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Dermatology > Psoriasis, Eczema and Pruritus > Flashcards

Psoriasis, Eczema and Pruritus Flashcards

1
Q

Epidemiology of Psoriasis (4)

A

prevalance: 2% in caucasians

F>M

peak incidence in 20s and 50s

30% have FHx

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2
Q

Pathology of psoriasis (4)

A

T IV hypersensitivity

epidermal proliferation

T-cell driven inflammatory infiltration

Histology:

  • acanthosis: epidermal thickening
  • parakeratosis: nuclei in stratum corneum
  • Munro’s microabscesses: neutrophils
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3
Q

Triggers of psoriasis (5)

A

Stress

infection-esp. strep

trauma-Kobner

drugs: beta-b, Li, anti-malarials, EtOH

smoking

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4
Q

Presentation of psoriasis (3)

A

Plaques

  • symmetrical, well defined w. silver scale
  • extensors: elbows knees
  • flexors: axillae, groin, submammary-no scale
  • scalp, behind ears, umbilicus, sacrum

nail changes (50%)

  • pitting
  • onycholysis
  • subungal hyperkeratosis

10-40% develop seronegative arhtritis:

  • mono/oligoarthritis-mainly affects DIPs
  • asymmetrical polyarthritis
  • rheumatoid-like
  • psoriatic spondylitis
  • arhtritis mutlians
  • may>dactylitis
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5
Q

Psoriasis variants (3)

A

Guttate:

  • small, salmon-pink papules w. fine silvery scale
  • mainly on trunk
  • occurs in children. commonly after strep infection

Pustular:

  • eruption of tiny sterile pustules
  • may be localised to palms and soles

erythroderma and generalised pustular:

  • generalised exfoliative dermatitis
  • severe systemic upset: temperature, raised WCC and dehydration
  • can be triggered by rapid steroid withdrawal
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6
Q

DDx for psoriasis (3)

A

tinea: asymmetrical

seborrhoeic dermatitis

Eczema

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7
Q

Mx of psoriasis (7)

A

Education: avoid triggers

Soap substitues: aqueous cream, epaderm ointment, dermol cream

emollients: Epaderm, diprobase, dermol

topical therapies:

  • vit D analogues: calcipotriol
  • steroids: betamethasone
  • coal tar: mainly in-patient use
  • dithranol
  • topical retinoids: tazarotene

UV phototherapy:

  • UVB
  • P-UVA: more effective but increased risk skin ca.

non-biologicals:

  • methotrexate
  • ciclosporin
  • acetretin: oral retinoid, SEs: hyperlipidaemia, hyperglycaemia

biologicals:

  • infliximab
  • etanercept
  • adalimumab
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8
Q

Presentation of Eczema (3)

A

extremely itchy

poorly demarcated rash:

  • acute: oozing papules and vesicles
  • subacute: red and scaly

chronic eczema>lichenification: skin thickening w. exaggerated skin markings

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9
Q

Pathology of eczema

A

epidermal spongiosus

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10
Q

Features of atopic eczema (4)

A

TH2-driven inflammation w. increased IgE production

affects 2% of children

most children grow out of it by 13 yrs

often have strong FHx of atopy

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11
Q

Triggers of atopic eczema (2)

A

specific allergens:

  • house dust mite
  • animal dander

diet e.g. dairy

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12
Q

Presentation of atopic eczema (3)

A

face: esp. around eyes and cheeks
flexors: knees and elbows

can get secondary infection:

  • staph: fluclox
  • HSV: aciclovir
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13
Q

Assoc. of atopic eczema (2)

A

asthma

hayfever

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14
Q

Ix for atopic eczmea (2)

A

raised IgE

RAST testing: identify specific antigens

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15
Q

Causes of irritant contact dermatitis (3)

A

detergents/soaps/solvents

oils

venous stasis

(everyone is susceptible to irritants)

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16
Q

Features of allergic contact dermatitis (3)

A

TIV hypersensitivity reaction

common triggers:

  • nickel
  • chromate: leather
  • lanolin: creams/cosmetics

locations correlates strongly w. allergen exposure

17
Q

Ix for allergic contact dermatitis

A

Patch testing

18
Q

Features of adult seborrhoeic dermatitis (3)

A

red scaly rash

due to yeast overgrowth

often on scalp, eyebrows, cheeks and nasolabial folds

19
Q

Rx of seborrhoeic dermatitis

A

mild topical steroid/antifungal:

-daktacort: miconazole+hydrocortisone

20
Q

Mx of atopic eczema (5)

A

education: avoid triggers

soap substitute:

  • aqueous cream
  • dermol cream
  • epaderm ointment

topical steroids:

  • 1%hydrocortisone for face and groin
  • eumovate: can use briefly on face
  • betnovate
  • dermovate: briefly on thick skin e.g. palms/soles

2nd line therapies:

  • topical tacrolimus
  • phototherapy
  • ciclosporin or azathioprine
21
Q

Causes of generalised pruritus (4)

A

CKD

cholestasis

haematological:

  • Hodgkin’s
  • polycythaemia
  • IDA
  • leukemia

endocrine:

  • DM
  • hyper/hypothyroidism
  • pregnancy
22
Q

extremely itchy derm diseases (4)

A

eczema

urticaria

scabies

dermatitis herpetiformis

Dermatology (6 decks)

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