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Dermatology > Pathology Part 2 > Flashcards

Pathology Part 2 Flashcards

1
Q

Psoriasis

A

A chronic autoimmune condition that causes recurrent symptoms of psoriatic skin lesions. There is a large variation in how severely patients are affected with psoriasis.

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2
Q

Psoriasis subtypes

A
  1. plaque psoriasis:
  2. flexural psoriasis
  3. guttate psoriasis
  4. pustular psoriasis
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3
Q

Plaque psoriasis features

A

The most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp.

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4
Q

Flexural psoriasis features

A

In contrast to plaque psoriasis the skin is smooth

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5
Q

Guttate psoriasis features

A

Transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body

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6
Q

Pustular psoriasis features

A

Commonly occurs on the palms and soles

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7
Q

General features of Psoriasis

A
  1. Nail signs: pitting, onycholysis
  2. Arthritis
  3. Well demarcated red scaly plaques
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8
Q

What drugs make psoriasis worse?

A
  1. Lithium
  2. Anti-malarials
  3. Beta-blockers
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9
Q

Complications of psoriasis

A

> psoriatic arthropathy
increased incidence of metabolic syndrome
increased incidence of cardiovascular disease
increased incidence of venous thromboembolism
psychological distress

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10
Q

Auspitz sign

A

Psoriasis - refers to small points of bleeding when plaques are scraped off

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11
Q

Koebner phenomenon

A

Psoriasis - Refers to the development of psoriatic lesions to areas of skin affected by trauma - typically sternum

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12
Q

Second line treatment for chronic plaque psoriasis

A

Second-line: if no improvement after 8 weeks then offer: a vitamin D analogue twice daily

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13
Q

First line treatment for chronic plaque psoriasis

A

A potent corticosteroid applied once daily plus vitamin D analogue

Applied once daily should be applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment

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14
Q

Third line treatment for chronic plaque psoriasis

A

Third-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily

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15
Q

Secondary management for plaque psoriasis (in secondary care)

A
  1. oral methotrexate is used first-line.
  2. ciclosporin
  3. systemic retinoids
  4. biological agents: e.g infliximab, etanercept and
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16
Q

Plaque psoriasis management

A

The use of potent topical corticosteroids used once daily for 4 weeks

If no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (for example, a shampoo or mousse) and/or a topical agents to remove adherent scale (for example, agents containing salicylic acid, emollients and oils) before application of the potent corticosteroid

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17
Q

Face, flexural and genital psoriasis management

A

A mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks

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18
Q

Vitamin D analogues examples

A

Calcipotriol (Dovonex), calcitriol and tacalcitol

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19
Q

Dithranol mechanism of action

A

> Vitamin D analogue - inhibits DNA synthesis
wash off after 30 mins
adverse effects include burning, staining

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20
Q

Uriticaria

A

o Cutaneous swellings or weals developing acutely over minutes
o Last between minutes and hours before resolving
o Flesh-colored or erythematous

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21
Q

Angioedema

A

o Oedema around the eyes, lips and hands

o Non-itchy

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22
Q

Treatment for Uriticaria and Angio-oedema

A
  1. Avoid salicylates and opiates (as they can degranulate mast cells)
  2. Oral antihistamines are most useful in treating idiopathic cases
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23
Q

Why are salicylates and opiates avoided in Uriticaria and Angio-oedema?

A

Avoid salicylates e.g aspirin and opiates (as they can degranulate mast cells)

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24
Q

What drugs cause urticaria?

A
  1. aspirin
  2. penicillins
  3. NSAIDs
  4. opiates
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25
Q

Pityriasis rosea

A

Describes an acute, self-limiting rash which tends to affect young adults.

Aetiology unknown but thought (HHV-7) may play a role.

26
Q

Management of Pityriasis rosea

A

Self-limiting - usually disappears after 6-12 weeks

27
Q

Features of Pityriasis rosea

A
  • Circular or oval pink macules
  • More prominent on the trunk than the limbs
  • ‘Christmas tree’ pattern on back
  • Rash may be preceded by a ‘herald patch’ usually on trunk
28
Q

Lichen planus

A

A skin disorder of unknown aetiology, most probably being immune-mediated.

