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MBBS - Year 2 > Blisters, Pruritus and Rashes due to Systemic Condn > Flashcards

Blisters, Pruritus and Rashes due to Systemic Condn Flashcards

1
Q

What is erythema nodusum

A

Skin condn where red, tender nodules forms on the skins and less commonly the thighs and forearms

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2
Q

What can eryhema nodusum be classified as

A

A type of panniculitis - infl disorder affecting s/c fat

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3
Q

Epidemiology of erythema nodusum

A

Ages 20-45, peak 20-30
3-6x more common in F than M
Often associated w/ recent illness or infection

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4
Q

Causes of erythema nodosum

A

NODOSUM

No - idiopathic 
D - drugs 
O - OCP/ pregnancy
S - sarcoidosis 
U - ulcerative colitis (IBD)/ Crohns
Micro
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5
Q

Drugs causing erythema nodosum

A 
Sulphonamides 
Salicylates 
NSAIDs
Dapsone
Bromides 
Gold salts
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6
Q

Micro (pathogens) casing erythema nododum

A

TB
Strep
Toxoplasmosis

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7
Q

Px of erythema nodosum

A

Sx of underlying disease
2-50 red lumps
Fever, joint pain and feeling unwell

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8
Q

Natural hx of erythema nodosum

A

Hot and painful, bright red when first appears

Later becomes purple and fades through colour changes of a bruise

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9
Q

Dx of erythema nodosum

A 
Throat swab 
Sputum ot gastric washing 
FBC, ESR, CRP
ASO titre (strep)
CXR (TB and sarcoidosis)
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10
Q

What is cutaneous vasculitis

A

Group of disorder in which there are inflamed blood vessels in the skin

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11
Q

Skin changes in cutaneous vasculitis

A

Capilaritis
Pigmented purpura
Characterised bu petechiae resolving w/ haemosiderin deposition

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12
Q

What skin changes are typiccalya associated w/ small vessel vasculitis

A

Palpabal epurpura

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13
Q

What skin changes are medium vasculitis usually associated w/

A

Nodules

Livedo reticularis

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14
Q

Causes of cutaneous vasculitis

A 
Infection 
CTD 
Malignant 
Drugs - abx 
Idiopathic - IgA vasculitis (HSP)
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15
Q

CTD causing cutaneous vasculitis

A 
SLE and related condns 
RhA
SScl
Sjorgen 
Dermatomyositis
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16
Q

Malignancy causing cutaneous vasculitis

A

Haematological
Myleoproliferative
Lymphoma
Myeloma and MGUS

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17
Q

Dx of cutaneous vasculitis

A

Clinical picture
Skin bx
Screening for underlying

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18
Q

Pyoderma gangerosum

A

Condn causing rapid;y enlarging, very painful ulcers

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19
Q

Feature of pyoderma gangrenosum

A

Ragged
Purple
Undermined edge

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20
Q

Causes of pyoderma gangrenosum

A 
IBD 
Myeloproliferative disease 
RhA 
Drugs 
Monoclonal gammopathy 
Idiopathic
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21
Q

Dx of pyoderma gangrenosum

A 
Clinical picture 
Swabs 
Bx to excl other causes of ulcer 
Associated systemic disease 
Response bro oral steroids
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22
Q

Necrobiosis lipoidica

A

Granulomatous skin disorder which can affect skin of insulin dependent diabetics, although it can occur in non diabetic subjects as well

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23
Q

Features of necrobiosis lipoidica

A

Tender, yellowish, brown patches develop slowly on the lower legs over several months
Slow healing

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24
Q

How do the patches in necrobiosis lipoidoca change over time

A

Round, oval or an irregular shape

Centre of patch becomes shiny, pale, thinned w/ prominent blood vessels (telangiectasia)

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25
Q

What can a minor injury to an established lesion in necrobiosis lipoidica cause

A

Ulceration of the lesion

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26
Q

What can localised granuloma annulare be associated with

A

Autoimmune thyroiditis

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27
Q

What can extensive GA be associated with

A

DM, hyperlipidaemia

More rarely w/ lymphoma, HIV infection and solid tumours

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28
Q

What type of GA is most common in children

A

Localised

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29
Q

What type of GA presents in adults

A

Generalised

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30
Q

Px of generalised GA

A

Widespread skin-coloured, pinkish or slightly mauve-coloured patches
DIssemnated type is composed of small papules

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31
Q

What is erythema multiforme

A

A HS reaction usually triggered by infections, most commonly HSV
Usually a/c and self-limiting

