weeks
Description-maculopapular eruption which may coalesce into confulent erythema. ALso can have acral erythema with violaceous discoloration of pinna
Triad- 1. dermatitis, enteritis with diarrhea, and hepatitis.
Histology-vacuolization of basal layer, necrotic keratinocyes.
Tx- systemic steroids
Occurs usually 4 months after transplant. 50% from acute and 50% de novo
1. Lichenoid-Violaceous o erythematous lichenoid paules over doral hands, forearms, trunk
2. Scerodermoid GVHD: Sclerotic plaques similar to morphea+- hyperpigmentation, sicca symptoms,
Tx- Topical calcineurin inhibitor, PUVA< UVB or immunosuppresents
Irritant Contact Dermatitis(ICD)
80% of CD due to dirrect local cytotoxxic effect of irritant on skin
1. Acute ICD- acute exposure to toxic agent with pruritis and sharply localized erythema with vesicles, edematous papules, or hemmoragic blisters. No distant spread
Chronic-repeated exposure to mild irritants. Presents with diffuse or localized, but ill defined scaly patches and plaques
Allergic Contact Dermatitis(ACD)
20% of CD
-Type 4 hypersensitivity to contractant, ie delayed reaction)
-patch testing is how you diagnose.
Acute- Typically presents 24-48 hours with pruritis, vesicles, and weeping and erythema
Subacute-presents with eczematous scaly plaques or lichenification coorelating to areas of contact with allergen.
Treatment-avoid exposure and topical corticosteroid
Asymptomatic benig and self limited granulomatous disease of the dermis
Presentation-skin colored to pink non scaly papules coalescing into annular or acriform plaques. Typically over dorsal hand or foot
Variants- Patch(usually over extremities), Generalized(trunk+ extremities usually diabetics), perfroating- central umbillification in dorsal hands, subcutaneous GA( deep dermal nodules
Necrobiosis Lipodica+- Diabeticorum
Uncommon necrobiotic disease associated with diabetes mellitus.
Presentation-yellow to red brown atrophic to indurated plaques over pretibial areas, prominent telangiectasias
Histology-histiocytes often encircling necrobiotic collagen in dermis in layered fashion with plasma cels.
rare histiocytic disease
presentation- Red orange to yellow papules, nodules, or plaques on face
80% IGG monoclonal gammopathy
Cutaneous crohns disease
Genital-labial and scrotal erythema with swelling
Nongenital-erythematous indurated plaque or ulcerations with drainage, typically perianal
oral-cobblestoning, small abthous ulcers, indurated fissuring of lower lip
Treatment- topical or IL steroid
Foreign body granuloma
Immune response to exogenous or endogenous material that has wounded skin
Urticaria chapter skipped for now
Pigmented Purpuric Dermatosis
Group of dermatoses with cappillaritis and petechial hemmorages.
Tx-ascorbic acid and possibly oother stuff
Discrete clusters of pinpoint erythematous nonblanching macules typically onl ower legs. Apperarence of cayenne pepper
annular erythematous plaques with punctate telangiectasias typically in young adults
Pigmented purpuric lichenoid dermatitis of Gougerot and Blum
Lesions similar to Schamberg's disease plus red-brown lichenoid papules and plaques
Typically solitary rust to purple colored patch or plaque on lower extremity with golden hue
Eczematid like purpurra of Doucas and Kapetanakis
Scaly purpuric or petechial macules, patches and papules.
Direct IF- Detects in vivo antibiodies bound to tissue antigens in perilesional skin
Indirect IF-Detects circulating serum antibiodies(substrate sections react with serially diluted serum from patient.--> incubated with anti-IgG or other specific fluorescent dye tagge antibody
-best substrate-monkey esophagus, guinea pig esophagus, transitional rat bladder epithelium
Salt Split Skin Technique- Variant of indirect allowing distinction between different subedpidermal blistering conditions with similar DIF findings. This locates the spot of split.
Autoantigens- Desmoglein 3(mucosal) desomoglein 1(mucocutaneous)
Clinical-present with flaccid vessicles and bullae, which rupture leaving large painful erosions with crusting.
Histology-suprabasal cleavage with acantholytic keratinocytes, tomb stone row of basal cellsattached to basement membrane
Vegetating plaque in scalp or intertrigenous areas that causes similar clinical and histologic picture as PV
Treatment-oral steroids, methotreaxate
Less severe and more superficial than PV
Clinical-flaccid bullae which rupture easily, often more superficial with patches and erosions
Fogo Selvagem-seen in rural Brazil and clinically identical to PF, caused by black fly(Simulium spp.)
Localized PF variant with erythematous overlap, usually in sebborrheic areas with erythema and erosions. ANA positive
Path: DIF intercellular and linear IfG at BMZ
Tx-sunprotection and topical steroids.
Paraneoplastic Pemphigus (PNP)
Associated with underlying benign or malignant neoplasm
Most common-Non hodglkins, CLL, Castleman's disease, thymoma, waldenstrom macroglulinemia, sarcoma
Clinical: Severe stomatitis that extends onto vermillion lip; intraorally can involve entire oropharynx. Can look like alot of different allergic and immunologic presentations.
