Dermatology II: Seborrheic Dermatitis, Pityriasis Rosea, Lichen Planus – Flashcards
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describe epidemiology of seborrheic dermatitis. who does it affect? Males and females? prevalence?
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biphasic incidence (infants then teens/adult); M>F; break prevalence in 30s and 40s
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etiology of seborrheic derm?
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we don't really know. sebaceous glands create favorable environment for malessezia furfur and the host's immune system responds?
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spectrum of seborrheic derm?
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mild dandruff to extensive inflammatory dermatitis
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when is seborrheic derm worse
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stress, cold
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describe clinical presentation of seborrheic dermatitis in infants. what is it called?
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cradle cap, yellow adherent scale on vertex of scalp that might affect diaper area and axillary skin too
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clinical presentation of seborrheic dermatitis in adults (lesions)
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red, coalescing macules patches or plaques with greasy looking, yellow scales
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what body areas of adult are typically affected by seborrheic derm?
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scalp, face (eyebrows, eyelids, nasolabial folds), presternal skin, ears, upper back
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in who is seborrheic derm most severe?
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HIV/AIDs pts
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what is seborrheic blepharitis
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periocular presentation of seborrheic derm, greasy appearing flakes stick to eyelashes
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treatment of seborrheic blepharitis?
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warm compresses and eye lid scrubs
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differential dx of seborrheic term?
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psoriasis, rosacea, perioral dermatitis, SLE rash, pityriasis rosea
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treatment of blepharatis and cradle cap treatment
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olive oil to loosen crusts, baby shampoo, warm water
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how to treat scalp sebhorreic derm? (general and then specific (3))
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antifungal agents and topical corticosteroids: ketoconazole shampoo, cream, selenium sulfide of antidandruff shampoo
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how to treat sebhorreic derm of face? (2)
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low potency topical corticosteroid cream, topical anti fungal or combo
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classic presentation of pityriasis rosea?
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Christmas tree
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etiology of pityriasis rosea?
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unknown, maybe HHV-7
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is pityriasis rosea benign or malignant?
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benign
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in who is pityriasis rosea common? when does it appear?
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teens, young adults; fall, spring
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prodrome of pityriasis rosea?
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malaise, headache, pharyngitis
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clinical presentation of pityriasis rosea? (timing too)
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exanthematous eruption with primary lesion followed by secondary rash 1-2 weeks later, usually no itch
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what is the primary lesion of pityriasis rosea called? where is it usually?
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herald's patch usually on the trunk
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describe herald's patch
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oval, slightly raised lesion 2-5 cm, pink or salmon colored with marginal collarette scale
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describe secondary rash of pityriasis rosea
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christmas tree pattern in back; fine scaled, pink, oval papules and plaques
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what do some of the plaques of pitarias rosea look like?
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cigarette paper`
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main differential diagnosis of pityriasis rosea? how to distinguish
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tinea corporis...KOH prep
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differential diagnoses of pityriasis rosea
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tinea versicolor, guttate psoriasis, nummular eczema, drug eruptions, secondary syphillis
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treatment of pityriasis rosea? (4)
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reassurance, rash is self-limiting but can last 6-8 weeks, oral antihistamines, medium strength topical corticosteroids, sun exposure
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how long can pityriasis rosea last?
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6-8 weeks
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possible causes of lichen planus? (3)
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idiopathic, drugs (gold, antihypertensive, antimalarial), association with hep c?
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what drugs are associated with causing lichen planus
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gold, antihypertensive, antimalarial
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what kind of response is lichen planus
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immune mediated, involving T cells
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what percent of the population is affected by lichen planus? what age most frequently?
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about 1%, adults 30-60
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if someone with hep C comes in with a rash what is your fist thought
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lichen planus
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4 Ps of lichen planus?
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pruiritic, polygonal, purple, plaques/papules
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describe clinical presentation of lichen planus
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papulosquamous eruption characterized by flat top purple papules on skin
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most common sites of lichen planus (6)
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wrists, back, shins, scalp, penis, mouth
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what percent of people with lichen planus have mouth presentation?
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50%
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what are wickam's striae? pathoneumonic? if so, for what?
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fine white lines on lesions, not pathoneumonic but seen in lichen planus
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differential diagnoses of lichen planus (3)
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granuloma annulare, drug eruption, graft vs host
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why do you provide treatment of lichen planus
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can last 1-2 years, treatment is to hasten resolution and manage pruritis
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1st line of treatment of lichen planus?
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topical steroid or intralesional (triamcinolone), high potency or super high potency on trunk and extremities
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2nd line of lichen planus treatment (4)
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oral steroids, phototherapy, oral retinoids, cyclosporine
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how long does lichen planus last?
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1-2 years
