Page 150 - TNFlipTest
P. 150
D16 Dermatology
Papulosquamous Diseases Toronto Notes 2019 Stasis Dermatitis
Clinical Presentation
• erythematous,scaly,pruriticplaquesinlowerlegs,particularlythemedialankle
• brownhemosiderindeposition,woodyfibrosis,atrophyblanche,andlipodermatosclerosisinlatestages • usuallybilateral,accompaniedbyswelling,oozing,crusting,mayhaveaccompanyingvaricosities
Pathophysiology
• chronicvenousinsufficiencyleadstovenousstasis
• surroundingsofttissueinflammationandfibrosisresults
Investigations
• Dopplerandcolour-codedDuplexsonographyifsuspiciousforDVT • swabforbacterialcultureifthereiscrusting
Management
• compressionstockings
• restandelevatelegs(abovetheleveloftheheart)
• moisturizertotreatxerosis
• mid-highpotencytopicalcorticosteroidstocontrolinflammation
Complications
• ulceration(commonatmedialmalleolus),secondarybacterialinfections
Lichen Simplex Chronicus
Clinical Presentation
• well-definedplaque(s)oflichenifiedskinwithincreasedskinmarkings±excoriations • commonsites:neck,scalp,lowerextremities,urogenitalarea
• oftenseeninpatientswithatopy
Pathophysiology
• skinhyperexcitabletoitch,continuedrubbing/scratchingofskinresults • eventuallylichenificationoccurs
Investigations
• ifpatienthasgeneralizedpruritus,ruleoutsystemiccause:CBCwithdifferentialcount,transaminases, bilirubin, renal and thyroid function tests, TSH, glucose, SPEP
• CXRiflymphomasuspected
Management
• antipruritics(e.g.antihistamines,topicalorintralesionalglucocorticoids,Unnaboot)
Papulosquamous Diseases
Lichen Planus
Clinical Presentation
• acuteorchronicinflammationofmucousmembranesorskin
• morphology:pruritic,well-demarcated,violaceous,polygonal,flat-toppedpapules
• common sites: wrists, ankles, mucous membranes in 60% (mouth, vulva, glans), nails, scalp
• distribution:symmetricalandbilateral
• Wickham’sstriae:reticulatewhite-greylinesoversurface;pathognomonicbutmaynotbepresent
• mucousmembranelesions:lacy,whitishreticularnetwork,milky-whiteplaques/papules;increasedrisk
of SCC in erosions and ulcers
• nails: longitudinal ridging; dystrophic; pterygium formation
• scalp:scarringalopeciawithperifollicularhyperkeratosisanderythema
• spontaneouslyresolvesbutmaylastforwk,mooryr(mouthandskinlesions) • rarelyassociatedwithhepatitisC
• Koebnerphenomenon
Pathophysiology
• autoimmune,antigenunknown
• lymphocyteactivationleadstokeratinocyteapoptosis
Epidemiology
• 1%,30-60yr,F>M
The 6 Ps of Lichen Planus Purple
Pruritic
Polygonal
Peripheral
Papules
Penis (i.e. mucosa)
