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Dermatology > Lichenoid Disorders > Flashcards

Lichenoid Disorders Flashcards

1
Q

What is meant by a lichenoid disorder?

A

clinically - shiny flat topped itchy papular rash

histologically - band like inflammatory infiltrate in the upper dermis with basal cell necrosis

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2
Q

Name four lichenoid disorders

A
  • lichen planus
  • drug eruptions
  • graft vs host disease
  • pityriasis lichenoides
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3
Q

What is the name given to the appearance of basal cell necrosis?

A

Civatte bodies

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4
Q

Describe the aetiology of Lichen Planus

A

Genetic association & links to hepatitis C, T cell mediated autoimmune inflammatory condition

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5
Q

Describe the histological appearance of lichen planus

A

Acanthosis (irregular saw tooth thickening of epidermis) civatte bodies with lymphocytic infiltrate

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6
Q

Name the different types of lichen planus

A

Hypertrophic
Atrophic
Follicular
Mucosal

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7
Q

How does lichen planus present?

A

Shiny flat topped violaceous polygonal papules often very itchy

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8
Q

What is the name for the white lines with a lace like patten on surface of papules and bullae?

A

Wickham’s striae

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9
Q

How is Lichen Planus managed?

A

Can clear spontaneously but treatment is symptomatic and potent topical steroids. If unresponsive systemic therapies may be required.

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10
Q

What are the four types of immune mediated reactions?

A

I - anaphylactic
II - cytotoxic reactions
III - immune complex mediated
IV - cell mediated delayed

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11
Q

For each of the immune mediated reactions what is the typical corresponding dermatological presentation?

A

I - Urticaria
II - Pemphigus and Pemphigoid
III - Purpura/rash
IV - erythema/rash

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12
Q

Name the risk factors for a drug eruption

A
  • age
  • gender
  • genetics
  • concomitant disease (virus/CF)
  • immune status
  • drugs
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13
Q

What is the most common type of drug eruption?

A

Exanthematous type 4 hypersensitivity reaction

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14
Q

How does exanthematous type 4 hypersensitivity reaction present?

A

Widespread symmetrical rash with no mucosal involvement can be itchy but often associated with a mild fever, 4-21 days after taking first dose

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15
Q

What are the indications of a severe exanthematous reaction?

A
  • mucous/fascial involvement or oedema
  • confluent erythema
  • SOB/Wheeze/Lymphadenopathy
  • Blisters, purpura, necrosis
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16
Q

What antibiotics can cause an exanthematous reaction?

A 
SEPS 
sulphonamides
erythromycin  
penicillin
streptomycin
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17
Q

What anti-epileptic drugs can cause an exanthematous reaction?

A

Carbamazepine

Phenytoin

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18
Q

Other than anti - biotic and epileptic drugs what can cause an exanthematous drug eruption?

A

allopurinol
NSAIDs
chloramphenicol for conjunctivitis

19
Q

When can a type 1 hypersensitivity reaction occur?

A

First exposure - direct release of inflammatory mediators from mast cells
Re-challenge with drug

20
Q

Which drugs can cause a direct mast cell degranulation and thus anaphylactic shock?

A

Morphine
NSAIDs
Codeine
Aspirin

21
Q

Which drugs can cause an IgE response and thus anaphylactic shock?

A

Penicillins

Cephalosporins

22
Q

Name three drugs that can cause exanthematous pustulosis

A

Antibiotics, Calcium channel blockers, antimalarials

23
Q

What drugs can induce bullous pemphigoid?

A

ACE inhibitors, penicillin, furosemide

24
Q

What drug eruption can happen from glucocorticoids?

A

Acneform no increased sebum or comedones

25
Q

Describe fixed drug eruptions

A

Lesions occur in the same area each time a particular drug is taken - well demarcated round/ovoid plaques are red and painful

26
Q

Name some common drugs that cause fixed drug eruptions

A
  • tetracycline/doxycycline
  • paracetamol
  • NSAIDs
  • Carbamazepine
27
Q

Name four very severe drug reactions

A

Stevens Johnson Syndrome
Toxic Epidermal Necrolysis
Drug Reaction with eosinophilia and systemic symptoms (DRESS)
Acute generalised ezanthemaouts pustolosis (AGEP)

28
Q

Describe Steven Johnson Syndrome

A

Life threatening much-cutanous exfoliation, severe variant of erythema multiform that leads to systemic complications

29
Q

What are the extra-cutaneous manifestations of SJS?

A

Stomatitis, oesophagitis, diarrhoea, painful micturition, desquamation of respiratory tract

30
Q

Describe Toxic Epidermal Necrolysis

A

Widespread erythema followed by epidermal necrosis with loss of large sheets of epidermis

31
Q

Where must patients with TEN be managed?

A

HDU/Burns Unit

32
Q

What is the biggest risk to patients with TEN?

A

Multi-organ failure due to loss of thermoregulation

33
Q

What drugs can cause SJS and TEN?

A 
Anti-biotics 
NSAIDs
Anticonvulsants 
Anti-retroviral medication 
Opiates
34
Q

How are SJS and TEN managed?

A

Withdraw underlying cause
Prevent complications
Fluid and electrolyte replacement
Systemic antibiotics if evidence of infection
Emollients
TEN - IV immunoglobulins improve prognosis

35
Q

What is a phototoxic drug reaction?

A

Some drugs will absorb UV, the drug will act as a chromophore leading to non-immunoligcal reactions if a patient is exposed to enough drug & light

36
Q

Describe the features of acute phototoxic drug reactions

A
  • photosensitivity
  • systemic toxicity
  • photo degradation
37
Q

Describe the features of chronic phototoxic drug reactions

A
  • pigmentation
  • photo ageing
  • photocarcinogenesis
38
Q

What drugs would cause immediate prickling with delayed erythema?

A

Chlorpromazine and amiodarone

39
Q

What drugs would cause exaggerated sunburn?

A

Quinine and thiazides

40
Q

What drug would cause exposed telangiectasia?

A

CCBs

41
Q

What drug would cause delayed pigmentation/erythema?

A

Psoralens

42
Q

What drugs would cause increased skin fragility?

A

Tetracycline, naproxen, amiodarone

43
Q

What reaction would azathioprine cause?

A

?

44
Q

How should drug eruptions be managed?

A

Discontinue drug if severe
Topical steroids
Anti-histamine if Type 1
Allergy bracelet/yellow card scheme

Dermatology (13 decks)

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