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Immuno Skin Disorders Flashcards

0
Q

other autoantibdoies that may be in lupus

A

autoabs that cause HSR II–>cytopenias

anti-smith antibodies–>APL

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1
Q

genetic etiology of lupus

A

antinuclear autoantibdoies (ANA) to dsDNA–>form immune complexes–> deposit in multiple tissues–> Hypersensitivity 3

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2
Q

skin findings in lupus

A 
malar rash
red scaly rash
discoid rash
photosensitivty
oral ulcers
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3
Q

skeletal findings lupus

A

arthritis of PIP and MCP (like RA, but not deforming)

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4
Q

CV issues in lupus

A

serositis (pleuritis or pericarditis)

*linman-sacks endocarditis)

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5
Q

renal disease in lupus

A

CRF

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6
Q

heme findings in lupus

A

cytopenias

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7
Q

neuroendocrine findings in lupus

A

seizures, stroke, psychosis

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8
Q

labs in lupus

A

ANA antibodies
Anti-dna, anti-sm, APL
decrease in compliment
direct combs

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9
Q

what confirms lupus dx

A

biopsy

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10
Q

three types of cutaneous rashes in lupus

A

acute cutaneous
subacute cutaneous
chronic cutaneous

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11
Q

acute cutaneous percentage that is systemic

A

90%

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12
Q

main rash in ACLE

A

malar or butterly rash

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13
Q

% systemic in subacute cutaneous lupus

A

50% systemic

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14
Q

labs for subacute cutaneous lupus

A

usually ANA negative

anti-Ro, anti- La antibodies often positive though

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15
Q

rash in SCLE

A

widespread red scaly rash on arms, chest, upper back, face

very photosensitive

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16
Q

what can SCLE be secondary to

A

meds- procainamide, terbinafine, HCTZ, nsaids, diltizaem

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17
Q

how do the drugs cause SCLE

A

drugs increase photosensitivity or bind histones and cause +autoantibodie

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18
Q

how to confirm SCLE secondary to drugs

A

ANA is negative
but histone Ab is positive
no decrease in comp, no renal/cns disease and this will all decrease when drug is stopped

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19
Q

neonatal lupus is due to what antibody

A

anti-ro antibodies (cross placenta)

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20
Q

what is the rash for neonatal lupus

A

transient skin rash on face, around eyes, trunk

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21
Q

what category does neonatal lupus fall into

A

SCLE –>annular and scaly

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22
Q

what is the risk of neonatal lupus

A

complete heart block

*can require pacemaker

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23
Q

what can neonatal lupus be associated with

A

hepatobiliary disease, thrombocytopenia

24
percentage of chronic cutaenous lupis that is systemic
10%
25
ccle aka
discoid lupus
26
rash in ccle
very photosensitive and favors light exposure (face and scalp)
27
what is different about CCLE from the other two rashes
this one can lead to scarring and the others dont
56
tx lupus
sun protection topical and intralesional steroids antimalarials (hydroxychloroquine) biologics-retinoids, immunsups, thaliodmide
57
dematomyositis etio
skin + muscle inflammation secondary to CD4 cells-->autoantibodies that target muscle capillaries
58
amyopathic derm
no muscle involvment-skin only
59
skin findings in dermatomyositis
``` helicotrope face gottron's papules gottron's sign perungal telangiectasias erythema and hyperkeratosis on hands photosensitive red scaly rash (shawl sign) ```
60
gottron's papules
flat red papules on dorsal surface of hands, over jts
61
gottron's sign
symmetric, scaly, erytehmatous rash over the extensor surfaces of the hands (usually over jts)
62
muscular findings in dermatomyositis
proximal muscle weakness (difficulty rising from chair or combing hair) increase muscle enzymes (CPK) abnormal EMG abnormal bx
63
what does the biopsy show
muscle tissue necrosis and atrophy
64
what do you see in children
calcinosis cutis-->ectopic calcium deposits in tissues (skin & lung-->breathing problems) *can be painful and debilitating
65
what may also be involved in dermatomyo
cardiac and pulmonary involvment
66
what is gower's sign
cant get off the floor
67
severity of skin and muscle involvment + antibodies
do not necessarily correlate
68
antibodies in dermato
ANA+ (remember- ANA- in subacute LE) | anti-trna synthetase (Jo1) antibodies -->pulm dz
69
tx of dermatomyo
sun protection systemic corticosteroids for skin involvment-->FIRST LINE steroid sparing agents like MTx and azathiprine IVIG for refractory
70
malignancy in adults
10-50% of cases--check! age >60 w
71
when should you suspect malignancy
skin refractory to treatment
72
morphea and scleroderma are dz characterized by
thickening of the skin (sclerosis/fibrosis) and vessel walls secondary to increases in collagen can sometimes involve deeper tissues in underlying areas such as subC tissue, muscle, bone
73
gender and race in sclerodermas
F>M | black >white
74
morphea
localized and superficial form of scleroderma that is strictly skin-- no raynaud's, no abnormal labs- NOT fatal
75
what do you see in morphea
slowly expanding inflammatory patches and plaques; usually on the trunk, extremities, or face **can initially be violaceous or hyperpigmented, can involve subcutaneous tissue, can cause disfigurment
76
if mirphea is over joints
can form contractures and decrease ROM of knees and arms
77
morphea eventually
burns out-stops expanding and softens, but some residual textural and pigment abnormality usually present
78
therapy of morphea
MTX + prednisone
79
scleroderma (systemic sclerosis) 10 year survival
10%
80
T cells in scleroderma
CD4 TH2 cells--> positive ANA (95% of patients) to -DNA topoisomerase I (scl 70, 30-70% diffuse--associated wtih pulm fibrosis) centromeres (40% in crest)
81
earliest endothelial finding in scleroderma
vasculitis secondary to finrosis of walls, decrease PG
82
skin fidnings in sceleroderma
``` thickening and contration of skin hyperpig telangiectasias digital ulers sclerodacytly ```
83
systemic features of scleroderma
raynaud's arthralgia esopheal/GI, lung, kidney, heart
84
what is usally the intiial sign scleroderma
raynauds
85
CREST syndrome- subset of sclero
``` Calcinosis Raynauds esophageal dysmotility Sclerodacyylyl telangiectasias ```
86
tx of scleroderam
Ca channel blockers for raynauds AceI for renal dz immunosup-mTX, azathiprine

Derm (15 decks)

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