Derm - skin disorders

Question 1

What type of disease is psoriasis?

Answer 1

Immune-mediated

Chronic

Question 2

Psoriasis predispositions?

Answer 2

Polygenic + environmental triggers

Question 3

Psoriasis signs/symptoms and location?

Answer 3

Sharply demarcated scaly erythematlus plaques

Scalp, elbows, knees commonest
Then nails, hands, feet and trunk

Question 4

What is the commonest systemic manifestation of psoriasis?

Answer 4

Psoriatic arthritis

Question 5

Outline the pathophysiology of psoriasis?

Answer 5

DNA released from stressed keratinocytes 
Form complexes with peptides 
→ cytokines produced 
→ dermal DCs activated 
→ go to lymph nodes
→ chemokines
→ more cytokines in dermis 
→ keratinocytes proliferate 
→ plaques

Question 6

3 triggers for psoriasis?

Answer 6

Stress
Trauma
Pathogens

Question 7

Indirect management of psoriasis?

Answer 7

Treat/manage co-morbiditiss

Stop smoking, reduce alcohol

Question 8

4 therapeutics of psoriasis?

Answer 8

Topical therapies
Phototherapy
Systemic immunosuppression
Advanced therapies

Question 9

4 topical therapies of psoriasis?

Answer 9

Vit D analogues
Topical corticosteroids
Retinoids
Tacrolimus/pimecrolimus

Question 10

2 types of psoriasis phototherapy?

Answer 10

Narrowband UVB

Psoralen + UVA (puva)

Question 11

Two immunosuppressive drugs for psoriasis?

Answer 11

Methotrexate

Cyclosporine

Question 12

3 advanced therapies for psoriasis?

Answer 12

PDE4 inhibitors - apremilast
Biologics- anti-tnf a
JAK inhibit

Question 13

Atopic eczema type of disease?

Answer 13

Chronic
Inflammatory
Pruritic

Question 14

Atopic eczema causes?

Answer 14

Genetic + environment

Question 15

When does atopic eczema normally present?

Answer 15

Infancy or early childhood

Question 16

What other conditions can eczema be associated with?

Answer 16

Asthma

Rhinoconjuctivitis

Question 17

Signs/symptoms of eczema in infants?

Answer 17

Acute inflammation of cheeks scalp and extensors in infants

Question 18

Signs/symptoms of eczema in children and adults?

Answer 18

Flexiral inflammation
Lichenification
Fissuring

Question 19

Main forms of management for eczema?

Answer 19

Emollients

Anti inflammatory therapy

Question 20

Eczema pathophysiology?

Answer 20

Barrier defect
→ filaggrin mutations 
→ less extracellular lipids and ceramide
→ increased transepidermal water loss
→ less protection against microbes and allergens 

Immune dysregulation

Question 21

What is impetigiinisation?

Answer 21

Gold crust forms

Secondary infection of atopic eczema by staphylococcus aureus

Question 22

Which eczema is an emergency and which virus causes it?

Answer 22

Eczema herpeticum

HSV herpes simplex virus

Question 23

When is a biopsy taken in patients thought to have eczema?

Answer 23

Nipple eczema that is not getting better with treatment - could be cancerous , Paget’s disease

Question 24

2 types of topical therapies for eczema?

Answer 24

Topical corticosteroids

Tacrolimus/pimecrolimus

Question 25

Phototherapy for eczema?

Answer 25

Narrowband UVB

PUVA

Question 26

What can be some of the issues with topical therapies?

Answer 26

Underuse - poor adherence

Overuse - tachyphylaxis or adverse effects

Question 27

Eczema topical steroids from least to most potent? (5)

Answer 27

Hydrocortisone 
Clobetasone
Betamethasone
Mometasone
Clobetasol

Question 28

5 ways of managing eczema?

Answer 28

Topical therapies
Phototherapy 
Retinoids
Immunsuppression
Advanced therapies