Gen Derm 3 Flashcards
1
Q
What is the most common type of juvenile idiopathic arthritis? What joints does it affect?
A
Oligo/pauciarticular arthritis (60%). Usually favors knees.
2
Q
There are two types of oligo arthritis type JIA. What are they?
A
Type 1 is the most common type. In 1-8yo, have uveitis in 50%. ANA positive, RF negative. Type 2 is in 9-16yo, ANA -, RF-
3
Q
Is JIA an autoimme disease?
A
No, should be classifed as an autoinflammatory sndrome as it is due to activation of innage immune system’s iL1
4
Q
How does JIA present?
A
High episodic fevers with salmon pink rash in the late afternoon/evening
5
Q
What does the two JIA rashes look like?
A
There’s the pink evanesent rash that favors the waist and axilla, and also koebnerizes. And there’s another one with persistent papules and plaques
6
Q
What does the two JIA rash look like on histopath?
A
The evanescent one looks like urticaria but with more neutrophils. The persistent papules one look like urticaria + parakeratosis and superfically scattered necrotic keratinocytes
7
Q
What are two types of good treatments for juvenile stills?
A
IL1 receptor inhibitor: anakinra, rilonacept, canakinumab and IL6 receptor inhibitor tocilizumab
8
Q
What is a classic arthritic finding for adult onset stills?
A
Carpal ankylosis: limited range of motion with minimal pain
9
Q
What does ANA, RF, ESR, CRP and ferritin look like for adult stills?
A
ANA RF negative for adults. ESR/CRP high and Ferritin >4000
10
Q
If the JIA kid has polyarthritis instead of oligoarthritis, and the ANA and RF are positive, what does that mean?
A
That he has erosive joint disease and like will get rhueumatoid nodules
11
Q
Most common type of morphea in adults and kids
A
plaque type in adults, linear in kids
12
Q
What Borrelia spp is associated w morphea in europe and japan?
A
Borrelia afzelii and Borrelia garinii
13
Q
most common site for linear morphea
A
legs
14
Q
antibody for linear morphea?
A
ssDNA
15
Q
What does atrophoderm of Pasini and Pierini look like clinically and histologically?
A
Hyperpigmented oval atrophic plaques with cliff drop borders. On histopath, you have decreased dermal thickness
16
Q
How is linear atrophoderma of moulin different from other types of morphea?
A
less induration and less pigmentary changes
17
Q
NSF, Scleromyxedema, morphea, scleroderma. Which ones lose CD34?
A
Morphea and scleroderma lose CD34+ dendritic cells
18
Q
What antibody do all forms of morphea have?
A
All forms of morphea are positive for anti-topoisomerase 2 antibodies. They are all negative for topoisomerase 1 (scl70) and centromere. Those are positive in systemic sclerosis
19
Q
Linear morphea and generalized morphea are most likes to be + for what antibodies?
A
ANA and antihistone and ssDNA
20
Q
What Xray finding do you see in linear morphea?
A
Melorheostosis. Which is roughening long bone surfaces underlying area of linear morphea. Resembles wax dripping. Also seen in buschke Ollendorff
21
Q
how do you treat superficial generalized morphea?
A
nbUVB
22
Q
how do you treat deep generalized morphea?
A
MTX, pulsed intravenous corticosteroids + MTX
23
Q
What is the profibrotic cytokine seen in scleroderm, morphea and eosinophilic fascitiis?
A
TGF BETAAAA
24
Q
Nail dermoscopy for scleroderma?
A
dilated capillary loops alternating with capillary drop out
25
ventral pterygium
scleroderma
26
most common cause of death in scleroderma? How do you screen for it?
interstital lung disease. Screen with CT and PFTs
27
pulmonary problem in diffuse scleroderma
ILD
28
pulmonary problem in limited scleroderma? What does limited scleroderma look like clinically?
pulmonary hypertension. Also with sclerosis of distal fingers and face.