DIF: Intercellular: Linear IgG/C# along BMZ
IIF: use rat bladder epithelium
Treatment: Stomattis refractory to treatment and immunosuppressive agents less effective than for PV
Autoantigens-Desmocolin 1 (SPD)
Clinical two types
1. Subcorneal psutular dermatosis: Seripiginous vesicles or pustules: may be associated with underlying IgA gammopathy
2. Intraepidermal neutrophillic type(IEN): Flaccid pustules and bullae involving intertriginous locations which enlarge forming annular or polycyclic arrangements
Treatment: Dapsone, oral steroid.
Bullous Pemphigoid (BP)
Autoantigen- BPAG 2 NC16A domain
Causes PF ChaNGS-Phototherapy, Genicillamine, PCN, Furosemide, Captopril, NSAIDS, Gold, Sulfasalazine
DIF- linear C3 and IgG at BMZ
Treatment-oral steroids and steroid sparing agents.
Rare Autoimmune disease involving the mucous membrane with subsequent scarring.
Autoantigens-BPAG2, B4 subunit, Laminin 5
Clinical: ocular symptoms, entropion
Treatment: Dapsone First line for oral with cutaneous disease, topical steroids.
Dermatitis Herpetiformis (Duhring's Disease)
Recurrent chronic pruritic disease associated with gluten sensitive enteropathy
Autoantigens: Epidermal tranflutaminase, tissue tranglutaminase
Clinical: erythmatous grouped paules or vesicles over elbows, knees, and buttock, intensely pruritic.
DIF granular IgA
Treatment: Dapsone, referral to GI, increased risk of small bowel lymphoma and thyroid disease.
Chronic cutaneous Lupus(discoid lupus)
Chronic cutaneous form of lupus comonly on face/scalp of young women
Presentation: indurated erythematous thin papules with adherent scane and follicular plugging, carpet tack(follicular plugs with removal of scale_, 25% with oral involvement
Variants of lupus
Tumid lupus: deep nodular lesions with erythema and induration in the face and truck no scalling or follicular plugging, more intens e inflammatory
Lupus panniculitis: tnder subcutaneous nodules with typical DLE on survace. More likely to meet lupus criteria
Hyeprtrophic or verrucous LE: Hyperkeratotic or verrucous papules/plaques over extensor arms, may appear similar to warts
Chillbain LE: Acral dusky purple papules and plaques associated with acrocynosis
Treatment: sun avoidance, topical/IL steroids.
Subacute cutaneous lupus
Overlap between DLE and SLE with photosensitivity
Presentation: Papuloquamous or annular/polycyclic erythematous scaly patches/plaques on shoulders, trunk, etensor arms, face typically spared. artharlias common
Treatment: sun protection, antimalarial
As studied in other classes
Presentation: Facial erythema, violaceous pikiloderma of eyelids with edema(heliotrope sign) violaceous papules over MP joints(gottron's papules)
Classic antibody is anti Jo, also Anti PL7, and 12)
Associations: lung and GI cancer, ovarian and breast in women
Labs: ANA, CK, LDH
Treatment: oral steroids. sterooid sparing agents as well
Mixed Connective tissue disorder
Clinical overlap with systemic sclerosis with specific serology(U1RNP)
Presentation: Raynaud's pneomenon, dacrylitis, arthritis
Presentation: xeroisis of the mucous membranes and skin(pruritis) foreign body sensation, can see parotid gland enlargement
Labs: ESR, rheumatoid, anti ro and la
Morphea: Localized scleroderma
- initially presents with expanding erythema than becomes ivery sclerotic plaque. Many forms
Treatment: topical mid to high potency topical steroids
Systemic sclerosis- disease of multiple organs leading to broad fibrosis
- anti scl 70
-cutaneous iniital edematous face with following sclerosis(shiny and taut), ulcerations
Other: the things that kill the person
CREST: Calcinosis, raynaud's esophageal, scerlodactyly, and telangectasisa,
Nephroenic systemic slcerosis
ESRD patients with exposure to gadolidium
Presentation-fibrotic plaques on extremities and trunk with brawny hyperpigmentation
Histology: dermal sclerosis
Treatment: UVA 1, restoration f renal function
Episodic inflammatory condition involving cartilagenous structures
Antibodies: Anti type 2 collagen, and anti matrillin 1
Presenation: episodic, painful, beefy red erythema and edema of cartilagenous structures. Over type cartiledge is esctroyed. Can have respiratory tract and migratory arthitis
Treatment: oral steroids, dapsone,
Associated with Myelodysplactic syndrome and MAGIC syndrome
Mouth and genital ulcers with inflammed cartiledge
Effects children and women in 5th to 6th decade. Autoimmune
Presentation: hypopigmented plaques with inflammatory border in genital area. can become atrophic with figure eight pattern in perianala nd vulvar area
higher risk of SCC
Treatment: superpotent topical coerticosteroid
YOU MIGHT ALSO LIKE...
infectious diseases of the skin
Pathology Chapter 4 Infections of the Or…
PM: Derm diseases 1
OTHER SETS BY THIS CREATOR
Chapter 5 Jain-Benign and Malignant Tumors