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Systemic Disease (Wolfe) > Dermatological > Flashcards

Dermatological Flashcards

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1
Q

What is atopic dermatitis?

A

chronic, relapsing, skin disease of unknown etiology

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2
Q

What is the mechanism of atopic dermatitis?

A

IgE mediated hypersensitivity type 1 to environmental allergens

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3
Q

When does atopic dermatitis begin?

A

infancy and can continue to adulthood

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4
Q

What are other names for atopic dermatitis?

A

allergic eczema, infantile eczema, allergic dermatitis

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5
Q

What are common ocular complications of atopic dermatits?

A

cataracts around age 20; ASC if eye rubbing and PSC if steroid induced

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6
Q

What are common ocular findings of atopic dermatitis?

A

keratoblepharoconjunctivitis, keratitis, herpes

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7
Q

What is keratoblepharoconjunctivitis?

A

buildup on the lashes with itchy/flaky skin on the lid margin

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8
Q

What is keratitis?

A

ocular finding from mechanical rubbing or secondary to blepharitis irritation the cornea

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9
Q

What is the prevalence of atopic dermatitis?

A

2-5% of children, 33% of children with FMHx of atopy or asthma (60% chance if 1 parent and 80% if 2); male=female

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10
Q

When is the typical onset of atopic dermatitis?

A

90% of cases onset <5 years of age

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11
Q

What is the most common ocular sign of atopic dermatitis?

A

keratoconjunctivitis superiorly, under UL

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12
Q

What are signs/symptoms of keratoconjunctivitis?

A

pruritus, FB sensation, superior SPK>pannus, sympblepharon, thickened lid margins, blepharitis, slight mucous discharge, Trantas dots

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13
Q

What are trantas dots?

A

superior collection of dead eosinophils

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14
Q

What is a Dennie Morgan fold?

A

prominent infraorbital fold of lower eyelid secondary to repeated episodes of swelling with atopic dermatitis; prevalence 25%

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15
Q

What are less frequent ocular signs of atopic dermatitis?

A

keratoconus, uveitis, ocular HTN, RD, herpes simplex

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16
Q

What are systemic signs of atopic dermatitis?

A

pruritus, lichenification, xerosis, keratinization, scaly/rough/red patches–> weeping lesions over time

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17
Q

Where are atopic dermatitis systemic signs located in an infant?

A

cheeks, forearms, legs, diaper area

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18
Q

Where are atopic dermatitis systemic signs located in an toddler?

A

elbows, knees, wrists and ankles once crawling and walking

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19
Q

Where are atopic dermatitis systemic signs located in an adult?

A

hands, face, neck, genitalia, legs

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20
Q

How do you diagnose atopic dermatitis?

A

clinical presentation and FMHx, IgE levels may or may not be elevated, not related to ocular manifestations, higher levels with cataract formation

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21
Q

What is the systemic treatment of atopic dermatitis?

A

removal of inciting agents, avoid itching and scratching, cold compresses/astringents for itching, oral antibiotics for secondary infections, oral antihistamines, topical steroids (or systemic), oral cyclosporin A (immunosuppressive), UVA and B exposure to dry rash

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22
Q

What is the ocular treatment of atopic dermatitis?

A

cold compresses, topical antihistamines/decongestants, topical steroids, 1% hydrocortisone cream for facial skin, artificial tears between attacks, systemic therapy, cataract surgery

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23
Q

What is rosacea?

A

facial issue of the cheeks, nose, forehead, chin and eyes

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24
Q

What are signs of rosacea?

