Test Your Psoriasis Knowledge
1. A 66-year-old woman’s psoriasis suddenly worsened after she underwent a biopsy of a tumor in her breast. The biopsy report revealed no evidence of breast cancer. What is responsible for this flare of psoriasis?
a) An allergic reaction to 1 of the anesthetics
b) An exaggerated allergic reaction to the preoperative povidone-iodine preparation
c) A flare of psoriasis that is unrelated to the biopsy
d) A flare caused by the psychological stress of the procedure
2. A 54-year-old female with a several year history of psoriasis that is well-controlled on adalimumab (Humira, AbbVie Inc.) presents with a 1-week history of a worsening rash. She had been diagnosed with strep throat and was prescribed amoxicillin a week prior. The rash is itchy and involves the trunk and extremities, but spares palms, soles and mucous membranes. How would you diagnose the rash on her trunk and extremities?
a) Psoriasis failure while on adalimumab
b) Guttate psoriasis from streptococcal infection
c) Amoxicillin drug reaction
d) Pityriasis rosea
e) Lichen planus
3. This 52-year-old male presents with a 2.5-year history of a cracking and bleeding rash on the corona. What is this rash and how would you treat this chronic condition?
a) Candida balanitis
b) Balanitis xerotica obliterans
c) Dermatophyte infection
d) Psoriasis
e) Lichen planus
ANSWERS
1. A 66-year-old woman’s psoriasis suddenly worsened after she underwent a biopsy of a tumor in her breast. The biopsy report revealed no evidence of breast cancer. What is responsible for this flare of psoriasis?
d) Psychological stress is the primary trigger for psoriasis. This patient’s anxiety about the procedure and its potential outcome induced a major flare of her psoriasis. A short course of a selective serotonin reuptake inhibitor and aggressive topical corticosteroid therapy calmed the patient and the outbreak within a few weeks.
This case was originally published in Consultant 2012;52(10)681-682.
2. A 54-year-old female with a several year history of psoriasis that is well-controlled on adalimumab presents with a 1-week history of a worsening rash. She had been diagnosed with strep throat and was prescribed amoxicillin a week prior. The rash is itchy and involves the trunk and extremities, but spares palms, soles and mucous membranes. How would you diagnose the rash on her trunk and extremities?
b) This patient had guttate psoriasis from her streptococcal infection. She was given a 2-month tapering course of methotrexate that resolved the flare. Drug reactions typically do not have this much scale. Both pityriasis rosea and lichen planus would have a different clinical appearance. Psoriasis failure does occur with all the biologics but with the patient’s history, it is not likely here.
This case was originally published in Consultant. 2014;53(6):478-480.
3. This 52-year-old male presents with a 2.5-year history of a cracking and bleeding rash on the corona. What is this rash and how would you treat this chronic condition?
d) Psoriasis. Signs of psoriasis usually are noted by examining the nails, scalp, belly button and axillae-seborrheic distribution areas. Biopsy can be helpful if necessary. Lichen planus is usually not that scaly in this location. Dermatophyte is extremely rare unless diabetic or immune compromised (same with Candida). Balanitis xerotica obliterans is usually inflammatory with atophic scarring with hypopigmentation. Because the condition is chronic, use intermittent low-potency corticosteroids or any one of the non-steroidal options. Since genital psoriasis can be emotionally devastating, systemic therapy is not unreasonable and often covered by insurance plans.
This case was originally published in Consultant. 2013;53(12):924.
36-38_Derm12_PsoriasisRev.indd 38 12/10/14 12:46 PM
Test Your Psoriasis Knowledge
1. A 66-year-old woman’s psoriasis suddenly worsened after she underwent a biopsy of a tumor in her breast. The biopsy report revealed no evidence of breast cancer. What is responsible for this flare of psoriasis?
a) An allergic reaction to 1 of the anesthetics
b) An exaggerated allergic reaction to the preoperative povidone-iodine preparation
c) A flare of psoriasis that is unrelated to the biopsy
d) A flare caused by the psychological stress of the procedure
2. A 54-year-old female with a several year history of psoriasis that is well-controlled on adalimumab (Humira, AbbVie Inc.) presents with a 1-week history of a worsening rash. She had been diagnosed with strep throat and was prescribed amoxicillin a week prior. The rash is itchy and involves the trunk and extremities, but spares palms, soles and mucous membranes. How would you diagnose the rash on her trunk and extremities?
a) Psoriasis failure while on adalimumab
b) Guttate psoriasis from streptococcal infection
c) Amoxicillin drug reaction
d) Pityriasis rosea
e) Lichen planus
3. This 52-year-old male presents with a 2.5-year history of a cracking and bleeding rash on the corona. What is this rash and how would you treat this chronic condition?
a) Candida balanitis
b) Balanitis xerotica obliterans
c) Dermatophyte infection
d) Psoriasis
e) Lichen planus
ANSWERS
1. A 66-year-old woman’s psoriasis suddenly worsened after she underwent a biopsy of a tumor in her breast. The biopsy report revealed no evidence of breast cancer. What is responsible for this flare of psoriasis?
d) Psychological stress is the primary trigger for psoriasis. This patient’s anxiety about the procedure and its potential outcome induced a major flare of her psoriasis. A short course of a selective serotonin reuptake inhibitor and aggressive topical corticosteroid therapy calmed the patient and the outbreak within a few weeks.
