Integumentary immune disorders Flashcards Preview

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Flashcards in Integumentary immune disorders Deck (45):

Erythematous papules and plaques covered with silvery scales - chronic - remissions and exacerbation are common



Coal Tar Agents - Estar , PsoriGel

topical; for mild - moderate psoriasis; suppresses DNA synthesis, decreasing mitonic activity ; may stain clothing, skin and hair


Estar, PsoriGel - SE

1. skin irritation - burning
2. photosensitivity
3. staining effect


Anthrolin (AnthraDerm, Lasan)

for moderate psoriasis; inhibits DNA synthesis thus suppressing proliferation of the epidermal cells. may stain clothing, hair and skin.


Anthrolin - SE

1. erythema (redness) to normal skin; burn - cover medicated lesions ; wash off with mineral oil after 2 hrs
2. inflamed eyes
3. staining effect


Tazarotene (Tazaac, Avage) - vitamin A derivative

for mild-moderate psoriasis; reduces epidermal inflammation ; photosensitivity can occur ; X pregnancy - 2 forms of contraception used during treatment


Calcipotriene (Dovonexsynthetic Vitamin D)

for mild to moderate plaque psoriasis; burning, stinging and erythema may occur ; excess use may increase Ca levels


1. Coal Tar Agents
2. Anthrolin
3. Tazarotene
4. Calcipotriene

Topical agents - psoriasis


Retinoid; severe psoriasis; inhibits keratin formation and skin inflammation; pregnancy X ( pregnancy delayed up to 3 years after tx); avoid alcohol - convert med to toxic metabolite ; take with food ; derivative of vitamin A

Acitretin (Soriatane)


Folate Analog Metabolic Inhibitor; Inhibits rapid cell proliferation; block folic acid metabolism which interferes with DNA synthesis; can cause hepatotoxic and nephrotoxic problems - regular evaluation ; causes immunosuppresion - risk for lymphoma - evaluate WBCs

Methotrexate (Folate) - psoriasis, psoriatic arthritis, lupus , scleroderma


Calcineurin Inhibitor Immunosuppressant; suppresses immune response; used when other meds produced poor outcome ; causes general immune suppression; tablets or liquid (dilute); no grapefruit juice; SE: hypertension, nephrotoxicity

Cyclosporin A (Neoral, Sandiimmune)


Antimetabolite; off label use; antineoplastic ; causes myelosupression - especially neutropenia; nausea, vomiting, diarrhea, stomatitis ; wash hands and wear gloves when handling

Hydroxyurea (Hydrea)


Tumor Necrosis Factor Blocker; reduces levels of cytokines that cause joint destruction and inflammation; used to treat psoriatic arthritis - administered subcut - site irritation, headache and infection

Etanercept (Enbrel)


ingestion of Psoralen (photosensitizing drug) 2 hours before exposure UVA light; 2-3 hours per week; exposure gradually increased until tanning occurs; dark glasses during treatment and for the rest of the day following treatment; SE: cataracts, premature aging of the skin , skin cancer

PUVA - Psoralen and Ultraviolet A therapy


used when condition becomes more widespread; potency and distance constant; exposure time gradually increased; monitor for burning and tenderness; can be used in combination with topical treatment; SE: premature aging of the skin, skin cancer, actinic keratosis

Ultraviolet Light B (UVB) therapy


Abnormal, aggressive growth of epidermal cells - reach skin surface in 4-5 days vs usual 28-30 days; autoimmune reaction? - overstimulation of immune system - overproduction of skin cells & plaque formation

Psoriasis - pathophysiology


skin condition in which small, red, and scaly teardrop-shaped spots appear on the arms, legs, and middle of the body

Psoriasis - guttate


red, skin patches covered by silvery, white scales ; MOST COMMON

Psoriasis vulgaris


Pustular plaques, may be accompanied by fever & leukocytosis; MOST SEVERE FORM

Pustular psoriasis


Generalized erythema & scales - increases blood flow to skin - vasodilation can lead to dehydration from evaporation & fluid loss

Exfoliative psoriasis


Psoriasis - tx goals

Decrease inflammation & removal of scales



is a drug or other substance capable of interfering with the development of an embryo fetus that may lead to birth defects or developmental malformations.