29
most common site of visceral disease in scleroderma?
esophageal dysphagia and dysmotility causing aspiration and esophagitis
30
diffuse systemic sclerosis patients should be given what to prevent scleroderma renal disease?
ACE-inhibitors
31
what can you give for digital ulcers in scleroderma?
IV iloprost (prostacycline analogue), Bosetan (endothelin receptor antagonist, prevent new ulcers)
32
what is scleroderma's earliest presenting features?
raynauds and hand edema
33
what's a new biomarker for skin and lung fibrosis and PAH?
CXCL4
34
does eosinophilic fasciitis have raynauds phenomenon?
no it does not
35
where is the eosinophilia in eosinophilic fasciitis?
pheripheral eosinophilia >> tissue eosinophilia
36
what is a new serologic marker of eosiniphilic fasciitis activity?
metalloproteinase inhibitor-1 (TIMP-1)
37
cause of nephrogenic systemic fibrosis?
gadolinium-containing contrast exposure in the setting of acute kideny injury or CKD
38
onset of NSF fibrosis?
about 2-4 weeks after gadolinium exposure
39
What do you see in the eyes of nephrogenic systemic fibrosis patients?
scleral plaque (white yellow plaques) with dilated capillaries in patients <45yo
40
How does histopath of NSF fibrosis different from scleromyx?
the fibrosis of NSF goes down to the fat and fascia
41
NSF fibrosis is mediated by what cells?
CD34+ and Procollagen I+ cells
42
Tx for NSF?
skin is refractory to treatment. The treatment of kideny disease is most important
43
What types of scleredema can have facial involvement?
Types 1 (post-infectious) and Type 2 (monoclonal gammopathy)
44
Name the 3 types of scleredema?
Type 1 Strep pharyngitis. Type 2 IgGk monoclonal gammopathy. Type 3 Diabetes.
45
What is scleromyxedema associated with? Gammopathy. Extracutaneous involvement.
IgG lamda. GI:dysphagia, MSK: arthritis, proximal muscle weakness, carpal tunnel, Neuro: peripheral neuropathy
46
Glomeruloid hemangiomas associated with?
POEMs (polyneuropathy, organomegaly, endocrinopathy, M -protein, skin changes)
47
Diabetic cheiroarthropathy
symmetric painless loss of joint mobility , stiffness of joints with scleroderma-like thickening of the dorsal aspect of the hands and feet (prayer sign)
48
What exogenous substances cause scleroderma?
aniline contaminated rapeseed cooking oil, L-tryptophan (eosinophlia-myalgia syndrome), Polyvinyl Chloride, Bleomycin, taxanes (diffuse leg edema followed by sclerosis)
49
What agents can cause sclerosis at injection sites?
Vitamin K, bleomycin, opiods (methadone, pentazocine)
50
Familial and acquired perforating dermatosis difference? What is perforating?
Collagen. Familial reactive perforating is rare childhood onset at sites of trauma vs acquired perforating dermatosis is in adults and d/t diabetes and/or renal failure
51
Wher do you find EPS commonly on the body?
serpiginous plaques with keratotic papules along the rim on the lateral neck
52
MAD PORES is for what disease? What does it stand for
EPS (Marfans, Acrogeria, Downs, Penicillamine/PXE, Osteogenesis Imperfecta, Rothmund-Thomson, Ehers-Danlos, Scleroderma)
53
What is perforatin calcific elastosis?
Transepidermal elimination of clacified elastic fibers periumbilical multiparous black women
54
Anetoderma on histopathology
Normal H&E. elastic tissue stain shows near complete loss of elastic fibers in papillary and reticular dermis;fragmented elastic fiber remnants visible
55
What is follicular atrophoderma?
Ice pick depresseions on the doral hands/feet and cheek since childhood
56
What syndrome is follicular atrophoderma associated with?
Bazex Dupre Christol syndrome (follicular atrophoderma, BCC of the face, milia, hypohidrosis anove neck, hypotrichosis). Think of a priveliged french person with acne scars, cosmetic treatements that made him hairless, sweatless)
57
What is atrophoderma vermiculatum?
