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CHHD > Dermatology II > Flashcards

Dermatology II Flashcards

1
Q

Name some types of mucocutaneous lesions

A
  • Lichen planus
  • Lichenoid reaction
  • Discoid lupus erythematosus
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2
Q

What parts of the body does Lichen Planus tend to present in

A

Oral
Cutaneous
Genital

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3
Q

What kind of disease and presentations does lichen plants show

A
  • Premalignant condition thought to be immunologically mediated
  • Wide spectrum of presentation
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4
Q

How long do lichen planus lesions remain

A

Oral: 4-25 years, mean 7 years
Skin: 18 months on average

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5
Q

What are the oral presentations of Lichen Planus

A
  • Reticular
  • Erythematous (atrophic)
  • Erosive (Ulcerative)
  • Symmetrical - both in mouth and on skin
  • Buccal/labial mucosa, tongue, gingiva adherent (very rarely palate, lingual)
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6
Q

What is the koebner phenomenon in Lichen Planus

A

Lesions in areas of increased friction e.g. occlusal line

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7
Q

What morphological variants of lichen planus lesions can be found

A
  • Papular
  • Reticular
  • Plaque-like
  • Atrophic
  • Erosvie (ulcerative)
  • Bullous
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8
Q

How does extra-oral Lichen Planus present

A
  • Purple polygonal pruritic papules
  • Dystrophic nails
  • Lichen planopilaris leading to scarring alopecia
  • Ocular, nasal, laryngeal, oesophageal, gastric and bladder
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9
Q

What are wickham’s striae

A

A surface network of fine white striations from cutaneous LP

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10
Q

Where is cutaneous LP usually found

A

On flexor surfaces of wrists and shins

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11
Q

What happens when LP affects the nails

A

Longitudinal grooving and pitting often reversible but can get complete nail loss

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12
Q

What do koebners often show up as

A

Line of LP

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13
Q

What are the characteristics of vulvovaginal-gingival syndrome

A
  • Often unrecognised
  • Usually ulcerative and and symptomatic
  • Progressive vulval disease leading to scarring
  • Reports of malignant transformation
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14
Q

What are the identifiable aetiologies of the Lichenoid reaction

A
  • Drug induced

- Dental materials

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15
Q

What is the most reliable diagnostic tool of the lichenoid drug reactions

A

Withdrawal of the drug

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16
Q

What are some drugs that are associated with oral lichenoid reactions

A
  • Beta blockers
  • ACE inhibitors
  • Diuretics
  • Methydopa
  • Oral hypoglycaemics
  • NSAIDs
  • Allopurinol
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17
Q

What are the clinical features of the lichenoid reaction

A
  • Soreness like with LP especially with erosive form
  • Often indistinguishable from LP
  • May have asymmetric distribution if due to reaction to local materials
  • More likely to be erosive form and affect palate and tongue
  • Resolves on stopping implicated drug
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18
Q

What types of lupus erythematosus are there

A
  • Systemic lupus erythematosus

- Discoid lupus erythematosus

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19
Q

Describe what systemic lupus erythematosus is

A
  • Multisystemic autoimmune disease
  • Autoantibodies generated against a variety of auto antigens e.g. ANA
  • Involves vascular and Connective tissues
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20
Q

What does discoid lupus erythematosus present with

A
  • Scaly atrophic plaques in sun-exposed skin
  • Round or oval plaques - red, scaly with keratin plugs
  • Scarring may cause alopecia
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21
Q

Who is most likely to get systemic lupus erythematosus

A

Females 8x more likely

22
Q

What does systemic lupus erythematosus tend to present with

A
  • Serological or haematological changes
  • Facial butterfly rash
  • Photosensitivity, discoid lesions, diffuse alopecia and vasculitis
  • Sun exposure may trigger acute systemic flares
23
Q

What parts of the body may be involved with discoid lupus erythematosus

A

Oral and genital mucosa, skin and hair

24
Q

What management options are there for Discoid lupus erythematosus

A
  • Sun protection

- Potent topical or intralesional corticosteroids, antimalarial

25
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

10% of discoid lupus erythematosus may evolve in SLE

26
Q

What is a vesicle

A

Small fluid-filled blisters < 5mm in diameter

27
Q

What is a bulla

A

Fluid-filled large blister > 5mm in diameter

28
Q

What is varicella zoster virus and what does it cause

A

It is the herpes virus that causes chickenpox and shingles

29
Q

What occurs on primary infection and recurrence of varicella zoster virus

A

Primary = chicken pox in non immune

Recurrence - shingles, may be a sign of underlying malignancy, immunosuppression

30
Q

What are the clinical presentations of chicken pox

A
  • Itchy maculopapular rash: back, chest, face 2-3 weeks after initial infection
  • Initial site: upper respiratory tract - droplet infection
  • May have areas of oral vesicles/ulceration palate/fauces
31
Q

