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Flashcards in Skin Conditions Deck (135):
1

Autoimmune condition that destroys the melanocytes in the skin

Vitiligo

2

Possible future Treatment for vitiligo =
Works by _____
May potentially cause increased risk of _____

Melanotan
Short tripeptide of hormone that stimulates melanin production
Melanoma

3

MSH excess from pituitary =

Nelsons syndrome - hyperpigmentation

4

AI loss of pilosebaceous units as follicles are attacked

Alopecia areata

5

Inherited DEJ disease 2 types =

Epidermolysis bullosa simplex and dystrophic (EBS and EBD)

6

Acquired DEJ conditions due to auto-antibodies

Pemphigoid
Pemphigus
Dermatitis herpetiformis

7

inherited condition that causes breakdown of the skin barrier due to impaired cholesterol synthesis

Steroid sulfatase deficiency X-linked ichthyosis

8

Psoriatic plaque eruption caused by minor skin trauma =

Koebner's phenomenon

9

atopic eczema lesions usually contain:

Th2, dendritic cells, keratinocytes, macrophages and mast cells

10

Pemphigus/pemphigoid are examples of type __ hypersensitivity reaction

type 2

11

purpura/rash are examples of type ___ hypersensitivity reaction

3

12

urticaria is a type __ hypersensitivity reaction

1

13

erythema/rash is a type ___ hypersensitivity reaction

4

14

symmetrical skin erupion of sudden appearance - suspect ___

drug induced

15

exanthematous drug reaction is a type __ reaction that is ___ mediated
causes a ____ rash

type 4
t cell
widespread symmetrical

16

drugs that cause exanthematous drug reaction =

penicillins
sulfonamide antibiotics
erythro/streptomycin
allopurinol
anti-epileptics (carbamazepine)
NSAIDs
phenytoin
chloramphenicol

17

urticaria is usually a type __ hypersensitivity reaction mediated by ___ after rechallenge
examples of drugs that cause this =

1
IgE
beta lactam antibiotics, carbazepine

18

urticarial reaction on first exposure to the drug is caused by ___
examples of drugs that cause this =

mast cells releasing inflammatory mediators
vancomycin, NSAIDs, aspirin, opiates, muscle relaxants, quinolones

19

drugs that can cause acne as an adverse reaction

glucocorticoids, androgens, lithium, isoniazid, phenytoin

20

AGEP =
(very rare) drugs that cause this adverse reaction =

acute generalised exanthematous pustulosis
antibiotics, CCBs, antimalarials

21

drug induced bullous pemphigoid caused by

ACEI, penicillin, furosemide

22

drug induced linear IgA disease caused by

vancomycin

23

describe the appearance of fixed drug eruptions

well demarcated, round/ovoid plaques
red and painful
usually mild and a single lesion
can be eczematous, papules vesicles or urticaria

24

common locations of lesions of fixed drug eruptions

hands, genitalia, lips and occasionally oral mucosa

25

drugs that can cause fixed drug eruptions

vancomycin, doxycycline, paracetamol, NSAIDs, carbamezepine

26

DRESS stands for ___
it is a severe cutaneous adverse reaction, drugs that cause =

drug reaction with eosinophilia and systemic symptoms
sulfonamides, anticonvulsants, allopurinol, minocycline, dapsone, NSAIDs, abacavir, nevirapine, vancomycine

27

TEN and SJS are severe cutaneous adverse reactions
drugs that cause them =

Toxic epidermal necrolysis Stevens Johnson Syndrome
sulfonamide Abx, cefalosporins, carbamazepine, phenytoin, NSAIDs, nevirapine, lamotrigine, tramadol, pantoprazole

28

T/F phototoxic drug reactions can occur through windows?

