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Y2 MCD Immunology > hypersensitivity, allergy and inflammation > Flashcards

hypersensitivity, allergy and inflammation Flashcards

inflammatory dermatoses: summarise the biology and significant clinical manifestations of specific inflammatory dermatoses including acne, eczema, psoriasis, bullous pemphigoid and pemphigus vulgaris

1
Q

microanatomy of skin (layers from superficial to deep)

A

epidermis (including stratum cornea) -> dermis -> hypodermis (containing subcutaneous tissue)

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2
Q

contents of dermis and hypodermis

A

sweat gland, sebaceous gland, hair follicle, blood vessels

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3
Q

2 layers of dermis (superficial to deep)

A

papillary dermis -> reticular dermis

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4
Q

what is present in hair bearing skin

A

apocrine glands, hair follicle, sebaceous gland

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5
Q

4 important cells of epidermis

A

keratinocytes, Langerhans cells, Merkel cells, melanocytes

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6
Q

structure of epidermis (from young at bottom, old at top)

A

dermis -> stratum basale -> stratum spinosum -> stratum granulosum -> stratum lucidum -> stratum corneum

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7
Q

what is present in dermis

A

sensory nerve ending

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8
Q

what is present in stratum basale

A

dividing keratinocyte (stem cell), tactile cell

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9
Q

what is present in stratum spinosum

A

melanocyte, dendritic cell, living keratinocytes

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10
Q

what is present in stratum corneum

A

dead keratinocytes (those on surface flake off)

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11
Q

keratinocyte differentiation pathway

A

basal cell -> prickle cell -> granular cell -> keratin

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12
Q

structure of stratum corneum

A

protein and lipids in between corenocyte layers (dead keratinocytes - flat and no nuclei)

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13
Q

function of stratum corneum

A

barrier

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14
Q

what do defects in stratum corneum lead to

A

eczema

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15
Q

common gene mutation in eczema patients (intrinsic factor), meaning more suscpetible to other atopic diseases

A

filagrin, as protein in between corenocyte layers, so defect allows allergens entry

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16
Q

define atopy

A

tendency to develop hypersensitivity

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17
Q

3 atopic diseases

A

eczema, asthma, hayfever

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18
Q

3 features of atopic eczema

A

common (typical as baby but most grow out of it), relapsing, remitting

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19
Q

describe atopic march: sequence of atopic diseases and when they typically come about

A

eczema -> food allergies -> asthma -> rhinitis; typically rise as child, peak at teens, reduce as adult

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20
Q

extrinsic factors of atopic eczema

A

penetration of exogenous agents e.g. allergens, irritants, pathogens (usually due to intrinsic factor causing defect first)

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21
Q

describe acute form of atopic eczema

A

activation of CD4+ lymphocytes and Th2 response

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22
Q

describe chronic form of atopic eczema

A

activation of CD4+ and CD8+ lymphocytes and Th1 response

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23
Q

what is a sign of a filagrin gene mutation

A

palmar hyperlinearity (palms on hands are more prominent)

24
Q

common sites of infantile atopic eczema

A

affected on face, elbows and knees (irritable areas where able to rub themselves)

25
Q

common sites of adult atopic eczema

A

hands, back of knees, elbows, neck, face (flexures)

26
Q

acute vs chronic eczema appearance

A

acute: very red with crusty appearing skin; chronic: less red but more lichenified (thickened with extenuated skin marks), with poor cut off between affected and unaffected skin

27
Q

describe eczema herpecitum

A

cold sore virus which can spread over eczema area (appear as ulcers and vesicles)

28
Q

3 other types of eczema (not atopic)

A

seborrhoeic, allergic contact dermatitis, discoid

29
Q

describe seborrhoeic eczema appearance, location and susceptibility

A

red and greasy scale (similar to dandruff), affecting nose, eyebrows, chest, back; appears at times of stress

30
Q

describe process of allergic contact dermatitis

A

when patient becomes sensitised to specific allergen antigens, causing eczema

31
Q

describe discoid eczema appearance and predisposition

A

disc like patches of eczema (appears like coins), related to dryness (e.g. overwashing)

