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Systemic Disease (Wolfe) > Dermatological > Flashcards

Dermatological Flashcards

1
Q

What is atopic dermatitis?

A

chronic, relapsing, skin disease of unknown etiology

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2
Q

What is the mechanism of atopic dermatitis?

A

IgE mediated hypersensitivity type 1 to environmental allergens

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3
Q

When does atopic dermatitis begin?

A

infancy and can continue to adulthood

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4
Q

What are other names for atopic dermatitis?

A

allergic eczema, infantile eczema, allergic dermatitis

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5
Q

What are common ocular complications of atopic dermatits?

A

cataracts around age 20; ASC if eye rubbing and PSC if steroid induced

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6
Q

What are common ocular findings of atopic dermatitis?

A

keratoblepharoconjunctivitis, keratitis, herpes

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7
Q

What is keratoblepharoconjunctivitis?

A

buildup on the lashes with itchy/flaky skin on the lid margin

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8
Q

What is keratitis?

A

ocular finding from mechanical rubbing or secondary to blepharitis irritation the cornea

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9
Q

What is the prevalence of atopic dermatitis?

A

2-5% of children, 33% of children with FMHx of atopy or asthma (60% chance if 1 parent and 80% if 2); male=female

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10
Q

When is the typical onset of atopic dermatitis?

A

90% of cases onset <5 years of age

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11
Q

What is the most common ocular sign of atopic dermatitis?

A

keratoconjunctivitis superiorly, under UL

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12
Q

What are signs/symptoms of keratoconjunctivitis?

A

pruritus, FB sensation, superior SPK>pannus, sympblepharon, thickened lid margins, blepharitis, slight mucous discharge, Trantas dots

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13
Q

What are trantas dots?

A

superior collection of dead eosinophils

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14
Q

What is a Dennie Morgan fold?

A

prominent infraorbital fold of lower eyelid secondary to repeated episodes of swelling with atopic dermatitis; prevalence 25%

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15
Q

What are less frequent ocular signs of atopic dermatitis?

A

keratoconus, uveitis, ocular HTN, RD, herpes simplex

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16
Q

What are systemic signs of atopic dermatitis?

A

pruritus, lichenification, xerosis, keratinization, scaly/rough/red patches–> weeping lesions over time

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17
Q

Where are atopic dermatitis systemic signs located in an infant?

A

cheeks, forearms, legs, diaper area

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18
Q

Where are atopic dermatitis systemic signs located in an toddler?

A

elbows, knees, wrists and ankles once crawling and walking

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19
Q

Where are atopic dermatitis systemic signs located in an adult?

A

hands, face, neck, genitalia, legs

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20
Q

How do you diagnose atopic dermatitis?

A

clinical presentation and FMHx, IgE levels may or may not be elevated, not related to ocular manifestations, higher levels with cataract formation

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21
Q

What is the systemic treatment of atopic dermatitis?

A

removal of inciting agents, avoid itching and scratching, cold compresses/astringents for itching, oral antibiotics for secondary infections, oral antihistamines, topical steroids (or systemic), oral cyclosporin A (immunosuppressive), UVA and B exposure to dry rash

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22
Q

What is the ocular treatment of atopic dermatitis?

A

cold compresses, topical antihistamines/decongestants, topical steroids, 1% hydrocortisone cream for facial skin, artificial tears between attacks, systemic therapy, cataract surgery

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23
Q

What is rosacea?

A

facial issue of the cheeks, nose, forehead, chin and eyes

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24
Q

What are signs of rosacea?

A

rhinophyma, erythema, telangiectasia, papule, pustule, ocular rosacea

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25
Q

What is rhinophyma?

A

hypertrophy of sebaceous glands

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26
Q

What are signs of ocular rosacea?

A

blepharitis, meibomianitis, hordeolum, chalazia, keratitis, corneal vascularization and thinning, decreased VA, penetrating keratoplasty in advanced cases

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27
Q

Who gets systemic rosacea?

A

adults 30-60 years, women 2x more than men

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28
Q

T/F more women get ocular rosacea than men

A

false, equal incidence when ocular

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29
Q

What is the etiology of rosacea?