A variant of follicular atrophoderma on the face/cheeks exclusively
58
What syndrome is atrophoderma vermiculatum associated with?
Rombo (atrophoderma vermiculatum, BCC, milia, acral erythema, peripheral vasodilation with cyanosis) and Naicolau Balus (eruptive syringomas, atrophoderma vermiculata and milia)
59
Perforating GA most commonly on? Perforating with what?
Dorsal hands and fingers. Perforating with degenerated collagen
60
Interstitial granulomaous drug eruption culprit?
CCBs, ACE, TNFalpha
61
NXG clinical presentation?
Yellow-xanthomatous plaques in the periorbital region
62
NXG associated with what gammopathy? What other organ system can it also affect?
IgG kappa. Enodcardial involvement. Hepatosplenomegaly common.
63
Cutaneous Crohns disease can manifest as what skin diseases?
Erythema nodosum, PG, pyostomatitis vegetans, EB aquisita (IBD is the most common cause of EBA), acrodermatitis enteropathical-like syndrome
64
Genital crohns can look like what?
labial or scrotal edema with erythema +/- ulcerations and fissures
65
What does oral crohns look like?
cobblestoning of buccal mucosa, pyostomatitis vegetands, cheilitis granulomatosa
66
Sarcoidosis is a multisystem grnaulomatos disease cause by upregulation of what type of T cells?
Th1 cells
67
What are three drugs that can cause sarcoidosis?
Hepatitis C pts on IFN-alpha, and ribavirin, HIV patients on HAART, TNF alpha inhibitors
68
What percentage of sarcoid patient have skin lesions?
35%
69
why do sarcoid patients have hypercalcemia?
due to calcitriol synthesis by arcoidal granulomas (convert 25-hydroxyvitamin D) to more active 1,25-dihydroxyvitamin D
70
What laboratory or imaging tests do you need for sarcoidosis? What would it show?
CXR/CT scan to detect hilar lymphadenopathy, PFTs to detect restrictive lung disease (decreased TLC, DC, Vital Capacity), increased ACE levels (useful for monitoring response to treatment)
71
Is measuring ACE levels in Sarcoidosis useful?
Yes, useful for monitoring response to treatment
72
What is darier-roussy? Whats the prognosis?
subcutaneous sarcoid, painless, firm, often multiple lesions. A/w good prognosis
73
whats lofgren syndrome? Whats the prognosis?
acute form of sarcoidosis with erythema nodosum and hilar adenopathy and fever and acute iritis and polyarthritis. a/w good prognosis
74
What's heerfordt's syndrome?
Uveitis + parotid gland enlargmeent + fever + cranial nerve palsy (facial nerve)
75
Blau syndrome?
Early onset sarcoid-like disease caused by NOD2 mutation. Triad of skin, eye, and joint disease
76
what is the prognosis for lupus pernio?
strongly associated with chronic sarcoid lung (75%) and upper respiratory tract disease (50%) along with cystic degeneration of the bones. Poor prognosis
77
what color is the most comon cause of delayed reaction in tattoo?
Red (mercuric sulfide, cinnabar)
78
what colors are the most comon causes of photoallergic reaction in tattoo?
Yellow (cadmium sulfide), red ink (cadmium selenide), yellow-red (azo dye)
79
what type of reaction does red tattoo have on histopath?
Lichenoid dermatitis sor pseudolymphoma
80
what type of reaction does aluminum tattoo have on histopath?
granulomatous
81
Silica foreign body reactions are from penetrating injuries from what 4 things over 25 years?
Sand, soil, rocks, glass
82
what type of reaction does silica foreign body reaction have on histopath?
sarcoidal granulomas containing colorless, birefrigent crystals
83
Where do you find zirconium? What can it cause clinically?
in antiperspirants. Causes soft brown papules in axilla.