True
Usually UVA or visible light

29

Phototoxic drug reactions are ___ mediated
mechanism behind them = appropriate wavelength hits ___ under surface releasing __+__

non-immunological
drug chromophore
free radicals and photoproducts

30

acute phototoxic drug reactions =

skin toxicity, systemic toxicity and photodegradation

31

chronic phototoxic drug reactions =

pigmentation, photoaging and photocarcinogenesis

32

typical manifestations of Type 1 hypersensitivity reaction

anaphylaxis
eczema
asthma
hives
hayfever
urticaria
angioedema

33

dermatological examples of type 4 hypersensitivity reactions

contact dermatitis
tubercular lesions
graft rejection

34

In type 1 HS reactions: Th2 produces _+_+_ that stimulate B cells to produce ___ which then ___

IL4, 5 and 13
IgE
becomes Fce receptor on mast cell

35

In type 1 HS urticaria appears within __ and lasts for __

1hr
2-6/24 hrs

36

Investigations for suspected type 1 HS reaction

RAST - blood test for specific IgE
skin prick and if it is negative = challenge test
serum mast cell tryptase level (during anaphylaxis)

37

doses of adrenaline in epipens for anaphylactic shock

adults = 300microg
kids = 150microg

38

Drugs that can be used day to day if have a type 1 allergy

mast cell stabilisers - sodium cromoglicate

39

In type 4 HS skin reactions: ___ T cells cause apoptosis of __ and produce ___+___ causing ____

CD8+
keratinocytes
chemokines and cytokines
leukocyte recruitment

40

Gold standard test for suspected allergic contact dermatitis

patch test

41

treatment for allergic dermatitis

minimise exposure to allergen
emollients
topical steroids
UV phototherapy
immunosuppressants

42

mode of inheritance of tuberous sclerosis

auto-dom or de novo

43

earliest cutaneous sign of tuberous sclerosis

ash-leaf macule - depigmented

44

pathognomic of tuberous sclerosis

periungal fibromata

45

s+s of tuberous sclerosis

infantile seizures
longitudinal nail ridging
periungal fibromata
facial angiofibroma
cortical tubers +//- calcification of falx cerebri may => seizures
angiomyolipomas
bone cysts
Shagreen patch
enamel pitting

46

3 types of epidermolyis bullosa

simplex
junctional
dystrophic

47

characteristic of simplex epidermolysis bullosa

epidermal
light grazes and blisters
doesn't cause scarring

48

characteristics of junctional epidermolysis bullosa

blistering and ulcers
may scar

49

characteristics of dystrophic epidermolysis bullosa

dermal and causes scarring
digits shorten causing mitten hands if not bandaged separately

50

EB aquisita is rare and caused by ___

AI against collagen 17

51

cafe au lait spots, axillary freckling, optic glioma, Lisch nodules are characteristic of

NF1

52

filaggrin loss of function mutations can cause:

leratosis pilaris
hyperlinear palms
ichthyosis vulgaris ( auto dom - fish scaling due to loss of granules in granula layer)

53

filaggrin mutations increase your risk of : (3)

eczema x4
asthma and hayfever x3
peanut allergy x5

54

ratio of melanocytes:basal cells at DEJ

1:10

55

2 components of skin basement membrane

laminin and collagen 4

56

an example of a spongiotic inflammatory skin reaction

eczema

57

elongation of the rete ridges = ___ inflammatory skin reaction

psoriasiform

58

auspitz sign in psoriasis =

pick off plaque and bleeds as vessels are close to surface

59

pemphigus vulgaris is a loss of the integrity of ___

epidermal cell adhesion

60

pemphigus vulgaris basis of AI =

IgG auto-Ig against desmoglein 3 (maintains desmosomal attachments) =>immune complexes> complement and protease > desmosomes disrupted > acanthosis