A

rhinophyma, erythema, telangiectasia, papule, pustule, ocular rosacea

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25
What is rhinophyma?
hypertrophy of sebaceous glands
26
What are signs of ocular rosacea?
blepharitis, meibomianitis, hordeolum, chalazia, keratitis, corneal vascularization and thinning, decreased VA, penetrating keratoplasty in advanced cases
27
Who gets systemic rosacea?
adults 30-60 years, women 2x more than men
28
T/F more women get ocular rosacea than men
false, equal incidence when ocular
29
What is the etiology of rosacea?
30% FMHx, unknown etiology, potentially H. pylori, inflammatory component and/or type IV hypersensitivity
30
How often does systemic rosacea become ocular?
58% ocular involvement before, during or after systemic onset
31
T/F ocular rosacea can have symptoms>signs
true, bilateral FB sensation, pain, burning, red eyes, styes, epiphora (signs: tear debris, oily, foamy tears, SPK inferior 2/3)
32
How is rosacea diagnosed?
clinical impression, facial features must exist to make ocular dx
33
What are differentials of rosacea?
seborrheic dermatitis, lupus, acne vulgaris
34
What is the treatment for systemic rosacea?
250 mg tetracycline qid x 4-6 weeks, low maintenance dose may be required; topical and/or oral metronidazole; accutane, dietary restriction of alcohol, spicy foods and hot beverages; stress reduction, laser tx
35
Is metronidazole antibacterial or antiinflammatory?
both
36
What is the treatment for ocular rosacea?
same as facial treatment, 100 mg doxycycline qday x4-6 weeks as alternative to tetracycline, lid hygiene therapy, artificial tears, topical steroids, keratoplasty, conjunctival flap, amniotic membranes, scleral lenses
37
What is verruca?
benign lesion, viral etiology, lobulated (looks like cauliflower)
38
What is a papilloma?
benign overgrowth of cells, skin-tag, smooth surface
39
What is a typical treatment of benign lesions?
excision, cautery, laser
40
What is molloscum contagiosum?
viral infection of epidermis from pox virus, flesh colored with umbilicated center
41
Where is molloscum contagiosum located?
face, eyelids, trunk, axillae, extremities, genitals-- tend to form wherever there is hair
42
What increases the incidence of molloscum?
AIDS
43
Is molloscum contagious?
yes, active and infectious if excreted; leads to follicular conjunctivitis or toxic keratitis
44
What is treatment of molloscum?
self limiting 6-9 months in immunocompetent patient; can consider cryotherapy and HIV testing
45
What is keratoacanthoma?
benign skin tumor, derived from hair follicles on sun exposed skin; rapid growth of central crater and keratin cap
46
What is treatment of keratoacanthoma?
involute and resolve alone or surgical removal- both cause a scar
47
What is seborrheic keratosis?
greasy lesion confined to epidermis on sun-exposed skin, may occur adjacent to malignant lesions
48
What is actinic keratosis?
pre-malignant lesion from years of accumulated sun exposure, rough lesion
49
What can actinic keratosis become?
squamous cell carcinoma, 25% of the time
50
What is treatment for actinic keratosis?
topical retin-A, cryotherapy, biopsy
51
What is the most common skin/eyelid malignancy?
basal cell carcinoma; 90% occur on head and neck, lower>upper euelid
52
What is basal cell carcinoma?
pearly, round lesion with raised borders and bleeding; grows and expands by direct vertical invasion
53
How common is basal cell metastasis?
rare
54
What are complications of basal cell?
high degree of local destruction, orbital extension suggested by diplopia on extreme gaze, globe displacement, pain, tissue redness, chemosis
55
What is treatment of basal cell?
cryotherapy, surgical excision, radiation
56
What is squamous cell carcinoma?
lesion on sun-exposed/damaged skin; UL=LL; 60-75% occur on head and neck
57
How common is squamous cell metastasis?
highly metastatic, spreads through lymphatic system
58
What is the treatment of squamous cell?
recognize and refer promptly for biopsy
59
What is sebaceous gland carcinoma?