84
what does a zirconium foreign body reaction look like on histopath?
no polarizable particles seen
85
what 3 foreign body materials are too small to be seen by polarized light microscopy?
zirconium, beryllium, aluminum
86
Where do you find beryllium What can it cause clinically?
found in the manufacturing of fluorescent lights. Inhalation can cause granulomatous lung disease. Localized puncture wounds by fluorescent bulbs can cause slowly healing nodules/ulers
87
how do you diagnosis systemic berylliosis?
bronchioalveolar lavage
88
how do you get alumunium in the skin?
vaccine injection sites, hemostasis
89
how do you get zinc in the skin?
zinc-containing insulin shots
90
what does a zinc foreign body reaction look like on histopath?
birefringent rhomboid crystals
91
how do you get starch in the skin?
contamination of rounds from surgical gloves with starch lubricant
92
what does a starch foreign body reaction look like on histopath?
oivoid basophilic starch granules that stain postive with PAS
93
what does a ILK foreign body reaction look like on histopath?
Granuloma with central pale bluish material that resembles mucin on H&E
94
Is Silica PAS positive or negative?
negative
95
Is talc PAS positive or negative?
negative
96
Is zinc PAS positive or negative?
negative
97
Is keratin PAS positive or negative?
negative
98
Is sea urchin spine PAS positive or negative?
negative
99
Is sutures PAS positive or negative?
negative
100
Is arthropod parts PAS positive or negative?
negative
101
Is starch PAS positive or negative?
positive
102
Is cactus spines PAS positive or negative?
positive
103
Is wood splinters PAS positive or negative?
positive
104
Macrophage histiocytes stain positive for what 2 markers?
CD 68 and HAM 56
105
Dermal dendritic cells stain positive but singly for what 2 markers?
Factor 13a for papillary dermis dendritic cells and CD 34+ for reicular dermis dendritic cells
106
Langerhan cell histiocytosis have mutations in what?
BRAF V600E mutation (60%) and MAP2K1 mutations
107
Langerhan cell histiocytosis stain negatively for what?
Factor 13a, CD 68, HAM 56
108
2-6 year old kids that present with disseminated LCH have what triad?
Diabetes insipidus (Excessive urination and extreme thirst as a result of inadequate output of the pituitary hormone ADH (antidiuretic hormone, also called vasopressin)) , osteolyitic bone lesions in the skull, exophthalmos
109
how do you treat diabetes insipidus
vasopressin
110
Congenital self-healing reticulohistiocytosis vs benin cephalic histiocytosis. Which is a langeran cell histiocytosis?
CSRH
111
Non-langerhan cell histiocytosis stain positive for? Negative for?
Positive for CD 68, Negative for Langerin
112
CD1a and S100 is positive in what non-langerhan cell histiocytosis?
Indeterminate cell histiocytosis
113
S100 and CD68 is positive in what histiocytosis?
Rosai Dorfman
114
JXG can also involve what part of the eye?
Iris
115
Risk factors for JXG eye involvement?
Multiple cutaneous JXGs and children <2yo
116
Whats the triple association of JXG?
JXG, NF1, and JMML. >20x increased risk of juvenile myelomonocytic leukemia
117
Describe Generalized eruptive histiocytosis. How does it present?
Adults, recurrent eruption of hundreds of small red-brown papules in the axial trunk, proximal extremities, face. No mucosal involvement
118
Indeterminate cell histiocytosis stain?
S100 +, CD1a +, CD 68+, Langerin neg
119
NXG people can have what complicatoins?
ophthalmic ( iritis, episcleritis) , hepatosplenomegaly, leukopenia
120
Describe MRH clinically . Multicentric Reticulohistiocytosis
Coral bead along periungal reion, red brown nodules on the the head, dorsal hands, oral cavity
121
What is MRH associated with?
Destructive arthritis (arthritis mutilans), solitary organ malignancy. melanoma, mesothelioma, lymphoma, and carcinomas of the penis, stomach, ovary, endometrium, breast, and cervix
122
Describe solitary reticulohistiocytoma clinically
Solitary yellow-red nodule on the head
123
Describe Rosai Dorfman clinical syndrome
bilateral cervical lymphadenopathy, fever, night sweats, polyclonal gammopathy,
124
What % of Rosai Dorfman have skin symptoms? Where and What? Natural history?