What are the clinical features of Shingles

A
  • Usually presents on trunk, affecting a single dermatome
    Occasional underlying immunosuppression
  • Often misdiagnosed in pre-dromal phase
  • Predilection for cranial nerves V and VII
32
Q

How common is shingles

A

Affects 10-20% of british population over lifetime

33
Q

Who is most commonly affected by dermatitis herpetiformis

A
  • Rare

- Most commonly affects native irish

34
Q

What are the typical presentations of dermatitis herpetiformis

A
  • Chronic pruritic papulovesicular rash
  • Small vesicles on urticated base
  • Buttocks, elbows and knees
  • Oral: transient superficial blisters - tender non-specific ulcers
  • Associated with gluten sensitive enteropathy
35
Q

What are the clinical features of dermatitis herpetiformis

A
  • May affect younger age group including children
  • Smaller bullae and vesicles - hence herpetiform appearance of lesions
  • Association with coeliac disease (gluten enteropathy)
36
Q

What treatment is there for dermatitis herpetiformis

A

Dietary restriction with gluten free diet and dapsone

37
Q

How does erythema multiforme present

A
  • Target/Iris lesions, erythematous papule blisters

- Extremities (palms and soles) and mucous membranes

38
Q

What are the clinical features of erythema multiforme

A
  • Oral lesions - bullae or erythematous base break rapidly into irregular ulcers, bleed, form crusts
  • Lips more frequently involved, rare for gingiva to be affected
  • Skin and macule and papule, central, pale area surrounded by oedema and bands of erythema -iris type but can also be bullae
39
Q

What infections can cause Erythema multiforme

A 
HSV (70%)
Hepatitis viruses
Mycoplasma
Bacterial fungal 
Parasites
40
Q

What drugs can cause erythema multiforme

A

NSAIDs
Antifungals
Barbiturates

41
Q

What are some systemic causes of erythema multiforme

A

Systemic lupus erythematous
Malignancy
Pregnancy

42
Q

What is pemphigus vulgaris and what causes it

A
  • Chronic organ-specific autoimmune blistering disease
  • Circulating and tissue bound IgG autoantibodies directed against adhesion proteins of desmosomes
  • Dissolution of cell-cell adhesion
  • Intraepithelial blisters affecting skin and mucosa
43
Q

What oral features of pemphigus vulgaris are there

A
  • Mouth involved in most cases and is only site involved in over half of cases
  • Oral bullae fragile + short lived
  • Large shallow non-healing ulcers are typical
  • Palate, buccal mucosa and gingival are most commonly affected
44
Q

What are the management options of pemphigus vulgaris

A
  • Topical corticosteroids - mouthwashses
  • Systemic corticosteroids - prednisolone
  • Steroid-sparing agents e.g. azathioprine pr mycophenolate mofetil
  • IV immunoglobulins
45
Q

What are the clinical features of cutaneous pemphigus

A
  • Large non healing erosions and ulcers of the skin
  • May appear 3/4 months after mouth lesions but opposite may also occur
  • Rare to see frank blisters
46
Q

What is mucous membrane pemphigoid (MMP) and what goes wrong in the body to cause it

A
  • Rare, autoimmune blistering disease of middle aged or elderly
  • Circulating and tissue bound antibodies against basement membrane zone
47
Q

Where can mucous membrane pemphigoid (MMP) be found

A

Usually a mucosal disease - orogential, conjunctive, larynx and oesophagus

Skin rarely involved, scalp involvement = alopecia

48
Q

What are the management options for mucous membrane pemphigoid (MMP)

A
  • Topical corticosteroids
  • Oral prednisolone
  • Oral dapsone
  • Oral tetracyclines
  • Oral azathioprine
  • Oral cyclophosphamide
49
Q

Who does bullies pemphigoid affect mostly

A

The elderly

50
Q

Describe the presentation of bullous pemphigoid

A
  • Initial urticarial eruption precedes onset of blistering
  • Tense large blisters involve involve skin of limbs, trunk and flexures
  • May be localised to one site
51
Q

What are some of the management options for treating bullous pemphigoid

A
  • Systemic prednisolone
  • +/- azathioprine
  • Disease is self-limiting in 50%
  • Systemic corticosteroids can be stopped after 2 years

CHHD (27 decks)

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