Methotrexate - Folate
Hydroxyurea - Hydrea
Cyclosporin A - Neoral
Acitretin - Soriatane
Etanercept - Enbrel

Systemic and biological agents - psoriasis - suppress immune system slowing epidermal cellular division


PUVA - teach !!!

Observe for generalized redness with edema and tenderness - if present treatment must be interrupted until they subside ; wear dark glasses during treatment and for the remainder of the day


Steroids - Prednisone - SE

1. Infection
2. Cushing's Syndrome
3. Diabetes
4. Osteoporosis


premalignant (can progress to squamous); small papule or macule; can disappear without treatment or reappear after treatment ; common in elderly or sun-damaged skin.

Actinic Keratosis


cancer of the epidermis; invades and can metastasize - firm nodular lesion topped with crust

Squamous cell carcinoma


cells of inner dermal layer; mets are rare; MOST COMMON type of skin cancer - pearly papule with central crater and rolled waxy borders

Basal cell carcinoma


life-threatening; easy metastasis; MOST LETHAL type of skin cancer - irregularly shaped, pigmented papule or plaque



Skin cancer - ABCD

Asymmetry of shape
Border irregularity
Color variation within one lesion
Diameter greater than 6 mm (pencil eraser)


Lupus erythematosus - types

1. DLE - discoid lupus erythematosus -affects only skin
2. SLE - systemic lupus erythematosus


SLE + Scleroderma

chronic inflammatory autoimmune disorder of connective tissue


SLE - S/s

1. Butterfly rash - dry, scaly, raised - face
2. Oral and nasal lesions
3. Arthritic changes
4. Pericarditis
5. Pleural effusion
6. Renal chronic disease - lupus nephritis leading cause of death
7. Fever + fatigue


Scleroderma - S/s

1. Raynaud's phenomenon
2. Skin thick + hard
3. Smooth + shiny
4. Loss of elasticity/ movement
5. CREST syndrome '
6. GI/Renal


CREST syndrome

* Scleroderma
- Calcinosis - calcium deposits in the tissue
- Raynaud's phenomenon - spasm of blood vessels in response to cold or stress
- Esophageal dysmotility - acid reflux and decrease in mobility of esophagus
- Sclerodactyly - thickening and tightening of skin on hands and fingers
- Telangiectasia - capillary dilation that causes spider-like hemangiomas


SLE - pathophysiology

autoimmune process - antinuclear antibodies primarily affect the DNA within the cell nuclei - immune complexes form in the serum and organ tissue - inflammation + damage - invade organs directly or cause vasculitis (deprives organs of arterial blood and oxygen).


Scleroderma/ systemic sclerosis

lymphokines stimulate procollagen - insoluble collagen deposits - inflammatory response - edema - fibrotic changes of skin and eventually organs


SLE and Scleroderma - DX

1. Skin biopsy
2. + ANA - antinuclear antibody
3. Pancytopenia
4. Inflammatory markers - CRP + ESR
* No definitive dx


Target organs for lupus

1. Skin
2. Joints
3. Kidneys
4. Heart + vessels (vasculitis)
5. Lungs
6. CNS


Hydroxychloroquine (Plaquenil )

antimalarial agent; eye exams needed Q 6 mo (toxic to retina) ; Tx - SLE


SLE - Tx

2. Skin - topical steroids
3. IV steroids for flare ups + p.o. for maintenance
4. Antimalarial
5. Immunosuppresive + cytotoxic meds - methotrexate + cytoxin
6. Plasmapheresis


Lupus - helpful organizations

Arthritis foundation
as progresses - Kidney foundation


Lupus - sign of flare-up



Penicillamine (Cuprimine)

Antirheumatic Agent; decrease pain + join swelling


Minocycline (Minocin)

Anti-infective ; thought to decrease collagen thickening