29
Q

Lichen planus features

A
  1. itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
  2. rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
  3. Koebner phenomenon
  4. oral involvement in around 50% of patients:
  5. nails: thinning of nail plate, longitudinal ridging
30
Q

Lichenoid drug eruptions - causes:

A
  1. gold
  2. quinine
  3. thiazides
31
Q

Management of Lichen planus

A

> Potent topical steroids are the mainstay of treatment

> Benzydamine mouthwash or spray for oral involvement

> Extensive lichen planus may require oral steroids or immunosuppression

32
Q

Lichen sclerosus

A

It is an inflammatory condition which usually affects the genitalia and is more common in elderly females. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming

33
Q

Lichen sclerosus features

A
  1. atrophy of the epidermis with white plaques forming

2. Itch is prominent

34
Q

Management of Lichen sclerosus

A
  1. Topical steroids and emollients

2. Follow-up due to increased risk of vulval cancer

35
Q

Acne vulgaris

A

A common skin disorder which usually occurs in adolescence. It typically affects the face, neck and upper trunk and is characterised by the obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules.

36
Q

Pathophysiology of Acne vulgris

A

Characterised by the obstruction of the pilosebaceous follicle with keratin plugs which results in comedones, inflammation and pustules.

37
Q

What bacteria can be involved in the formation in acne vulgaris?

A

Anaerobic bacterium Propionibacterium acnes

38
Q

Features of Acne vulgaris

A
  1. Open comedones (blackheads) or closed comedones (whiteheads)
  2. Inflammatory papules
  3. Pustules
39
Q

Acne fulminans

A

Very severe acne associated with systemic upset (e.g. fever). Hospital admission is often required and the condition usually responds to oral steroids

40
Q

Mild Acne vulgaris features

A

Open and closed comedones with or without sparse inflammatory lesions

41
Q

Moderate Acne vulgaris features

A

Widespread non-inflammatory lesions and numerous papules and pustules

42
Q

Severe Acne vulgaris features

A

Extensive inflammatory lesions, which may include nodules, pitting, and scarring

43
Q

First line treatment for Acne vulgaris

A
  1. Single topical therapy (topical retinoids, benzoyl peroxide)
  2. Topical combination therapy (topical antibiotic, benzoyl peroxide, topical retinoid)
44
Q

Second line treatment for Acne vulgaris

A

Tetracyclines: lymecycline, oxytetracycline, doxycycline

Erythromycin in pregnant, breastfeeding women and in children younger than 12 years of age

45
Q

Third line treatment for Acne vulgaris

A

Oral isotretinoin: only under specialist supervision

Pregnancy is a contraindication to topical and oral retinoid treatment

46
Q

Management of Acne vulgaris in pregnant or breastfeeding women

A

Erythromycin in pregnant, breastfeeding women and in children younger than 12 years of age

47
Q

Examples of Keratolytics

A

Benzyol peroxide

48
Q

Examples of Topical retinoids

A

Tretinoin or isotretinoin

49
Q

Example of oral retinoids

A

Oral Isotretinoin

50
Q

Isotretinoin

A

An oral retinoid used in the treatment of severe acne

51
Q

Retinoid features

A 
>   teratogenicity
>   dry skin, eyes and lips/mouth
>   low mood
>   raised triglycerides
>   hair thinning
>   nose bleeds
>   intracranial hypertension
>   photosensitivity
52
Q

Why should isotretinoin treatment not be combined with tetracyclines?

A

Intracranial hypertension

53
Q

Acne rosacea

A

Common inflammatory rash predominantly affecting the face of unknown cause.

Onset usually in middle age and commoner in women

54
Q

Features of Rosacea

A
  1. Affects nose, cheeks and forehead
  2. flushing
  3. telangiectasia
  4. papules and pustules
  5. rhinophyma
  6. ocular involvement: blepharitis
  7. sunlight may exacerbate symptoms
55
Q

What ocular condition can arise from rosacea?

A

Blepharitis

56
Q

First line treatment for mild symptoms of rosacea

A

Topical metronidazole - i.e. limited pustules and papules

57
Q

Management of rosacea with predominant flushing but limited telangiectasia

A

Topical brimonidine gel

58
Q

Management of severe rosacea

A

Systemic antibiotics e.g. Oxytetracycline

59
Q

Management of rosacea with prominent telangiectasia

A

Laser therapy

60
Q

Management of rosacea with rhinophyma

A

Should be referred to dermatology

Dermatology (4 decks)

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