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32
Q

Px of erythema multifrome

A

Target-like lesions

May be mucous membrane involvement

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33
Q

What can erythema multiform be divide dinto

A

Major and minor forms

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34
Q

Causes of erythema multiforme

A

Viral infection

Drugs

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35
Q

Viral infection causing erythema multiform

A 
Para poxvirus 
VZV
Adenovirus 
Hepatitis 
HIV 
CMV
Viral vaccine
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36
Q

Drugs causing erythema multiforme

A 
Barbituates 
NSAIDs
Penicillin 
Sulphonamides 
Phenothiazines
Anticonvulsnats
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37
Q

Dx of erythema multiforme

A

Clinical dx
Skin bx
Screen for underlying cause

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38
Q

Xathoma

A

Skin lesions caused by accumulation of fat in macrophages in the skin and rarely s/c layer of skin

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39
Q

What might xanthoma be indicative fo

A

Lipid metabolism holism disorders

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40
Q

Congenital conditions causing xanthomas

A

Primary billiard cirrhosis (autoimmune)
Familial hyperlipidamie
May also be idiopathic

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41
Q

Acquired causes of xanthoma

A

DM
Cholestasis
Hypothyroidism
C/c renal failure

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42
Q

How are xanthoma classified

A

According to where they re found on the body and how they develop e.g. palmar xanthoma, tendon xanthoma, xanthelasma

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43
Q

Causes of eruptive xanthoma

A

Familial triglyceridaemia

Lipoprotein lipase deficiency

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44
Q

Xanthelesma palpebrum

A

Most common type of xanthoma, arise symmetrically on upper and lower eyelids
May or may not be associated w/ hyperlipidaemia

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45
Q

Tuberuous xanthoma

A

Firm, painless, red-yellow nodules that develop around the pressure areas such as knees, elbows, heels and buttocks

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46
Q

What is tuberous xanthoma usually associated w/

A

Hypercholesterolaemia

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47
Q

Tendinous xanthoma

A

Slowly, enlarging s/c nodules related to a tendon or ligament

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48
Q

What is tendinous xanthoma associated w/

A

Severe hypercholesterolaemia and elevated LDL levels

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49
Q

What is eruptive xanthoma seen in

A

DM pts

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50
Q

What areas of the body are affected by eruption;tive xanthoma

A

Buttocks
Shoulder
Arms - extensor aspect

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51
Q

What does xanthoma disseminatum affect

A

Internal organs

Self-limiting

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52
Q

Skin changes during pregnancy

A 
Striae 
Skin tags 
Changes in hair growth 
Acne breakouts 
Spider veins and VV 
Darkening of areas of your skin 
Darkening of moles and freckles
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53
Q

When does pruritic urticariated papules and plaques of pregnancy occur

A

3rd trimester of primiparous women

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54
Q

Primiparous

A

Women who have been pregnant and given birth

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55
Q

Features of pruritic, urticraiated papules and plaques of pregnancy

A

Doesn’t recur w/ future pregnancies

Spares umbilicus

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56
Q

Treatment of pruritic, urticariated papules and plaques of pregnancy

A

Topical steroids

Antihistamines

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57
Q

Do pruritic urticated papules and plaques of pregnancy pose a risk to newborn

A

No

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58
Q

Pemphigoid gestations

A

Abrupt onset of urticarial plaques and blisters usually in 2nd trimester

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59
Q

Features of pemphigoid gestations

A

Recurs in future
Takes weeks-months to resolve postpartum
Histologically similar to bullies pemphigoid (C3, IgG)

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60
Q

Treatment of pemphigoid gestations

A

Oral steroids

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61
Q

Intrahepatic cholestatis of pregnancy (ICP) presentation

A

Pruritus (palms and soles)
Dark urine
Jaundice

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62
Q

When does Intrahepatic cholestatis of pregnancy px

A

2nd or 3rd trimester

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63
Q

Does Intrahepatic cholestatis of pregnancy resolve on delivery

A

Yes

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64
Q

Does Intrahepatic cholestatis of pregnancy carry any risks to the newborn

A

Yes - higher risk of premature or stillbirth

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65
Q

Pathology of Intrahepatic cholestatis of pregnancy

A

Bile acids from liver unable to flow properly and build up in the body

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66
Q

Treatment of ICP

A

Urseodeoxycholic acid

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67
Q

Neurophyiology of pruritus

A

Complex and not fully understood
Itch transmitted by C fibres
Spinothalamic tracts –> thalamus —> sensory cortex

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68
Q

Differntials of generalised itch w/out rash

A 
Renal pruritus 
Cholestatic pruritus 
Endocrine - thyroid, DM 
Paraneoplastic 
Haematological 
HIV
Pregnancy related 
Drug related
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69
Q

Ddx of generalised itch w/ rash

A 
Scabies 
Eczema 
Urticaria/ dermographism 
Paraneoplastic 
Bullous disease 
Psoriases - main cause
Pregnancy related 
Drug eruptions
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70
Q