10% have skin lesion, #1 site is eyelid and malar cheek. Self resolves
125
Xanthoma Disseminatum triad?
cutanoue xanthomas, mucosal xanthomas (airway), diabetes insipidus
126
What is xanthoma disseminatum assocated with?
Monoclonal gammopathy, plasma cell dyscrasia
127
What monoclonal gammopathy is plane xanthomas associated with?
IgG
128
What monoclonal gammopathy is EED associated with?
IgA
129
What monoclonal gammopathy is POEMS associated with?
IgA and igG
130
What monoclonal gammopathy is POEMS associated with?
Type one is monoclonal IgM and IgG, Type 2 is monoclonal IgM and polyglonal IgG
131
Eruptive xanthomas as associated with what types?
type 1, 4, 5
132
If you suspect Reiter's syndrome, what labs should you draw?
HIV
133
Which hyperlipoproteinemias have hypercholesterolemia and are associated with atherosclerosis?
Type 2 and 3
134
Which hyperlipoproteinemia is associated with plane/palmar creases?
Type 3 with familial dysbetalipoproteinemia
135
Which hyperlipoproteinemia is associated with plane xanthomas in the intertriginous and interdigital web spaces creases?
Type 2 familial hypercholesterolemia
136
Eruptive xanthomas usually have triglycerides at what level?
triglycerides usually >3000 mg/dL
137
tuberous xanthomas found where on the body? Associated with which type?
2 and 3
138
verruciform xantomas are found in what areas of the body?
Mouth or genital area
139
are verruciform xanthomas assoicated with hyperlipidemia?
no
140
Veruciform xanthomas can be associated with what syndromes?
CHILD, Epidermolysis bullosa, LS&A, pemphigus, GVHD. Any disorder that causes epidermal damage
141
what non-immunologic mechanisms causes mast cell degranulation?
opiates, C5a anaphylatoxin, stem cell factor, neuropeptides (substance P and VIP)
142
Top 3 causes of acute urticaria
Idiopathic, URIs, Beta-lactams
143
Top 3 causes of chronic urticaria
idiopathic/infection, physical, vasculitic
144
What autoimmune disease is chronic urticaria associated with?
autoimmune thyroid, vitiligo, IDDM,
145
What systemic symptoms do people with urticarial vasculitis have?
Arthralgias (50%), GI involvement (20%), obstructive pulmonary disease (20%)
146
Treatment for schnitzler's syndrome?
Anakinra.
147
Hereditary Angiodema is AD or AR?
AD
148
What ar the two types of hereditary angioedema? Mutation in what enzyme?
both due to mutations in C1 inh. Type 1 (most common) has decreased C1 inh, type 2 due to decrease in C1inh function
149
Acquired angioedema is d/t what disorders?
B -cell lymphoproliferative disorders. Autoimmune CTDs. Plasma cell dyscrasias.
150
For cases of angioedma lacking urticaria (HAE, AAE, ACE-induced), excess what is the cause?
bradykinin
151
How do you distinguish between Type 1 and Type 2 Hereditary angioedema?
C1inh levels (decreased in type 1, normal or increased in type 2)
152
Labs to draw for acquired and hereditary angioedema? What's the screening test?
C4 (decreased ) and bradykinin (increased)
153
How to distinguish between Hereditary and acquired angioedma?
only acquired angioedema has decreased C1q levels because the malignancy forms anti-C1 antibodies
154
What ethnicity has an increased risk of ACE-inhibotr induced angioedma?
Black
155
Is PCN induced angioedema via bradykinin?
no
156
how long does angioedema last?
2-5 dyas
157
Prophylaxis for C1inh deficiency?
danazol
158
What types of sweets syndrome is associated with malignancy?
