Inflammatory & Papulosquamous Dermatoses

A 27-year-old man has pruritic plaques on elbows and knees in winter; silvery scale with pinpoint bleeding on scraping; <10% BSA, no joint pain. First-line therapy?

A 22-year-old woman develops numerous “drop-like” erythematous scaly papules 2 weeks after streptococcal pharyngitis. Best next step?

A 35-year-old with long-standing plaque psoriasis now has nail pitting and onycholysis but no synovitis. What additional screening is important?

A 9-year-old boy with severe atopic dermatitis has nighttime itch despite emollients and low-potency steroids. Best escalation?

A 28-year-old woman with itchy erythematous plaques on flexures; burning with steroids. Alternative steroid-sparing agent?

A 42-year-old with scalp erythema and greasy scale involving nasolabial folds and eyebrows. Best initial treatment?

A 31-year-old develops a single herald patch followed by a “Christmas tree” distribution of oval scaly plaques along cleavage lines. Management?

A middle-aged man with polygonal, violaceous, flat-topped papules on wrists and lacy white reticular streaks on buccal mucosa. Best first-line?

A 65-year-old with rapidly worsening generalized erythema and scaling covering >90% BSA, chills and edema. Initial priority?

A 24-year-old runner with sharply demarcated annular scaly plaques on the buttocks unresponsive to steroids; KOH pending. Likely diagnosis?

A 55-year-old woman with chronic venous insufficiency develops pruritic scaly erythema over medial ankles with oozing. Best management?

A 6-month-old infant with erythematous, crusted lesions on cheeks and extensor limbs; family atopy. First-line skin care?

A 38-year-old chef develops well-circumscribed, coin-shaped oozing plaques on shins with intense itch in winter. Most likely diagnosis?

A 30-year-old woman with postpartum flare of psoriasis involving scalp and intertriginous areas. Best scalp approach?

A 50-year-old with severe chronic plaque psoriasis (BSA 18%, PASI high) failed topicals/phototherapy. Preferred systemic option with metabolic syndrome and fatty liver?

A 26-year-old with vesicles on sides of fingers with tapioca-like appearance, intensely pruritic, stress-related. Diagnosis?

A 40-year-old woman develops an itchy eczematous eruption under a new smartwatch band; patch tests later show nickel positivity. Best management now?

A 48-year-old with violaceous papules, intense oral pain; biopsy confirms erosive oral lichen planus. Important counseling?

A 32-year-old pregnant woman (22 weeks) with chronic plaque psoriasis on trunk (BSA 12%). Safest escalation?

A 37-year-old with sharply demarcated, erythematous, macerated plaques in axillae with minimal scale; KOH negative. Likely diagnosis?

A 29-year-old has thick hyperkeratotic plaques on palms and soles with fissuring; elsewhere mild psoriasis. Best first-line for palms/soles?

A 45-year-old with chronic pruritic papules on shins; scratching leads to lichenified plaques. Diagnosis?

A 19-year-old student with sudden symmetric erythematous plaques with targetoid scaling after a new NSAID; biopsy: lichenoid interface dermatitis. Diagnosis?

A 60-year-old with diffuse scaling and fissures on hands from frequent washing at hospital work. Best management?

A 33-year-old with plaques on extensor surfaces; PASI 10. He has active tuberculosis under treatment. Which psoriasis therapy to avoid now?

A 7-year-old with scalp scaling and alopecia patches; posterior cervical adenopathy. Most appropriate therapy?

A 58-year-old with plaques on elbows and buttocks; wishes to conceive with partner. Which systemic agent is contraindicated for him?

A 41-year-old with chronic eczematous dermatitis on hands unresponsive to topicals; patch testing positive to methylisothiazolinone (MI). Key intervention?

A 36-year-old with psoriatic plaques and pruritus; ALT mildly elevated, heavy alcohol use. Best systemic choice?

A 52-year-old woman with sharply marginated salmon-colored plaques on trunk and islands of sparing; follicular hyperkeratosis on elbows. Diagnosis?

A 25-year-old man with episodic intensely pruritic papules and plaques after sweating; resolves with cool environment. Diagnosis?

A 47-year-old with thick erythematous plaques over shins after chronic topical steroid misuse on presumed “eczema”; KOH positive for hyphae. Diagnosis?

