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Psoriasis & Acne Flashcards

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1
Q

What is the most common type of psoriasis?

A

Psoriasis vulgaris

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2
Q

What sites does Psoriasis commonly cover?

A 
Extensors (knee, elbows)
Scalp 
Sacrum 
Hands 
Feed 
Trunk 
Nails
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3
Q

What causes psoriasis?

A

Genetics
Environmental -> stress, drugs, infection
Trauma

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4
Q

What does psoriasis look like?

A

Sharply demarcated, scaly, erythematous plaques

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5
Q

What are all the types of psoriasis?

A

Vulgaris
Guttate (little circular lesions, raindrop like)
Nail disease
Erythrodermis / widespread pustular

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6
Q

What is Koebner Phenomenon?

A

Psoriasis builds due to trauma

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7
Q

What are the 4 signs of psoriasis in the nails?

A

Oncholysis
Nail pitting
Dystrophy
Subungal Hyperkeratosis

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8
Q

What is the main treatment and first line treatment for psoriasis?

A

Topical Emollients

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9
Q

What are the topical treatments for psoriasis?

A 
Vitamin D analoguse 
Coal tar
Steroid ointments
Dithranol 
Salicylic acid
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10
Q

What does the patient have to do before PUVA treatment?

A

Soak in bath of potassium permaganate for 15 mins

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11
Q

What are the systemic treatments for psoriasis (2nd line treatments)

A

Methotrexate

Ciclosporin

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12
Q

You get a patient with severe arthritis who is obese, smoke and drinks regularly - what advice would you give to him in terms of lifestyle advice?

A

There are link between obesity and psoriasis and also drinking and psoriasis. They could lose weight, stop drinking and as much and their psoriasis would improve

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13
Q

What is acne vulgaris?

A

Chronic inflammatory disease of the pilosebaceous unit

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14
Q

What 4 things causes acne in the pilosebaceous unit?

A

Increased production of sebum
Sebaceous duct becomes blocked
Glands or ducts rupture and cause inflammation
Bacterial growth

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15
Q

What is the correct terminology for a black head?

A

Open comedone

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16
Q

What is the correct terminology for a white head?

A

Closed comedone

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17
Q

What is a closed comedone?

A

Oxidised kertain and sebum

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18
Q

Where does acne most commonly occur?

A

Face
Upper back
Anterior chest
[related to sites with most sebaceous glands]

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19
Q

What are the different kinds of acne?

A

Comedones
Pustules
Papules
Cysts

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20
Q

Which kind of acne is most likely to scar?

A

Pustule with lots of inflammation around them

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21
Q

What are the secondary features of acne?

A

Atrophic scars
Ice pick scars
Texture changes
Hypertrophy

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22
Q

What are the different acne gradings?

A

Mild: scattered papules and pustules, comedones
Moderate: numerous papules, pustules and mild atrophic scarring
Severe: as above, cysts, nodules and significant scarring

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23
Q

What are the topical treatments for acne? (1st line)

A

Keratolytics e.g. benzoyl peroxide
Topical retinoids e.g. tretinoin
Topical antibiotics e.g. erythromycin

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24
Q

What are the systemic treatments for acne? (3rd line)

