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Dermatology Flashcards

1
Q

In older children and adults what part of the body does atopic dermatitis commonly affect?

A

extremities

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2
Q

In infants which part of the body does atopic dermatitis most commonly affect?

A

Generalised: cheeks, forehead and scalp

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3
Q

In children which part of the body does atopic dermatitis most commonly affect?

A

Becomes more localised: flexor regions of the body: elbows, behind knees, ankles, wrists

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4
Q

What test is used for diagnosing the specific antigen that might cause atopic dermatitis?

A

The patch test

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5
Q

How would you define the lesion in atopic dermatitis?

A

pruritic, oozing lesion

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6
Q

How does early exposure to the various environmental antigens affect the chance of developing atopic dermatitis?

A

decreases the chance of getting atopic dermatitis

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7
Q

Which type of hypersensitivity is atopic dermatitis associated with?

A

Type I hypersensitivity (Allergic)

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8
Q

Does living in a dry climate affect atopic dermatitis?

A

increases chance of developing atopic dermatitis

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9
Q

Who is most commonly affected with atopic dermatitis?

A

Children (15-30%)

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10
Q

Describe atopic dermatitis (eczema)….

A

superficial skin inflammation + vesicles (when acute), redness, oedema, oozing, scaling and usually pruritis

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11
Q

Give some causes of atopic dermatitis….

A

GENETICS

- filaggrin def (caucasians)&raquo_space; poor barrier func and dry skin&raquo_space; allows antigen penetration into epidermis

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12
Q

What is the atopic triad?

A
  1. Atopic dermatitis
  2. Asthma
  3. Allergic rhinitis
    - if have one of these likely to have experience others
    - eczema first to appear&raquo_space; asthma&raquo_space; hayfever
    - all caused by hypersensitivity reaction to certain allergens
    - conditions of atopic triad tend to be passed on through genetics
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13
Q

Give some triggers of atopic dermatitis…

A

cigarette smoke, pet fur, dust mites, hygiene hypothesis, strong detergents, dietary antigens

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14
Q

What forms the mainstay of atopic dermatitis treatment?

A

Topical corticosteroids

  • weak steroids = hydrocortisone for face
  • stronger steroids = betamethasone for body and soles
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15
Q

What forms the mainstay of atopic dermatitis treatment?

A

Topical corticosteroids

  • weak steroids = hydrocortisone for face
  • stronger steroids = betamethasone for body and soles
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16
Q

In what type of eczema would you see round, oval, and erythematous lesions on both legs. There is noticeable xerosis of the affected skin.

A

Nummular (meaning round or “coin shaped”) dermatitis or eczema (NE) is an inflammatory skin condition characterized by the presence of well-demarcated round-to-oval erythematous plaques

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17
Q

Chronic scratching or rubbing in atopic dermatitis may lead to….

A

Lichenification = leather skin

  • skin thickens due to inflammation
  • see thickened skin plaques + scaling
  • skin lines exaggerated
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18
Q

If both parents have atopic dermatitis what is the chance of their offspring having it?

A

70%

STRONG GENETIC DISPOSITION

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19
Q

Name one of the most common triggers of a flare up of atopic dermatitis…

A

Staph Aureus invasion&raquo_space; stimulates Tcell responses + produces IgE&raquo_space; exacerbations

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20
Q

Which dermatological condition is associated with coeliac disease?

A

Dermatitis hepetiformis

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21
Q

How is atopic dermatitis seen histologically?

A
  • epidermal vesicles (spongiosis)
  • hyperkeratosis (or scalyness)
  • acanthosis (an enlargement of the stratum spinosum layer).
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22
Q

Name the 5 layers of the skin….

A 
Stratum Basale
Stratum Spinosum
Stratum Granulosum
Stratum Lucidum
Stratum Corneum
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23
Q

Who does acne affect?

A

adolescents to mid 20’s

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24
Q

What is the most common type of acne?