aka meibomian gland carcinoma, small/firm and painless mass, yellowish in color due to high lipid content, madarosis
60
Does a sebaceous gland carcinoma metastasize?
yes metastatic potential
61
What are differentials for sebaceous gland?
recurrent hordeolum, chalazion
62
What is malignant melanoma?
itchy, bleeding and painful lesion; typically red/white/blue that grows horizontally before vertically
63
How common and deadly is malignant melanoma?
3% of dermatologic malignancies, causes 2/3 of all fatalities related to skin cancer
64
What is prognostic for survival rate with malignant melanoma?
vertical thickness
65
What is treatment of malignant melanoma?
excision, chemo, radiation; can recur
66
What is erythema-multiform?
acute, inflammatory condition of skin and mucous membranes; usually self-limiting
67
When does erythema-multiform occur?
20-40 years
68
What are the 2 types of erythema-multiform?
EM minor male=female and EM major "SJS" males>females
69
What are systemic associations of erythema-multiform?
sulfonamides, infections, collagen vascular disease, vaccinations, pregnancy, neoplasms, radiation
70
What medications are associated with SJS?
sulfonamides, PCNs, salicylates, barbiturates, arsenicals, mercurials, tropicamide, proparacaine, oral acetazolamide
71
What is the pathophysiology of erythema-multiform?
monocyte infiltration into dermis, lymphocytes around the dermal blood vessels, subepithelial bullae form and the epidermal cells become edematous
72
What are signs and symptoms of erythema-multiform?
flu-like symptoms, dermal eruptions (itchy and painful bulls eye lesions)
73
When do dermal eruptions occur with erythema-multiform?
can occur within hours of the pro-drome
74
What are s/s of EM minor?
skin, extremities rash only
75
What are s/s of EM major?
skin and mucous membranes, trunk rash
76
What is the ocular involvement of EM?
lid edema, focal ulceration, conj membranes, conj and corneal scarring, iritis, symblepharon, ankyloblepharon, dry eye, decreased mucin layer
77
How is EM diagnosed?
clinical signs and Hx
78
What is EM r/o systemically?
Reiter syndrome, behcet's, bullous pemphigoid, lupus
79
What is EM r/o ocularly?
sjogren, sarcoidosis, cicatricial pemphigoid, chemical burns, trauma
80
What is treatment of EM?
discontinue causative agent, antibiotics for secondary infections, manage dry eye, bandage CL, topical tretinoin, debride filaments, surgical intervention for symblepharon, mitomycin-C injection to prevent adhesion reformation, epilation for trichiases
81
What is the mortality rate of EM?
25%
82
What does topical tretinoin do?
as a vitamin A derivative, it enhances goblet cell regeneration and mucin production
83
What is cicatricial pemphigoid?
progressive bullous disease of skin and mucous membrane
84
What is the onset of cicatricial pemphigoid?
55-70 years old
85
How often does cicatricial pemphigoid have ocular involvement?
75-85% of the time
86
How many patients with cicatricial pemphigoid have ocular HTN or glaucoma?
1/3
87
What is the etiology of cicatricial pemphigoid?
type II autoimmune disorder with antibodies to basement membrane (IgM and IgG)
88
What topical drugs are associated with cicatricial pemphigoid?
timolol, epinephrine, dipivefrin, pilocarpine
89
What are systemic signs of cicatricial pemphigoid?
bullous lesions of the oral mucosa, skin lesions much less common than mucosal
90
What are ocular signs of cicatricial pemphigoid?
bilateral conjunctivitis, conjunctival shrinkage, symblepharon, severe dry eye, ocular surface keratinization, corneal scarring, significant VA reduction
91
How is cicatricial pemphigoid diagnosed?
history, signs, progression
92
What is the treatment of cicatricial pemphigoid?
corticosteroids, immunosuppressives to control inflammation and prevent loss of vision, dry eye treatment (including tarsorrhaphy), tx secondary infections, lid hygiene, topical steroids, penetrating keratoplasty (low success rate)

Systemic Disease (Wolfe) (10 decks)

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