A

30% FMHx, unknown etiology, potentially H. pylori, inflammatory component and/or type IV hypersensitivity

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30
Q

How often does systemic rosacea become ocular?

A

58% ocular involvement before, during or after systemic onset

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31
Q

T/F ocular rosacea can have symptoms>signs

A

true, bilateral FB sensation, pain, burning, red eyes, styes, epiphora (signs: tear debris, oily, foamy tears, SPK inferior 2/3)

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32
Q

How is rosacea diagnosed?

A

clinical impression, facial features must exist to make ocular dx

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33
Q

What are differentials of rosacea?

A

seborrheic dermatitis, lupus, acne vulgaris

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34
Q

What is the treatment for systemic rosacea?

A

250 mg tetracycline qid x 4-6 weeks, low maintenance dose may be required; topical and/or oral metronidazole; accutane, dietary restriction of alcohol, spicy foods and hot beverages; stress reduction, laser tx

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35
Q

Is metronidazole antibacterial or antiinflammatory?

A

both

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36
Q

What is the treatment for ocular rosacea?

A

same as facial treatment, 100 mg doxycycline qday x4-6 weeks as alternative to tetracycline, lid hygiene therapy, artificial tears, topical steroids, keratoplasty, conjunctival flap, amniotic membranes, scleral lenses

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37
Q

What is verruca?

A

benign lesion, viral etiology, lobulated (looks like cauliflower)

38
Q

What is a papilloma?

A

benign overgrowth of cells, skin-tag, smooth surface

39
Q

What is a typical treatment of benign lesions?

A

excision, cautery, laser

40
Q

What is molloscum contagiosum?

A

viral infection of epidermis from pox virus, flesh colored with umbilicated center

41
Q

Where is molloscum contagiosum located?

A

face, eyelids, trunk, axillae, extremities, genitals– tend to form wherever there is hair

42
Q

What increases the incidence of molloscum?

A

AIDS

43
Q

Is molloscum contagious?

A

yes, active and infectious if excreted; leads to follicular conjunctivitis or toxic keratitis

44
Q

What is treatment of molloscum?

A

self limiting 6-9 months in immunocompetent patient; can consider cryotherapy and HIV testing

45
Q

What is keratoacanthoma?

A

benign skin tumor, derived from hair follicles on sun exposed skin; rapid growth of central crater and keratin cap

46
Q

What is treatment of keratoacanthoma?

A

involute and resolve alone or surgical removal- both cause a scar

47
Q

What is seborrheic keratosis?

A

greasy lesion confined to epidermis on sun-exposed skin, may occur adjacent to malignant lesions

48
Q

What is actinic keratosis?

A

pre-malignant lesion from years of accumulated sun exposure, rough lesion

49
Q

What can actinic keratosis become?

A

squamous cell carcinoma, 25% of the time

50
Q

What is treatment for actinic keratosis?

A

topical retin-A, cryotherapy, biopsy

51
Q

What is the most common skin/eyelid malignancy?

A

basal cell carcinoma; 90% occur on head and neck, lower>upper euelid

52
Q

What is basal cell carcinoma?

A

pearly, round lesion with raised borders and bleeding; grows and expands by direct vertical invasion

53
Q

How common is basal cell metastasis?

A

rare

54
Q

What are complications of basal cell?

A

high degree of local destruction, orbital extension suggested by diplopia on extreme gaze, globe displacement, pain, tissue redness, chemosis

55
Q

What is treatment of basal cell?

A

cryotherapy, surgical excision, radiation

56
Q

What is squamous cell carcinoma?

A

lesion on sun-exposed/damaged skin; UL=LL; 60-75% occur on head and neck

57
Q

How common is squamous cell metastasis?

A

highly metastatic, spreads through lymphatic system

58
Q

What is the treatment of squamous cell?

A

recognize and refer promptly for biopsy

59
Q

What is sebaceous gland carcinoma?

A

aka meibomian gland carcinoma, small/firm and painless mass, yellowish in color due to high lipid content, madarosis

60
Q

Does a sebaceous gland carcinoma metastasize?

A

yes metastatic potential

61
Q

What are differentials for sebaceous gland?

A

recurrent hordeolum, chalazion

62
Q

What is malignant melanoma?

