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Diseases Flashcards

1
Q

allergic contact dermatitis (ACD)

A

type IV delayed hypersensitivity: T cell mediated
Sx: pruritus
rash: eczematous, scaly edematous plaques with vesicles in area of exposure
Hx: daily skin care routine, all topical products, occupation/hobbies, regular and occasional exposure (lawn care products, animal shampoos)
Tx: avoid exposure

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2
Q

irritant contact dermatitis (ICD)

A

inflammatory reaction in skin resulting from exposure that can cause an eruption in most people (non-immunologic)
host and environmental elements
NO previous exposure necessary
single application with severely toxic substance or repeated application of mildly irritating substances (soap, detergent)
sites: thinner skin: face, neck, scrotum, dorsal hands
risk factor: atopic dermatitis
Sx: erythema, chapped skin, dry, fissuring, pruritus, pain
severe Sx: edema, exudate, tender, bull within hours
Tx: avoid irritant, topical steroids, emollients to improve barrier
prevention: protective equipment, avoidance
need patch test in occupational cases to exclude allergic contact dermatitis

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3
Q

atopic dermatitis (AD)

A

before age 5, clears by adolescence
loss of FILAGGRIN: Th2 immunity
mutlifactorial: genetics, skin barrier dysfunction, impaired immune response, environment
type I hypersensitivity triad: allergic rhinitis, bronchial asthma, AD
chronic, pruritic, inflammatory skin disease
Sx: pruritus, xerosis
ITCH that RASHES: erythematous papules that coalesce to plaques with weeping, crusting, or scaling
Tx: avoid trigger, anti-inflammatory therapy, skin care to compensate for genetically determined impaired barrier, emollients (petrolatum), topical steroids, tacrolimus, pimecrolimus, oral steroids, phototherapy in refractive cases, oral antibiotics if infected with staph

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4
Q

dyshidrotic dermatits

A

firm vesicles of the palms, soles, lateral and medial fingers and toes
Sx: pruritus, burning, prickling sensation
associations: atopic dermatitis, contact dermatitis
NO disturbance of sweat gland function
may be related to stress, atopy, allergens (topical and ingested)
Tx: steroids (topical and systemic), topical calcineurin inhibitors, consider underlying allergen/irritant

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5
Q

Lichen simplex chronicus

A

chronic, intensely pruritic skin condition triggered by repeated rubbing and scratching
Sx: solitary, well-defined, pink to tan, thick and lichenified plaque
locations: lateral neck, scrotum/vulva, and dorsal foot
Tx: topical steroids and break habit of scratching

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6
Q

acute dermatitis

A

appears vesicular or bullous

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7
Q

chronic dermatitis

A

red, scaly and lichenified with fissures

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8
Q

pruritus

A

itching

common in all types of dermatitis

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9
Q

causes of contact dermatitis

A

most common: Rhus dermatitis: poinson ivy, oak, sumac (all contain urushiol)
other: nickel, rubber, fragrance, preservatives, formaldehyde, topical antibiotics, benzocaine, Vitamin E

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10
Q

What are the two phases of allergic contact dermatitis?

A
  1. sensitization (induction): 10-14 days

2. elicitation (challenge): dermatitis within 12-48 hours

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11
Q

Rhus allerg

A

allergic contact dermatitis: poison ivy, sumac, oak
initial episode: rash 7-10 days after exposure
duration: up to 6 weeks
other episodes: within 2 days
duration: 10-21 days
Tx: topical steroids, antihistamine, oatmeal soak/ calamine lotion
severe: oral steroids for 2-3 weeks
prevention: avoid plants, wash objects exposed, apply barriers

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12
Q

eyelid allergic contact dermatitis

A

causes: often from transfer from hands: nail polish, cosmetics, nickel
Sx: intensely pruritic
scaling red plaques greater on upper lids

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13
Q

patch testing

A

determines which allergens a patient with allergic contact dermatitis reacts against
use ONLY when allergen is unclear
apply to back, remove in 2 days

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14
Q

latex allergy (2 types)

A

delayed hypersensitivity: allergic contact dermatitis on dorsal surface of hands
immediate hypersensitivity: immediate burning, stinging, itching with or without localized urticaria, may include disseminated urticaria, allergic rhinitis, anaphylaxis

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15
Q

location of atopic dermatitis lesions by age

A
  1. infants and toddlers: eczematous plaques on cheeks, foreheads, scalp, extensor surfaces
  2. older children, adolescents: lichenified eczematous plaques in flexural areas of neck, elbows, wrists, ankles
  3. adults: lichenification in flexural regions and involvement of hands, wrists, ankles, feet, face (forehead and around eyes)
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16
Q

eczema herpeticum

A

severe herpes simplex virus infection in atopic dermatitis patient
severe cases require hospitalization
Tx: IV acyclovir

