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FA Step2 CK Dermatology > Dermatology: allergic and immune-mediated disorders > Flashcards

Dermatology: allergic and immune-mediated disorders Flashcards

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Dermatology Board Prep flashcards
1
Q

define atopic dermatitis

A

aka eczema
a relasping inflammatory skin disorder that is common in infancy
characterized by pruritus leading to lichenification

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2
Q

pt with atopic dermatitis are at increased risk of what?

A

increased risk of 2nd bacterial (S aureus) and viral (HSV or molluscum) infection

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3
Q

name common triggers of eczema?

A

climate, food, contract will allergens, or physical or chemical irritants, and emotional factors

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4
Q

how does eczema present in infants? what area is usually spared?

A
  • erythematous, edematous, weeping, pruritic papules and plaques on the face, scalp, and extensor surfaces of extremities
  • diaper area is usually spares
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5
Q

how does eczema present in children

A

dry, scaly, pruritic, excoriated papules and plaques in the flexural areas and neck

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6
Q

how does eczema present in adults? what 2 areas are often involved?

A

lichenfication and dry fissures skin in flexural distribution. often hand or eyelid involvement

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7
Q

how is eczema diagnosed?

A

diagnosis is clinical

pt may have mild eosinophilia and increased IgE

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8
Q

what is atopic dermatitis commonly associated with? 2

A

asthma and allergic rhinitis

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9
Q

how is eczema prophylactically treated?

A

nondrying soaps, applications of moisturizers, and avoidance of known triggers

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10
Q

name 1st line treatment for eczema? what is used in pt >2yrs of age with moderate to severe?

A 
tropical corticosteroids
topical immunodulators (tacrolimus, pimecrolimus) are useful moderate to severe if pt is >2 yrs of age
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11
Q

how long should corticosteroids be used in treatment of eczema?

A

topical corticosteroids should not be used for longer than 2-3 wks to avoid decreasing the integrity of the skin

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12
Q

how is erythema toxicum neonatorum defined? how is it treated?

A

-begins 1-3 days after delievery and resembles eczema, presenting with red papules, pustules, and or vesicles with surrounding erythematous halos.. increases eosinophils are present in pustules or vesicles. usually resolves in 1-2 wks with no treatment

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13
Q

how is contact dermatitis defined?

A

a type IV hypersensitivity reaction that results from contact with an allergen to which the pt has previously been exposed and sensitized. more common in adults in children

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14
Q

how does contact dermatitis present?

A

pruritus and rash

can also present with edema, fever, and lymphadenopathy

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15
Q

name some common allergens in contact dermatitis?

A

poison ivy, poison oak, nickel, soaps, detergents, cosmetics,and rubber products containing latex (gloves and elastic bands in clothing)

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16
Q

what is shape of rash in contact dermatitis?

A

often mimics that of exposing object and characteristic distributions of involvement are often seen where makeup, clothing perfume, nickel jewelry, and plants
-it can spread over body via transfer of allergen by the hands or via circulating T lymphocytes

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17
Q

how can contact dermatitis be diagnosed?

A
  • clinical impression

- patch testing can be used to establish the causative allergen after the acute phase rash has been treated

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18
Q

how is contact dermatitis treated?

A

prophylaxis consist of avoiding allergen

topical or systemic corticosteroids as needed with cool, wet compresses to soothe crusted lesions of skin

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19
Q

an infant with a history of ecczema treated with corticosteroids is brought in for a new-onset rash and fever. physical examination reveals grouped vesicles involving eczematous areas of the infant’s extremities and face. what is appropriate therapy?

A

this infant has eczema herpeticum a medical emergency that is due to propensity for HSV infection to spread systemically, potentially affecting the brain. acyclovir must be started immediately!

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20
Q

how is seborrheic dermatitis defined?

A

a common disease that may be caused by Malassezia furfur a generally yeast found in sebum and hair follicles. it has predilection for areas with oily skin

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21
Q

name appearance of seborrheic dermatitis in infants

A

presents with severe, red diaper rash with yellow scale, erosions, and blisters. a thick crust “craddle cap” may be seen on the scalp

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22
Q

name appearance of seborrheic dermatitis in children/adults

A

red, scaly patches are seen around the ears, eye brows, nasolabial fold, midchest, and scalp. the rash is more localized and less dramatic than that seen in infants

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23
Q

name groups of pts are risk for severe seborrheic dermatitis?

