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Mar Der > Fitz9. Part 3. Dermatitis > Flashcards

Fitz9. Part 3. Dermatitis Flashcards

1
Q

Case: multiple pruritic erythematous papulovesicles with pinpoint crusting or frank weeping on flexures and extremities

  1. Disease?
  2. primary manifestation in adults?
  3. hallmark symptom of disease?
A
  1. ATOPIC DERMATITIS
  2. chronic hand eczema
  3. pruritus
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2
Q

Major criteria of atopic dermatitis

A

pruritus,
eczematous dermatitis: face extensors infant, flexures adult
chronic relapsing disease,
personal or family history

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3
Q

most common complication in atopic dermatitis:

  1. Bacterial:
  2. viral:
  3. fungal:
A
  1. Bacterial: superficial staph aureus
  2. viral: eczema herpeticum
  3. fungal: Malassezia sympodialis
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4
Q

(2) pathways responsible for atopic dermatitis

A
  1. epidermal dysfunction

2. altered/ innate or adaptive immune response

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5
Q

decrease in skin barrier function of atopic dermatitis due to inc/dec of:

  1. cornified envelopes
  2. ceramide
  3. proteolytic enzymes
  4. TEWL
A
  1. Dec cornified envelopes
  2. Dec ceramide
  3. Inc proteolytic enzymes
  4. Inc TEWL
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6
Q

Mutations seen in atopic dermatitis

  1. loss of function mutations
  2. gain of function mutations
A
  1. loss of function: filaggrin

2. gain of function:IL4, IL13

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7
Q

the only FDA approved systemic drug for atopic dermatitis that targets IL4 and IL13

A

Dupilumab

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8
Q

Syndromes with atopic dermatitis are ___ with ___ mutations

A
  1. Netherton (SPINK5)

2. NISCH (Claudin 1)

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9
Q

key cytokines in atopic dermatitis (2)

A

TSLP, IL33

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10
Q

chemokines in atopic dermatitis

A

fractalkine, IFNy-10, monokine CC chemokines, eotaxin, RANTES

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11
Q

most potent cytokines downregulating filaggrin in atopic dermatitis (3)

A

TSLP, IL4 and IL13

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12
Q

IL___ that causes pruritus in atopic dermatitis

A

IL31

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13
Q

Histopathologic difference between acute versus chronic atopic dermatitis

A

Acute: spongiosis, inc memory T cells, DEgranulating mast cells

Chronic: elongated rete ridges, inc IgE, macrophages in dermis, granulated mast cell, eosinophils

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14
Q

cornerstone treatment of mild atopic dermatitis

A

emollients

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15
Q

FDA drug for younger children with atopic dermatitis (3)

A

Desonide, fluocinolone, fluticasone

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16
Q

Case: well-demarcated coin-shaped plaques form from coalescing papules and papulovesicles. Often studded or satellite papulovesicles appear at periphery with crust at the entire surface with normal surrounding skin.

  1. Disease?
  2. Commonly assoc with? (5)
  3. Commonly assoc infection?
  4. Due to what drugs? (7)
  5. Mainstay treatment?
A
  1. NUMMULAR ECZEMA
  2. atopic dermatitis, xerosis, ICD, ACD, candida
  3. Staph infection: odontogenic/ dental
  4. Isotretinoin, IFN a-2b, infliximab, gold, ribavirin, amalgam, mercury
  5. topical corticosteroids
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17
Q

Case: lichenified dry and scaly plaques with excoriations on the scalp, name, angles, extensors. May have hyperlinear palms

  1. Disease?
  2. associated with what disease?
  3. histopath?
A
  1. LICHEN SIMPLEX CHRONICUS
  2. Atopic dermatitis (dennie morgan fold, hyperlinear palms)
  3. thickened papillary dermal collagen with vertical streaks
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18
Q

Case: Hyperkeratotic firm hard nodules with overlying excoriation. May see sparing of the upper back or butterfly sign.