Ulcerative, bullous, and oral lesions
159
Extracutaneous features of sweets include? Name 4
Fever, Leukocytosis, arthritis, ocular involvement
160
Infectious trigger for sweets?
Strep and yersiniosis
161
Cancer trigger for sweets?
AML
162
Autoimmune trigger for sweets?
IBD
163
Drug trigger for sweets?
G-CSF, GM-CSF, ATRA, Bactrim, Minocycline, OCPS
164
Is pregnancy a trigger for sweets?
Yes
165
What is Marshall syndrome?
Rare childhod disease tha thas Sweets like lesions that resolve with cutis laxa
166
Location and cause of Pyoderma Gangrenosum in kids?
Head and anogenital region, associated with IBD or leukemia
167
Bullous PG is associated with what disease?
AML, CML, MDS
168
Behcet's disease HLA association?
HLA B51
169
Behcets disease is a syndrome of?
Oral ulcerations, genital ulceration, ocular lesions, and cutaneous papulopustules
170
#1 cause of morbidity in Behcets's
Uvetitis, retinal vasculitis (may lead to blindness)
171
what vascular problems do Behcets ppl have?
Superficial migratory thrombophlebitits and SVC thrombosis
172
what's MAGIC syndrome?
Behets and relapsing polychondritis
173
what are patients who have had a jejunoileal bypass urgery and blind loops of bowel at risk for?
Bowel-assoiated dermatosis arthritis syndrome. Overgrowth of bacteria and then immune complexes w/ bacterial antigens that cause a serum sickness like symptoms
174
What is the classic rash for bowel-associated dermatosis arthritis syndrome?
Red purpuric papulo pustules on proximal extremities and trunk AND EN-like lesions on lower legs
175
Treatment for papuloerythroderm of Ofuji.
Systemic steroids, PUVA, oral retinoids. Deck chair sign
176
what are flame figures?
collagen fibers coated with major basic protein
177
Criteria for hypereosinophilic syndrome?
Eos >1500 mm3 for > 6 months or if <6 months, must have organ damage
178
#1 cause of death for Hypereos syndrome?
Congestive heart failure
179
there are two types of hypereos syndrome? What are they, whats the prognosis and what is the treatment?
myeloproliterative HES and lymphocytic HES. Myeloproliferative worse prognosis with cardiomyopathy. Tx is imatinib for myeloproliferative type and prednisone for the lymphocytic type
180
erythema marginatum d/t
group A beta-hemolytic strep infection of the pharynx (in 3% of untreated patients)
181
erythema migrans d/t what bug, what is the natural host?
d/t borrelia burgdorferi. Carried by the Ixodes tick that lives on white-tailed deer and wood mouse
182
what can the Ixodes tick transmit?
borrelia burgdorderi, babesiosis and human granulocyte anaplasmosis
183
After how many hours does the robust transmission of lyme disease happen?
48-72hrs after the onset of feeding
184
Average size of erythema migrans at presentation?
10cm
185
Whe does the peak IgM response happen for lyme disease?
About 3-6 weeks into infection
186
How do you test for lyme disease?
ELIS or IFA. If positive, then western blot
187
Tx for lyme?
Doxy if >8yo. Amoxillin 500mg BID for 2 weeks if <8yo.
188
Tx for lyme neuro disease?
IV ceftriaxone or Penicillin G IV. Both for 2 weeks
189
what % of adults and kids with lyme diseaes develop Erythema migrans?
90% of kids. 50% of adults
190
Whats the agar for borrelia?
barbour-stoenner-Kelly
191
maglinancy for erythema gyratum repens?
lung, breast, GI
192
at what rate does erytehma gyratum repens expand?
at 1cm/day. Rapidly
193
propionibacerium acnes activates what TLR that retinoid downregulate?
TLR2
194
propionibacerium acnes produces what what lites up on woods
Coproporphyrin 3
195
acne fulminans can have what systemic fingind?
Fever, increase WBC, ESR, and STERILE OSTEOLYTIC BONE LESIONS (sternum, clavicle)
196
what malignancy can be mistaken for neonatal acne?