This case was originally published in Consultant 2012;52(10)681-682.
2. A 54-year-old female with a several year history of psoriasis that is well-controlled on adalimumab presents with a 1-week history of a worsening rash. She had been diagnosed with strep throat and was prescribed amoxicillin a week prior. The rash is itchy and involves the trunk and extremities, but spares palms, soles and mucous membranes. How would you diagnose the rash on her trunk and extremities?
b) This patient had guttate psoriasis from her streptococcal infection. She was given a 2-month tapering course of methotrexate that resolved the flare. Drug reactions typically do not have this much scale. Both pityriasis rosea and lichen planus would have a different clinical appearance. Psoriasis failure does occur with all the biologics but with the patient’s history, it is not likely here.
This case was originally published in Consultant. 2014;53(6):478-480.
3. This 52-year-old male presents with a 2.5-year history of a cracking and bleeding rash on the corona. What is this rash and how would you treat this chronic condition?
d) Psoriasis. Signs of psoriasis usually are noted by examining the nails, scalp, belly button and axillae-seborrheic distribution areas. Biopsy can be helpful if necessary. Lichen planus is usually not that scaly in this location. Dermatophyte is extremely rare unless diabetic or immune compromised (same with Candida). Balanitis xerotica obliterans is usually inflammatory with atophic scarring with hypopigmentation. Because the condition is chronic, use intermittent low-potency corticosteroids or any one of the non-steroidal options. Since genital psoriasis can be emotionally devastating, systemic therapy is not unreasonable and often covered by insurance plans.
This case was originally published in Consultant. 2013;53(12):924.
36-38_Derm12_PsoriasisRev.indd 38 12/10/14 12:46 PM
Test Your Psoriasis Knowledge
1. A 66-year-old woman’s psoriasis suddenly worsened after she underwent a biopsy of a tumor in her breast. The biopsy report revealed no evidence of breast cancer. What is responsible for this flare of psoriasis?
a) An allergic reaction to 1 of the anesthetics
b) An exaggerated allergic reaction to the preoperative povidone-iodine preparation
c) A flare of psoriasis that is unrelated to the biopsy
d) A flare caused by the psychological stress of the procedure
2. A 54-year-old female with a several year history of psoriasis that is well-controlled on adalimumab (Humira, AbbVie Inc.) presents with a 1-week history of a worsening rash. She had been diagnosed with strep throat and was prescribed amoxicillin a week prior. The rash is itchy and involves the trunk and extremities, but spares palms, soles and mucous membranes. How would you diagnose the rash on her trunk and extremities?
a) Psoriasis failure while on adalimumab
b) Guttate psoriasis from streptococcal infection
c) Amoxicillin drug reaction
d) Pityriasis rosea
e) Lichen planus
3. This 52-year-old male presents with a 2.5-year history of a cracking and bleeding rash on the corona. What is this rash and how would you treat this chronic condition?
a) Candida balanitis
b) Balanitis xerotica obliterans
c) Dermatophyte infection
d) Psoriasis
e) Lichen planus
ANSWERS
1. A 66-year-old woman’s psoriasis suddenly worsened after she underwent a biopsy of a tumor in her breast. The biopsy report revealed no evidence of breast cancer. What is responsible for this flare of psoriasis?
d) Psychological stress is the primary trigger for psoriasis. This patient’s anxiety about the procedure and its potential outcome induced a major flare of her psoriasis. A short course of a selective serotonin reuptake inhibitor and aggressive topical corticosteroid therapy calmed the patient and the outbreak within a few weeks.
This case was originally published in Consultant 2012;52(10)681-682.
2. A 54-year-old female with a several year history of psoriasis that is well-controlled on adalimumab presents with a 1-week history of a worsening rash. She had been diagnosed with strep throat and was prescribed amoxicillin a week prior. The rash is itchy and involves the trunk and extremities, but spares palms, soles and mucous membranes. How would you diagnose the rash on her trunk and extremities?
b) This patient had guttate psoriasis from her streptococcal infection. She was given a 2-month tapering course of methotrexate that resolved the flare. Drug reactions typically do not have this much scale. Both pityriasis rosea and lichen planus would have a different clinical appearance. Psoriasis failure does occur with all the biologics but with the patient’s history, it is not likely here.
This case was originally published in Consultant. 2014;53(6):478-480.
3. This 52-year-old male presents with a 2.5-year history of a cracking and bleeding rash on the corona. What is this rash and how would you treat this chronic condition?
d) Psoriasis. Signs of psoriasis usually are noted by examining the nails, scalp, belly button and axillae-seborrheic distribution areas. Biopsy can be helpful if necessary. Lichen planus is usually not that scaly in this location. Dermatophyte is extremely rare unless diabetic or immune compromised (same with Candida). Balanitis xerotica obliterans is usually inflammatory with atophic scarring with hypopigmentation. Because the condition is chronic, use intermittent low-potency corticosteroids or any one of the non-steroidal options. Since genital psoriasis can be emotionally devastating, systemic therapy is not unreasonable and often covered by insurance plans.
This case was originally published in Consultant. 2013;53(12):924.
36-38_Derm12_PsoriasisRev.indd 38 12/10/14 12:46 PM