A 30-year-old with severe scalp psoriasis unresponsive to topicals; no contraindications. Next best step?

A 62-year-old with widespread pruritic, eczematous dermatitis after initiating loop diuretic; no infection. Management?

A 16-year-old with atopic dermatitis has recurrent impetiginization (honey crusts). Best step to reduce flares?

A 45-year-old with well-demarcated erythematous plaques and silvery scale over sacrum; arthralgia in fingers and morning stiffness 45 minutes. Next step?

A 34-year-old woman with suspected allergic contact dermatitis to hair dye (PPD). Immediate advice?

A 58-year-old man with generalized pustules, fever, leukocytosis on background of known psoriasis after abrupt steroid withdrawal. Diagnosis?

A 21-year-old with coppery-brown hyperpigmented lichenified plaques in antecubital fossae and neck; severe itch, positive family atopy. Long-term control?

A 43-year-old office worker with chronic itchy plaques on dorsum of feet at shoe contact points; patch test later positive to rubber accelerators. Best footwear advice?

A 46-year-old smoker presents with recurrent sterile pustules on palms and soles with scale and fissuring. Best initial management?

A 19-year-old develops widespread small scaly “raindrop” papules 2 weeks after strep throat; topical therapy ineffective. Next best step?

A 38-year-old woman with patchy scarring alopecia and perifollicular erythema/scale on vertex. Diagnosis?

Middle-aged man with hyperkeratotic pruritic plaques on shins; biopsy: hypergranulosis with wedge-shaped hypergranulosis and sawtooth acanthosis. Best therapy?

A 27-year-old with months of small, scaly, reddish-brown papules on trunk, minimal symptoms. KOH negative. Best treatment?

A 55-year-old with orange-red scaly plaques, islands of sparing, follicular hyperkeratosis on elbows, nail changes. First-line systemic?

Adult with moderate–severe atopic dermatitis unresponsive to optimized topicals and NB-UVB. Appropriate next step?

A 33-year-old woman with AD and photosensitive lupus erythematosus. Flare requires escalation beyond topicals. Best option?

A 62-year-old with thin, chronic, slightly scaly patches on flanks (“digitate”). Concern for early CTCL vs small-plaque parapsoriasis. Next step?

Infant with “diaper rash” nonresponsive to antifungal; sharply demarcated erythematous plaques with minimal scale in folds. Most likely?

A 10-year-old with numerous tiny, shiny, flat-topped papules on forearms and penile shaft; asymptomatic. Management?

A 21-year-old with acute crops of necrotic crusted papules on trunk/extremities; biopsy: dense lymphocytic infiltrate with necrotic keratinocytes. Best treatment?

Patient with thick adherent scale of scalp, erythema of eyebrows and nasolabial folds, plus classic plaques on elbows. Best regimen?

Inverse psoriasis complicated by suspected candidal superinfection (satellite pustules). Best addition?

A 40-year-old with psoriasis and multiple sclerosis needs systemic therapy. Which to avoid?

A 29-year-old with psoriasis and active Crohn disease needs biologic. Preferred agent?

A patient develops PR-like eruption weeks after starting imatinib. Best management?

Teenager with rough “chicken skin” on posterolateral arms; worse in winter; asymptomatic. Best advice?

Adult with AD presents with fever and rapidly spreading painful monomorphic vesicles on eczematous skin. Immediate management?

Severe scalp psoriasis with diffuse scale and hair shedding; no scarring. Next best step?

Refractory AD with recurrent impetiginization. Evidence-based adjunct to reduce colonization?

Lichen planus with nail matrix involvement (trachyonychia, pterygium formation). Best therapy?

Pregnant patient (28 weeks) with life-threatening generalized pustular psoriasis. Preferred systemic?

Patient on adalimumab for PsO needs live-attenuated vaccine. Best approach?

Erythrodermic PRP vs psoriasis in unstable course; initial systemic with best evidence in PRP?

Adult AD inadequate on dupilumab after optimization; eosinophilia and high IgE persist. Next option?

A 6-year-old with linear band of flat-topped, hypopigmented papules along Blaschko lines on arm; asymptomatic. Diagnosis/management?