  1. Disease
  2. Pathogenesis
  3. hallmark of disease
  4. what is this disease called if it is associated with atopic dermatitis?
  5. histopath and stain?
A
  1. PRURIGO NODULARIS
  2. Increase CGRP (calcitonin), substance P, nerve growth factor, TNFa, IL1, IL8, TRPV
  3. itch
  4. besnier prurigo
  5. thick epidermal collagen with neural hypertrophy. S100.
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19
Q

Case: pruritic eczematous dermatitis initially localized to the primary site of allergen exposure

  1. Disease?
  2. key components of the history as clues to allergy?
  3. key symptom for this disease?
  4. diagnostic test of choice
  5. mainstay tx
  6. first line tx.
A
  1. ALLERGIC CONTACT DERMATITIS
  2. itch and swelling
  3. pruritus
  4. patch testing
  5. avoidance
  6. topical corticosteroids
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20
Q

ACD is what type of hypersensitivity reaction?

A

Type IV (delayed)

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21
Q

What are the primary cells responsible for contact sensitization?

A

CD1a+/ CD141+ dermal dendritic cells

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22
Q

What are the cluster of immune cells in the elicitation phase

A

inducible skin associated lymphoid tissue

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23
Q

Define the types of allergic contact dermatitis:

  1. acute
  2. subacute
  3. chronic
A
  1. acute: erythema, edema, vesicles
  2. subacute: oozing, scaly juicy papules with weeping and crusting
  3. chronic: scaling, fissuring, lichenified erythematous plaques
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24
Q

hair allergens

  1. permanent hair dyes (but spares the scalp)
  2. permed/waved hair
  3. bleach
  4. relax
A
  1. permanent hair dyes (but spares the scalp): PPD
  2. permed/waved hair: GMT
  3. bleach: ammonium persulfate
  4. relax: sodium hydroxide
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25
Q

this allergen has a risk of active sensitization during patch testing

A

PPD

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26
Q

allergen causing eyelid dermatitis and is the most common allergen causing persistent patch test reaction of more than 30 days

27
Q

most prevalent contact allergens (3)

A

nickel, thimerosal, fragrance mix

28
Q

systemic exposure to allergen in a sensitized patient with a subsequent development of cutaneous delayed hypersensitivity reaction

A

systemic contact dermatitis

29
Q

the simplest presentation of systemic contact dermatitis that occurs at a site of PRIOR topical sensitization

A

localized recall reaction

30
Q

ERYTHEMA of the buttocks and upper inner thighs due to application of mercury/ nickel/ ampicillin

A

Erythrodermic systemic contact dermatitis/ baboon

31
Q

specific cutaneous ADR in which previous cutaneous sensitization is NOT a necessary condition

A

SDRIFE/ symmetric drug-related intertriginous and flexural exanthema

32
Q

all cutaneous reactions that share the commonality of SENSITIZATION occurring through cutaneous exposure

A

ACD syndrome

33
Q

scattered generalized distribution has how many body sites involved?

34
Q

causes dyshidrosiform hand eczema

A

nickel and balsam

35
Q

mc antibiotics in ACD

A

neomycin and bacitracin

36
Q

single most important clue in the diagnosis of ACD

A

dermatitis distribution

37
Q

criteria of SDRIFE/ symmetric drug-related intertriginous and flexural exanthema (5)

A
  1. exposure to systemic drug
  2. sharply demarcated eryhtema (gluteal or V shaped inguinal)
  3. invt of intertriginous/ flexural
  4. symmetrical
  5. no systemic signs and symptoms
38
Q

stages of ACD syndrome (1,2,3a,3b)

A
  1. Localized
  2. regional
    3a. generalized or distant
    3b. systemic
39
Q

3 markers for topical steroid allergy (TBH)

A

tixocortol
budesonide
hydrocortisone

40
Q

safest topical steroid from an allergic standpoint

A

Desoximethasone ointment

41
Q

Case: redness, fissuring, oozing, pain with epidermal hardening after exposure to rubber.

  1. disease?
  2. primary finding?
  3. important sign?
  4. skin resolves as ___ after continued exposure
  5. best treatment
A
  1. IRRITANT CONTACT DERMATITIS
  2. epidermal disruption
  3. flexural accentuation
  4. hardening
  5. avoidance
42
Q

atopic dermatitis patients had greater reactivity to this specific irritant

A

sodium lauryl sulfate

43
Q

dermal injury producing scarring can result from corrosive chemicals except if it is within ___ hours

44
Q

atopic dermatitis is associated with inflammatory responses to these 3 common organisms

A

(‘SAM’)
staph aureus
Malassezia sympodialis
alternaria

45
Q

What are the common irritants for ICD?

