Rashes

Question 1

Pathogensis of acne

Answer 1

Increased androgens at puberty
Increased androgen sensitivity of sebaceous glands
Keratin plugging of pilosebaceous units
Infection with corynebacterium acnes

Question 2

Clinical presentation of rosacea

Answer 2

More commonly females 
Recurrent facial flushing 
Visible blood vessels 
Pustules 
Tickening of skin - rhinophyma

Question 3

Triggers of rosacea

Answer 3

Sunlight
Alcohol
Spicy foods
Stress

Question 4

What are the 3 important bullous disorders?

Answer 4

Pemphigus
Bullous pemphigoid
Dermatitis herpetiformis

Question 5

What is bullous pemphigus?

Answer 5

Rare autoimmun bullous disease resulting in loss of integrity of epidermal cell adhesion

Question 6

Which subtype are 80% of pemphigus cases?

Answer 6

Pemphigus vulgaris

Question 7

What immunology results would be indicative of pemphigus vulgaris?

Answer 7

IgG auto-antibodies against desmoglein 3

Question 8

Pathogenesis of pemphigus vulgaris

Answer 8

Demsoglein (glue) contains desmosomal attachments
Immune complexes form on cell surface
Compliment activation & protease release
Disruption of desmosomes
Ending in ACANTHOLYSIS (cells float apart)

Question 9

What process is common to all variants of pemphigus?

Answer 9

Acantholysis

Question 10

Clinical presentation of pemphigus vulgaris

Answer 10

Ruptured fluid filled blisters
Involves esp. scalp, face, axillae, groin, trunk
May affect mucosa

Question 11

What is bullous pemphigoid?

Answer 11

Subepidermal blister with no evidence of acantholysis

Epidermis lifts of basement membrane

Question 12

What is the findings of bullous pemphigoid on immunofluorescence?

Answer 12

Linear IgG & complement depositied around the basement membrane

Question 13

Why is it important to always send early lesions for histology of bullous pemphigoid?

Answer 13

As older lesions show re-epithelialisation of their floor - mimicking pemphigus vulgaris

Question 14

What is dermatitis herpetiformis?

Answer 14

Rare autoimmune bullous disease associated with coeliac disease

Question 15

Clinical presentation of dermatitis herpetiformis

Answer 15

Intensely itchy symmetrical lesions
Elbows, knees and buttocks - often excoriated
Hallmark is papillary dermal microabscesses

Question 16

Findings of dermatitis herpetiformis on immunofluorescence

Answer 16

Deposits of IgA in dermal papillae

Question 17

What are the common sites involved in psoriasis?

Answer 17

Extensors
Scalp, sacrum, hands, feet, trunk
Nails

Question 18

Describe psoriasis plaques

Answer 18

Sharply demarcated, scaly, erythematous plaques

Question 19

Psoriatic nail symptoms

Answer 19

Pitting
Oncholysis
Dystrophy
Subyngal hyperkeratosis

Question 20

What is the Koebner phenomenon?

Answer 20

Appearance of new skin lesions on areas of cutaneous injury

Question 21

Topical treatment options for psoriasis

Answer 21

Vit D analogues (calcipotriol, calcitrol)
Coal tar
Steroid ointments

Question 22

Other alternative treatment options for psoriasis

Answer 22

Phototherapy
Retinoid
Immunosupression
Fumaric acid ester

Question 23

Morphology of acne vulgaris

Answer 23

Comedones
Pustules
Papules
Cysts

Question 24

Characteristics of mild acne

Answer 24

Scattered papules and pustules, comedones

Question 25

Characteristics of moderate acne

Answer 25

Numerous papules, pustules & mild atrophic scarring

Question 26

Characteristics of severe acne

Answer 26

Numerous papules, pustules, cysts, nodules and significant scarring

Question 27

Topical treatment avaliable for acne

Answer 27

``` Benzoyl peroxide (keratolytic, antibacterial) Topical vit A derivatives - adapalene (drying effect) Topical antibiotics (antibacterial & anti-inflammatory) ```

Question 28

Systemic treatments available for acne

Answer 28

Antibiotics | Isotretinoin (oral retinoid)

Question 29

What is the initial effect of isotretinoin?

Answer 29

Flare up

Question 30

Which topical antibiotic can be particularly effective in rosacea?

Answer 30

Metranidazole

Question 31

Which bullous disorder is nikolsky sign negative?

Answer 31

Bullous pemphigoid

Question 32

Which bullous disorder is more supperficial?

Answer 32

Pemphigus

Question 33

Which bullous disorder is more likely to involve mucosa?

Answer 33

Pemphigus

Question 34

Where is acne found?

Answer 34

Sebaceous gland sites (face, upper back, anterior chest)

Question 35

Which skin disorders are associated with pregnancy?

Answer 35

Polymorphic eruption with pregnancy | Pemphigoid gestationis

Question 36

Characteristics of pemphigoid gestationis

Answer 36

Pruritic blistering lesions Peri-umbilical region Rarely seen in first pregnancy Oral corticosteroids usually required

Question 37

Characteristics of polymorphic eruption of pregnancy

Answer 37

Pruritic condition associated with third trimester | Lesions in abdominal striae