Inflammatory skin diseases Flashcards Preview

1.1 Dermatology > Inflammatory skin diseases > Flashcards

Flashcards in Inflammatory skin diseases Deck (141):
1

What are the 4 types of inflammatory skin diseases and what do they look like histologically?

Psoriaform = elongated rete ridges
Spongiotic = intra-epidermal oedema (eczema)
Lichenoid = damaged basement membranes (lichen planus/Lupus)
Vestibulobullous = blistering

2

What are the 3 types of vestibulobullous inflammatory skin disease?

Pemphigus
Pemphigoid
Dermatitis herpetiformis

3

What is the prevelance of psoriasis?

2-3%

4

What are the 9 environmental triggers of psoriasis?

Trauma
Infection
NSAIDs
Beta-blockers
Lithium
Alcohol
Sunlight (10%)
Psychological stress

5

What is the mean age of onset of psoriasis?

28 y/o

6

What condition is particularly associated with psoriasis?

IBD (Crohn's>UC)

7

What is the genetic risk of inheritance of psoriasis?

1 parent = 25%
2 parents = 60%

8

__% of psoriasis patients have a +ve family history

35%

9

Describe the general pathology of psoriasis

Keratinocytes under stress triggers wrongly continuing late phase would healing response

10

What are the 4 main histological features of psoriasis?

Chronic inflammation altered tissue structure
Hyperkeratosis
Elongation of rete ridges
Munro-micro-abscesses (neutrophils)

11

What are the 9 types/patterns of psoraisis?

Erythroderma
Generalised pustular
Plaque (m/c)
Scalp psoriasis
Guttate
Flexural
Nail
Palmoplantar pustulosis
Napkin psoriasis

12

What are 4 discussion points for a diagnostic consultation of psoriasis?

Explain/decide management
Chronic condition
Not infectious
Social/psychological problems are common

13

What is the primary systemic effect of psoriasis?

increased cardiovascular risk

14

What 3 measurements should be monitored in psoriasis for CVD?

BP
Lipids
Glucose for DM

15

What are the 6 main co-morbidities associated with psoriasis?

Psoriatic arthritis
Metabolic syndrome
Crohn's disease
Cancer
Depression
Uveitis

16

What are 4 features of generalised pustular psoriasis?

Patient is systemically unwell
Sheets of small yellowish pustules
Develops on erythematous background
Spreads rapidly

17

Give 4 features of the lesions of chronic plaque psoriasis

Well-defined, disc shaped lesions
Red
Covered in waxy/white scale
Auspitz sign (bleeds after scale is removed)

18

What are the 6 areas commonly affected by chronic plaque psoriasis?

Knees
Elbows
Scalp
Hair margin
Sacrum
Extensor surfaces

19

What are the 4 nail changes seen in psoriasis?

Pitting
Onchyolysis
Dystrophy
Subungal hyperkeratosis

20

What are the 2 differentials for chronic plaque psoriasis?

Psoriatic drug reaction
Hypertrophic lichen planus

21

What are the 4 main features of Guttate psoriasis?

Acute, symmetrical rain drop lesions
Itchy and uncomfortable
Salmon-pink papules
Can have a scaly surface

22

What is the primary location of Guttate psoriasis?

Trunk/limbs

23

What normally preceeds Guttate psoriasis?

Strep throat infection
Viral infection

24

What are the 2 consequences of Guttate psoriasis?

Heals completely
Goes on to chronic plaque psoriasis

25

What is the differential diagnosis for Guttate psoriasis?

Pityriasis roasea

26

What is the age range commonly affected by Guttate psoriasis?

Teens and young adults

27

What are the 3 main locations for flexural psoriasis?

Armpits
Sub-mammary
Natal cleft

28

What is the common age range for flexural psoriasis?

Elderly

29

What do the plaques look like in flexural psoriasis?

Smooth/glazed

30

What is a differential diagnosis for flexural psoriasis?