61

Characteristic of lesions caused by pemphigus vulgaris

fluid filled blisters which rupture to cause shallow erosions

62

bullous pemphigoid causes a ___ blister with no sign of ___

subepidermal
acanthosis

63

AI basis of bullous pemphigoid =

IgG attack hemidesmosomes that anchor basal cells to basement membrane

64

immunofluorescence in bullous pemphigoid shows:

linear IgG and complement around basement membrane
lots of eosinophils

65

histology of bullous pemphigoid shows:

fluid and inflam cells between basal cells and dermal papilla projectinto bulla

66

dermatitis herpetiformis is associated with ___ disease and ___ gene

coeliacs
HLA-DQ2

67

AI bullous disease that causes v itchy symmetrical lesions on elbow knees and buttocks

dermatitis herpetiformis

68

hallmark of dermatitis herpetiformis

papillary dermal microabscesses - deposits of IgA

69

Lichenoid inflammatory skin reactions are characterised by

damage to basal epidermis

70

examples of lichenoid inflammatory skin reactions

lichen planus
discoid lupus
drug rashes

71

characteristics of lichen planus =

ithcy flat topped violaceous papules
irregular sawtooth acanthosis
hypergranulosis, orthohyperkeratosis
melanocytes drop out
upper dermal infiltrate of lymphocytes
cytoid bodies

72

comedones =

build up of keratin and sebum in pilosebaceous units

73

aggravators of rosacea

sunlight
alcohol
spicy foods
stress

74

characteristics of rosacea

recurrent facial flushing
visible blood vessels
pustules
rhinophyma

75

follicular ___ are often present in rosacea

dermodex mites

76

histology of rosacea =

vascular ectasia
patchy inflam with plasma cells
perifollicular granulomas

77

sites on the body of psoriatic plaques

extensor surfaces
scalp sacrum, hands, feet, trunk, nails

78

auspitz sign is in ___ (condition)
caused by

psoriasis
dilated capillaries in elongated dermal papillae

79

4 subtypes of psoriasis

vulgaris (chronic plaque)
guttate
palmoplantar pustular
erythrodermic/widespread pustular (rare)

80

guttate psoriasis is commonly set off by

strep infection

81

nail signs of psoriasis

pitting
dystrophy
onycholysis
subungal hyperkeratosis

82

systemic factors associated with psoriasis

increased systemic inflam markers
psoriatic arthritis
metabolic syndrome
Crohn's
cancer
depression
uveitis

83

topical treatments for psoriasis

vit D analogues (calcipotriol/calcitrol)
coal tar
dithranol
steroids
emollients

84

treatments for psoriasis (non-topical)

Phototherapy (UVB narrowband and pUVA)
IS - methotrexate
biological agents

85

features of mild acne -

scattered papules and pustules - mild atrophic scarring

86

features of moderate acne -

numerous papules and pustules and mild atrophic scarring

87

features of severe acne -

cysts nodules significant scarring

88

topical treatments for acne

benzoyl peroxide
retinoids
tetracyclines

89

properties of benzoyl peroxide that make it good for acne treatment

keratolytic
antibacterial

90

systemic drugs for acne

antibiotics
isotretinoin

91

type of drug that isotretinoin is and its effect in the Rx of acne

oral retinoid
affects sebaceous gland activity - initially aggravates acne - lots of side effects

92

eye problems that can be ass with rosacea

conjunctivitis
gritty eyes

93

topical treatments for rosacea

metronidazole
ivermectin

94

mech of action of ivermectin in rosacea Rx

decreased dermodex mite population

95

in rosacea there are no ___ on the skin as isnt a disease of pilosebaceous unit

comedones

96

oral Rx for rosacea

tetracycline
isotretinoin low dose if severe

97

Rx for 1 telangiectasia and 2 rhinophyma in rosacea

1 vascular laser
2 laser shaving/sx

98

Wickham's striae appearance
An example of a ___

white reticular network on
lichenoid eruption

99

shiny flat-topped pink/purple papules and plaques = an example of a __

lichenoid eruption

100

sites that lichen planus typically affects

volar wrist and forearm
shin
ankles

101

lichen planus usually lasts ___

12-18mnths - burns itself out

102

treatment of severe itch in lichen planus

topical potent steroid, oral if extensive

103

which is deeper and which is more superficial out of bullous pemphigoid and pemphigus vulgaris