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17
Q

nummular dermatitis/ discoid eczema

A

older
coin shaped, well demarcated plaques with scales and tiny vesicles
location: legs, dorsal hands, extensor surfaces
Sx: intensely pruritic, worse in winter (DRY SKIN)
Tx: topical steroids, topical tacrolimus or pimecrolimus, emollients, phototherapy
may be linked to impaired skin barrier function

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18
Q

urticaria

A

rapid development of hives: evanescent, itchy swellings of skin
wheals last few hours before resolving, may have angioedema up to 72 hrs
*consider urticarial vasculitis if wheals last longer than > 24 hrs
HISTAMINE release and other cytokines: edema
can be allergic or non-allergic, with or with our identifiable cause
Prevent: antihistamines, leukotriene antagonists, H2 blockers
usually avoid steroids: risk of rebound

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19
Q

causes of urticaria

A

acute ( 6 weeks): unknown, chronic infection, rheumatologic disorder, Ab to IgE

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20
Q

angioedema

A

swelling of deep dermis and subcutaneous tissue
more frequent with food induced urticaria
typically face: lips, periorbital, hands, feet
also: tongue larynx, respiratory, GI: can cause anaphylaxis (wheezing, difficulty breathing, abdominal pain, dizzy, low BP)

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21
Q

hereditary angioedema

A

C1 inhibitor deficiency

recurrent episodes of edema, abdominal pain

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22
Q

angioedema without urticaria

A

often drug therapy related

angiotensin-converting enzyme inhibitors

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23
Q

physical urticarias

A

not immunologic; physical cause

dermatographism, cold/heat ,delayed pressure , solar, aquagenic, cholinergic

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24
Q

cutaneous drug reactions

A

risk: increased age, female, concomitant viral infection (HIV, EBV)
common causes: antibiotics, anticonvulsants, NSAIDS
rash: morbilliform (maculopapular) or urticarial