Flexural candiasis

31

What is psoriatic nail changes associated with?

Psoriatic arthropathy

32

What is the differential diagnosis for psoriatic nail changes, and how can they be distinguished?

Fungal nail infection
Send clippings for mycology

33

Describe palmoplantar pustular psoriasis

Yellow/brown sterile pustules on palms or soles

34

What is napkin psoriasis?

Well-defined eruption in nappy area of infants

35

__% of patients with psoriatic skin changes are affected by psoriatic arthropathy

40%

36

What are the 3 pieces of general advice given to those with psoraisis in terms of management?

Stop smoking
Avoid excess alcohol
Maintain an optimum weight

37

What are the 6 possible topical theraputics that can be used in psoriasis?

Emollients
Coal tar
Vitamin D analogues
Dithranol
Salicylic acid
Topical steroids

38

What are the 3 therapies used for refractory psoraisis?

Phototherapy (UVB then PUVA)
Immunosuppression (methotrexate)
Immune modulation (targeted biologics)

39

What is the main immunosuppressant used in psoriasis?

Methotrexate

40

What is an example of a vitamin D analogue?

Calcipotriol

41

What are the 2 disadvantages of dithranol?

Can be an irritant
Stains normal skin

42

What must you be careful about with topical steroids and psoriasis?

Rebound psoriasis

43

What are the 4 treatments used for scalp psoriasis?

Greasy ointment (to soften scale)
Tar shampoo
Steroids in alcohol base or shampoo
Vitamin D analogues

44

What are the 2 main options for management of flexural psoriasis?

Mild/moderate topical steroids
Calcineurin inhibitors

45

What are the 2 effects of coal-tar in psoriasis?

Anti-inflammatory
Anti-scaling

46

What are the 2 advantages of vitamin D analogues?

No smell and does not stain clothing

47

What is the max dosage of vitamin D?

100g/week

48

What is the consequence of excess vitamin D analogue usage?

Systemic absorbtion causing hypercalcaemia

49

NICE stages of management of chronic plaque psoriasis

1 = potent corticosteroid (1/d) and vitamin D analogue (1/d) for 4 weeks

2 = vitamin D analogue twice daily if no improvement after 8 weeks

3 = Either potent corticosteroids twice daily (up to 4 months)
Or coal tar preparation 1-2/day
If no improvement after 8-12 weeks

+ regular emollients
+Short-acting dithranol if needed

50

What is the initial stage of chronic plaque psoriasis management?

Potent corticosteroid once/day and vitamin D analogue once/day for 4 weeks

51

What is the 2nd stage of chronic plaque psoriasis management if there is no improvement after 8 weeks of stage 1?

Increase vitamin D analogue to 2/day

52

What is the 3rd stage of chronic plaque psoriasis management if there is no improvement after 8-12 weeks?

Either give potent corticosteroid 2/day (for up to 4 months)
OR
Coal tar preparation 1-2/day

53

What should always be given to patients with psoriasis, regardless of their stage in treatment?

Regular emollients

54

What are the 2 histological hallmarks of dermatitis?

Spongiosis
Inflammatory cell infiltrate

55

What is the characteristic symptom of dermatitis?

Intense itch

56

What are the 4 main features of dermatitis?

Itchy
Ill-defined
Erythematous
Scaly

57

What are the 4 features of acute phase eczema?

Papulovesicular
Erythematous
Oedema/spongiosis
Ooze/scaling/crusting

58

What are the features of chronic eczema due to?

Chronic itching

59

What are the 3 main features of chronic phase eczema?

Thickening (lichenification)
Elevated plaques
Increased scaling

60

What type of hypersensitivity is contact allergy?

Delayed type 4 hypersensitivity

61

What is the cause of contact irritant dermatitis?

Chemical trauma (from soap or water)

62

What is the cause of atopic dermatitis?

Genetic and environmental factors resulting in inflammation

63

What type of hypersensitivity reaction is drug-induced dermatitis?