Who is renal pruritus seen in

A

Seen in pst w/ c/c renal failure (mainly advanced)

Peaks 2nd nights w/out dialysis,

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71
Q

Mx of renal pruritus

A

Improves after dialysis
Subtotal parthyroidectomy
Phototherapy and antihistamines

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72
Q

Is renal pruritus dependent on raised serum urea

A

No

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73
Q

When does cholestatic pruritus occur

A

In any liver disease - usually intrahepatic cholestasis

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74
Q

Where is cholestatic worse

A

Worse on hands, feet and body and body regions constricted by clothing
Also worse at night

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75
Q

Treatment of cholestatic pruritus

A

Treat underling cause

Dugs - cholestyramine, ursodeoxycholic acid, rifampicin

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76
Q

MOA of cholestyramine

A

Binds to bile acids preventing re-absorption

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77
Q

MOA of ursodeoxycholic acid

A

Regulates cholesterol via absorption rates

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78
Q

Enodrcine causes of pruritus

A

Thyroid disease - more h-common in hyper > hypo
DM - associated w/ poor glycaemic control, can be part of diabetic neuropathy

May also be candida infection in DM pts

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79
Q

Haematological causes of pruritus

A

IDA
Haemochromatosis
PV - aquagenic
CLL

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80
Q

HIV asd a cause of pruritus

A

Can px w/ generalised itch
Secondary dermatoses are more common: candidiasis, Kaposi sarcoma, 2’ to lymphoma, eosinophilic folliculitis, drug reaction

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81
Q

Infections seen in hIV pts causing itch

A

Hepatitis A, B, C, E
Swimmer’s itch
Helminths

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82
Q

Skin involvement in cutaneous T-cell lymphoma

A

Mycosis fungicides
Dry, peeling, itchy skin
Erythroderma
Thickened skin on sole and palms

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83
Q

Rashes due to scratching

A

Excoriation
Nodular prurigo - butterfly sign
Lichen simples chronic - caused by constant rubbing and scratching

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84
Q

Butterfly sign in nodular prurigo

A

No lesions on back where pt cannot reach

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85
Q

Tyepes of cutaneous drug reaction

A 
Exanthematous 
Pustular 
Urticaria, angiodema, anaphylaxis 
Fixed drug eruption 
Drug HS syndrome 
Pigmentation 
Pseudoprohyria 
Necrosis
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86
Q

Types of blisters (sizing)

A

Bullae - >0.5cm elevated circumscribed fluid filled sac

Vesicles - <0.5cm elevated circumscribed fluid filled sac

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87
Q

Hx for drug-induced rashes

A

Sites e.g. single dermatome, where cream apples, light exposed areas
Onset & timing e.g. insect bite, had this before
Charters
Exacerbating 7 relieving factors
Any recent illness
Any new exposures
Allergies

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88
Q

How does erythema multiforme start

A

Target plaques and papules predominantly starts aurally distributed

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89
Q

Features of Erythema multiforme major

A

Major has fever & >1 mm involved (mouth, eye, genitals, GI tract/ anus, trachea/ bronchi)

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90
Q

SJS

A

Steven Johnsons Syndrome

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91
Q

TEN

A

Toxic Epidermal Necrolysis

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92
Q

SJS and TEN

A

Macules or blisters developing into sheets of skin detachment
SJS: 10-30%
TEN: >30%

Typically associated w/ prodormoal illness

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93
Q

Drugs that may cause a reaction —-> SJS/ TEN

A 
Sulphonamides 
Imidiazole 
Naproxen 
Ibuprofen 
Anticonvsulanst e.g carbamazepine, phenytoin, valproic acid
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94
Q

+ve Nikolsky sign

A

Rubbing red skin then formation of blisters

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95
Q

How is SJS/TEN graded

A

SCORTEN

7 parameters of disease severity used to predict in-hosp mortality

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96
Q

When do pustular drug orectaiosn start

A

1-3 week(s) after drug

May cause desquamation after initial reaction

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97
Q

Where do pustular drug reactions occur

A

Face

Flexures

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98
Q

Ix findings of pustular drug reactions

A

Raised neutrophils

Sterile pus

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99
Q

When do pustular drug reactions resolve

A

<15 days

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100
Q

Features of fixed drug eruption

A

Solitary erythematous plaques, bullae or erosion
Occurs 30mins - 8hrs
If exposed to same drugs –> same site in hrs
Area becomes hyper pigmented