32
Q

describe psoriasis cause and appearance

A

inflamed skin with overproduction of immature keratinocytes (due to polygenic inflammatory susceptibility, and possible triggers e.g. stress, infections), with scales and plaques which are well defined and symmetrical

33
Q

5 histological features of psoriasis

A

hyperkeratosis (thick keratin layer), parakeratosis (keratinocytes at top have not lost nuclei), acanthosis (thickening of epidermis), inflammation (lymphocytes in dermis, neutrophils in epidermis), dilated blood vessels

34
Q

common locations of psoriasis

A

scalp, face, armpit, trunk, elbows, buttocks, groin, nails, knees (extensor surfaces), feet

35
Q

features of psoriasis vulgaris on soles of feet

A

well-demarcated, symmetrical, erythematous plaques with thick, yellowish scale and desquamation on sites of pressure arising on plantar feet (similar lesions present on palms)

36
Q

psoriasis nail changes: subungual hyperkeratosis

A

build up of debris under nail

37
Q

psoriasis nail changes: dystrophic nail and loss of cuticle

A

dystrophy of nail of bacteria and fungi can enter and cause infection

38
Q

psoriasis nail changes: onycholysis

A

splitting of nail (lifts off of nail plate) - can also cause pitting of nail

39
Q

describe guttate psoriasis susceptible patients and appearance

A

teenagers and young adults, where small papules (2-4mm) - same as plaques just small

40
Q

describe location and appearance of palmoplantar pustulosis

A

just affects hands and feet, with small pustules

41
Q

describe appearance of generalised pustular psoriasis

A

extensive involvement of skin with small pustules (sterile neutrophils in epidermis; also caused by infection and drug reaction)

42
Q

what is acne a disorder of

A

disorder of pilosebacceous unit (hair follicle and sebaceous gland)

43
Q

describe acne formation

A

genetic predisposition causing accumulation of dead cells and sebum in hair follicle pore by androgens -> bacteria (propionibacteria acnes) proliferate (pimple - comedone formation) -> rupture of follicular canal (inflammation)

44
Q

5 clinical features of acne (usually all present at same time), and 3 possible treatments

A

whitehead (closed comedones), blackhead (open comedones), papule, pustule, nodule; treat by: sterilising skin, administering topical antibiotics (lipophilic), using contraceptive pill to reduce androgen concentration

45
Q

conditions causing blistering: describe blisters in bullous pemphigoid

A

blisters are deep

46
Q

location of basement membrane zone in skin

A

between epidermis and dermis, so different embryological orgins

47
Q

what proteins anchor basement membrane

A

tonofilaments in epidermis, anchoring fibrils in dermis

48
Q

causes of blistering due to attack of basement membrane proteins

A

genetically defective proteins, or proteins e.g. BPAg1, BPAg2 are a target of auto-antibodies

49
Q

conditions causing blistering: epidermolysis bullosa

A

genetically defective protein where small traumas cause skin to blister and sheer off

50
Q

conditions causing blistering: pathology of bullous pemphigoid

A

autoantibody against BPAg1 and 2 causing split in basement membrane

51
Q

conditions causing blistering: location and appearance of bullous pemphigoid

A

tense blisters (bullae) all over body, including mouth, with blisters arising in inflamed areas (tense blisters) as well as normal appearing skin

52
Q

conditions causing blistering: treatment of bullous pemphigoid

A

immunosuppressants to suppress auto-antibody formation

53
Q

conditions causing blistering: pempigus vulgaris

A

flaccid blisters which break easily and arise in normal appearing skin

54
Q

connections between keratinocytes

A

between plasma membranes; attachment plaque; keratin intermediate filaments

55
Q

connections between keratinocytes: between plasma membranes

A

desmogleins and desmocollins

56
Q

connections between keratinocytes: in attachment plaque to keratin intermediate filaments

A

plakophilin, plakoglobin, desmoplakin

57
Q

pephigus vulgaris pathology

A

auto-antibodies (vs desmogleins antigen) causing split between epidermis keratinocytes

Y2 MCD Immunology (14 decks)

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