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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
AY BAWS CAN I HABE DE NOTE PLZ
10% of discoid lupus erythematosus may evolve in SLE
26
What is a vesicle
Small fluid-filled blisters < 5mm in diameter
27
What is a bulla
Fluid-filled large blister > 5mm in diameter
28
What is varicella zoster virus and what does it cause
It is the herpes virus that causes chickenpox and shingles
29
What occurs on primary infection and recurrence of varicella zoster virus
Primary = chicken pox in non immune | Recurrence - shingles, may be a sign of underlying malignancy, immunosuppression
30
What are the clinical presentations of chicken pox
- 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
What are the clinical features of Shingles
- 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
How common is shingles
Affects 10-20% of british population over lifetime
33
Who is most commonly affected by dermatitis herpetiformis
- Rare | - Most commonly affects native irish
34
What are the typical presentations of dermatitis herpetiformis
- 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
What are the clinical features of dermatitis herpetiformis
- May affect younger age group including children - Smaller bullae and vesicles - hence herpetiform appearance of lesions - Association with coeliac disease (gluten enteropathy)
36
What treatment is there for dermatitis herpetiformis
Dietary restriction with gluten free diet and dapsone
37
How does erythema multiforme present
- Target/Iris lesions, erythematous papule blisters | - Extremities (palms and soles) and mucous membranes
38
What are the clinical features of erythema multiforme
- 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
What infections can cause Erythema multiforme
``` HSV (70%) Hepatitis viruses Mycoplasma Bacterial fungal Parasites ```
40
What drugs can cause erythema multiforme
NSAIDs Antifungals Barbiturates
41
What are some systemic causes of erythema multiforme
Systemic lupus erythematous Malignancy Pregnancy
42
What is pemphigus vulgaris and what causes it
- 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
What oral features of pemphigus vulgaris are there
- 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
What are the management options of pemphigus vulgaris
- Topical corticosteroids - mouthwashses - Systemic corticosteroids - prednisolone - Steroid-sparing agents e.g. azathioprine pr mycophenolate mofetil - IV immunoglobulins
45
What are the clinical features of cutaneous pemphigus
- 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
What is mucous membrane pemphigoid (MMP) and what goes wrong in the body to cause it
- Rare, autoimmune blistering disease of middle aged or elderly - Circulating and tissue bound antibodies against basement membrane zone
47
Where can mucous membrane pemphigoid (MMP) be found
Usually a mucosal disease - orogential, conjunctive, larynx and oesophagus Skin rarely involved, scalp involvement = alopecia
48
What are the management options for mucous membrane pemphigoid (MMP)
- Topical corticosteroids - Oral prednisolone - Oral dapsone - Oral tetracyclines - Oral azathioprine - Oral cyclophosphamide
49
Who does bullies pemphigoid affect mostly
The elderly
50
Describe the presentation of bullous pemphigoid
- 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
What are some of the management options for treating bullous pemphigoid
- Systemic prednisolone - +/- azathioprine - Disease is self-limiting in 50% - Systemic corticosteroids can be stopped after 2 years

CHHD (27 decks)

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