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101
Q

When do fixed drug eruption resolve

A

In a few weeks

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102
Q

When does drug hypersensitivity syndrome occur

A

2/12 later

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103
Q

What does DRESS syndrome consist of

A

Drug rash
Eosinophilia
Systemic sx

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104
Q

DRESS px

A

Fever
Papaules, facial oedema +/- exfoliative dermatitis
Lymphadenopathy

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105
Q

Haematological findings in DRESS

A

Eosinophilia

Atypical lymphocytes

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106
Q

Organ involvement in DRESS

A

Hepatitis
Carditis
Interstitial nephritis
Interstitial pneumonitis

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107
Q

Causes of drug-induced pigmentation

A

Amiodarone - slate grey
Antimalarial (>4/12) - brown or blue-black
Oestrogen/ progesterone - hyperpigmneted patches (melasma)

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108
Q

Drug related necrosis and warfarin

A

Seen days 3-5

Prone if hereditary deficiency of protein C. S or antithrombin III

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109
Q

Px of pseudoporphyria

A

Photosensitive, bulbous rash on hands and feet

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4
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110
Q

Features of pseudoporphyria

A

Heals w/ scars and milia

Histologically different from porphyria & porphyrin studies are -ve

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111
Q

Drug reaction mimics of pemphigus vulgaris

A

Captopril
P;eniclllamine
Ampicillin

112
Q

Drug reactions mimics of bullous pemphigoid

A 
Furosemide 
Bumetanide 
Spiro 
Penicillamine 
Amoxi 
Cipro
113
Q

Drug reaction mimics of lineal IgA disease

A

Vancomycin

114
Q

Ix for drug induced rashes

A

Blood tests - akin autoimmune, raised IgE, serum + blister fluid IMF
Swab - viral, bacterial
Bx

115
Q

What are welling for when we perform a bx for blisters

A

Levl of split - sub-corneal, into-epidermal & sub-epidermal

What is depositing at that layer e.g. IgA, IgG, C3

116
Q

IMF as an ix for blistering disorders

A

Determines which layer of the basement membrane is splitting e.g. desmosome for pemphigus

117
Q

Which layer of skin are the blisters in pemphigus vulgaris found

A

Within the epidermis floor, lined by basal cells

118
Q

What types of cells are found in blister fluid for pemphigus vulgaris

A

Acantholytic

119
Q

Which layer of skin are the blisters in pemphigoid found

A

Sub epidermal

120
Q

Which layer are the blisters in dermatitis herpetiformis found

A

Sub epidermal

121
Q

Infiltrates in underlying dermis for pemphigoid vs dermatitis herpetiformis

A

Eosinophil for pemphigoid

Neutrophil fro dermatitis herpetiformis

122
Q

IMF results for diff blistering disorders

A

Intercellular IgG & C3 - pemphigus
Basement membrane IgG & C3 - pemphigoid
Dermal papillary IgA - DH

123
Q

Mx for drug-induced rashes

A

Stop drug
Antihistamine (sedating)
Steroids - top or po

124
Q

Mx for drug-induced rashes causing anaphylaxis

A

CHAOS

Chlorphenamine IM/IV
Hydrocortisone IM/ IV 
Adrenaline 
Oxygen 
Salbutamol 
IV fluids
125
Q

Exanthematous drug rectaion

A

Measles-like rash (morbilliform, maculopapular)
EBV + amoxi or ampicillin = rash
3-5 darts after stopping drug

126
Q

Examples of blistering disorders

A

Bullous pemphigoid
Pemphigus vulgarise
Dermatitis herpetiformis

127
Q

Types of blisters (level of split)

A

Sub-epidermal

Intra-epidermal

128
Q

Where is the basement membrane found

A

Interface between dermis and epidermis

129
Q

Features of blisters in pemphigoid

A

Thick walled and tense

Occur at hemidesmosome

130
Q

Features of blisters in pemphigus

A

Thin walled and flaccid

Occur at desmosome

131
Q

Epidemiology of pemphigoid

A

Acquired blistering disease
Most common autoimmune bullouse disease
Peak incidence 8th decade

132
Q

Hx of pts w/ pemphigoid

A

Itchy rash - weeks to months

Blisters

133
Q

Examination of pts w/ pemphigoid

A

Eczematous or urticariated rash
Tense blisters (vesicles and bullae)
Localised or widespread
Mucous membrane involvement 1/3 - 1/2

134
Q

Difference in distribution of lesions in PV and pemphigoid

A

Pemphigoid is more likely to a facet limbs

135
Q

Ix for pemphigoid

A 
Bx - histology, direct IMF
indirect IF (circulating bp abs in 70%)
136
Q

What kind of sample needs to be taken for pemphigoid IMF

A

Perilesional skin - band of IgG +/- C3 along bm

137
Q

Treatment for pemphigoid

A

Orla steroids (30-40mg) (+bisphosphonates, PPi)
May use doxycycline
Nicotinamine
+/- azathioprine

