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Mar Der > Fitz9. Part 3. Dermatitis > Flashcards

Fitz9. Part 3. Dermatitis Flashcards

1
Q

Case: multiple pruritic erythematous papulovesicles with pinpoint crusting or frank weeping on flexures and extremities

  1. Disease?
  2. primary manifestation in adults?
  3. hallmark symptom of disease?
A
  1. ATOPIC DERMATITIS
  2. chronic hand eczema
  3. pruritus
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2
Q

Major criteria of atopic dermatitis

A

pruritus,
eczematous dermatitis: face extensors infant, flexures adult
chronic relapsing disease,
personal or family history

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3
Q

most common complication in atopic dermatitis:

  1. Bacterial:
  2. viral:
  3. fungal:
A
  1. Bacterial: superficial staph aureus
  2. viral: eczema herpeticum
  3. fungal: Malassezia sympodialis
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4
Q

(2) pathways responsible for atopic dermatitis

A
  1. epidermal dysfunction

2. altered/ innate or adaptive immune response

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5
Q

decrease in skin barrier function of atopic dermatitis due to inc/dec of:

  1. cornified envelopes
  2. ceramide
  3. proteolytic enzymes
  4. TEWL
A
  1. Dec cornified envelopes
  2. Dec ceramide
  3. Inc proteolytic enzymes
  4. Inc TEWL
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6
Q

Mutations seen in atopic dermatitis

  1. loss of function mutations
  2. gain of function mutations
A
  1. loss of function: filaggrin

2. gain of function:IL4, IL13

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7
Q

the only FDA approved systemic drug for atopic dermatitis that targets IL4 and IL13

A

Dupilumab

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8
Q

Syndromes with atopic dermatitis are ___ with ___ mutations

A
  1. Netherton (SPINK5)

2. NISCH (Claudin 1)

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9
Q

key cytokines in atopic dermatitis (2)

A

TSLP, IL33

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10
Q

chemokines in atopic dermatitis

A

fractalkine, IFNy-10, monokine CC chemokines, eotaxin, RANTES

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11
Q

most potent cytokines downregulating filaggrin in atopic dermatitis (3)

A

TSLP, IL4 and IL13

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12
Q

IL___ that causes pruritus in atopic dermatitis

A

IL31

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13
Q

Histopathologic difference between acute versus chronic atopic dermatitis

A

Acute: spongiosis, inc memory T cells, DEgranulating mast cells

Chronic: elongated rete ridges, inc IgE, macrophages in dermis, granulated mast cell, eosinophils

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14
Q

cornerstone treatment of mild atopic dermatitis

A

emollients

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15
Q

FDA drug for younger children with atopic dermatitis (3)

A

Desonide, fluocinolone, fluticasone

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16
Q

Case: well-demarcated coin-shaped plaques form from coalescing papules and papulovesicles. Often studded or satellite papulovesicles appear at periphery with crust at the entire surface with normal surrounding skin.

  1. Disease?
  2. Commonly assoc with? (5)
  3. Commonly assoc infection?
  4. Due to what drugs? (7)
  5. Mainstay treatment?
A
  1. NUMMULAR ECZEMA
  2. atopic dermatitis, xerosis, ICD, ACD, candida
  3. Staph infection: odontogenic/ dental
  4. Isotretinoin, IFN a-2b, infliximab, gold, ribavirin, amalgam, mercury
  5. topical corticosteroids
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17
Q

Case: lichenified dry and scaly plaques with excoriations on the scalp, name, angles, extensors. May have hyperlinear palms

  1. Disease?
  2. associated with what disease?
  3. histopath?
A
  1. LICHEN SIMPLEX CHRONICUS
  2. Atopic dermatitis (dennie morgan fold, hyperlinear palms)
  3. thickened papillary dermal collagen with vertical streaks
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18
Q

Case: Hyperkeratotic firm hard nodules with overlying excoriation. May see sparing of the upper back or butterfly sign.