Either a type1 or type 4

64

What is present in a biopsy of drug-induced dermatitis?

Eosinophils

65

What is the cause of lichen simplex?

Physical trauma to the skin due to scratching

66

What is the cause of stasis dermatitis?

Physical trauma to the skin via hydrostatic pressure and extravasation of RBCs

67

Atopic dermatitis is due to impaired ____ ___ ___

Skin barrier function

68

What mutation can be found in some eczema patients, and what is it associated with?

Filaggrin gene mutation
= severe/earlier onset of disease

69

What is the normal function of filaggrin?

Breakdown on the keratin layer, with the products helping to bind water to the keratin layer (=> moisturising)

70

What is the effect of a mutated filaggrin gene in eczema?

Decreased AMP => dryness and increased microbe penetration to skin

71

What are the 2 main consequences of the defective skin barrier in eczema?

Allows access/sensitisation to allergens
Promotes colonisation by micro-organisms

72

What are the 5 main components of the immune system involved in the development of atopic eczema?

Th2 cells
Dendritic cells
Keratinocytes
Macrophages
Mast cells

73

Which 2 interleukins are associated with eczema?

IL-4 and IL-13

74

Describe the non-lesional skin in eczema?

Not normal

75

What is the classical distribution of eczema?

Flexural surfaces

76

What is the distribution of eczema in infants?

Cheeks and extensor surfaces

77

What is the general condition of the skin in eczema?

Dry

78

What is the diagnostic criteria for eczema?

Itching + 3 or more of:
Visible flexural rash (cheeks and extensors in infants)
History of flexural rash
Personal history of atopy (1st-degree relative if <4y/o)
Generally dry skin
Onset before 2 y/o

79

What are the 6 possible treatments for eczema?

Plenty of emollients (250g/w)
Avoid irritants (incl. shower gels and soaps)
Topical steroids
Treating infections
Phototherapy (UVB)
Systemic immunosuppressants

80

What are the 2 complications of ezcema?

Staph aureus infection
Eczema herpeticum

81

What is the characteristic feature of staph aureus skin infection?

Golden crust

82

Why are atopic children much more likely to get a staph aureus infection?

They have a much higher carriage rate

83

What is the cause of eczema herpeticum?

Infection of eczematous rash with herpes simplex virus

84

What does eczema herpeticum look like?

Monomorphic, punched out lesions

85

What is the difference between discoid eczema and normal eczema?

Discoid = well defined (normal = ill defined)

86

How can you distinguish between discoid eczema and psoriasis?

Discoid eczema = flat
(psoriasis = plaque => raised)

87

What is the common complication of discoid eczema?

Staph aureus infection

88

What is photosensitive eczema also known as?

Chronic actinic dermatitis

89

What is a distinctive feature of photosensitive eczema?

Cut-off of rash at clothing lines

90

What are the 3 causes of varicose eczema?

Hydrostatic pressure
Oedema
Red cell extravsation

91

What is the medical term for cradle cap?

Seborrhoeic dermatitis

92

What are the 4 main causes of erythroderma?

Drugs
Lymphedemas
Psoriasis
Eczema

93

Why can erythroderma be so serious?

Causes electrolyte imbalance

94

Give 2 examples of lichenoid disorders with a marked vacuolar interface changes

Erythema multiform
Topical epidermal necrolysis

95

What is the prevelance of lichen planus?

0.5%

96

What are the 5 histological features of lichen planus?

Irregular saw tooth acanthosis
Hypergranulation
Orthohyperkeratosis
Band-like upper dermal infiltrate of lymphocytes
Basal damage with formation of cytoid bodies

97

Give 2 descriptions of the lesions of lichen planus

Itchy, flat topped violaceous papules
Wickham's striae

98

What are the 2 extra-dermal manifestations of lichen planus?

White reticular pattern on buccal mucosa
Nail ridges

99

What are the 4 locations of a lichen planus rash?

Volar wrist
Forearms
Shins
Ankles

100

How long does lichen planus last before burning out?