138
Q

Why may doxycycline be used in pemphigoid

A

Steroid-sparing agent for anti-infl

139
Q

Prognosis of pemphigoid

A

Pt relapse/ remitting
Can last for 5 yrs
Morbidity/ mortality related to treatment

140
Q

Pathogenesis of pemphigus vulgaris

A

Acquired autoimmune blisters
IgG to desmosomal antigens
Target = demsoglein 3, codes for cadherin

141
Q

Hx of pts w/ pemphigus

A

Age 40-60 yrs (median 7th decade)
Oral ulcers - preceding rash (months)
“Sore” rash rather than itchy

142
Q

Examination features of pemphigus

A

Mouth ulcers
Erosion of skin
Fragile/ flaccid blisters
+/- involvement of other mms

143
Q

Mm involvement seen in pemphigus

A 
Laryngeal 
Pharyngeal 
Nasal 
Oesophageal 
Urethral 
Vulval

Mucosal surfaces erosions seen rather than bullae

144
Q

Sites of pemphigus vulgaris

A 
Scalp 
Face 
Chest 
Axillae 
Groin 
Umbilicus 
Back if bed ridden
145
Q

Acantholysis

A

Loss of normal cell-cell adhesion

146
Q

Direct IMF for PV

A

‘Chicken wire’ or ‘crazy paving appearnce’

147
Q

Ix for PV

A

Bx - histology (intra-epidermal split), direct IMF, acantholysis
Indirect IF
Titre proportional to activity

148
Q

Treatment of PV

A

High dose oral steroids
Azathioprine
Plasmapheresis
IV Ig

149
Q

Prognosis of PV

A

Mortality of 5-15%. Associated w/ tx, infection, fluid and electrolyte imbalance

150
Q

Rare variants of PV

A

Follaceous

Paraneoplastic

151
Q

Features of follaceous PV

A

Desmoglein antibody causes upper epidermal pacantholysis, not mms
Benign course

152
Q

Where does follaceous PV present

A

Scalp, face, chest, upper back - similar distribution as Seb K

153
Q

What do pt’s dermatitis herpetiformis also have

A

Gluten sensitive enteropathy (coeliac) - usually 2’ gluten enterooptahy

154
Q

What is dermatitis herpetiformis associated w/

A

Other autoimmune condns - DM, thyroid, pernicious anaemia, SLE

155
Q

Pathogenesis of dermatitis herpetiformis

A

Deposition of IgA and epidermal transglutaminase complexes in the papillary dermis

156
Q

Hx of pts w/ DH

A 
Age of onset 20-60
Have an intensely, itchy rash 
Small blisters (herpetiform) - vesicles
157
Q

Examination of pts w/ DH

A 
Erythematous papules + blisters 
Excoriations 
Extensor aspects - knees, elbows, buttocks (grouped vesicles)
May be more widespread 
MM not involved
158
Q

Ix for DH

A 
Bx
Histology - sub-epidermal 
Direct IMF (sample from uninvolved skin)
Indirect IMF for skin autoantibodies
Distal duodenal bx 
Antiendomysial and tTG (+ve)
159
Q

Direct IMF results for DH

A

Granular deposits IgA in dermal papillae

160
Q

Treatment of DH

A

Gluten free diet - rash resolves after 2-3yrs on diet
Dapsone
Sulphonamides

161
Q

Dapsone side effects

A 
Headaches 
Depression 
Lethargy 
Haemolytic anaemia - severe in G6PD deficiency
Neuropathy
162
Q

What needs to be checked before prescribing dapsone

A

G6PD levels for deficiency

163
Q

Sulphonamides side effects

A 
Bone marrow suppression (esp neutrophils)
Nausea 
Depression 
Rashes 
Hepatitis 
Interstitial pneumonitis
164
Q

Azathioprine side effects

A

GI disturbance - nausea, vomiting, diarrhoea
Bone marrow suppression
Liver damage

165
Q

Blood tests to monitor azathioprine

A

LFT
FBC
U&E

166
Q

Prurigo of pregnancy

A

Discrete erythematous or skin coloured papules, excoriated

Occurs in any stage of pregnancy

167
Q

Treatment of prurigo of pregnancy

A

MInld to moderate steroids
1% menthol in aq cream arm
Antihistamines

168
Q

Which antihistamines should be used in prurigo of pregnancy

A

Cetirizine

Loratidine

169
Q

What level of the skin does UVA rays reach

A

Dermis

Causes skin damage e by damage to the dermis

170
Q

Which level of the skin do UVB rays reach

A

Absorbed by the epidermis

Causes erythema, oedema and skin ageing

171
Q

Which form of UV radiation is responsible for Vit D synthesis

A

UVB

Also more potent than UVA

172
Q

Fitzpatrick I features

A

Burns easily, never tans

Ivory/ white

173
Q

Fitzpatrick II features

A

Burns easily, tans minimally w/ difficulty

White

174
Q

Fitzpatrick III features

A

Burns moderately, tans moderately and uniformly

Beige

175
Q

Fitzpatrick IV features

A

Rarely burns, tans profusely

Light brown

176
Q

Fitzpatrick V features

A

Never burns, tans profusely

Dark brown

177
Q

Factors increasing incidence of sunburn

A 
Regions situated closer to the equator 
Areas at high altitude 
Skin exposure between 10am - 2pm
Clear skies
Envirpnemnetal reflection (from snow and ice)
178
Q