Leukemoid reaction that neonates with trisomy 21 can develop a severe pustular eruption.
197
Cause of chloracne?
Chlorinated aromatic hydrocarbons
198
Tx for chloracne?
isotretinoin
199
drug-induced acne mnmonic?
SHIELD yourself from acne with Vitamin T. Steroids, halogens, Isonizid, EGFR, Lithium, Dilatin (phenytoin), vitamin B 2,6,12 and Testosterone)
200
Tx for EGRF induced acne? What not to give?
doxycline. Do not give irritating topical retoinds or benzoyl peroxide
201
what is the most common site of inflammation for SAPHO syndrome?
Stenoclavicular area is the most common site of inflammation. Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis
202
PAPA stands for
Pyogenic arthritis, PG, Acne
203
PASH/GASH stands for
Pyoderma gangrenosum, Acne, Hidradenitis
204
PAPASH stands for
Pyogenic arthritis + PG + Acne + hidradentis
205
Haber syndrome
Genodermatosis with rosacea-like eruption and verrucous lesions
206
LMDF clinical picture? What area of the face does it like to affect?
Smooth red monomorphous papules that prefer the eyelid skin
207
Clear zone aroudn the vermilion lip?
Perioralficial dermatitis
208
tx for gram negative folliculitis
isotretinoin
209
hot tub folliculitis tx
self-resolves
210
tx for eosinophilic folliculitis
oral indomethacin
211
Red chromhidrosis cause?
clofazimine and rifampin
212
what miliaria do adults in hot climates get?
miliaria profunda
213
highest risk medications for rash?
Aminopenicillins, anticonconvulsants, Bactrim and NSAIDs
214
culprit medications for HIV + patients with drug rash?
Bactrim #1, dapsone, betalactams, nevirapine, and abacavir
215
what puts you at increased risk of anticonvulsant hypersensitivity syndrome?
if you cannot detoxify arene oxide metabolites
216
What medication should you switch ppl who develop a drug rash to anticonvulsants?
valproic acid or levetiracetam
217
what puts you at increased risk of allopurinol hypersensitivity syndrome? What are some end-organ damage?
renal failure puts you at risk. End organ: pancreatitis, diabetes, kidney failure
218
what puts you at increased risk of sulfonamide hypersensitivity syndrome?
slow acetylator
219
dapsone hypersensitivity syndrome can have elevated level of what and decreased levels of what?
Elevated bilirubin leading to jaundice. And low eosinophilia
220
what puts you at increased risk of minocycline hypersensitivity syndrome?
glutathione S transferase deficiency
221
what end-organ damage is minocyline DRESS associated with?
eosinophlic pneumonia, liver damage, cardiac damage
222
What two drugs cause cardiac damage after DRESS?
ampicillin and minocycline
223
is systemic steroids helpful for DRESS?
Yes for lung and heart damage.
224
Name 2 non-drug causes of AGEP?
mercury exposure. Radiocontrast
225
Top 3 drug culprit for AGEP
beta lactams (penicillin, cephalosporin, carbapenem, monopenum), macrolide (erythromycin), CCBs
226
MOA of phototoxic drug reaction
drug metabolite reacts with UVA. Everyone that is given enough of the drug develops this reaction
227
MOA of photoallergic drug reaction
UVA induces a chemical change in the drug and it becomes a photo allergen
228
Phototoxic drugs are usually systemic or topical?
systemic medications
229
Photoallergic drugs are usually systemic or topical
topical
230
Common drugs for phototoxic rxns
tetracyclines, NSAIDs (piroxicam), fluoroquinolones, amiodarone, psoralens, voriconazole, st Johns wart, HCTZ
231
Slate gray hyperpigmentation drugs
amiodarone, Tricyclic antidepressants, diltiazem
232
Photolichenoid eruptions drugs
HCTZ and NSAIDS
233
Common drugs for photoallergic reactions
oxybenzone, fragrance (musk ambrette), NSAIDs and ketoprofen
234
how do you confirm photoallergy?
photopatch testing utilizing UVA
235
most common drugs to cause hyperpigmentation
minocyline, chemotherapy, zidovudine, antimalarials
236
most common drugs to cause hypopigmentation
phenols (hydroquinone, MBEH), sulfhydryls (methimazole), tyrosinase kinase (imatinib)
237
Bleomycin can be associated with sclerodermoid. T or F
TRUE
238
hyperpigmentation occurs in what percentage of pts taking antimalarials?
