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PM3A: Spring > Eczema, Systemic Lupis, Psoriasis, Acne and Rosacea > Flashcards

Eczema, Systemic Lupis, Psoriasis, Acne and Rosacea Flashcards

1
Q

What are the main roles of the stratum corneum

A

Regulation of water loss and barrier integrity

Mediates hydrolytic enzymes

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2
Q

What does the stratum granulosum produce

A

Filaggrin

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3
Q

Which section of the epidermis does the cell division begin from

A

Stratum basale

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4
Q

What section does cell differentiation begin

A

Stratum spinosum

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5
Q

What is the natural moisturising factor

A

An endogenous breakdown product from filaggrin hydrolysis that contains hygroscopic mixture of: amino acids, pyrrolidone carboxylic acid, lactic acid, urea

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6
Q

What is the role of the natural moisturising

A
  1. Maintains free water in stratum corneum alongside corneocyte maturation and desquamation
  2. Acts as a buffer
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7
Q

How do you create natural moisturising factors

A

Profilaggrin converts to filaggrin via dephosphorylation

Filaggrin converts to natural moisturising factor via hydrolysis

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8
Q

What does filaggrin loss result in

A

Corneocyte deformation- flattening of surface cells

Reduction in NMF

Increase in skin pH which encourages serine protease activity- enzymes that digest desmosomes

DRIER SKIN

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9
Q

What is the genetic predisposition factor that causes eczema

A
  1. Genetic defect of filaggrin produces less NMF
  2. Enzymes gone wrong due to pH change
  3. Eczema patients have at least one mutated filaggrin gene
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10
Q

Describe what is atopic eczema, symptoms and causes

A
  1. Most common form of eczema especially in babies of 3 months
  2. Dry, scaly, itchy rash on face, scalp, neck and cheek
  3. atopic march: sequence of IgE response to stimulus
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11
Q

If you have atopic eczema, what can that develop into

A

50% of patients will develop atopic dermatitis, go on to develop asthma or allergic rhinitis

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12
Q

Describe what irritant/contact/allergic dermatitis is (causes) and symptoms

A
  1. Caused by use of harsh chemicals that dry out the skin
  2. Allergic reaction towards them (nickel, leather, dye)
  3. Symptoms: blisters filling with fluid
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13
Q

How do you treat eczema (dermatitis)

A
  1. Emollients, emulsifying ointment to maintain hydration of stratum corneum to reduce water evaporation
  2. Topical steroids
  3. Sedating oral antihistamines (chlorpheniramine)
  4. Avoid soaps, wool fabrics, synthetic material
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14
Q

Why shouldn’t aqueous cream be used in eczema

A
  1. Contains Sodium Lauryl Sulphate (SLS) which is a harsh anionic surfactant
  2. This can dry out skin and damage pH to affect NMF, increases transepidermal water loss
  3. Advise aqueous cream as a soap substitute
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15
Q

Describe what is seborrhoea eczema, causes and

A
  1. Common harmless rash that affects skin in scalp region and other areas
  2. Also known as dandruff
  3. Can be aggravated by: Illness, stress, fatigue, season change
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16
Q

How do you reduce seborrhoea eczema

A
  1. Reduce exposure to allegens e.g. house mites, moulds, grass, pollens
  2. Keep cool, wear loose clothing, avoid dusty conditions
17
Q

How do you treat seborrhoea eczema

A
  1. Use of regular anti fungal agents and intermittent applications of topical steroids
  2. Scalp: Medicated shampoos that contain ketoconazole, coal tars, salicylic acid
  3. Face, ears, chest and back: Ketoconazole cream, hydrocortisone cream
18
Q

What is systemic lupus erythematous (symptoms)

A

A classic butterfly rash on the cheeks and nose: trunk and extremities

Exacerbated by sunlight

Other symptoms:
Non specific joint pain (morning stiffness)
Joint pain
Rapid hair loss (regrows during remission)

19
Q

What causes systemic lupus erythematous

A 
Beta blockers
Lithium
Methyldopa
Chlorpromazine 
Penicilliamine
PHENYTOIN
20
Q

What is psoriasis

A
  1. Chronic scaling skin disease associated with skin redness or inflammation
  2. Appears as a reddened, raised, rough, area with silvery scales
  3. Represents cell differentiation that occurs as a much faster rate
  4. Eruption first appears at back of elbows and front of knees
21
Q

What are the causes of psoriasis

A
  1. Genetics: chromosomes 6p21, 17q/4q
  2. Infection: throat and upper RTI
  3. Trauma: burns and incisions
  4. Emotional stress
  5. Climatic factors
  6. Drugs: lithium, chloroquine, beta blockers, NSAIDS
22
Q

Describe the different types of psoriasis

A
  1. Plaque psoriasis: most common, itchy and sore
  2. Gluttate: small discreet patches
  3. Flexural: skin to skin contact
  4. Generalised pustular: red skin and pustule eruption
  5. Psoriatic arthritis: inflammatory joint disease that affects hands and feet
23
Q

How do you treat psoriasis using topical treatment?

A
  1. Emollients: hydrating the skin
  2. Topical corticosteroids
    Mild: face, flexures (hydrocortisone)
    Moderate: Scalp, hands or feet (betamethasone)
  3. Calcipotrol (dovonex): vitamin D3 analogue that interferes with cell division: coal tar, salicylic acid (breaks plaques and keratin)
  4. Coal tar: anti-inflammatory or anti scaling properties
  5. Salicylic acid: breaks down keratin and plaques
  6. Dithranol: most likely to induce
  7. Retinoids: tazarotene:
24
Q

How do you treat psoriasis with other treatments other than topical delivery and systemic?

A

UVB light: Effective for stable psoriasis, consider in patients when topical has failed

PUVA therapy: long wave radiation, psoralen enhances effect

25
Q

How does 8-methoxypsorlaen work

A
  1. Fits very nicely into the helical structure of DNA
  2. Activated by UV light, gets into UV structure
  3. Stops cell in basal layer from dividing- do not get so many cells that disrupt stratuemn corneum
26
Q

How do you treat psoriasis using systemic (oral) treatments?

A
  1. Acitretin (retinoid): combined with other treatments
  2. Cyclosporin: used for severe psoriasis and severe eczema
  3. Methotrexate
27
Q

What is acne vulgaris

A

Hair follicles with sebaceous glands that become blocked

Characterised by comedones (mild to moderate), papules, nodules, cysts (severe)

28
Q

How do you treat acne vulgaris

A

Mild: benzoyl peroxide, azelacid acid, topical retinoids, salicylic acid

Moderate: tetracyclines, deoxycline

Severe: Oral isotretinoin (effective but has side effects)

29
Q

What is rosacea characterised by and symptoms

A
  1. Inflammatory skin condition affecting middle third of face
  2. Symptoms: persistent redness over areas of face and nose that normally blush, dilatation of blood vessels appearing under skin
30
Q

How is rosacea normally caused

A

Affects those that blush easily

Emotional factors: stress, fear, anxiety, embarrassment

Helicobacter pylori and certain medications (vasodilations)

Certain foods and beverages (alcohol, coffee, tea)

31
Q

How do you treat rosacea

A

DO NOT USE BENZOYL PEROXIDE

  1. Topical metronidazole
  2. Azeliac acid
  3. Tetracycline, minocycline, doxycycline
  4. Start with oral, topical formulations then move to maintenance cream
  5. ISOTRENOLIN can be used for most severe

PM3A: Spring (16 decks)

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