inflammatory skin diseases

Question 1

what does the word eczema mean

Answer 1

the greek word for boil over

Question 2

how common is eczema

Answer 2

5% in children

Question 3

describe eczema

Answer 3

it is a reaction pattern rather than a specific disease

Question 4

what does the acute stage of eczema look like

Answer 4

red and weeping

can have serous exudate that can have small vesicles present

Question 5

what does subacute dermatitis look lik

Answer 5

red skin
less exudate
itchy
crusty

Question 6

what does the chronic stage of eczema look like

Answer 6

more scaled and leathery

Question 7

what does eczema look like histologically

Answer 7

oedema in the skin
with fluid filled white spaces
which can cause blisters in the epidermis

Question 8

what does the subacute chronic eczema look like

Answer 8

the epidermis is thickening and the undulation is pronounced
thick keratin layer

Question 9

describe atopic eczema

Answer 9

starts in childhood occasionally adults

family history

Question 10

what is atopic eczema associated with

Answer 10

asthma and hay fever

type 1 HS reaction

Question 11

define contact irritant dermatitis

Answer 11

direct injury to skin by an irritant

Question 12

define contact allergy dermatitis

Answer 12

can occur from metals, rubber etc

delayed type 4 HS reaction

Question 13

what type of HS reaction is contact allergy dermatitis

Answer 13

type IV

Question 14

describe contact allergic dermatitis

Answer 14

act as haptens which combine the epidermal protein to become immunogenic

Question 15

describe seborrheic dermatitis

Answer 15

affects sebaceous gland rich areas eg scalp

no known aetiology

Question 16

describe nummular dermatitis

Answer 16

coin shaped lesions- no known aetiology

Question 17

how much of the population have psoriasis

Answer 17

1-2% of the population

Question 18

what does psoriasis look like clinically

Answer 18

well defined 
red oval plaques on the extensor surface
fine silvery scale
audpitz signs 
pitted nails 
sero negative arthritis

Question 19

what is audpitz signs

Answer 19

Removal of scale causes small bleeding points

Question 20

what do we see microscopically in psoriasis

Answer 20

Similar elongation of the undulations in the epidermis
Loss of granular layer
Elongation is very regular
Lots of lymphocytes
Little aggregates- often within the corneal layer
Thinned epidermis
Monroe micro abscesses
Postulates- little pustules can form in the epidermis seen in pustular psoriasis

Question 21

what is the pathogenesis of psoriasis

Answer 21

autoimmune
not sure yet
think from a trigger eg trauma

Question 22

what mutation can be seen in psoriasis

Answer 22

PSORS gene- on chromosome 6p2 implicated

Question 23

comorbidity seen in psoriasis

Answer 23

arthritis
CVD
cancer

Question 24

treatments for psoriasis

Answer 24

UV light

but it is a risk for non melanoma skin cancers

Question 25

what is lupus erythematosus

Answer 25

auto immune disorder affecting the CT of the body

Question 26

what happens in systemic lupus erythematosus

Answer 26

autoantibodies directed at various tissues | may affect any part of the body but importantly kidneys

Question 27

what do we see on the skin in SLE

Answer 27

discoid LE

Question 28

in systemic LE what can we see on the skin

Answer 28

visceral disease Red scalp patches on sun exposed skin scarring Scalp involvement causes alopecia Malar rash

Question 29

what is malaria rash

Answer 29

which is a butterfly shaped rash on the cheeks and nose

Question 30

what dow e see in systemic LE microscopically

Answer 30

``` epidermis is thin basal keratinocytes missing oedema basement membrane thickens inflammation underneath- can be around the vessels plasma cell might be prominent lymphocytic ```

Question 31

describe dermatomyositis

Answer 31

peri ocular oedema and erythema | erythema in photosensitive distribution

Question 32

why might adults suffer from dermatomyositis

Answer 32

25% associated with underlying visceral cancers

Question 33

what do we see histologically in dematomyositis

Answer 33

Do not get immunoglobulins at the base of the epidermis therefore no immunofluorescence Similar to lupus

Question 34

how can we detect SLE

Answer 34

immunofluorescence | Created antibody against human antibodies with fluorescent tag:

Question 35

describe lichen planus

Answer 35

generally in adults duration 1-2 years associated with HIV

Question 36

which HS reaction is lichen planus associated with

Answer 36

type IV HS reaction

Question 37

what do we see histologically in lichen planus

Answer 37

Missing keratinocytes Inflammation pronounced Superficial

Question 38

what is a bullous disease

Answer 38

formation of fluid filled blisters

Question 39

what are pemphigus disorders

Answer 39

by a loss of cohesion between keratinocytes resulting in a INTRAepidermal blister

Question 40

what are pemphigoid blisters

Answer 40

At the bottom of the epidermis Tense and robust Can be localised or extensive disease

Question 41

describe pemphigus blisters

Answer 41

fragile blisters formed within the epidermis antibodies to the components to the intercellular junctions

Question 42

will people have oral manifestations in pemphigus diseases

Answer 42

90% yes

Question 43

how can we detect pemphigus blisters

Answer 43

immunofluorescence

Question 44

what can we see histologically in pemphigus blisters

Answer 44

Deposition of these antibodies that causes the epidermis to fall apart Tombstoning of the epidermis

Question 45

what is the pathogenesis of pemphigoid blisters

Answer 45

Antibodies forming to the basement membrane

Question 46

histologically what do we see in pemphigoid blisters

Answer 46

smooth boundary between top and bottom of blisters a lot of eosinophils inflammation varies

Question 47

describe dermatitis herpetiformis

Answer 47

Small itchy blisters Often young pts associated with coeliac disease IgA deposition in dermal papillae

Question 48

what is the histopathology of dermatitis herpetiformis

Answer 48

Neutrophil microabscesess in the dermal papillae Subepidermal bulla igA located within the bulla Neutrophil aggregation at the base

Question 49

give examples of skin lesions as a manifestation of a systemic disease

Answer 49

acanthuses nigricans- dark warty lesions in armpit dermatomyositis linked with visceral cancer dermatitis herpetiformis and coeliac disease

Question 50

what is dermatomyositis associated with

Answer 50

visceral cancer

Question 51

what is dermatitis herpetiformis associated with

Answer 51

coeliac disease

Question 52

what is erythema nodosum associated with

Answer 52

infections elsewhere eg lungs

Question 53

what is erythema nodosum

Answer 53

red tender nodules on shins

Question 54

what is pretibial myxoedema seen with

Answer 54

thyroid disease

Question 55

what are the two forms of chronic idiopathic inflammatory disease

Answer 55

ulcerative colitis | cronhs disease

Question 56

describe UC

Answer 56

Disease of the colon Inflammation begins at the rectum and moves through the large bowel Inflammation is superficial but leads to the mucous membrane being eroded

Question 57

what are some manifestations seen in UC

Answer 57

Skin- pyoderma ganrenosum Joints: Large joint arthritis Ankylosing spondylitis Liver: primary sclerosing cholangitis

Question 58

describe crowns disease

Answer 58

May arise form mouth to anus Inflammation tends to be patchy- skip lesions Can get fistulas between the Gi tract and the skin or other bits of the organs

Question 59

what is the histological landmark of crohns disease

Answer 59

non caseating granulomas

Question 60

what are oral manifestations of crohns disease

Answer 60

deep ulcers