  1. Disease
  2. Pathogenesis
  3. hallmark of disease
  4. what is this disease called if it is associated with atopic dermatitis?
  5. histopath and stain?
A
  1. PRURIGO NODULARIS
  2. Increase CGRP (calcitonin), substance P, nerve growth factor, TNFa, IL1, IL8, TRPV
  3. itch
  4. besnier prurigo
  5. thick epidermal collagen with neural hypertrophy. S100.
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19
Q

Case: pruritic eczematous dermatitis initially localized to the primary site of allergen exposure

  1. Disease?
  2. key components of the history as clues to allergy?
  3. key symptom for this disease?
  4. diagnostic test of choice
  5. mainstay tx
  6. first line tx.
A
  1. ALLERGIC CONTACT DERMATITIS
  2. itch and swelling
  3. pruritus
  4. patch testing
  5. avoidance
  6. topical corticosteroids
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20
Q

ACD is what type of hypersensitivity reaction?

A

Type IV (delayed)

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21
Q

What are the primary cells responsible for contact sensitization?

A

CD1a+/ CD141+ dermal dendritic cells

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22
Q

What are the cluster of immune cells in the elicitation phase

A

inducible skin associated lymphoid tissue

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23
Q

Define the types of allergic contact dermatitis:

  1. acute
  2. subacute
  3. chronic
A
  1. acute: erythema, edema, vesicles
  2. subacute: oozing, scaly juicy papules with weeping and crusting
  3. chronic: scaling, fissuring, lichenified erythematous plaques
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24
Q