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25
morbilliform drug reaction
type-IV hypersensitivity: cell-mediatedmorbilliform MOST common 5-7 days after starting drug (even few days after drugs is discontinued) penicillins, cephalosporins, sulfonamides anticonvulsants Tx: resolve spontaneously in one to two weeks
26
urticarial drug reactions
``` immediate hypersensitivity: IgE mediated requires prior exposure penicillins, cephalosporins aspirin latex ```
27
drug rash with eosinophilia and systemic systems (DRESS)
drug hypersensitivity syndrome severe morbillifrom drug reaction with eosinophilia and systemic illness onset: 2-6 weeks after exposure, facial edema, fever, lymphadenopathy, joint pain, liver persists weeks to months after drug is stopped cause: anticonvulsants, antibiotics (sulfonamides, minocycline, erythromycin) Tx: long term with corticosteroids mortality: 10% from fulminant hepatitis
28
fixed drug eruption
``` well circumscribed, red brown plaque, may blister heals with hyper pigmentation same location with repeated exposure location: genitals, lips, extremities causes: sulfonamides, NSAIDS, laxatives ```
29
stevens-johnson syndrome/toxic epidermal necrolysis
life-threatening blistering skin and MUCOUS membranes onset: 1-2 mo. starting drug Sx: flu like, mucosal irritation, conjunctivitis, dysuria rash: starts morbillifrom or dusky target lesions, painful or burning; skin peels full thickness multisystem involvement Tx: remove drug, supportive care in burn unit, IV immunoglobulin high mortality steroids increase mortality
30
drugs associated with stevens-johnson syndrome
antibiotics: sulfonamides, penicillins, cephalosporin anticonvulsants: phenobarbital, carbamazepine, lamotrigine allopurinol, NSAIDS (oxican derivatives), nevirapine, abacavir, acetaminophen in children
31
What is the difference between stevens-johnson syndrome and toxic epidermal necrolysis?
less than 10% body area: SJS 10-15%: overlap greater than 15%: TEN
32
bullous pemphigoid
female, old Ab to HEMIDESMOSOMES target antigens: BP 180/230 Sx: very itchy urticarial rash, tense blisters (usually symmetric distribution) with/out surrounding erythema, mucous membrane involvement in a few DIF: solid line with IgG and C3 at dermal-epidermal junction Dx: skin biopsy for DIF may or may not find Ab in blood Tx: systemic steroids, immunosuppressants
33
pemphigus vulgaris
50-60 yrs, men Mediterranean, Ashkenazi Jew Ab to DESMOSOMES target antigen: desmoglein 1/3 Sx: erosion in mouth, painful erosions, if have blisters they break easy location: head, chest, back, intertriginous areas (armpit, groin), extensive membrane involvement (mucosa, larynx, esophagus, conjunctiva) Dx: skin biopsy: DIF; serum Ab Tx: steroids, immunosuppressants, Rituximab high fatality without Tx
34
dermatitis herpetiformis
``` men, 30-40 autoimmune CELIAC disease: enteric GLUTEN sensitivity EPIDERMAL TRANSGLUTAMINASE IgA Ab to e-TG Sx: GI, intensely itchy (may see blisters) location: elbow, butt, knee, scalp, neck Tx: gluten free diet, dapsone for itch complication: lymphoma ```
35
hemidesmosome
attach epidermis to BM | BULLOUS PEMPHIGOID
36
mucous membrane pemphigoid
Ab to hemidesmosomes scarring eye involvement, can lead to blindness; oral lesions with/out skin lesions
37
gestational pemphigoid (herpes gestationis)
Ab to hemidesmosomes bullous pemphigoid in pregnant women (2nd trimester), can reoccur with successive pregnancies or oral contraceptives associated with preterm labor or low weight for gestational age regresses post partum
38
pemphigus foliaceus
superficial pemphigus Brazil Ab to desmoglein 1 Sx: scale crust resembles corn flakes
39
paraneoplastic pemphigus
pemphigus associated with malignancy | sever and recalcitrant mucosal involvement
40
tissue transglutaminase (t-TG)
CELIAC | cross reacts with epidermal transglutaminase (e-TG)
41
transglutaminases
cytoplasmic Ca dependent enzymes that catalyze crosslinks between glutamine and lysine important in forming insoluble protein polymers: blood clots hair, skin
42
BP 180 or BP 230
BULLOUS PEMPHIGOID
43
desmosomes
attach keratinocytes to one another | PEMPHIGUS VULGARIS
44
desmoglein 1 and 3
PEMPHIGUS VULGARIS
45
epidermal transglutaminase (e-TG)
DERMATITIS HERPETIFORMIS
46
purpura
non-blanchable, pink to purple macules/patches or papule causes by extravasated RBCs in skin or mucus membranes blood under skin (press and don't blanche) causes: coagulation/clotting abnormalities, leaky or abnormal vessels, trauma
47
macular/non-palpable purpura
generally non-inflammatory
48
palpable purpura
sign of vasculitis
49
petechiae
non-palapable purpura | small,
50
ecchymosis
non-palpable purpura larger area of purpura > 5 mm may be painful or tender abnormalities in COAGULATION: hyper or hypo
51
multifactorial causes of purpura
1. thrombocytopenia and infection/trauma/inflammation 2. abnormal platelet and infection/trauma/inflammation 3. infection 4. anticoagulant and trauma (DIC, renal/hepatic dysfunction,Vit. K deficiency, anticoagulation drugs) 5. poor dermal support and trauma (actinic damage, amyloid, steroid atrophy, scurvy, fragility syndromes)
52
palpable purpura
associated with inflammation in blood vessels | hallmark of leukocytoclastic vasculitis
53
vasculitis
affects skin primarily and visibly | can effect: kidneys, lungs, CNS, GI
54
small vessel vasculitis
palpable purpura, blisters, less commonly hives Henoch Schonlein purpura (IgA) infection, drug reaction, autoimmune, malignancy related. idiopathic, hypersensitivity
55
small/medium vessel vasculitis
ANCA associated: Churg-strauss, microscopic polyangiitis, Wegner's granulomatosis Cryoglobulinemic vasculitis
56
medium vessel vasculitis
nodules, purpura, livedo reticularis/racemosa | polyarteritis nodosa