Things to look out for in examination of pits w/ photosensitive skin disease

A

Sparing fo facial creases, behind ears, lower eyelids, beneath nose and chin
Erythema, blisters, wheals

179
Q

How can we group photosensitive disease

A 
Idiopathic 
Genetic 
Metabolic 
Autoimune 
Exogenous 
Other diseases that a re exacerbated by sunlight
180
Q

Pathogenesis of sunburn

A

Erythema and vasodilation of skin caused by excess exposure to UV(B)
UVB releases chemicals making skin tender, hot, blistering

181
Q

What chemicals are released by UIVB isn sunburn

A

Leukotrienes
NO
Histamines
PGE2

182
Q

Features of severe sunburn

A 
Blistering 
Dehydration 
Infection 
Electrolyte imbalance 
Shock
183
Q

What is sunburn typically followed by

A

Desquamation and pigmentation

184
Q

Long term consequences of sunburn

A

Increased risk of skin cancer
Lentigo formation
Skin ageing

185
Q

Polymorphic light eruption

A

Itchy, erythematous eruption
Spares habitually exposed ares (face, hands)
‘Prickly heat’

186
Q

Pathology behind polymorphic light eruption

A

Autoimmune infl response if the skin to UV radiation

187
Q

Mx of polymorphic light eruption

A

Avoidance/ sunblock
If severe, steroids (po or top)
Prophylactic UVB/ UVA

188
Q

Ddx of polymorphic light eruption

A

Lupus erythematous

189
Q

Px of c/c actinic dermatitis

A

Pruritic, erythematous, thickened xeroderma
Sun exposed skin
Often hx of pre-existing eczema

190
Q

Dx of c/c actinic dermatitis

A

Patch testing

Photo patch testing

191
Q

Epidemiology of c/c actinic dermatitis

A

Men > 50

192
Q

Mx of c/c actinic dermatitis

A

Sun avoidance/ sun block

As for eczema (emollient, top steroids)

193
Q

Solar urticaria

A

Rare, physical urticaria within mins of UV light, lasts a few hrs

194
Q

Px of solar urticaria

A

Raised, erythematous wheals

195
Q

Mx of solar urticaria

A

Sun protection
Antihistamine
Desensitising phototherapy

196
Q

Actinic prurigo

A

Photosensitivity causing v itchy papules on sun exposed areas

197
Q

Epidemiology of actinic prurigo

A

Usually children <10
More common in darker skin types
Often over lips and sun exposed ares on face - worse in spring/ summer

198
Q

Mx of actinic prurigo

A

Emollients
Topical steroids
Hydroxychloroquine
Desensitisation

199
Q

Hydroa vacciniforme

A

Blisters form over sun exposed ares and heal w/ scarring 30-120 mins after exposure
Causes burning sensation or itching

200
Q

Epidemiology of Hydroa vacciniforme

A

Children aged 3-15,
F>M
Resolves once teenagers, but left w/ scarring

201
Q

Mx of hydrovacciniforme

A

Sun protection/ avoidance
Desemnistising phtotheroay
Rarely, hydroxychloroquine

202
Q

Xeroderma pigmentosum

A

Rare, autosomal recessive defect in DNA repair

Results in photosensitivity, skin ageing tendency to form skin cancer

203
Q

What may xeroderma pigmentosum be associated w/

A

Neurological or ocular disease

204
Q

Mx of xeroderma pigmentsoum

A

Sun avoidance/ protection

Regular skin examination

205
Q

Px of Porphyria Cutanea Tarda

A

Erythema, blisters, erosions, hypertrichosis

Often over hands, face, neck, chest

206
Q

What are the skin changes in PCT in response to

A

UV
Radiation
Minor trauma

207
Q

Triggers of PCT

A

Alcohol
Oestrogen (cocp, liver disease, HRT)
Iron overload (oral iron/transfusions, hepatitis, haemochromatosis)

These all increase the production of porphyrins

208
Q

Ix for PCT

A 
Bx
Urinary porphyrins 
Woods light (fluoresces coral pink)
Check Hb, Fe, LFTs, viral hepatitis screen
Fasting blood glucose 
ANA
209
Q

