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year 3 exam 1 > eczema, dermatitis and psoriasis > Flashcards

eczema, dermatitis and psoriasis Flashcards

1
Q

define eczema/dermatitis

A

used interchangeably, group of skin conditions characterised by dry, itchy, irritated skin

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2
Q

what is atopic eczema

A

adaptive immune response, causing a type IV hypersensitivity reaction

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3
Q

atopic eczema epidemiology

A

most common 30% of skin issues seen by GPs 1-2% adults 15% children

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4
Q

atopic eczema aetiology

A

genetics - filaggrin gene normally maintains skin barrier

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5
Q

atopic eczema pathophysiology

A
  • Allergen presented to T cell by dendritic - TH2 –> IL4- B cell activation - IgE release –> mast cell activation Pro-inflammatory mediator release
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6
Q

clinical features of atopic eczema

A
  • Age specific * Flexural in children * Hands in adults- Dry, itchy skin - Red/grey patches - Skin infections may occur
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7
Q

what are the options for treating atopic eczema

A

prevention - moisturising, avoiding triggers treatment - 1st emollients, steroids, abx, phototherapy2nd - oral steroids, top calcineurin inhib, immunosuppressants, dupilimumab, alitretinoin

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8
Q

what is dupilimumab and what is it used for

A

IL4 inhibitor, used for severe atopic eczema

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9
Q

what is alitretinoin and what is it used for

A

oral retinoid for hand eczema refractory to steroids

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10
Q

what is contact dermatitis

A

irritant or allergic type IV hypersensitivity reaction

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11
Q

what is the epidemiology of contact dermatitis

A

adults > children 75% of cases

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12
Q

aetiology of contact dermatitis

A

wet workatopic eczema increased risk of contact

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13
Q

aetiology of irritant contact dermatitis

A

irritant exposure detergents strip skin amount of exposure is important

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14
Q

aetiology of allergic contact dermatitis

A

over time of exposure immune response build up

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15
Q

pathophysiology of irritant contact dermatitis

A

innate response keratinocytes release TNF IL1/8endothelial upregulation and cellular recruitment

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16
Q

pathophysiology of allergic contact dermatitis

A

adaptive immune response T cell activation T reg and mast cell activation

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17
Q

treatment of contact dermatitis

A

avoiding irritants emollients topical or oral steroids alitretinoin

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18
Q

what is seborrheic dermatitis

A

skin flakes or cradle cap

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19
Q

epidemiology of seborrheic eczema

A

1-3% of the population more common in males over 20y/o

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20
Q

aetiology of seborrheic eczema

A

overgrowth of Malassezia yeast which usually exists on the skinin children its caused by immature sebaceous glands

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21
Q

pathophysiology of seborrheic eczema

A

sebum metabolised into proteins that penetrate and irritate the scalp

22
Q

clinical features of seborrheic eczema in adults

A

flaky, itchy, inflamed skin with white/yellow scale

23
Q

clinical features of seborrheic eczema in infants

A

yellow, waxy scales on the scalp pink, flaky patches on the forehead, eyebrows, behind ears and nappy area

24
Q

treatment of seborrheic eczema in adults

A

shampoo - ketoconazolemild steroids - salicylic acid/anti-yeasts clotrimazole, miconazole, nystatin oral anti-fungal

25
Q

treatment of seborrheic eczema in infants

A

emollients/mineral oilstopical steroids with an antifungal for the body

26
Q

what are the different types of psoriasis

A

plaque scalp guttate pustular nail

27
Q

what is plaque psoriasis

A

most common type red, sore, itchy skin with silver scales

28
Q

what is scalp psoriasis

A

thick build up of skin on the scalp

29
Q

what is guttate psoriasis

A

normally triggered by strep, pink/red (dark) rash on torso, back and limbs

30
Q

what is pustular psoriasis

A

small, yellow filled pustules on red skin that crust once burst palms of hands/soles of feet but can spread derm treatment

31
Q

what is nail psoriasis

A

50% of pts get it often mistaken for fungal nail discolouration, pitting, crumbling, cracking

32
Q

epidemiology of psoriasis

A

2-3% of population peaks in late teens, 30s and 50-60

33
Q

aetiology of psoriasis

A

genetic - 1/4 children with infected parentstrigger event - stress/injury/infectionPSOR1 gene or IL23/12 mutation

34
Q

pharmacology of psoriasis

A
  1. keratinocytes stressed - release DNA and LL37 2. DNA/LL37 bind and are presented to T cells 3. dendritic cells release IL23 - T cell activation 4. TH and macrophage infiltrate keratinocyte layer 5. keratinocyte hyperproliferation
35
Q

topical treatment for psoriasis

A

topical moisturisers, emollients, vit d derivatives, steroids, coal tar, calcineurin inhibphototherapy systemic immunosuppressants, acitretin, biologics

36
Q

which biologics are used for psoriasis

A

anti-TNF - infliximab anti-IL23 - ustekinumab anti-IL12

37
Q

how do vitamin D derivatives work in psoriasis

A

inhibits proliferation and induces keratinocyte differentiation

38
Q

what is psoriatic arthritis

A

inflammatory joint/tendon disease - tender, swollen and stiff

39
Q

what is the treatment for psoriatic arthritis

A

painkillers corticosteroids DMARDs - leflunomide biologics - anti-tnf, jak inhibitors

40
Q

what are the other forms of eczema

A

nummular neurodermatitis stasis dishidrotic

41
Q

what is nummular eczema

A

oval, blistered lesions on lower legs, trunk and arms - emollients, steroids, abx and phototherapy

42
Q

what is neurodermatitis eczema

A

persistent and recurring, treated with emollients and topical steroids

43
Q

what is stasis eczema

A

fragile, thin, shiny, itchy skin in adults in varicose veins - emollients, steroids, compression stockings

44
Q

what is dyshidrotic eczema

A

itchy blisters on hands and feet, aggravated by heat and stress - emollients, steroids, abx, immunosuppressants

45
Q

NICE guidelines for the treatment of mild atopic eczema

A

managing triggers emollients mild top. steroid

46
Q

NICE guidelines for the treatment of moderate atopic eczema

A

managing triggers emollients moderate top. steroid top. calcineurin inhibocclusion

47
Q

NICE guidelines for the treatment of severe atopic eczema

A

managing triggers emollients moderate top. steroid top. calcineurin inhibocclusionphototherapy systemic steroids/immune suppress plus abx if inf - fluc, eryth, clarith

48
Q

NICE guidelines for the treatment of psoriasis

A
  1. emollient, vit d analogue, top. steroid, dithranol, coal tar 2. UVB/PUVA, methotrexate/ciclosporin, acitretin 3. biologics
49
Q

how does dithranol work

A
  • Anti-proliferative effect on epidermal keratinocytes
50
Q

how does UVB/PUVA work

A
  • UVB slows cell proliferation - Psoralen is light activated to interfere with DNA
51
Q

how does acitretin work

A
  • Oral vit d analogue - Induces keratinocyte differentiation and reduces epidermal hyperplasia

year 3 exam 1 (44 decks)

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