A

HIV/AIDS

Parkinson’s disease

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24
Q

how is seborrheic dermatitis diagnosed? what two illnesses should be ruled out

A

clinical impression

rule out contact dermatitis and psoriasis

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25
Q

name treatment for seborrheic dermatitis?

A

selenium sulfide or zinc pyrithione shampoos for scalp,

topical antifungals or corticosteroids for other areas

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26
Q

how is craddle cap treated?

A

often resolves wit routine bathing and application of emollients in infants

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27
Q

how is psoriasis defined

A

A t-cell mediated inflammatory dermatosis characterized by erythematous plaques with silvery scales due to dermal inflammation and epidermal hyperplasia

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28
Q

when does psoriasis start?

A

starts in puberty or young adulthood

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29
Q

where are psoriasis lesions found?

A

classically on extensor surfaces, including elbows, knees, scalp, and lumbosacral regions

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30
Q

what happens to pts nails in psoriasis?

A

pitting- oil spots

onycholysis (lifting of nail plate)

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31
Q

what is it called when psoriatic lesions are caused by irritation or trauma?

A

Koebner’s pnenomenon

32
Q

what medications can cause psoriasis?

A

beta-blockers, lithium, and ACEIs

33
Q

what is Auspitz sign? and what disease is it associated with?

A

bleeding when scale is scraped.

psoriasis

34
Q

what histological findings are in psoriasis?

A

thickened epidermis, elongated rete ridges, absent granular cell layer, preservation of nuclei in stratum corneum (parakertosis), and sterile neutrophilic infiltrate in stratum corneum (Munro’s microabscess)

35
Q

how is psoriasis treated? what is used for severe cases

A

topical steroids
keratolytic agents, tar, antralin along with UV therapy
metrotrexate for severe cases
retinoids and vitamin D3 analogs can also be used

36
Q

a 23 yr old female is seen for an itchy, linear rash on her right leg. She return from a camping trip 4 days a ago and denies using any new makeup clothing or jewelry. what features of this presentation factor a contact dermatitis?

A

the asymmetric involvement of the rash, its linear arrangement (possibly from contact with a plant during a camping trip) and the time from exposure to rash presentation all point to contact dermatitis

37
Q

rash common affecting extensor surfaces think?

flexor surfaces think?

A

psoriais

atopic dermatitis

38
Q

5% of pts with psoriasis also have what contidition

A

seronegative arthritis

39
Q

how is urticaria defined. what is it’s timeline?

A
  • characterized by superficial, intense erythema and edema in a localized area.
  • usually acute but can also be chronic
40
Q

name etiology of urticaria

A

results from histamine and prostaglandins from mast cells in a type I HSN RXN

41
Q

describe typical lesion in urticaria

A

elevated papule or plaque that is reddish or white and variable in size. widespread and last a few hrs

42
Q

what can happen in severe cases of urticaria

A

extracutaneous manifestations

such as tongue swelling, angioedema (deeper more diffuse swelling), asthma, GI symptoms, joint swelling, and fever

43
Q

name common triggers of urticaria

A

food, drug, virus, insect but, or physical stimulus.

44
Q

how is urticaria diagnosed?

A

clinical impression

45
Q

name treatment of urticaria

A

systemic antihistamines,

anaphylaxis=epinephrine IM, antihistamines, IV fluids, and airway maintenance

46
Q

define drug eruption

A

rxn takes many forms
can call all 4 types of HSN RXN
one drug can cause different rxns in different pts

47
Q

what do drug eruption occur?

A
  • usually 7-14 days after exposure

- if pt reacts within 1-2 days of starting a new drug, that drug is probably not causative agent

48
Q

describe lesion of drug eruption

A

generally widespread, relatively symmetrical, and pruritic

49
Q

how long does drug eruption last?

A

most are short-lived, disappearing within 1-2 wks following removal of offending agent

50
Q

name some extreme complications of drug eruptions

A

erythhroderma, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN)

51
Q

how is drug eruption treated?