25%
239
quinacrine hyperpigmentation look like?
diffuse yellow-brown discoloration of skin and eyes (mimics jaundice)
240
arsenic drug-induced pigmentation looks like? When does it present? Where on the body
hyperpigmented patches with superimposed raindrops of hypopigmentation. On the intertriginous, palms/soles, pressure points. Presents after 20 years
241
Gold hyperpigmentation looks like?
permanent blue-gray hyperpigmenation on face (periocular #1)
242
mercury hyperpigmentation looks like?
acrodynia (acral sites are dusky, red and painful)
243
silver hyperpigmentation looks like?
diffuse slate gray pigmentation accentuated on photo-exposed areas .
244
Slate gray hyperpigmentation area for amiodarone, TCAs, diltazem silver and mercury.
Amiodarone (face), silver and TCA and diltazem(sun exposed ) ,mercury ( skin folds).
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OCPs have hyperpigmentation of what areas?
nipple and nevi
246
Histology for amiodarone hyperpigmentation?
yellow-brown lipofucin (fontana masson +) in macrophages in a perivascular distribution.
247
Electron microscopy fo ramiodarone hyperpigmentation?
Electron microscopy shows lipid-like lysosomal inclusions
248
clofazamine pigmentation look like?
diffuse red-brown color of skin and conjunctiva. Or lesional hyperpigmentation
249
diltaizem pigmentation occurs in what people?
African americans. Who present with slate-gray discoloration on photo-exposed skin
250
fetal exposure to TCN can stain the teeth at different levels. What stains in the mid protion., What stains in the gingival one third?
Minocycline midportion. Tetracycline (gingival one third)
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Hand- foot skin reaction looks like what? Caused by what drugs?
Looks like toxic erythema of chemotherapy, but with prominent hyperkeratotic plaques on areas of friction. Caused by multi-kinase inhibitors (sorafenib, sunitinib, VEGF inhibitors)
252
is hydroxyurea a phototoxic drug?
yes
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Irreversible alopecia drugs (2)?
busulfan, docetaxel
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treatment for mucositiis
palifermin (keratinocyte growth factor)
255
extravasation reactions d/t what chemotherapy?
5FU, anthracycline (doxo, daunorubicin)
256
nail hyperpigmentation
doxorubicin, 5FU, cyclophosphamide, hydroxyurea, bleomycin
257
Hemorrhagic onycholysis
taxanes
258
exudative hyponychial dermatitis
docetaxel and capecitabine (breast cancer settign)
259
necrosis of psoriasis plaques
MTX
260
What chemo drug can cause: flushing?
asparaginase
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What chemo drug can cause: sticky skin syndrome?
doxorubicin with ketoconazole
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What chemo drug can cause: sclerodermoid reaction
taxanes
263
What chemo drug can cause: palmoplantar hyperkeratosis
Capecitabine
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What chemo drug can cause: acral sclerosis?
bleomycin
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What chemo drug can cause: hyperpigmentation of occluded skin?
Thiotepa
266
What chemo drug can cause: periungal pyogenic granuloma? Name 4
isotretinoin, HAART (indinavir, efavirenz, lamivudine), EGFR inhibitors, MTX,
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What drug can cause digital ischemia?
beta blocker, bleomycin
268
Texier disease
indurated morpheaform plaques . a pseudosclerodermatous reaction that occurs after injection with vitamin K, a subcutaneous sclerosis with or without fasciitis that lasts several years.