hair allergens

  1. permanent hair dyes (but spares the scalp)
  2. permed/waved hair
  3. bleach
  4. relax
A
  1. permanent hair dyes (but spares the scalp): PPD
  2. permed/waved hair: GMT
  3. bleach: ammonium persulfate
  4. relax: sodium hydroxide
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25
this allergen has a risk of active sensitization during patch testing
PPD
26
allergen causing eyelid dermatitis and is the most common allergen causing persistent patch test reaction of more than 30 days
gold
27
most prevalent contact allergens (3)
nickel, thimerosal, fragrance mix
28
systemic exposure to allergen in a sensitized patient with a subsequent development of cutaneous delayed hypersensitivity reaction
systemic contact dermatitis
29
the simplest presentation of systemic contact dermatitis that occurs at a site of PRIOR topical sensitization
localized recall reaction
30
ERYTHEMA of the buttocks and upper inner thighs due to application of mercury/ nickel/ ampicillin
Erythrodermic systemic contact dermatitis/ baboon
31
specific cutaneous ADR in which previous cutaneous sensitization is NOT a necessary condition
SDRIFE/ symmetric drug-related intertriginous and flexural exanthema
32
all cutaneous reactions that share the commonality of SENSITIZATION occurring through cutaneous exposure
ACD syndrome
33
scattered generalized distribution has how many body sites involved?
3
34
causes dyshidrosiform hand eczema
nickel and balsam
35
mc antibiotics in ACD
neomycin and bacitracin
36
single most important clue in the diagnosis of ACD
dermatitis distribution
37
criteria of SDRIFE/ symmetric drug-related intertriginous and flexural exanthema (5)
1. exposure to systemic drug 2. sharply demarcated eryhtema (gluteal or V shaped inguinal) 3. invt of intertriginous/ flexural 4. symmetrical 5. no systemic signs and symptoms
38
stages of ACD syndrome (1,2,3a,3b)
1. Localized 2. regional 3a. generalized or distant 3b. systemic
39
3 markers for topical steroid allergy (TBH)
tixocortol budesonide hydrocortisone
40
safest topical steroid from an allergic standpoint
Desoximethasone ointment
41
Case: redness, fissuring, oozing, pain with epidermal hardening after exposure to rubber. 1. disease? 2. primary finding? 3. important sign? 4. skin resolves as ___ after continued exposure 5. best treatment
1. IRRITANT CONTACT DERMATITIS 2. epidermal disruption 3. flexural accentuation 4. hardening 5. avoidance
42
atopic dermatitis patients had greater reactivity to this specific irritant
sodium lauryl sulfate
43
dermal injury producing scarring can result from corrosive chemicals except if it is within ___ hours
4 hours
44
atopic dermatitis is associated with inflammatory responses to these 3 common organisms
('SAM') staph aureus Malassezia sympodialis alternaria
45
What are the common irritants for ICD?
``` (SAD2) solvents (including water) anti-wrinkle medicaments detergents disinfectants ```
46
``` Compare ICD vs acd in terms of 1. margination and site 2. evolution 3. causative agents 4 incidence ```
ICD 1. sharp(acute)/ ill-defined (chronic); strictly confined to the site of exposure 2. rapid (hours) 3. dependent on CONCENTRATION of agent and state of skin barrier; occurs only above threshold level 4. everyone
47
Case: erythematous greasy scaling patches and plaques on the scalp and face. 1. disease? 2. normal flora important in this disease (3) 3. this disease is an indicator for evaluating the progression of what disease? 4. drugs that may cause this disease?
1. SEBORRHEIC DERMATITIS 2. Malassezia, pityriasis versicolor, pityrosporum folliculitis 3. HIV-associated seborrheic dermatitis 4. griseofulvin, cimetidine, lithium, methyldoma, arsenic, gold, etc
48
Case: Seborrheic dermatitis with diffuse papular eruption with peripheral erythema on trunk.
PITYROSPORUM FOLLICULITIS
49
Case: infantile Seborrheic dermatitis with desquamative erythroderma, sparse hair; frequent loose stools, failure to thrive. 1. disease? 2. associated with what disease?
1. LEINIER DISEASE | 2. Netherton disease
50
Case: large plates of thick silvering scale firmly adherent to both scalp and hair tufts. 1. disease? 2. common feature with staph infection? 3. most frequently associated with what disease? 4. causative drug?
1. PITYRIASIS AMIANTACEA 2. Alopecia 3. psoriasis 4. vemurafenib
51
Differentiate classic versus HIV-ASSOC seborrheic dermatitis histopathologically
E: widespread parakeratosis many necrotic keratinocytes focal interface obliteration with cluster of lymphocytes spares spongiosis D: many thick walled vessels, increase in plasma cells , focal leukocytoclasis
52
second most common occupational disease
OCCUPATIONAL SKIN DISEASE
53
allergens for healthcare workers (4)
glutaraldehyde, formaldehyde, quaternium-15, thiuram mix
54
hairdresser whose hands are excessively wet with thinner skin at dorsum of hands
IRRITANT REACTION DERMATITIS
55
1. weak irritants with multiple subthreshold insults versus | 2. harsh cleansers after acute skin trauma
1. CUMULATIVE DERMATITIS | 2. TRAUMATIV DERMATITIS
56
elderly with extensive usage of soaps forming ichthyosiform itchy scaling
ASTEATOTIC DERMATITIS
57
postadolescent without teenage acne presenting with pustules. 1. disease 2. due to what?
1. PUSTULAR/ ACNEIFORM DERMATITIS | 2. Croton / mineral oil
58
multiple closed comedones and straw-colored cysts at malar crescents and retroauricular folds. 1. disease 2. due to what
1. CHLORACNE | 2. TCDD
59
painful vascular spasms on the fingers and hands due to use of vibration-producing tools. 1. disease 2. what type of raynaud? 3. number of Hertz 4. risk factor involved
1. VIBRATION INDUCED WHITE FINGER 2. 2nd type 3. 30-300 Hz 4. smoking
60
prolonged exposure of heat (laptop)
ERYTHEMA AB IGNE
61
most common contact urticaria that is not inhibited by H1. it is localized and less severe
NONimmunologic contact urticaria
62
Type of bleaching hair booster that causes erythema edema, pruritus, URTICARIA, syncope, wheezing, dyspnea
ammonium persulfate
63
What are the 4 components of health risk assessment?
1. hazard identification 2. dose-response relationship 3. exposure assessment 4. risk characterization ("Hi DER")
64
A component of health risk assessment that helps delineate relative threshold concentrations of an exposure that results in adverse health effects that are dose- dependent with esposure
dose-response relationship

Mar Der (21 decks)

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