Red, well-demarcated plaques covered with dry, thick, silvery scales. The lesions tend to be located on the extensor surfaces of the extremities, the scalp, and the buttocks. Thickening and fissuring of the skin of the palms may also be seen.
How might psoriasis present in infancy?
Persistent diaper dermatitis
What are the common nail findings in psoriasis?
Reddish-brown psoriatic plaques in the nail bed (oil drop changes), surface pitting and distal hyperkeratosis
Describe Koebner phenomenon and Auspitz sign.
Auspitz sign – when the psoriatic scale is removed, small bleeding points are seen. This is the hallmark of psoriasis
What is guttate psoriasis and how is it different from typical psoriasis?
Drop-like psoriatic lesions that are found scattered all over the body. It may occur after a GAS infection.
Compare and contrast Erythema Toxicum Neonatorum and Transient Neonatal Pustular Melanosis. Be sure to include onset, description and microscopic findings.
Erythema Toxicum Neonatorum – lesions typically begin 24-48h after birth, lesions have intense erythma with a central papule or pustule that is 2-3mm in diameter, the erythema is large, a smear of material from the pustule will reveal numerous eosinophils, fading occurs within 5-7 days
Transient Pustular Melanosis – presents at birth, 1-2mm vesiculopustules or ruptured pustules that disappear at 24-48h leaving a pigmented macule with a scale, a smear of material from the pusule will show neutrophils, the hyperpigmentation takes 3 weeks to 3 months to fade
Which of the following have the potential for malignant transformation? (Bolded are correct)
Congenital Nevomelanocytic Nevi, Pyogenic granuloma, Nevus sebaceous (although rare), Infantile hemangiomas, Nevus simplex, Blue nevus, Spitz nevus
How can you tell the difference between the hypopigmented lesions of vitiligo and ash-leaf spots?
Vitiligo will result in partial to complete loss of pigmentation. Ash-leaf spots are not totally depigmented. The lesions of vitiligo will usually be seen around the eyes, mouth, genitals, elbows and hands. Ash-leaf spots more typically have a truncal distribution. While both will enhance with a Wood’s lamp examination, the enhancement with vitiligo is much more dramatic.
Describe the hair loss in the following conditions.
Alopecia Areata – round or oval patches of hair loss that may be located anywhere on the scalp, eyebrows, lashes or body and may occasionally be diffuse or generalized. There is a lack of inflammation but the presence of short easily plucked out hairs at the margins of the patch. The hair shaft narrows just before the point of entry into the follicle.
Trichorrhexis Nodosa – easy hair shaft breakage, brittle, short hairs with fraying of distal ends on microscopy
Friction Alopecia – most commonly on the posterior scalp of infants from rubbing
Traction Alopecia – hair loss at the sites of excessive traction due to ponytails, pigtails, braids or cornrows
Trichotillosis – bizarre patterns of hair loss often in broad, linear bands on the vertex or sides of the scalp (non-dominant hand), short-broken off hairs with different lengths (never completely bald)
List at least 5 skin findings associated with atopic dermatitis.
Keratosis pilaris, pityriasis alba, xerosis, lichenification, ichthyosis vulgaris
Describe the approach to treatment of SJS/TEN.
Treatment: IVIG and supportive care. Should transfer to burn center, especially in TEN. Treat the following complications: