Gen Derm 1 Flashcards by Kat Chiang

What HLA is associated with early onset psoriasis and guttate psoriasis?

HLA CW6

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What HLA is associated with saroiliitis- associated psoriasis?

HLA B27

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What HLA is associated with guttate and erythrodermic psorasis?

HLA B13, B17

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Psoriasis has an increase in what cytokines?

TH1 cytokines, IL1, IL2, IL6, TNFa

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Psoriasis has an decrease in what cytokines?

IL10

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What stimulates the Th17 cells to secrete what?

IL23 stimulates Th17 to secrete IL17, IL22

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What cytokine causes neutrophil chemotaxis that form the pustules of Kogoj and Munro?

CXCL8

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Keratinocytes secrete what antimicrobial proteins?

Keratinocytes secrete antimicrobial proteins (hBD 1-2, cathelicidin LL37, and SLP1)

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Systemic drug triggers for psoriasis?

(HB LITT) Hypocalcemia B-blockers Lithium, IFNs, TNFalpha, Terbinafine

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What systemic drug triggers have a long latency?

Lithium, B blockers

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What is impetigo herpetiformis? How/when does it present? What do you treat with?

Pregnancy associated generalized pustular psoriasis which begins in the flexures then generalizes. 3rd trimester. Treat with 1mg/kg of prednisone. Cyclosporine in refractory cases.

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What is von Zumbusch pustular psoriasis associated with?

Fever, leukocytosis, hypoalbuminemia, hypocalcemia

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Is there a fetal risk for impetigo herpetiformis?

Yes, Increased risk of stillbirth and perinatal mortality remains high, due to placental insufficiency, premature rupture of membranes, preterm labor and intrauterine growth restriction.

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What syndrome can palmopustular pustulosis be associated with?

SAPHO. Synovitis, Acne, Pustulosis, Hyperostosis. Osteitis + IBD.

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Psoriasis nail pits is d/t problems in what area of the nail?

Proximal matrix

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Psoriasis nail leukonychia is d/t problems in what area of the nail?

distal matrix

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Psoriasis nail subungal hyperkeratosis is d/t problems in what area of the nail?

nail bed> distal matrix

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Psoriasis nail oil spots, splinter hemorrhages, onycholysis, subungal hyperkeratosis are d/t problems in what area of the nail?

Nail bed (oil spots d/t exocytosis of lymphocytes) (splinter hemorrhages d /t fragility of capillaries), subungal hyperkeratosis and distal onycholysis are d/t parakeratosis of the nail bed

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What retinoid is effective for psoriasis? what type of psoriasis?

Acitretin. Erythrodermic and pustular psoriasis

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What does ustekinumab inhibit?

IL12, IL23

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Treatment for pustular von Zumbusch?

acitretin> cyclosporine> MTX> biologics

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whats the woronoff ring?

plae blanching rink around psoriatic lesions

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What are the scalp, skin, hand and nail clinical features of PRP?

Scalp erythema, folliculocentric keraototic papules on erythematous base, orange waxy keratoderma of palms and soles, thick yellow-brown nails

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What the classic PRP types in adults and kids?

Type 1 adult, type 3 kids

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What is the localized form of PRP?

Type 4 in children.

Treatment for PRP? name 4. whats 1st line?

Firt line is acitretin or isotretinoin 2mg/kg/day. Also vitamin A, MTX, TNF alpha inhibitors.

Histopath for PRP?

checkerboard (alternating vertical and horizontal parakeratosis and orthohyperkeratosis)

What drugs induce Pityriasis Rosea?

To get good PR, ACE stole GOLD from the BARbituates, but was b-BLOCKED by ICEsotretinoin. Ace inhibitors, gold, barbiturates, beta-blockers, isotretitoin.

What is inverse PR?

involvement of intertriginous sites, or more prominent involvement oft he limbs

What treatments for PR will hasten clearance?

erythromycin for 14 days, acyclovir 800 mg five times daily for 1 week

Pregnant women with PR will have what?

Increased likelihood of spontaneous abortion if they get PR during the first 15 weeks of gestation

Location of intertriginous/axillary granular parakeratosis?

axilla, inguinal, inframammary

Whats the #1 systemic finding in erythroderma?

peripheral ymphadenopathy

Whats the #1 cause of erythroderma in healthy patients? in HIV patients?

in healthy patients it's psoriasis, in HIV patients it's drugs

What are some causes of drug induced erythroderma?

Allopurinol, sulfa, antiepileptics, Isoniazid, HAART, minocycline. Picture tristan thompson eating at RED.

What is the diagnostic criteria for sezary syndrome?

1. T cell clone in the blood (preferably same as skin) 2. >1000 cells/mcL or 2. CD4:CD8 ratio of >10:1

Treatment for CARP?

Minocycline 100mg BID for 6 wks

Genes encoding what epidermal proteins are associated with AD development?

Filaggrin mutation and SPINK

What cytokines are upregulated in eczema?

IL4,IL5, IL12, IL13,

What is hertoghe sign?

diminished lateral eyebrows in eczema

Children with eczema can often have what 4 associated derm things?

pityriasis alba, lichen spinulosis, dyshidrotic eczema, juvenile plantar dermatosis

what are some ocular complications of eczema. In adults? in kids?

In adults, atopic keratoconjunctivitis. In kids, vernal keratoconjunctivitis. Posterior subcapsular cataracts. Keratoconus (elongation of the cornea). Retinal detachment.

In high risk AD patients, what is the best prevention?

Breastfeeding in the first 4-6 months of life

When during the menstrual cycle does progesterone dermatitis start?

Luteal phase (1 week before menses)

What is the diagnostic test for progesterone dermatitis?

intradermal injection of progesterone

MOA of irritant dermatitis? Need sensitization? most common site?

Via direct damage of keratinocytes by irritant, not immune mediated. Does not need sensitization. Hands most common site

Cross-reaction definition?

compounds with similar chemical structures ie poison ivy and mango peel

Co-reaction definition?

compounds that are commonly used together ie neomycin and bacitracin

Phytophotodermatitis is due to a reaction between what and what?

fucocoumarins and UVA, which causes blistering and then hyperpigmentation afterwards

Bergamot oil causes phytophotodermatitis via what?

5-methoxypsoralen, a furocoumarin

Fingertip ACD?

Florist, tulip

Eyelid ACD?

tosylamide> acrylates from nail products

Disperse Dye ACD types? Found where?

Blue dyes 106, 124. Found in 100% acetate (derived from cellulose) and 100% polyester liners of women's clothing.

Cosmetic ACD?

fragrance

Perianal ACD? Name 2

Lidocaine and preservatives

Shoe dermatitis? Name 3

Mercaptobenzzothiazole (rubber accelerator) Chromates (leather), and Colophony (adhesives)

Airborne ACD?

compositae

Ulcer ACD?

bacitracin, neomycin, lanolin

What can have delayed positive patch test? name 6

Gold, neomycin, PPD, corticosteroids, dodecyl gallate (preservative in foods), palladium

How do you treat hydrofluoric acid Irritant Contact dermatitis ?

Neutralize with calcium gluconate.

How do you neutralize phenol?

65% ethyl or isopropyl alcohol.

What is a cause of non-immunologic contact urticaria?

nettle/urticaceae family which has sharp hairs on plants that contain histamine, serotonin, and acetylcholine. Everyone which contacts it gets urticaria.

What is the cause of mechanical Irritant contact dermatitis?

Prickly pear (opuntia spp.) which causes glochid dermatitis causing penetrating injuries. Inoculates clostridium tetani, s aureus, s shenckii and atypical mycobacteria

Chemical ICD: Bromelin?

Pineapple

Chemical ICD: calcium oxalate? name 3 flowers, 1 plant, 1 fruit

daffodil (narcissus spp), hyacinth, tulip, dumbcane, pineapple

Chemical ICD: capsacin?

Solanaceae family with hot peppers

Chemical ICD: phorbol esters + diterpenes (latex)? name 3

Euphorbiacea family in croton plant, spurges, and poinsettas

Chemical ICD: ranunculin/protoanemonin? how do you differentiate between this and phytophoto?

Buttercups and marigolds. No post-vesticular hyperpigmentation like in phytophoto

Chemical ICD: Thiocyanates? name 2

alliacea family with garlic AND brassicaceae family with blackmustard/radish

Phytophotodermatitis plant families (4) Floating on the MAR

Fabaceae, Moracea, Apiaceae/umbelliferae, Rutaceae

Apiaceae/umbelliferae contains what plants and vegetables?

Hogweed, parsley, chervil, parsley, parsnips, celery, carrots

Rutaceae contains what plants ? 2

Cirtus (lemon, lime, grapefruit), hawaiian leis

Moraceae contains what plants? 2

figs, mulberry

Fabaceae contains what plants? 2

Scurf Pea, Balsam of Peru

Rhus dermatitis is what family? What is the allergen?

Anacardiaceae. Allergen is urushiol's derivative called pentadecylcatechol

Exotic hardwoods can cause what type of ACD?

Erythema multiforme like reaction

Test for nickel?

DMG test

Chromates found in?

Green Dyes, Cement, leather

Cobalt found in?

Blue-green dyes, glass/pottery, cement, Vitamin B12 injections (hand dermatitis), metal products

Poral reaction in what allergen?

Cobalt

Most common cause of oral lichenoid reaction?

Amalgams

Risk factors for latex allergy?

Spina bifida, healthcare profession

Latex will cross react with what?

Bananas, Avocado, chestnut, kiwi, passion fruit

Most common glove allergy?

Thiuram

What allergen is released from bleached elastic?

Carbamates

What is the #1 cause of shoe dermatitis?

MBT (mercaptobenzothiazole)

What do thiurams cross react with?

disulfiram (treatment for alcohol abuse)

Wet suit dermatitis?

neoprene (dialkyl thioureas)

PPD found in?

Hair dye, printer ink, black rubber

What are the 4 types of rubber accelerators?

Thiuram, Carbamates, Diphenylguanidine, benzothiozoles, Hexamethylenetetramine

Allergy to glue that holds leather products together?

p-tert-butylphenol formaldehyde (PTBP)

Allergy to PVC and plastic materials?

Epoxy resin

Allergy to Krazyglue for artificial nails?

Cyanoacrylates (ethyl)

Dermabond allergy ingredient?

Octyl cyanoacrylate

Artificial joint and dental prostheses allergy?

methacrylate

What textile has the least formaldehyde?

polyester