57
large vessel vasculitis
less likely to affect skin | Giant cell arteritis, Takayasu arteritis, Behcet's
58
retiform purpura
NETLIKE pattern of ecchymosis results from vascular ischemia due to underlying thrombotic disorder (acquired or congenital) ill patient with fever with retiform purpura: INFECTION (meningococcemia is most worrisome)
59
purpura fulminans
widespread retiform purpura
60
psoriasis
20s, 50s T cell mediated familial mucosal changes, geographic tongue NAIL disease: oil spots, nail pitting, distal onycholysis, subungual debris risk of: arthritis, obesity, DM, hyperlipidemia, HTN, CV disease flares associated with: group A strep, drugs, stress Tx: phototherapy, TNFa inhibitors, IL12/23 blocker, IL-17 blocker topical: steorids, retinoids, vit. D, topical keratolytics, tar NOT systemic steroids: risk of flare with discontinuing
61
seborrheic dermatitis
inflammatory rxn to MALASSEZIA (Pityrosporum ovale) yeast that thrives on old producing skin: sebum production erythematous or hypopigmented greasy scaling patches on scalp, hairline, eyebrows, eyelids, central face, nasolabial folds, external auditory canal or central chest worse in HIV Tx: low potency topical steroids, topical ketoconazole, topical pimecrolimus, antidandruff shampoo (ketoconazole, selenium sulfide, zinc pyrithione)
62
pityriasis rosea
young 10-35 yrs HHV6/7 possible salmon, purple, brown or gray: herald patch first, second CHRISTMAS TREE trunk and extremities (follow tension lines) Sx: none or flu-like Tx: resolves on own in 5-8 wks if it itches: OTC anti-itch lotion, topical steroid, antihistamine, oral erythromycin
63
Lichen planus
middle-age autoimmune rxn to antigens on lesional keratinocytes idiopathic inflammatory disease of skin, hair, nails, mucous membranes pruritic, purple, polygonal, flat topped papule with reticulated network of white lines (Wickham's striae) lesions koebnerize: FLEXOR wrists, forearms, dorsal hands, lower legs, pre sacral area, neck glans penis associations: HEP C Tx: topical/ intralesional corticosteroids
64
plaque type psoriasis
MOST COMMON well demarcated, erythematous plaques with adherent silver to while scale scalp, extensor surfaces of extremities, periumbilical and sacral trunk
65
guttate type psoriasis
second most common young adults multiple small drop shaped erythematous scaly plaques diffusely on body: mostly trunk often preceded by streptococcal infections (PHARYNGITIS) Tx: antibiotics if caused by strep
66
pustular type psoriasis
superficial pustules localized on palm and soles or general
67
inverse psoriasis
intertriginous areas
68
erythrodermic psoriasis
diffuse erythroderma with fine scaling
69
Koebner phenomenon
psoriasis at sites of trauma
70
cradle cap
infantile seborrheic dermatitis | pink to yellow macule and patches with white greasy scales on scalp, face, diaper area
71
inverse pityriasis rosea
confine to groin and axilla
72
lichen planopilaris
follicular variant of lichen plans that causes scarring alopecia
73
lichen planus clinical variants
1. annular 2. bullous 3. hypertrophic 4. inverse 5. linear 6. ulcerative 7. vulvovaginal-gingival 8. drug induced 9. lichen planopilaris difficult to treat mucosal; hypertrophic needs high potency under occlusion or intralesional steroids
74
drug induced lichen planus
photodistribution or indistinguishable from idiopathic | drugs: ACE inhibitors, thiazides, antimalarials, quinidine, gold
75
sarcoptes scabiei (scabies)
direct contact or fomites infestation to Sx: 3-4 wks (re-infestation only 1-2 days) location: axillae, breasts, umbilicus, penis, scrotum, finger webs, wrists head and scalp in infants, elderly, immunocompromised Dx: skin scraping (mineral oil prep) Sx: itching at NIGHT Tx: two topical tx one week apart with Rx (permethrin cream, precipitated sulfur, oral ivermectin) neck down and leave overnight (include face and scalp for infants and elderly) itch/lesions can persist for 2-4 wks after Tx environment: wash clothing and linens, high heat dry, seal others in bad 3 days
76
pediculosis (lice)
school age (any socioeconomic), less in AA live eggs remain close to scalp (1cm): can estimate duration spread: close contact, fomites viable egg: tan/brown hatched: white Sx: itching, posterior cervical LAD, dermatitis at posterior neck Dx: nits/lice (more likely to see nits, lice scurry away from light) Tx: topical permethrin, re-treat in 7-9 days to kill newly hatched, nit comb resistant: malathion other: examine/treat household, wash bedding, clothing and dry on hot, brushes hot water for 10 min, plastic bad 3 days for non washables
77
lyme disease
Borrelia spirochete, IXODES tick NE US: MINNESOTA, WISCONSIN ERYTHEMA MIGRANS Tx: early doxycyline, amoxicillin, cefuroximine
78
bed bugs
CIMEX LECTULARIUS feed at NIGHT all populations spread: travel linear array bites: breakfast, lunch and dinner edematous papules scattered over the body, some excoriated (can have no rxn) resolve 1-2 weeks Tx: for symptoms antihistamines, topical steroids launder bed linens, vacuum furniture, exterminator
79
risk factors for scabies
1. women, children 2. immunocompromised 3. congregated facilities
80
crusted scabies
hyperkeratotic thick, scaly, white-gray plaques with minimal itching scalp, face, back, buttocks, feet fissures provide entry for bacteria; sepsis, death immune suppressed or neurological impaired Tx: oral ivermectin, topical permethrin ISOLATE
81
pediculus humanus var capitis
head lice | retroauricular and occipital scalp easiest to see nits
82
pediculus humanus var. corpis
body lice back, neck, shoulder, waist nits and lice on clothing
83
phthirus pubis
pubic or crab lice | lower abdomen, pubic area, thighs

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