A

discontinue offending agent, treat symptoms with antihistamines and topical steroids to relieve pruritius

52
Q

what is common on histology in pts with drug eruptions

A

pts often have eosinophilia and eosinophilia on histopathology

53
Q

how is erythema multiforme defined

A

cutaneous rxn with targetoid lesions that has many triggers and is other recurrent

54
Q

where can erythema muliforme occur? and how do lesions start?

A
  • can occur on mucus membranes, palms and sole are often affected.
  • start as erythematous macules that become centrally clear and then develop a blister
55
Q

what are signs and symptoms of erythema multiforme?

A

fever, myalgias, HA, and arthralgias

56
Q

what complications can occur as a result from erythema multiforme

A

in minor form disease is uncomplicated

but EM major can lead to TEN or SJS

57
Q

name common triggers of erythema multiforme

A

recurrent HSV infection of the lip. other common triggers are drugs and mycoplasmal infections

58
Q

how is erythema multiforme treated?

A

treat symptoms, systemic corticosteroids are of no benefit
minor cases treat with antipruritics
major cases treat as burns

59
Q

how are Steven Johnson Syndrome and Toxic Epidermal Necrolysis defined?

A

SJS/TEN are on 2 different point of the spectrum of life-threatening exfoliative mucocutanteous diseases
SJS30% of BSA

60
Q

what are SJS/TEN caused by?

A

drug induced

61
Q

what can SJS and TEN be preceded by what diseases?

A

erythema multiforme, flulike prodrome, skin tenderness, a maculopapular drug rash, or painful outh lesions

62
Q

what is SJS and TEN associated with?

A

history of exposure to new drugs, sulfonamindes, penicillin, seizure medications (phenytoin, carbamazepine), quinolones, cephalosporins, allopurinol, corticosteroids, or NSAIDs

63
Q

what is expected on PE for SJS and TEN

A

examination reveals severe mucosal erosions (eyes, mouth, genitals) with widespread erythematous, dusky red or purpuric macules or atypical targetoid lesions

64
Q

what happens to skin on palpation in SJS and TEN?

A

Nikolsky’s sign (separation of superficial skin layers with slight rubbing) and epidermal detactment

65
Q

what are result of biopsy in SJS

A

shows degeneration of the basal layer of the epidermis

66
Q

what are the results of biopsy of TEN

A

full thickness eosinophilic epidermal necrosis

67
Q

what should be in the differential for SJS and TEN?

A

staphylococcal scaled-skin syndrome (SSSS), graft vs host rxn (usually after bone arrow transplant), radiation therapy, and burns

68
Q

SJS and TEN vs Staphylcoccal scaled skin syndrome
age
etiology

A

SSSS: children <6 and infectious cause

SJS/TEN: adults and drug rxn

69
Q

name complications for SJS/TEN

A

pt have the same complications as burn victims, thermoregulatory difficulties, electrolyte disturbances, and infections

70
Q

name treatment of SJS and TEN?

A
  • skin coverage and maintenance of fluid and electrolyte balance.
  • corticosteroids in the early stages becasuse there is high risk mortality
71
Q

how is erythema nodosum defined

A

panniculitis or inflammatory process of the subcutaneous adipose tissue

72
Q

name triggers of erythema nodosum

A
  • infection (Streptococcus, Coccidiodes, Yersinia, TB),
  • drug rxns (sulfonamides, various antibiotics, OCPs)
  • chronic inflammatory diseases (sarcoidosis, Crohn’s disease,
  • ulcerative colitis, Beehcet’s disease)
73
Q

name signs and symptoms of erythema nodosum

A
  • painful, erythematous nodules appear on pts lower leg, slowly spread turning brown or gray.
  • may present with fever and joint pain
74
Q

what lab tests may be false + in pts with erythema nodosum

A

VDRL

75
Q

what is workup for erythema nodosum?

A

ASO titer, a PPD test in high risk pts, an CXR to rule out sarcoidosis or a small bowel series to rule out IBD based on pts complaints

76
Q

how is erythema nodosum treated?

A

remove triggering factor and use NSAIDs

FA Step2 CK Dermatology (5 decks)

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