Middle-aged man with pruritic papulovesicles on trunk in hot weather; biopsy: acantholysis. Diagnosis?

New onset of widespread psoriasis after months on infliximab for rheumatoid arthritis. Mechanism and step?

A 30-year-old man has pinpoint bleeding after removing scale from elbow plaques. This sign is called?

AD on face/eyelids needing anti-inflammatory maintenance with minimal atrophy risk. Best agent?

Palmoplantar psoriasis severely painful, limiting work; failed topicals. Most appropriate next step?

Lichen planus involving genital mucosa with erosions; severe pain. Best first-line local therapy?

Widespread pityriasis rosea early in pregnancy with severe pruritus. Management?

Psoriasis patient with NAFLD and hypertriglyceridemia seeks systemic therapy. Best choice?

Atopic hand dermatitis in a hairdresser; chronic and relapsing. Key long-term intervention?

Child with pityriasis alba on cheeks. Best management?

Chronic plaque psoriasis becomes unstable with widespread flare after oral prednisone taper. What happened?

Patient starting biologic for psoriasis. Which screening is essential?

Woman with inverse psoriasis in inframammary folds; frequent maceration. Best topical vehicle?

A 34-year-old man with plaque psoriasis has pitting and onycholysis of several fingernails; skin disease is mild. Best targeted nail therapy?

A 20-year-old with atopic dermatitis asks about oral antihistamines for itch. Best advice?

A 45-year-old with severe, recalcitrant seborrheic dermatitis of face and scalp. What underlying condition should be screened?

A hiker develops linear, intensely pruritic vesiculo-erythematous streaks on forearms after plant exposure. Best initial therapy for moderate involvement?

Patient on doxycycline develops photodistributed painful erythema with burning after sun exposure; sharp demarcation where clothing covered. Diagnosis?

A 26-year-old with suspected pityriasis rosea has involvement of palms/soles and mucosa. Next step?

Parents of a 2-year-old with AD ask about extensive food allergy testing to “find the cause.” Best counseling?

A 49-year-old with plaque psoriasis is HBsAg-positive with high HBV DNA. Before starting biologic therapy, best step?

A patient with mild–moderate plaque psoriasis struggles with adherence. Most effective topical combination?

Coin-shaped oozing plaques on legs in winter; KOH pending. Best immediate step?

Post-lichen planus hyperpigmentation on shins in dark skin. Best management?

A 58-year-old woman with new generalized erythema and scaling after starting a TNF inhibitor for RA; classic psoriasiform plaques appear. Mechanism?

A 33-year-old with guttate psoriasis asks if antibiotics will clear the skin without sore throat. Best response?

A tattoo enthusiast with psoriasis asks about new tattoos during active disease. Key counseling?

Unstable erythrodermic psoriasis with systemic symptoms. Which rapid-acting systemic is favored in hospital?

Before starting methotrexate for severe psoriasis, which baseline assessment is essential?

Chronic topical steroid overuse on face leads to telangiectasias and atrophy. Best corrective approach?

A child with AD and recurrent flares despite optimized topicals; parents ask about bleach baths. Advice?

Occupational chronic hand eczema refractory to topicals and avoidance. Next evidence-based systemic?

Lichen simplex chronicus on the nape from habitual scratching. Best regimen?

Psoriasis patient asks about heart risk. What is accurate counseling?

PR-like eruption with systemic symptoms and generalized lymphadenopathy. Best test to avoid missing mimic?

Allergic contact dermatitis from fragrance mix confirmed on patch testing. Key long-term measure?

Severe flexural AD unresponsive to optimized topicals; patient has history of melanoma. Best escalation?

Which condition is a relative contraindication to PUVA?

Patient starting an IL-17 inhibitor for psoriasis. Common mucocutaneous adverse effect to counsel?

Starting ustekinumab for psoriasis. What screening remains essential?

Apremilast counseling point most characteristic?

Dangerous drug interaction with methotrexate in psoriasis?

Sun-exposed, hyperpigmented lichenoid plaques on forehead and cheeks in a farmer; summer flares. Diagnosis?

Postpartum woman breastfeeding with limited plaque psoriasis on trunk. Safe options?

Lichen planus associated systemic disease to screen?

Patient with scalp psoriasis resistant to topicals asks about salicylic acid use. Best counsel?