Deeper = pemphigoiD
Superficial = pemphiguS

104

bullous pemphigoid causes a split in the __ pemphigus vulgaris in the ___

BP = DEJ
PV = intra-epidermal

105

nikolsky sign =
differentiates between __+__

when rubbed lightly on top the skin slips away
+ve = pemphigus vulgaris
-ve = pemphigoid bullosa

106

large tense bullae on normal skin with erythematous base = ___ (condition)

pemphigoid bullosa

107

mucosal lesions are unlikely in pemphigoid bullosa/pemphigus vulgaris

pemphigoid bullosa
(it's very common in PV)

108

flaccid vesicles/bullae that rupture to leave raw area with increased infection risk = ___ (condition)

pemphigus vulgaris

109

PV and BP are ___ and last ___, remission on Rx in ___

self-limiting in months-yrs
3-6mnths

110

mortality rates for BP and PV

PV = high mortality if untreated
BP = lower risk

111

Ix for BP and PV

biopsy with direct immunofluorescence
indirect immunofluoroscence

112

treatments for BP and PV

systemic steroids
IS agents
topicals: emollients, steroids, antiseptics
tetracycline (BP)

113

treatment for boil with surrounding cellulitis

flucloxacillin PO 1g qds

114

pyoderma gangrenosum is ass with __+__ and usually affects the _+_+_

UC and Crohn's
legs, trunk and stoma

115

patient returns from abroad with a rash that after 1-2 days leads to painful sores =

hand, foot and mouth

116

describe lesions of dermatitis and eczema

itchy, ill-defined, scaly and erythematous

117

acute phase of dermatitis and eczema lesions=

papulovesicular, red, spongiosis, ooze/scale/crust

118

chronic phase of dermatitis and eczema lesions =

lichenification, elevated plaques, increased scaling

119

histology and pathogenesis of contact allergic dermatitis

type 4 hypersensitivity
spongiotic dermatitis

120

histology and pathogenesis of contact irritant dermatitis

spongiotic dermatitis
trauma eg. soap and water

121

histology and pathogenesis of atopic eczema

genes and envnt => inflam
spongiotic dermatitis

122

histology and pathogenesis of drug induced dermatitis

type 1+4 HS reaction
spongiotic dermatitis with eosinophils

123

histology and pathogenesis of photo-induced dermatitis

reaction to UV
spongiotic dermatitis

124

histology and pathogenesis of lichen simplex dermatitis

physical skin trauma eg. scratching
spongiotic dermatitis and external trauma

125

histology and pathogenesis of stasis dermatitis

physical skin trauma - hydrostatic pressure
spongiotic dermatitis and extravasation of RBCs

126

atopic eczema distribution in babies

often wide spread
cheeks and extensors

127

appearance of herpeticum =
caused by __ infected with ___

monomeric punched-out lesions
eczema infected by herpes simplex

128

diagnostic criteria for eczema -

itching +>= 3 of:
visible+/Hx of flexural rash
generally dry skin
Hx atopy
onset <2yo

129

treatments for eczema

emollients
topical steroids
treat infection
UVB mainly phototherapy
systemic IS

130

appearance of discoid eczema

itchy, red, swollen and cracked in circular/oval patches

131

chronic actinic dermatitis causes a photosensitive reaction in ____ = type __ HS

24-72hrs
type 4

132

drug induced photosensitive eczema causes reaction in ___ type of reaction = ___

mins-hrs
exaggerated sunburn

133

stasis eczema is 2ndry to ____
site = ___ and may lead to ___/___

hydrostatic pressure, oedema, RBC extravasation
lower legs
ulceration and hyperpigmentation

134

cradle cap in infants or dandruff =

seborrhoeic eczema

135

appearance of pompholyx eczema

spongiotic vesicles on hands/feet