A

itchy, bleeding and painful lesion; typically red/white/blue that grows horizontally before vertically

63
Q

How common and deadly is malignant melanoma?

A

3% of dermatologic malignancies, causes 2/3 of all fatalities related to skin cancer

64
Q

What is prognostic for survival rate with malignant melanoma?

A

vertical thickness

65
Q

What is treatment of malignant melanoma?

A

excision, chemo, radiation; can recur

66
Q

What is erythema-multiform?

A

acute, inflammatory condition of skin and mucous membranes; usually self-limiting

67
Q

When does erythema-multiform occur?

A

20-40 years

68
Q

What are the 2 types of erythema-multiform?

A

EM minor male=female and EM major “SJS” males>females

69
Q

What are systemic associations of erythema-multiform?

A

sulfonamides, infections, collagen vascular disease, vaccinations, pregnancy, neoplasms, radiation

70
Q

What medications are associated with SJS?

A

sulfonamides, PCNs, salicylates, barbiturates, arsenicals, mercurials, tropicamide, proparacaine, oral acetazolamide

71
Q

What is the pathophysiology of erythema-multiform?

A

monocyte infiltration into dermis, lymphocytes around the dermal blood vessels, subepithelial bullae form and the epidermal cells become edematous

72
Q

What are signs and symptoms of erythema-multiform?

A

flu-like symptoms, dermal eruptions (itchy and painful bulls eye lesions)

73
Q

When do dermal eruptions occur with erythema-multiform?

A

can occur within hours of the pro-drome

74
Q

What are s/s of EM minor?

A

skin, extremities rash only

75
Q

What are s/s of EM major?

A

skin and mucous membranes, trunk rash

76
Q

What is the ocular involvement of EM?

A

lid edema, focal ulceration, conj membranes, conj and corneal scarring, iritis, symblepharon, ankyloblepharon, dry eye, decreased mucin layer

77
Q

How is EM diagnosed?

A

clinical signs and Hx

78
Q

What is EM r/o systemically?

A

Reiter syndrome, behcet’s, bullous pemphigoid, lupus

79
Q

What is EM r/o ocularly?

A

sjogren, sarcoidosis, cicatricial pemphigoid, chemical burns, trauma

80
Q

What is treatment of EM?

A

discontinue causative agent, antibiotics for secondary infections, manage dry eye, bandage CL, topical tretinoin, debride filaments, surgical intervention for symblepharon, mitomycin-C injection to prevent adhesion reformation, epilation for trichiases

81
Q

What is the mortality rate of EM?

A

25%

82
Q

What does topical tretinoin do?

A

as a vitamin A derivative, it enhances goblet cell regeneration and mucin production

83
Q

What is cicatricial pemphigoid?

A

progressive bullous disease of skin and mucous membrane

84
Q

What is the onset of cicatricial pemphigoid?

A

55-70 years old

85
Q

How often does cicatricial pemphigoid have ocular involvement?

A

75-85% of the time

86
Q

How many patients with cicatricial pemphigoid have ocular HTN or glaucoma?

A

1/3

87
Q

What is the etiology of cicatricial pemphigoid?

A

type II autoimmune disorder with antibodies to basement membrane (IgM and IgG)

88
Q

What topical drugs are associated with cicatricial pemphigoid?

A

timolol, epinephrine, dipivefrin, pilocarpine

89
Q

What are systemic signs of cicatricial pemphigoid?

A

bullous lesions of the oral mucosa, skin lesions much less common than mucosal

90
Q

What are ocular signs of cicatricial pemphigoid?

A

bilateral conjunctivitis, conjunctival shrinkage, symblepharon, severe dry eye, ocular surface keratinization, corneal scarring, significant VA reduction

91
Q

How is cicatricial pemphigoid diagnosed?

A

history, signs, progression

92
Q

What is the treatment of cicatricial pemphigoid?

A

corticosteroids, immunosuppressives to control inflammation and prevent loss of vision, dry eye treatment (including tarsorrhaphy), tx secondary infections, lid hygiene, topical steroids, penetrating keratoplasty (low success rate)

Systemic Disease (Wolfe) (10 decks)

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