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BRS DERMATOLOGY > Skin Disorders > Flashcards

Skin Disorders Flashcards

1
Q

What is psoriasis?

A

chronic, immune-mediated disorder

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2
Q

What causes psoriasis?

A

polygenic predisposition + environmental triggers e.g., trauma, infections, or medications

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3
Q

What characterises psoriasis?

A

Sharply demarcated, scaly, erythematous plaques characterise the most common form of psoriasis

Common sites of involvement are scalp, elbows and knees, followed by nails, hands, feet and trunk (including intergluteal fold)

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4
Q

What is the most common systemic manifestation of psoriasis?

A

psoriatic arthritis

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5
Q

What is the pathophysiology of psoriasis?

A

● Stressed keratinocytes release DNA / RNA
→ form complex with antimicrobial peptides
→ induce cytokines (TNF-α, IL-1 and IFN-α) production
→ activate dermal dendritic cells (dDCs)

● dDCs migrate to lymph nodes → promote Th1, Th17, Th22 cells
→ chemokine release – migration of inflammatory cells into dermis
→ cytokine release
→ keratinocyte proliferation
→ psoriatic plaque

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6
Q

What can psoriasis look like in more pigmented people?

A

more brown

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7
Q

What are the methods of management of psoriasis?

A

Lifestyle
therapeutic ladder
phototherapy
medicine
systemic immunosuppression
advanced therapies

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8
Q

What do we mean by lifestyle for management of psoriasis?

A

Alcohol and smoking

co-morbidities

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9
Q

What is meant by therapeutic ladder for management of psoriasis?

A

● Topical therapies
➢ Vitamin D analogues
➢ Topical corticosteroids
➢ Retinoids
➢ Topical tacrolimus / pimecrolimus

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10
Q

What is phototherapy?

A

intentional daily exposure to direct sunlight or similar-intensity artificial light in order to treat medical disorders.

Narrowband UVB
PUVA (psoralen + UVA)

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11
Q

What is narrowband UVB?

A

A specific wavelength of UVB (311 to 312 nanometers) is thought to be the most useful range for treating skin conditions.

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12
Q

What is PUVA?

A

PUVA is an ultraviolet light therapy treatment for skin diseases

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13
Q

What medication can be used to treat psoriasis?

A

Acitretin (retinoid)

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14
Q

What are retinoids?

A

chemicals derived from vitamin A

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15
Q

What systemic immunosuppression can be used to manage psoriasis?

A

Methotrexate
Ciclosporin

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16
Q

What advanced therapies can be used to manage psoriasis?

A

PDE4 inhibitors (Apremilast)
Biologics (anti-TNF-α, anti-IL-17, anti-IL-23)
JAK inhibitors

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17
Q

What else do JAK inhibitors treat?

A

arthritis

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18
Q

What is atopic eczema?

A

Intensely pruritic chronic inflammatory condition

Complex genetic disease with environmental influences

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19
Q

When does atopic eczema typically begin?

A

Typically begins during infancy or early childhood

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20
Q

What is atopic eczema often associated with?

A

other ‘atopic’ disorders e.g., asthma, rhinoconjunctivitis

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21
Q

What are characteristics of atopic eczema?

A

Acute inflammation of cheeks, scalp, and extensors in infants

Flexural inflammation and lichenification in children and adults

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22
Q

What is lichenification?

A

thickening of the skin

23
Q

What is the management of atopic eczema usually like?

A

Daily emollients and anti-inflammatory therapy are cornerstone of management

24
Q

What is another word for eczema?

A

dermatitis

25
Q

What is eczema an umbrella term for?

A

atopic eczema, seborrheic dermatitis, venous stasis eczema, allergic contact dermatitis, irritant contact dermatitis

26
Q

What are the 2 parts of pathophysiology of eczema?

A

● Barrier defect
and
● Immune dysregulation

27
Q

what are Corneocytes?

A

Terminally differentiated keratinocytes and compose most of the stratum corneum

28
Q

Explain the barrier defect?

A

● Barrier defect

➢ Filaggrin - bind and aggregate keratin bundles &
intermediate filaments → form cellular scaffold in corneocytes
➢ Reduced extracellular lipids & impaired ceramide production
➢ Increased transepidermal water loss (TEWL)
➢ Impaired protection against microbes and
environmental allergens

29
Q

Explain the immune dysregulation?