Widespread pityriasis rosea in dark skin with severe pruritus; patient worries about lasting marks. Best plan?

Nail psoriasis with primarily matrix involvement (pitting, ridging). Procedure that helps?

Genital psoriasis causing pain and dyspareunia. Best topical approach?

Infant “cradle cap” with greasy yellow scale and mild erythema; otherwise well. Best management?

AD patient on dupilumab develops conjunctivitis. Next step?

Nummular eczema with intense nighttime itch; sleep is poor. Helpful adjunct?

Allergic contact dermatitis on chronically eczematous legs after using triple-antibiotic ointment. Likely allergen and step?

A 72-year-old man develops intensely pruritic “cracked porcelain” xerotic plaques on shins each winter after hot baths and space-heater use. Best initial management?

A 34-year-old woman with dark skin has insidious, photo-exposed slate-brown macules with subtle scale on forehead and temples; no mucosal erosions. Most likely and management?

A 25-year-old develops a herald patch, then multiple symmetric oval plaques along cleavage lines but concentrated in axillae and groin (inverse variant). Best approach?

A 48-year-old with long-standing atopic dermatitis has dozens of excoriated nodules on arms/legs with relentless itch and sleep loss. Evidence-based escalation?

Patch testing for chronic eczematous plaques shows allergy to budesonide and tixocortol pivalate. Next step?

Thick, adherent “shell-like” scalp scale binds hair tufts; underlying plaques consistent with psoriasis/seb derm. Best initial regimen?

A 68-year-old man has chronic lichenified eczematous plaques on sun-exposed sites, severe photosensitivity, and positive photo-patch tests to multiple allergens. Most appropriate plan?

A 23-year-old develops pruritic papules on forearms every spring; resolves by late summer. Prevention strategy?

Middle-aged patient has annular plaques with a trailing inner scale; workup otherwise benign. Most likely diagnosis/management?

Pruritic vesicles on sides of fingers appear after severe moccasin-type tinea pedis. Best management now?

A patient with stable plaque psoriasis suddenly flares after starting a new psychiatric medication. Which drug is most likely responsible?

Obese patient with moderate psoriasis asks about nonpharmacologic steps to improve skin and biologic response. Best counsel?

A 39-year-old with PRP has diffuse orange-red plaques and follicular plugging. What important screening should be added?

A 52-year-old with dyspareunia has porcelain-white atrophic vulvar plaques and fissures. First-line therapy?

A 27-year-old with recurrent bilateral eyelid eczema; patch testing later shows allergy to tosylamide-formaldehyde (nail polish resin). Key advice?

Correct reading schedule for standard patch tests?

A 31-year-old develops pruritic eczematous eruption on dorsal hands after using a new “long-wear” gel manicure system. Most likely culprit and next step?

Patient reports itchy dermatitis where tight, dark synthetic clothing contacts skin; patch tests positive to disperse dyes. Management?

Dorsal feet dermatitis at shoe contact points; patch testing positive to potassium dichromate. Best advice?

A 29-year-old with generalized papulosquamous eruption, mucous patches, and condylomata lata. Next best step?

Starting methotrexate for severe psoriasis: which instruction prevents serious error?

A patient on cyclosporine for unstable psoriasis asks about monitoring. Key risks to track?

Considering a JAK inhibitor for refractory AD. Important counseling?

A 40-year-old with photo-distributed annular scaly plaques and anti-Ro/SSA positivity. Best initial treatment?

Flexural, hyperpigmented, slightly scaly patches in axillae with chronic course; biopsy shows lichenoid interface dermatitis. Diagnosis/plan?

A 56-year-old with nail dystrophy and subungual debris attributed to “fungus” has psoriatic plaques. Before starting oral terbinafine, best step?

Unilateral chronic eczematous change of a nipple–areola complex unresponsive to topical steroids for months. Next step?

Severe PRP with retinoid contraindication. Evidence-based systemic alternative?

Which feature is most characteristic of psoriasis (vs most papulosquamous mimics)?

Starting acitretin in a woman of childbearing potential. Critical counseling?

Patient on an IL-17 inhibitor for psoriasis develops recurrent oral thrush. Best next step?