A

Antibiotics

Isotretinoin (oral retinoid) -> effects sebaceous gland activity

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25
What are the sides effect of Isotretinoin?
Initial aggravation of acne Hepatitis Dry lips
26
Where does rosacea affect the body?
Nose Chin Cheeks Forehead
27
What is the difference between acne and rosacea?
Rosacea has no comedones
28
What causes prominent facial flushing in roscea?
Sudden change in temperature Alcohol Spicy food
29
Why should topical steroids be avoided in rosacea?
Makes it worse
30
What is the management for rosacea?
``` Reduce aggravating factors: Reduce trigger factors Antibiotics e.g. metronidazole, tetracycline Isotretinoin Laser ```
31
What antibiotics are used to treat rosacea?
Topical Metronidazole | oral tetracylcine long term
32
Out of Bullous Pemphigoid and Pemphigus Vulgaris, which one is more common?
Pemphigus Vulgaris
33
Out of Bullous Pemphigoid and Pemphigus Vulgaris, which is affects the dermal-epidermal junction?
Bullous Pemphigoid
34
Out of Bullous Pemphigoid and Pemphigus Vulgaris, which is one is intra-epidermal?
Pemphigus Vulgaris
35
Who is mostly affected by bullous phemphigoid?
Elderly
36
What is Nikolsky sign?
A skin finding in which the top layers of the skin slip away from the lower layer when slighly rubbed
37
Is bullous pemphigoid Nikolsky sign -ve or +ve ?
-ve
38
Where does Pemphigus Vulgaris commonly affect?
Face Scalp Axilla Groin
39
Is Phemphigus Vulgaris Nikolsky sign -ve or +ve?
+ve
40
Out of Bullous Pemphigoid and Pemphigus Vulgaris, which one has a higher mortality rate?
Pemphigus due to infection
41
Treatment for Bullous Pemphigoid and Pemphigus Vulgaris?
Prednisolone Immunosuppressive agents e.g. ciclosporin Topicals
42
What investigations are done to diagnose Bullous Pemphigoid and Pemphigus Vulgaris?
Skin biopsy with direct immunofluoresence OR Indirect immunoflurorsence
43
What are Munro Microabcesses a cardinal sign for?
Psoriasis
44
What are Munro Microabscesses?
collection of neutrophils in the stratum corneum
45
Why is Eryithodermis so life threatening?
Excess fluid coming from the skin putting patient at high risk of infection
46
What are the histological features of psoriasis?
Parakeratosis (nuclei in stratum corneum) Thickened projections of prickle cell layer No granular layer Leukocytes and lymphocytes infiltrate dermis and epidermis
47
In acne, which part of the sebaceous duct gets blocked?
The neck
48
In rosacea you get Rhinophyma, what is this?
Thickening of the skin
49
What parasite can cause Roscea?
Follicular Demodex Mites
50
Does Pemphigus respond well the steroids?
Yes
51
What causes Pemphigus Vulgaris?
IgE autoantibodies made against desmoglein 3. Desmoglein 3 maintains desmosomal attachments => without it intraepidermal cells fall apart Immune complexes form on cell surface, causing complement activation and protease release. RESULTS IN ACANTHOLYSIS
52
What is Acantholysis?
Loss of intracellular connections, such as desmosomes, resulting in loss of cohesion between keratinocytes
53
Where does Pemphigus Vulgaris affect on the body?
``` Scalp Face Axillae Groin Trunk Sometimes mucosa e.g. mouth, resp tract ```
54
In Pemphigus, what happens when the fluid filled blisters burst?
Become shallow erosions
55
How to diagnose Pemphigus Vulgaris?
Take swab of blister that has not burst. Fluroescent labelled antibody used
56
What is the main difference between pemphigus vulgaris and bullous pemphigoid?
``` Pemphigus = Acantholysis Pemphigoid = NO Acantholysis ```
57
Which layer of the skin is affected in Bullous Pemphigoid?
Where the basal layer sticks to the basement membrane - becomes filled with fluid and some inflammatory cells
58
How to diagnose Bullous Pemphigus?
Swab of early lesion | Immunofluoresence
59
Why should you take a swab of a new lesion, not an old lesion in Bullous Pemphigoid?
Older lesions show re-epithelialisation of their floor, mimicking pemphigus vulgaris
60
What GI disease is strongly linked to Dermatitis Herpetiformis?
Coeliac disease
61
What haplotype is associated with Dermatitis Herpetiformis?
HLA-DQ2 haplotype
62
What parts of the body are affected by Dermatitis Herpetiformis?
Elbows Knee Buttocks
63
What is a key feature of Dermatitis Herpetiformis ?
It is symmetrical
64
Histologically, what is a hallmark of Dermatitis Herpetiformis?
Papillary Dermal Microabscesses
65
What immunoglobulin is found in the dermal papillae is Dermatitis Herpetiformis?
IgA
66
Treatment for Acne?
- topical retinoid - benzoyl peroxide - if neither of those work, azelaic acid - combined oral contraceptive in women - follow up in 6-8 weeks
67
What is the difference between dermatitis herpetiformis a and dermatitis herpeticum?
Dermatitis Herpetiformis is due to celiac disease whereas dermatitis herpeticum is lethal
68
What is the second line of treatment for acne?
Low dose oral antibiotic therapy for 3-4 months - minocycline - erythromycin Oral contraceptive for females
69
What are the advantages of taking an oral contraceptive for acne?
Contraception | Antiandrogen activity
70
What are the disadvantages of taking an oral contraceptive for acne?
Increased DVT risk
71
Common in children, has a honey coloured crust?
Impetigo
72
What bacteria causes Impetigo?
Staph OR Group A beta-haemolytic strep
73
Treatment for Impetigo?
Stap - Flucloxacillin | Strep - Penecillin V
74
How to prevent Impetigo?
Good hygiene, washing hands etc.
75
What bacteria causes Scaled Skin Syndrome?
Toxin B which is produced by staph
76
If Scalded Skin Syndrome occurs in an adult, what diseases are associated?
Renal disease | Immunosuppression
77
How do you differentiate TED to SSSS?
i) Mucosal involvement only in TED | ii) SSSS is more superficial
78
If the lesions of Mollsum Contagiosum are >1cm, what is the disease now referred to as?
Giant Mollsum
79
What type of individual gets Giant Mollscum?
Immunosuppressed, esp HIV infected people
80
Treatment for Mollscum Contagiosum?
Should go away on its own
81
What is Mollsum Contagiosum transmitted?
Through direct contact | Commonly sexually transmitted
82
What is Cellulitis?
Acute infection of skin and soft tissues. Common on the legs
83
What pathogens causes Cellulitis?
Beta-haemolytic strep Staph Community acquired MRSA
84
Treatment for Cellulitis?
Benzypenecillin (or penecillin V) and flucoxacillin | If pen allergic then erythromycin
85
What is dermatitis herpeticum a complication of?
Atopic Eczema
86
Characteristics of dermatitis herpeticum?
Fever | clusters of itchy blisters or punched-out erosions
87
What pathogen causes dermatitis herpeticum?
HPV type 1 of 2

Dermatology (10 decks)

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