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FCP - Dermatology Week > Immune-mediate Skin Disease > Flashcards

Immune-mediate Skin Disease Flashcards

1
Q

CIMD

A

Cutaneous Immune-Mediated Disease
Diverse set of RARE conditions

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2
Q

Factors affects presentation of CIMDs

A

Target tissue
Predominant hypersensitivity type

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3
Q

Target tissue for CIMDs

A

Desmosomal proteins in the upper epidermis
Cells of the basal epidermis
Sebaceous glands
Dermal skin vessels
Subcuticular fat

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4
Q

Hypersensitivity types involved in CIMDs

A

Type 2 - Antibody Cytotoxicity
Type 3 - Immune complexes
Type 4 - T-Cell mediated

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5
Q

Pemphigus Foliaceous target tissue

A

Desmosomal proteins in upper epidermis

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6
Q

Pemphigus Foliaceous mechanism

A

Type II - Antibody cytotoxicity

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7
Q

Pemphigus Foliaceous presentation

A

Pustules rapidly developing into crusts
Leaves erosions
Doesn’t form around a single follicle

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8
Q

Pemphigus Foliaceous differential diagnosis

A

Superficial pyoderma
* Directly associated with one follicular unit

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9
Q

Desmosome

A
  • Specialized and highly ordered membrane domains
  • Mediate cell-cell contact and strong adhesion
  • Provide anchorage sites for intermediate filaments
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10
Q

Facial cutaneous lupus erythematosus target tissue

A

Epithelial cells

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11
Q

Facial cutaneous lupus erythematosus mechanism

A

Type IV - T-Cell mediated

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12
Q

Facial cutaneous lupus erythematosus presentation

A

Damaged epithelium ulceration
Depigmentation

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13
Q

Facial cutaneous lupus erythematosus differential diagnosis

A

Mucocutaneous pyoderma
Epitheliotropic lymphoma

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14
Q

Vitiligo target tissue

A

Melanocytes

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15
Q

Vitiligo mechanism

A

Type II - Antibody cytotoxicity

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16
Q

Vitiligo presentation

A

Minimal inflammation
Hypopigmentation of epithelium

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17
Q

Vitiligo differential diagnoses

A

Any inflammatory disease that causes depigmentation

18
Q

Examples of dermal tissue targets

A

Isthmus of hair follicle
Hair bulb
Sebaceous glands
Dermal blood vessels
Anchoring fibrins (collagen VII)

19
Q

Conditions targeting isthmus of hair follicle

A

Pseudopelade
Scarring alopecia

20
Q

Conditions targeting hair bulb

A

Alopecia areata

21
Q

Conditions targeting sebaceous glands

A

Sebaceous adenitis

22
Q

Conditions targeting dermal blood vessels

A

Vasculitis
Atrophic skin disease
Ischaemic skin disease

23
Q

Sebaceous adenitis target tissue

A

sebaceous glands

24
Q

Sebaceous adenitis mechanism

A

Type IV - T-cell mediated

25
Q

Sebaceous adenitis presentation

A

Broken hair
Alopecia
scale

26
Q

Sebaceous adenitis differential diagnosis

A

Superficial pyoderma
Dermatophytosis
Many scaling diseases

27
Q

Sebaceous adenitis pathogenesis

A

Gland is destroyed
* No greasy material produced to allow hair to leave follicle without friction
* Results in keratin brought out of follicle
* Broken hairs
* Secondary infections

28
Q

Vasculitis target tissue

A

Dermal blood vessels

29
Q

Vasculitis mechanism

A

Type II - antibody cytotoxicity
+/- Type III - Immune complexes

30
Q

Vasculitis presentation

A

Alopecia
Necrosis
Not pruritic

31
Q

Vasculitis differential diagnosis

A

Any cause of alopecia
Tumours
Trauma

32
Q

Pathogenesis of vasculitis

A

Reduced blood supply to skin
Reduced growth of hair
alopecia in atrophic skin

33
Q

Panniculitis target tissue

A

Subcutaneous fat

34
Q

Panniculitis mechanism

A

Unclear
Pyogranulomatous inflammation

35
Q

Panniculitis presentation

A

Soft-fluctuation nodules hat may rupture

36
Q

Panniculitis differential diagnosis

A

Tumours
Deep infections

37
Q

Considerations of CIMDs

A

○ Cutaneous marker of a systemic disease
○ Accompanied by other apparently unrelated IMDs

38
Q

Where else can vasculitis affect?

A

Kidneys - glomerulonephropathy
Joints - Immune-mediated arthropathy
Eyes - retinal haemorrhage

39
Q

How to diagnose CIMDs

A

○ Exclusion of common differential diagnoses
○ Confirmation of correct histological pattern on histopathology
○ Occasionally need to rely on exclusion alone

40
Q

Why is accurate diagnosis of CIMDs essential?

A

Most need treatment with drugs that cause varying degrees of immuno-modulatory drugs
○ Adverse effects are common
○ Incorrect treatment for CIMDs may worsen or fail to resolve many infectious diseases

41
Q

Exclusion diagnosis

A

○ Careful history taking
First lesions
Speed of onset
Comorbidity
○ Rule out the common differential diagnoses
Skin scrapes & hair plucks
Dermatophyte culture
Cytology ± culture
Test treatment (e.g. some parasites)

FCP - Dermatology Week (25 decks)

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