A

acne vulgaris

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25
What are the psychological effects of acne?
affect self-esteem and mood - anxiety and depression - increased rates of suicide
26
Where on the body does acne present?
Face, back and chest (high number of sebaceous glands in these areas)
27
Name the different types of pimples...
whitehead, blackhead, papule, pustule, nodule and cyst
28
What is the difference between open and closed comedones?
Closed comedome = white head (closed pore) | Open comedome = blackhead (open pore)
29
When does inflammation occur in acne?
Inflammation occurs when the wall of the comedome ruptures
30
Describe the 3 things that contribute to acne...
1. hypercornification- blockage of pilosebaceous units (microplug formed) 2. seborrhoea: hyper proliferation of sebaceous glands >> increased sebum production 3. infection and proliferation of bacterium (proprionibacterium)- secretes inflammatory molecules and chemotactic factors that initiate and perpetuate the local inflammatory response
31
Why does acne occur specifically during puberty?
increased androgens in puberty >> hyper proliferation of sebaceous glands
32
What is post-inflammatory hyper-pigmentation?
the medical term used to describe discoloration of the skin that follows an inflammatory wound. Common in patients with darker skin
33
What is the difference between papule, pustules, nodules and cysts?
``` papule = small red bumps pustule = white/yellow spots nodule = large red bumps cyst = fluctuant nodules ```
34
Name the two different types of scar in acne...
1. Raised (hypertrophic) | 2. depressed (pitting)
35
What is the first line treatment in acne?
MILD ACNE Topical treatments - Benzoyl peroxide: antimicrobial (can combine with top Abx) - topical antibiotics (if inflamm): erythromycin/clindamycin - topical retinoids: tretinoin (re-establishes epithelial growth homeostasis) - Nictotinamide: Vit3 dérivative with anti-inflamm action
36
Wha is the second line treatment in acne?
MOD-SEVERE ACNE a) oral antibiotics (in add to topical except Abx) - tetracycline/doxycycline >6 months - CI in preg: erythromycin + trimethoprim b) hormone treatment - anti-androgen treatment: co-cyprindiol
37
What is the third line treatment in acne?
SEVERE = oral retinoids: isotretinoin (roaccutane) - given if Abx failed, nodular cystic acne + scarring or severe psych disturbance - synthetic vit A analogues modulating cell proliferation, differentiation, apoptosis and altering the immune response The only therapy that impacts on all of the major aetiological factors implicated in acne.
38
How effective are oral retinoids at treating acne?
>90% response rate and 65% long term 'cure'
39
What are the side effects of oral retinoids?
teratogenic, alter mood, increased risk of suicide, depression, dry skin (especially lips)
40
What is psoriasis?
a chronic hyper proliferative disorder
41
What is the aetiology of psoriasis?
Polygenic BUT dependent on certain environmental triggers: PSORS1 on Cr6 Triggers = infection, UV light, stress, drugs (lithium)
42
What is the epidemiology of psoriasis?
2% of UK pop Two peaks: 16-22 and 55-60yrs UNUSUAL IN CHILDREN M = F
43
What is the pathophysiology of psoriasis?
T- lymphocyte driven unidentified antigen >> T cell activation >> upset of Th1 cytokines e.g. IF gamma, IL1, 2 & 8, TGF and TNF alpha This causes kertainocyte hyper proliferation
44
What is Koebners phenomenon?
It describes the formation of psoriatic skin lesions on parts of the body that aren't typically where a person with psoriasis experiences lesions. This is also known as an isomorphic response.
45
Give some D/D's for psoriasis?
- dermatitis - SLE - Reactive arthritis - Lichen planes - Pitynasis Rosea - 2nd stage of syphilis
46
What nail changes can you see in psoriases?
- pitting - onycholysis (nail lifts off bed) - Beaus lines - subungal hyperkeratosis
47
What can you see on histology in psoriasis?
- parakeratosis (retain nucleus) - acanthuses (thickening of epidermis) - NO granular layer - lengthened Rete ridges - Munro's micro abscesses
48
What findings on histology reflect the increases in turnover of the skin in psoriasis?
parakeratosis- retained nuclei of cells | acanthosis- thickened epidermis
49
Name 5 types of psoriasis...
1. classical 2. gluttate 3. palmoplantar pustular 4. flexural 5. erythrodermic
50
Which type of psoriasis is most common?
Classical
51
Describe classical psoriasis... its features, distribution and features
``` plaques = well circumscribed, erythematous, silver scaling distribution = extensor surfaces, scalp or sacral features = pain/itch (less than eczema) ```
52
What is Auspitz sign?
bleeding when the scale is removed | - seen in classical psoriasis
53
Describe gluttate psoriasis....
RAINDROP LIKE - young age - onset = after streptococcal infection - clears with treatment - plaques = v.small, circular, discoid erythematous - seen on trunk, upper arms and legs
54
Describe palmoplantar pustular psoriasis...
- on palms of hands and feet - get thickening of palms and soles + yellow-brown pustules - heavy smokers - X severe systemic symptoms
55
Describe flexural psoriasis....
ELDERLY - localised to skin folds + genitals - NOT SCALY (glazed and red plaques)
56
Describe erythrodermic psoriasis...
EMERGENCY - ACUTE onset of erythroderma and pustular plaques - systemically unwell METHOTREXATE
57
What is the 1st line treatment for typical psoriasis?
Dithranol
58
What is the 2nd line treatment for typical psoriasis?
``` Vit D analogues e.g. calcitriol (decrease cell proliferation) + salycylic acid +- UVB ```
59
What is the third line treatment for typical psoriasis
Retinoids or PUVA + immunosuppressants
60
Name some topical treatments for psoriasis...
1. emollients 2. Vit D-analogues e.g. calcitriol (decreases cell prolif) 3. Coal tar: inhibits DNA synthesis 4. Dithranol: inhibits DNA synthesis 5. Keratolytics = salycylic acid (scalp psoriasis) 6. Corticosteroids (ONLY IN COMBINATION) 7. Retinoids e.g Tazarotene
61
Name some systemic treatments for psoriasis...
1. immunosuppressants e.g. methotrexate 2. Retinoids e.g. acitretin (teratogenic for <3 years) 3. phototherapy- UVB for classic & glutamate - PUVA for palmoplantar 4. Biological agents e.g. efalizumab
62
What is the Goekerman regime in psoriasis treatment?
TAR + UVB
63
What us the Ingram regime in psoriasis treatment?
Goekerman regime + dithranol
64
How does the migration time of skin cells differ in psoriasis?
Increases to ~4 days (normal = 4 weeks)
65
Give some side effects of Vit D analogues...
hypercalacaemia if overdose
66
Give some disadvantages of using coal tar
Smelly and messy
67
What does dithranol do to clothes?
stains them purple

Phase 2a (7 decks)

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