Mx of PCT

A

Avoid alcohol, oestrogen, iron
Sunblock/ sun avoidance
Venesection if necessary
Rarely, hydroxychloroquine

210
Q

What does cutaneous LE px with

A 
Mlar (butterfly) rash
Photosensitivity 
Mouth ulcers 
Urticaria 
Hair thinning
211
Q

Classification of Lupus Erythematosus

A

Cutaneous LE
Systemic LE
Drug-induced LE

212
Q

Aside from the skin, what may systemic LE also affect

A 
Joints
Kidneys 
Lungs
Heart 
Liver 
Blood vessels (vasculitis)

May be associated w/ aPL antibodies

213
Q

Which drugs can cause drug-induced LE

A 
Hydralazine 
Carbamazepine 
Lithium 
Phenytoin
Sulphonamides 
Minocycline
214
Q

Ix for LE

A 
FBC 
U+Es
ANA
Anti-dsDNA
Anti-Ro/La
aPLs
Skin bx w/ IMF
215
Q

Mx of LE

A 
Stop causative drugs
Smoking cessation 
Sun protection/ avoidance 
Topical steroids 
Oral steroids 
Immunosuppression
216
Q

Phytophotodermatitis

A

Form of plant dermatitis
Reaction to organic psoralens found in lime, celery, wild carrot, hogweed
Subsequent exposure to sunlight causes irregular erythema and blistering

217
Q

What are examples of conditions exacerbated by the sun

A

Darier’s
HSV
Pellagra
Photoaggravated psoriasis

218
Q

Pellagra

A

Deficiency in niacin

Causes diarrhoea, dermatitis and dementia

219
Q

What are examples of conditions that improve following sun exposure

A 
Atopic eczema 
Pityriasis lichenoides
Pityriasis rosea 
Psoriasis 
Pruritus/ of renal failure and liver disease
220
Q

What is purpura

A

Non blanching rash due to haemorrhage from skin vessels

221
Q

Macular vs palpable purpura

A

Macular is usually non-infl

Palpable purpura is usually infl (e.g. vasculitis)

222
Q

Causes of purpura

A

Platelet disorders
Vascular disorders
Coagulation disorder

223
Q

Platelet disorders as a cause of purpura

A

TTP - usually causes petechiae

224
Q

Vascular disorders as a cause of purpura

A

Blood vessel wall damage (vasculitis) - may be palpable
Deficient vascular support
Schamberg’s disease

225
Q

Deficiente vascular support as a cause of purpura

A

Senile purpura

Corticosteroid-induced

226
Q

Features of Schamberg’s disease

A

Brown macule

Red, cayenne pepper spots on legs

227
Q

Coagulation disorders as a cause of prpura

A

DIC, HIT, warfarin induced necrosis

Usually causes ecchymoses & external bleeding

228
Q

Non-palpable purpura causes - petechiae

A

Thrombocytopenia
Abnormal platelet function
Increased intravascular venous pressures
Some infl skin diseases

229
Q

Non-palpable purpura causes - echymoses

A 
External trauma 
DIC and infection 
Coagulation defects 
Skin weakness/ fragility 
Waldenstrom hypergammaglobulinaemia
230
Q

Does systemic vasculitis alway have cutaneous features

A

No

231
Q

Causes of vasculitis

A 
Idiopathic 
Infection 
Infl and autoimmune diseases 
Drugs 
Neoplastic
232
Q

What types of vasculitis can be caused by infection

A

Henoch-Schonlein Purpura

Septic vasculitis

233
Q

Infl and autoimmune disease causing vasculitis

A

SLE, RhA, Crohn’s, UC

Rare causes - Churg-Strauss, Wegener’s granulomatosis, polyarteritis nodosa (PAN)

234
Q

Drugs that may cause vasculitis

A 
Sulphonamides 
Beta-lactams 
Penicillin 
Quinolones 
NSAIDs
OCP
Thiazides
235
Q

Neoplastic causes of vasculitis

A 
Paraproteinaemia 
Lymphoproliferative disorders (lymphoma, leukaemias)
236
Q

Infections causing vasculitis

A

Can be any infection - often follows URTI
Bacterial esp meningocuus
Viral - hep B & C

237
Q

Pattern seen in Henoch-Schonlein Purpura (IgA)

A

Skin vasculitis
Joint pain
Abdo pain
Presence of IgA

238
Q

What type of vasculitis is livedo reticularis seen in

A

PAN

Anti-cardiolipin antibodies or cholesterol emboli

239
Q

Examples of large vessel vasculitis

A

Temporal/ GCA

Takayasu’ arteritis

240
Q

Examples of medium vessel vasculitis

A

PAN

Kawasaki disease

241
Q

Examples of small vessel vasculitis

A

Granulomatous vasculitis
Microscopic polyangitis (polyarteritis)
HSP (IgA)

