Dermatology Flashcards
what are the 2 main groups of lupus erythematosus
- systemic lupus erythematosus
- cutaneous lupus erythematosus
what are diagnostic criteria for systemic lupus erythematosus (3 aspects)
- mucocutaneous
- haematological
- immunological
what are the main diagnostic criteria in mucocutaneous aspect for systemic lupus erythematosus
oral ulcers
cutaneous lupus
alopecia (hair loss)
what are the main diagnostic criteria in haematological aspect for systemic lupus erythematosus (3)
haemolytic anaemia
thrombocytopenia
leukopenia
(usually blood cell types decrease)
what are the main diagnostic criteria in immunological aspect for systemic lupus erythematosus
ANA (Anti-nuclear antibodies)
anti dsDNA
anti Sm ( highly specific antibody for systemic lupus erythematosus)
antiphospholipid
low complement
Direct Coomb’s test (looks at your red blood cells to see if there are antibodies attached to them)
clinical presentations of pt in systemic lupus erythematosus (6)
- photodistributed rash
- cutaneous vasculitis
- alopecia
- livedo reticularis
- cutaneous vasculitis
- subacute cutaneous lupus (ring like pattern)
7.chilblains - palpable purapura
how does subacute cutaneous lupus (SCLE)look like on skin
ring like pattern
what does discoid/cutaneous lupus look like
scaring unlike SCLE
what kind of disease is dermatomyositis
autoimmune connective tissue disorder
main clinical presentations from pt in dermatomyositis (2)
proximal extensor inflammatory myopathy
photodistributed pink violet ras at scalp, periocular regional and extensor surfaces
what is Gottron’s papules in presentations of dermatomyostitis
red, often scaly, bumps overlying the knuckles of the fingers
other presentations of gottron’s papules of dermatoly
ragged cuticles
shawl sign (rash at upper trunk)
photosensitive erythema
heliotrope rash
can muscle myostitis be predicted depending on auto antibody profile
yes, as each subtype have very specific clinical features
what is Anti-p155/ TIF-1gamma associated with
cancer malignancy
what is anti-MDA5 associated with
interstitial lung disease
digital ulcer
ischaemia
how to diagnose dermatomyositis
1.blood tests (ANA, CK)
2. EMG
3. skin biopsy
4. LFT (ALT increased )
5. muscle MRI
6. screening for internal malignancy
what is Henoch–Schönlein purpura
IgA vasculitis(a disorder that causes the small blood vessels in your skin, joints, intestines and kidneys to become inflamed and bleed)
symptoms of IgA vasculitis
abdominal pain
bleeding
arthralgia (joint stiffness, pain)
glomerulonephritis (so we needa monitor urine)
which type of vessels are affected in IgA vasculitis
small vessels
manifestations of small vessel vasculitis
purpura (small flat spots on skin)
manifestations of medium vessel vasculitis
digital necrosis
retiform purpura ulcers
subcutaneous nodules along blood vessels
what is DRESS full form
Drug reaction with eosinophilia and systemic symptoms
DRESS symptoms
fever (>/=38.5)
tachycardia
lymphadenopathy (>/=2sites, >1cm)
circulating atypical lymphocytes
peripheral hypereosinophilia)
internal organs involved (liver, kidney, cardiac)
negative ANA
skin involvement
cutaneous eroption
is ANA positive or negative in DRESS
negative
what are internal organ involvements in DRESS
liver (hepatitis) associated with majority of death
kidneys (interstitial nephritis)
heart (myocarditis)
brain
thyroid (thyroiditis)
lungs (interstitial pneumonitis)
what are common triggers of DRESS
allopurinol (gout)
sulfonamides
anti-epileptics
antibiotics
ibuprofen
how do rash look like in DRESS
utricated papular exanthem (widespread papules)
maculopapular eruption
eryrthema multiforme-like
rash in abdomen region
will there be head neck oedema in DRESS
yes
treatment for DRESS
withdraw drug
corticosteroids as first line
mortality rate of DRESS
5-10%
what does pruritus ean
itchy
itching without rash suggest what
internal cause
internal organ dysfunction/ metabolic abnormalities
what are some internal causes of itchy without rash
haematological cause (lymphoma, polycythemia)
uraemia
cholestasis
iron deficiency or overload
HIV/ Hep A/B/C
cancer
drugs (opiods)
psuchogenic
old age
what can chronic rubbing and scratching when itchy
appearance of nodules
what test need when itchy
blood tests
lymph nodes
imaging
investigations for pruritus
FBC, LDH (lactate dehydrogenase test)
LFT
CXR
HIV
Hep A,B,C
what is SJS
stevens-johnson syndrome
toxic epidermal crisis
symptoms of SJS
flu like symptoms
abrupt onset of lesions on trunk more often than in face/limbs
macules, nlisters, erythema (atypical targetoid)
blisters merge (sheets of skin detachment ) to reflect extensive full thickness mucocutaneous necrosis
blisters merge are seen in which dermatology disease
SJS
what is macules
a flat, distinct, discolored area of skin
does SJS have lymphadenopathy
no
which has a larger BSA detachment , SJS or Toxic Epidermal necrolysis (TEN)
TEN
which has a higher mortality rate, SJS or Toxic Epidermal necrolysis (TEN)
TEN
cause of SJS / TEM
drugs
cell mediated cytotoxic reaction against epidermal cells
what are differential diagnosis for SJS / TEN
Staphylococcal scalded skin syndrome (SSSS)
thermal burns
cutaneous graft versus host disease
common drugs that cause SJS
antibiotics
anti-epileptic drugs
NSAIDs
what is the scoring system to helpa ssess severity of SJS / TEN
SCROTEN
what are the criterias for SJS severity
> 40yo
initial % epidermal detachment
serum urea, glucose, bicarbonate
presence of malignancy
complications of SJS/ TEN(9)
death
blindness
dehydration
hypothermia/hyperthermia
renal tubular necrosis
eroded GIT
interstitial pneumonitis
neutropenia
liver, heart failure
what is psoriasis
skin condition that causes flaky patches of skin, which form silvery-white or grey scales
which condition does psoriasis flare usually follow
recent streptococcal throat treated with oral steroids
what are systemic manifestations of erythema to reflect impariment in skin function
peripheral oedema
tachycardia
loss of fluids and proteins
disturbances in thermoregulation
risk of sepsis
why erythroderma cause peripheral oedema
loss of protein across epidermis
why erythroderma cause risk of sepsis
loss microbial biological barrier
what are aetiologies of erythroderma
psoriasis
atopic eczema
drug reaction
cutaneous Tcell lymphoma
idiopathic
what is sezary syndrome
cutaneous T cell lymphoma
management of erythroderma
treated psoriases
withdraw drug that caused it
restore fluid and electrolyte imbalance
manage body temp
emollients to support skin barrier
