Dermatitis/ Eczema

Question 1

What is parakeratosis?

Answer 1

Persistence of nuclei in the keratin later

Question 2

What is acanthosis?

Answer 2

Thickened epidermis…

Question 3

What is papillomatosis?

Answer 3

Irregular epithelial thickening

Question 4

What is spongiosis?

Answer 4

Oedema between keratinocytes

Question 5

What occurs in the acute phase of eczema?

Answer 5

Papulovesicular, red lesions, oedema (spongiosis), ooze or scarring and crusting

Question 6

What occurs in the chronic phase of eczema?

Answer 6

Thickening (lichenification), elevated plaques, increased scaling

Question 7

What are the causes of contact allergic dermatitis?

Answer 7

Response to chemicals, topical therapies, …

Question 8

What is hyperkeratosis?

Answer 8

Increased thickness of keratin layer

Question 9

What is the immunopathology of contact allergic dermatitis?

Answer 9

Langerhans in epidermis processes antigen (increased immunogenicity). Processed antigen is then presented to Th cells in dermis. Sensitized Th cells migrate into lymphatics, then to regional nodes where Ag presentation is amplified. Subsequent challenge- specific T cells proliferate/migrate to skin, results in dermatitis

Question 10

How can specific substances causing contact dermatitis be identified?

Answer 10

Patch testing

Question 11

What is irritant dermatitis?

Answer 11

Non specific physical irritation rather than specific allergic reaction

Question 12

What is nappy rash?

Answer 12

Irritant contact dermatitis to urine with ulceration

Question 13

What symptom occurs in atopic eczema which leads to neurocognitive impairment?

Answer 13

Pruritis> sleep disturbance> neurocognitive impairment

Question 14

What symptoms are associated with atopic eczema?

Answer 14

Pruritis, ill-defined erythema & scaling, generalized dry skin, flexural distribution (varies with age). Associated with other atopic diseases

Question 15

What chronic changes occur in atopic eczema?

Answer 15

Lichenification, excoriation, 2’ infection

Question 16

What bacteria does crusting in atopic eczema indicate?

Answer 16

S. aureus

Question 17

What virus causes eczema herpeticum with infection, and what is it characterized by?

Answer 17

HSV, monomorphic punched out lesions

Question 18

What is the UK diagnostic criteria for atopic eczema?

Answer 18

Itching plus 3 or more of: visible flexural rash, history of flexural rash, personal history of atopy (or 1’ relative if

Question 19

What is the treatment of eczema?

Answer 19

Plenty of emollients
Avoid irritants including shower gels and soaps
Topical steroids
Treat infection
Phototherapy – mainly UVB
Systemic immunosuppressants
(Biologic agents)

Question 20

What is the most important gene in the factors that cause atopic eczema?

Answer 20

Filaggrin

Question 21

If you see a dermatitis cut off at collar, what is it likely to be?

Answer 21

Photosensitive eczema/chronic actinic dermatitis, or caused by photosensitizing drugs

Question 22

What is stasis eczema secondary to?

Answer 22

Hydrostatic pressure, oedema, red cell extravasation

Question 23

What symptom will you commonly see in pompholyx eczema, and often where?

Answer 23

Spongiotic vesicles- often side of fingers

Question 24

Describe the lesions and locations in psoriasis

Answer 24

Symmetrical, sharply demarcated, scaly, erythematous plaques. Extensors, scalp, sacrum, hands, feet, trunk, nails

Question 25

Where is acne vulgaris distributed?

Answer 25

Sites with most sebaceous glands- face, upper back, anterior chest

Question 26

What morphology is noted with acne vulgaris?

Answer 26

Comedones- open (blackhead) and closed (whitehead), pustules, papules, cysts

Question 27

What secondary features are present in acne vulgaris?

Answer 27

Scars- atrophic, ice-pick, texture changes, hypertrophic

Question 28

What are the 3 grades of acne, and how are they defined?

Answer 28

Mild- scattered papules and pustules, comedones Moderate - numerous papules, pustules & mild atrophic scarring Severe - as above, cysts, nodules and significant scarring

Question 29

What is found in rosacea?

Answer 29

Papules, pustules and erythema with no comedones, prominent facial flushing exacerbated by sudden change in temperature , alcohol & spicy food

Question 30

What is the Nikolsky sign?

Answer 30

Nikolsky sign is a skin finding in which the top layers of the skin slip away from the lower layers when slightly rubbed

Question 31

When is the Nikolsky sign +ve and -ve?

Answer 31

+ve in pemphigus vulgaris, -ve in bullous pemphigoid

Question 32

What investigations are required in pemphigus and pemphigoid?

Answer 32

Skin biopsy with direct immunofluorescence, indirect immunofluorescence

Question 33

What is the treatment of pemphigoid and pemphigus?

Answer 33

Systemic steroids Other immunosuppressive agents: azathioprine, ciclosporin, mycophenolate In pemphigoid: tetracycline antibiotics, nicotinamide Topicals: emollients, topical steroids