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Toronto Notes 2019 Vesiculobullous Diseases Dermatology D19 2 . GUTTATE PSORIASIS (“DROP-LIKE”)
Clinical Presentation
• discrete,scatteredsalmon-pinksmallscalingpapules
• sites:diffuse,usuallyontrunkandlegs,sparingpalmsandsoles • oftenantecedentstreptococcalpharyngitis
Management
• UVBphototherapy,sunlight,lubricants,topicalsteroids
• penicillinVorerythromycinifGroupAβ-hemolyticStreptococcusonthroatculture
3 . ERYTHRODERMIC PSORIASIS
Clinical Presentation
• generalizederythema(>90%ofBSA)withfinedesquamativescaleonsurface
• associatedsignsandsymptoms:arthralgia,pruritus,dehydration,electrolyteimbalance
• aggravatingfactors:lithium,β-blockers,NSAIDs,antimalarials,phototoxicreaction,infection
Management
• IVfluids,monitorfluidsandelectrolytes,mayrequirehospitalization • treatunderlyingaggravatingcondition,sunavoidance
• cyclosporine, acitretin, methotrexate, UV, biologics
4 . PUSTULAR PSORIASIS
Clinical Presentation
• suddenonsetoferythematousmaculesandpapuleswhichevolverapidlyintopustules,canbepainful • maybegeneralizedorlocalized
• patientusuallyhasahistoryofpsoriasis;mayoccurwithsuddenwithdrawalfromsteroidtherapy
Management
• methotrexate, cyclosporine, acitretin, UV, biologics
5 . INVERSE PSORIASIS
Clinical Presentation
• erythematousplaquesonflexuralsurfacessuchasaxillae,inframammaryfolds,glutealfold,inguinal folds
• lesionsmaybemacerated
Management
• lowpotencytopicalcorticosteroids
• topicalvitaminDderivatives(e.g.calcipotriene,calcitriol)
• topicalcalcineurininhibitors(e.g.tacrolimus,pimecrolimus)
6 . PSORIATIC ARTHRITIS
• 20-30%ofpatientswithpsoriasisalsosufferfrompsoriaticarthritis
• psoriaticpatientswithnailorscalpinvolvementareatahigherriskfordevelopingpsoriaticarthritis • seeRheumatology,RH23
Vesiculobullous Diseases
Bullous Pemphigoid
Clinical Presentation
• chronicautoimmunebullouseruptioncharacterizedbypruritic,tense,subepidermalbullaeonan erythematous or normal skin base
• canpresentasurticarialplaqueswithoutbullae
• commonsites:flexoraspectofforearms,axillae,medialthighs,groin,abdomen,mouthin33%
Pathophysiology
• IgGproducedagainstdermal-epidermalbasementmembraneproteins(hemidesmosomes)leadsto subepidermal bullae
Epidemiology
• meanageofonset:60-80yrold,F=M