A 
(SAD2)
solvents (including water)
anti-wrinkle medicaments
detergents
disinfectants
46
Q 
Compare ICD vs acd in terms of 
1. margination and site
2. evolution
3. causative agents
4 incidence
A

ICD

  1. sharp(acute)/ ill-defined (chronic); strictly confined to the site of exposure
  2. rapid (hours)
  3. dependent on CONCENTRATION of agent and state of skin barrier; occurs only above threshold level
  4. everyone
47
Q

Case: erythematous greasy scaling patches and plaques on the scalp and face.

  1. disease?
  2. normal flora important in this disease (3)
  3. this disease is an indicator for evaluating the progression of what disease?
  4. drugs that may cause this disease?
A
  1. SEBORRHEIC DERMATITIS
  2. Malassezia, pityriasis versicolor, pityrosporum folliculitis
  3. HIV-associated seborrheic dermatitis
  4. griseofulvin, cimetidine, lithium, methyldoma, arsenic, gold, etc
48
Q

Case: Seborrheic dermatitis with diffuse papular eruption with peripheral erythema on trunk.

A

PITYROSPORUM FOLLICULITIS

49
Q

Case: infantile Seborrheic dermatitis with desquamative erythroderma, sparse hair; frequent loose stools, failure to thrive.

  1. disease?
  2. associated with what disease?
A
  1. LEINIER DISEASE

2. Netherton disease

50
Q

Case: large plates of thick silvering scale firmly adherent to both scalp and hair tufts.

  1. disease?
  2. common feature with staph infection?
  3. most frequently associated with what disease?
  4. causative drug?
A
  1. PITYRIASIS AMIANTACEA
  2. Alopecia
  3. psoriasis
  4. vemurafenib
51
Q

Differentiate classic versus HIV-ASSOC seborrheic dermatitis histopathologically

A

E: widespread parakeratosis
many necrotic keratinocytes
focal interface obliteration with cluster of lymphocytes
spares spongiosis
D: many thick walled vessels, increase in plasma cells , focal leukocytoclasis

52
Q

second most common occupational disease

A

OCCUPATIONAL SKIN DISEASE

53
Q

allergens for healthcare workers (4)

A

glutaraldehyde,
formaldehyde,
quaternium-15,
thiuram mix

54
Q

hairdresser whose hands are excessively wet with thinner skin at dorsum of hands

A

IRRITANT REACTION DERMATITIS

55
Q
  1. weak irritants with multiple subthreshold insults versus

2. harsh cleansers after acute skin trauma

A
  1. CUMULATIVE DERMATITIS

2. TRAUMATIV DERMATITIS

56
Q

elderly with extensive usage of soaps forming ichthyosiform itchy scaling

A

ASTEATOTIC DERMATITIS

57
Q

postadolescent without teenage acne presenting with pustules.

  1. disease
  2. due to what?
A
  1. PUSTULAR/ ACNEIFORM DERMATITIS

2. Croton / mineral oil

58
Q

multiple closed comedones and straw-colored cysts at malar crescents and retroauricular folds.

  1. disease
  2. due to what
A
  1. CHLORACNE

2. TCDD

59
Q

painful vascular spasms on the fingers and hands due to use of vibration-producing tools.

  1. disease
  2. what type of raynaud?
  3. number of Hertz
  4. risk factor involved
A
  1. VIBRATION INDUCED WHITE FINGER
  2. 2nd type
  3. 30-300 Hz
  4. smoking
60
Q

prolonged exposure of heat (laptop)

A

ERYTHEMA AB IGNE

61
Q

most common contact urticaria that is not inhibited by H1. it is localized and less severe

A

NONimmunologic contact urticaria

62
Q

Type of bleaching hair booster that causes erythema edema, pruritus, URTICARIA, syncope, wheezing, dyspnea

A

ammonium persulfate

63
Q

What are the 4 components of health risk assessment?

A
  1. hazard identification
  2. dose-response relationship
  3. exposure assessment
  4. risk characterization
    (“Hi DER”)
64
Q

A component of health risk assessment that helps delineate relative threshold concentrations of an exposure that results in adverse health effects that are dose- dependent with esposure

A

dose-response relationship

Mar Der (21 decks)

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