A

● Immune dysregulation
➢ Staphylococcal superantigens stimulate Th2
lymphocyte responses and subvert T-reg
➢ T-cell infiltrate - bias towards Th2 responses
➢ Role of microbiome?
➢ Eosinophils

30
Q

How would you describe the mediation of eczema?

A

Th2 mediated diseases

31
Q

What are the clinical features of infantile phase of atopic dermatitis?

A

erythematous, oedematous, papule and plaques +/- vesiculation

32
Q

What are the clinical features of eczema?

A

lichenification, crusting, excoriation and dyspigmentation, postinflammatory dyspigmentation, fissuring, allergic contact dermatitis, impetiginisation

33
Q

What is impetiginization?

A

secondary infection of a lesion by bacteria, usually by virtue of animated scratching.

  • gold crust
  • staphylococcus aureus
34
Q

What is the gold crust in impetiginisation?

A

shows it’s a superficial infection

the crust is cellular and bacterial debri (inflammatory infiltrate)

35
Q

What is the difference between scale and crust?

A

crust is cellular and bacterial debri
scale is keratin

36
Q

Where do you see scales?

A

Psoriasis

37
Q

What is venous stasis eczema?

A

Swelling of skin due to compromise of venous blood going back to the heart
It is treated with compression
It leads to water loss

38
Q

What is eczema herpeticum?

A
  • emergency
  • HSV (herpes simple virus)
  • treat with acyclovir
  • can lead to permanent neurological disease
  • looks like monomorphic punched out erosions
39
Q

What is eczema herpeticum often mistaken for?

A

for aggravation of eczema

40
Q

What is erythroderma?

A

skin failure

41
Q

What are the managements for eczema?

A

Lifestyle
-Emollients
-Omission of soap

Clinical Nurse Specialist involvement
- Topical application technique
- Day treatment
- Habit reversal

Co-morbidities

Patch testing

Biopsy

Topical therapies

Phototherapy

Topical immunomodulators

Retinoids

Systemic immunosuppression

Advanced therapies

42
Q

When do you need a biopsy?

A

When there is persistent nipple eczema, it can manifest into breast cancer

43
Q

What happens when you itch?

A

itching causes release of cytokines leading to more itching

44
Q

What are the therapeutic ladder methods of managing eczema?

A

Topical therapies
Topical corticosteroids - correct potency for correct site
Topical tacrolimus / pimecrolimus

45
Q

What are phototherapy methods of managing eczema?

A

Narrowband UVB
PUVA (hand dermatitis)

46
Q

What is important about topical immunomodulators for eczema?

A

● Important role in management of eczema

● Potential for:
➢ Underuse (poor adherence)
➢ Overuse of topical corticosteroids (tachyphylaxis / adverse effects)

● Counselling crucial:
➢ Correct steroid for correct site (steroid ladder)
➢ Adverse effects
➢ Amount to use – Fingertip unit

47
Q

What is the order of drugs in the steroid ladder?

A

hydrocortisone is safer for delicate areas like the face, neck and genitals

Clobetasol can be used for palms and soles

48
Q

What are adverse effects of topical corticosteroids?

A

● Adverse effects of topical corticosteroids:

➢ Rare: skin atrophy, folliculitis, exacerbation of acne and rosacea, infection

➢ Very rare: perioral dermatitis (right), rebound syndrome (tachyphylaxis), allergy (to steroid itself or vehicle)

➢ Extremely rare: hormonal imbalance (suppression of hypothalamic-pituitary- adrenal axis), hirsutism

49
Q

What are the adverse effects of topical calcineurin?

A

burning sensation

50
Q

What type of dermatitis are retinoids used for?

A

hand

51
Q

What systemic immunosuppression can be used for eczema?

A

➢ Methotrexate
➢ Ciclosporin
➢ Azathioprine
➢ Mycophenolate mofetil

52
Q

What advanced therapies can be used for eczema?

A

➢ Biologics (anti-IL-4α, anti-IL13)
➢ JAK inhibitors

53
Q

Overall what are the types of atopic eczemas you need to know?

A

erythroderma
herpeticum
venous stasis
allergic contact

BRS DERMATOLOGY (8 decks)

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