242
Q

Examples of granulomatous vasculitis

A

Wegener granulomatosis

Churg-Strauss syndrome

243
Q

Cutaneous px of larger vessel vasculitis

A

Claudication
Ulceration
Necrosis

244
Q

Cutaneous px of small-medium vessel vasculitis

A

S/c nodules
Purpura
Fixed livedo reticularis

245
Q

Cutaneous px of small vessel vasculitis

A

Palpable purpura

Rarely, urticarial lesions (urticarial vasculitis)

246
Q

Systemic manifestations of GCA

A

Associated w/ PMR
Headache
Jaw claudication
Blindness (amaurosis fugax)

247
Q

Cutaneous involvement of GCA

A

Tender, swollen, nodular indurated temporal artery

248
Q

Epidemiology of Takayasu arteritis

A

Usually occur in young women and Asian population

249
Q

Features of Takayasu;s arteritis

A

Typically affects aorta and branches:
Unequal BP in upper limbs
Claudiaction on exertion
Renal artery stenosis

250
Q

Mx of Takayasu’s arteritis

A

Steroids

251
Q

Epidemiology of PAN

A

More common in middle-aged men and its associated w/ Her B infections

252
Q

Features of PAN

A 
Livedo reticularis 
Fever, malaise, arthralgi 
HTN 
Renal disease - haemoturia 
Microaneurysm on angio*
Neuritis
253
Q

Cutaneous features of PAN

A

5-10mm s/c nodules distributed segmentally

May be painful, pulsatile or secondly ulcerated

254
Q

Kawasaki disease epidemiology

A

Seen in children

255
Q

Features of Kawasaki disease

A 
High grade fever for at least 5/7
Bright red, cracked lips 
Strawberry tongue 
Cervical lymphadenopathy 
Polymorphic rash followed by desquamation of palms and soles
256
Q

Prognosis of Kawasaki disease

A

Most cases are benign but risk of coronary artery aneurysms

257
Q

Mx of Kawasaki disease

A

High dose aspirin
IV Ig
Echo - screen for aneurysms

258
Q

Epidemiology of HSP

A

Most common in children <10

Can be triggered by URTI

259
Q

Pathogenesis of HSP

A

IgA deposition in vessel walls

260
Q

Cutaneous features of HSP

A

Symettricla, intermittent palpable purpura over buttocks and extensor extremities

261
Q

Systemic features of HSP

A

Abdo pain
Haematuria
Arthralgia

262
Q

Prognosis of HSP

A

Very good - eps in children

BP and urinalysis monitored to detect renal involvement

263
Q

Wegener’s granulomatosis (granulomatosis w/ polyangitis)

A

Necrotising granulomatous infl of upper and lower resp tract

264
Q

Resp features of Wegener’s granulomatosis

A

Epistaxis
Sinusitis
Haemoptysis

265
Q

Systemic features of Wegner’s granulomatosis

A

URT/LRT involvement
Glomerulonephritis
Saddle-shop nose deformity

266
Q

Cutaneous features of Wegener’s granulomatosis

A

Painful, s/c nodules
Pyoderma gangrenous lesion
Palpable puerperal

267
Q

Churg0Strauss syndrome (eosinophilic granulomatosis w/ polyangitis)

A

Triad of tissue eosinophilia, granulomatous inflammation and vasculitis

268
Q

Features of Churg-Strauss

A

Asthma and allergic rhiniti9s - typically precedes vasculitis phase
C/c sinusitis
Mononerutos multiplex
Blood eosinophilia

269
Q

Cutaneous stigmata of Churg-Struass

A

Palpable purpura

Infiltrated nodules

270
Q

Mx of Churg-Strauss syndrome

A

Steroids

271
Q

Pathophysiology of cutaneous leukocytoclastic vasculitis

A

Circulating immune complexes deposited in walls of affect small vessels/ post-capillary venules in dermis

272
Q

Epidemiology of cutaneous leukocytoclastic vasculitis

A

F > M (2.5: 1)

273
Q

Skin lesions in cutaneous leukocytoclastic vasculitis

A

Palpable purpura on ankles/ LL or pressure points

Urticaria or ulcers possible

274
Q

ANCA associated vasculitis

A

Wegners (cANCA)
Churg-Strauss (pANCA)
Microscopic polyarteritis (pANCA)

275
Q

Which vasculidities show low levels of complement

A

Mixed cryoglobulinaemia
Urticarial vasculitis
Lupus

MBBS - Year 2 (20 decks)

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