Topical tazarotene prescribed for limited plaque psoriasis in a woman planning pregnancy. Counseling?

Coal tar–based regimen chosen for refractory scalp psoriasis. Key counseling point?

Child with widespread AD; caretaker asks how to apply steroids correctly. Most practical dosing tool?

After 10 days of heavy salicylic acid ointment under occlusion for scalp scale, a small child becomes lethargic and nauseated. Concern?

Patient with severe AD starts cyclosporine as a short bridge to biologic response. Monitoring priority?

Persistent lip dermatitis worsened by cinnamon- and citrus-flavored products; patch test positive to Balsam of Peru. Best advice?

A patient with facial psoriasis asks about calcipotriol use on eyelids. Best counsel?

Widespread AD flare treated with wet-wrap therapy at home. Safety counseling?

Rosacea with overlapping seborrheic dermatitis on central face. Most appropriate combined regimen?

A 32-year-old woman develops papulopustular eruption around the mouth after months of potent topical steroids for “rash.” Best management?

A 54-year-old with psoriasis and chronic hepatitis C needs systemic therapy. Safest effective option?

A child with atopic dermatitis develops vesiculobullous lesions during a hand-foot-mouth outbreak, limited to eczematous skin. Management?

New symmetric lichenoid eruption 6 weeks after starting a beta-blocker. Best next step?

Psoriasis flares monthly after streptococcal pharyngitis; seeking prevention. Best approach?

Severe facial seborrheic dermatitis refractory to OTC agents. First-line prescription regimen?

Chronic pruritic thin plaques with fine scale on flanks; biopsy shows superficial perivascular lymphocytic infiltrate without atypia. Dx/plan?

Thick sharply demarcated plaques on palms/soles in a manual worker; KOH negative. Most appropriate?

Chronic hand eczema with hyperhidrosis triggers. Helpful adjunct?

Eyelid dermatitis due to fragrance mix. Best long-term strategy?

Chronic photo-distributed eczematous dermatitis in older man; worsens with sun. Most likely diagnosis?

Psoriasis patient starting biologic asks about vaccines. Correct advice?

Erythematous papules and plaques with trailing inner scale on thighs; workup negative. Diagnosis?

Male with pruritic white atrophic plaques on glans and foreskin; phimosis developing. First-line?

Widespread pityriasis rubra pilaris; retinoids contraindicated. Evidence-based alternative?

Chronic eyebrow/scalp scale with classic plaques on elbows; best single shampoo strategy?

Sudden plaque psoriasis flare after starting NSAID. Likely explanation?

Chronic eczematous otitis externa in atopic patient. Helpful topical choice?

Refractory hyperkeratotic hand eczema in an office worker despite avoidance and potent topicals. Next systemic?

Patch testing schedule question. Correct timing?

Teen with AD asks about bleach baths. Proper protocol?

Linear lichenoid papules along a scratch line in psoriasis patient. Term?

Painful hypertrophic lichen planus nodules on shins. Best targeted therapy?

Suspected allergic shoe dermatitis; patch test positive to colophony (rosin). Advice?

Chronic flexural rash with subtle hyperpigmentation and little scale; Wood’s lamp coral-red negative; KOH negative. Most likely?

Elderly man with wintertime “eczema craquelé” and pruritus. Best long-term prevention?

Persistent unilateral nipple dermatitis unresponsive to low-potency steroid. Next step?

Patient on methotrexate for psoriasis develops mouth ulcers. Immediate action?

Severe pityriasis rubra pilaris with ectropion and palmoplantar keratoderma. Supportive measure in addition to systemic?

Recalcitrant scalp psoriasis with thick adherent scale. Best debulking step?

Patient asks whether diet can “cure” psoriasis. Evidence-based advice?

Palmoplantar pustulosis with heavy smoking. Counseling?

Chronic lichenified plaques on neck from habitual scratching during stress. Key nonpharmacologic add-on?

Subacute cutaneous lupus erythematosus with positive anti-Ro/SSA. Sun counseling?

Teen with pityriasis rosea worried about contagion. Counseling?

Nail psoriasis with distal onycholysis and subungual hyperkeratosis; KOH negative. Best topical?

Elderly patient with generalized xerosis and pruritus plus faint eczematous patches. First investigation not to miss?