12-18 months

101

What is the treatment of lichen planus based on?

Symptoms

102

What is the management for lichen planus?

Potent topical steroids

103

What should be given to treat very extensive lichen planus?

Oral steroids

104

What is pompholyx eczema?

Sudden onset of itchy, spongiotic vesicles

105

What are immunobullous disorders?

Diseases that have blisters as their primary feature

106

What is the cause of immunobullous conditions?

Autoimmune damage to adhesion points in the epidermis/dermis

107

What is the cause of pemphigus?

Autoimmune damage to the desmosomes

108

What are the 2 types of pemphigus?

Pemphigus Vulgaris
Bullous pemphigoid

109

What would make a pemphigus disease very severe/fatal

Affecting the resp or GI tract

110

What histological feature is common to all pemphigus?

Anantholysis - lysis of intercellular adhesion points

111

How do you differentiate between pemphigus vulgaris and pemphigoid?

Nikolsky's sign

112

What is Nikolsky's sign +ve?

If by rubbing the epidermis, the top layers come off

113

What is the cause of 80% of pemphigus?

Pemphigus vulgaris

114

What is the cause of pemphigus vulgaris?

Autoimmune destruction of desmoglein 3 via IgG auto-antibodies

115

What is the end result of the pathogenesis of pemphigus vulgaris?

Acantholysis

116

What is the presentation of pemphigus vulgaris?

Flaccid, fluid-filled blisters that form shallow erosions

117

What are the 5 locations most likely to be affected by pemphigus vulgaris?

Trunk
Face
Groin
Axillae
Scalp

118

What symptom often accompanies the blisters in pemphigus vulgaris?

Pain, but not itching

119

What is left behind when pemphigus vulgaris blisters rupture?

Shallow eropsions - likely to get infected

120

What is seen on biopsy of pemphigus vulgaris?

Intra-epidermal IgG

121

What is the treatment for pemphigus vulgaris?

Steroids and immunosuppressant

122

What is the prognosis/natural progression of pemphigus vulgaris?

Chronic self-limiting to 3-6months but high mortality if left untreated

123

Where is the blister in Bullous pemphigoid?

Sub-epidermal

124

Is acanthosis seen in pemphigoid?

No

125

What histological sign is pathognomonic of pemphigus?

Tombstones

126

What group of people is normally affected by bullous pemphigoid?

Elderly patients

127

What is the cause of bullous pemphigoid?

IgG antibodies react with an antigen of the hemidesmosomes (anchor basal cells to the basement membrane) => entire epidermis detaches from basement membrane

128

What is the presentation of bullous pemphigoid?

Tense blisters that can be preceeded by itchy, erythematous plaques/papules

129

Describe the distribution of bullous pemphigoid

Localised to one area
OR over trunk and limbs

130

How are patients when they have pemphigoid?

Generally well

131

Will pemphigoid affect mucous membranes?

No

132

What is seen on biopsy of bullous penphigoid?

Linear IgG and complement deposition around the basement membrane

133

Bullous pemphigoid is Nikosky's sign ____

Negative

134

Describe the natural progression of pemphigoid

Self-limiting over months to years with lower mortality than pemphigus

135

What is the mainstay of bullous pemphigoid amangement?

Oral corticosteroids

136

What can be used to manage bullous pemphigoid in addition to oral steroids?

Topical corticosteroids
Immunosuppressants
Antibiotics

137

What do 90% of dermatitis herpetiformis patients ahve?

Coeliac disease

138

What HLA is associated with dermitis herpetiformis?

HLA-DQ2

139

What is the histological hallmark of dermatitis herpetiformis?

Papillary derma microabscesses

140

What is the cause of dermatitis herpetiformis?

IgA antibodies cross react with connective tissue proteins in the dermal papillae

141

Describe the presentation of dermatitis herpetiformis?

Intensely itchy, symmetrical lesions across the elbows, knees and buttocks