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Immunology - Inflammatory dermatoses Flashcards

1
Q

Describe the basic microanatomy of the skin

A
  • Epidermis
  • Basement membrane
  • Dermis
  • Fat
  • Fascia
  • Muscle
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2
Q

What does the dermis contain

A
  • Hair follicles
  • Sebaceous glands
  • Piloerector muscles
  • Sweat glands
  • Collagen
  • Elastin
  • Fibroblasts
  • Immune cells
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3
Q

What is the function of sebaceous glands

A

They produce and oil that coats hair and prevents bacterial and fungal infections

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4
Q

What are the 5 layers of the skin

A
  • Stratum Corneum
  • Stratum lucidum
  • Stratum granulosum
  • Stratum spinosum
  • Stratum basale
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5
Q

What comprises each of the layers of the skin

A
  • Stratum Corneum - dead keratinocytes, no nuclei
  • Stratum granulosum - keratin containing granules
  • Stratum spinosum - spines between cells = desmosomes
  • Stratum basale - merkel cells, melanocytes, dividing keratinocytes
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6
Q

What is the keratinocyte differentiation pathway

A

Basal cells -> prickle cells -> granular cells -> keratin

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7
Q

What are the functions of the stratum corneum

A
  • Important barrier function of the skin

- Made of corneocytes (differentiated keratinocytes) with lipids and proteins between them

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8
Q

Which one of these proteins can cause a predisposition to eczema

A

Filagrin (10% of population carry faulty filagrin gene)

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9
Q

What are the three atopic diseases

A
  • Eczema
  • Asthma
  • Hayfever
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10
Q

Describe the atopic march

A
  • First develop eczema which peaks at 1-2
  • Food allergies also peak at 1-2
  • Then they develop asthma
  • Then they develop rhinitis (hayfever)
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11
Q

How does eczema cause inflammation

A

Faulty barrier allows entry of irritants, allergens and pathogens

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12
Q

What is a sign of a filagrin gene mutation

A

Palmar hyperlinearity

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13
Q

Describe infantile ectopic eczema

A
  • Acute eczema - red, raw, weepy, blistering skin, poorly defined edges
  • Often in areas that baby can reach and rub e.g. face, elbow, knees
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14
Q

How does the pattern of atopic eczema change with age

A

In adults it occurs in more flexual areas that are sweatier and rub more

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15
Q

What is the visual difference between acute and chronic eczema

A

Chronic eczema is more skin colour and skin markings are more visible due to scratching/rubbing of the skin

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16
Q

Describe an example of severe eczema

A

Eryhtrodermic eczema

  • Red all over as well as general unwellness
  • Usually needs hospital admission
  • Usually caused by staphylococcal superinfection
17
Q

Describe the cause, appearance and possible effects of eczema herpeticum

A
  • Herpes simplex infection due to impaired barrier function of the skin
  • Small blisters that then break down to form small ulcers
  • If it is extreme it can enter the bloodstream and cause herpes encephalitis
18
Q

What causes seborrheic eczema and describe the presentation

A
  • Caused by an overgrowth of yeast

- Greasy scale with redness often around nose, eyes and scalp (dandruff on scalp)

19
Q

What is allergic contact dermatitis

A
  • Allergy to a specific product
  • Atopic eczema predisposes to allergic contact dermatitis
  • Could be caused by perfume, fragrances, nickel, rubber, topical treatments (steroids/antibiotics)
20
Q

What is PPD

A

It is a black dye that is sometimes used in henna but is banned in the UK as it causes a sensitisation when it is directly injected into the skin, meaning that it causes allergic reactions when used in other products such as hair dye

21
Q

What is discoid eczema

A
  • Circular discs of redness
  • Caused by overwashing
  • Treated with topical steroids
22
Q

What does the presentation of psoriasis look like

A

Raised, salmon pink, well defined plaques with a silvery scale

23
Q

What causes psoriasis

A

It requires a genetic susceptibility for which there are several genes and then there needs to be an environmental trigger

24
Q

What is the pathology of psoriasis

A

T cells predominate in dermis stimulating cytokine release causing neutrophils to enter the dermis causing overproduction of keratinocytes which thickens the epidermis

25
Q

Describe the histology of psoriasis

A
  • Hyperkeratosis - reddening on skin
  • Acanthosis - thickening of epidermis
  • Parakeratosis - retention of nuclei in keratinocytes
26
Q

Describe the presentation of guttate psoriasis

A
  • Lots of small raindrop popules of psoriasis
  • Often affects young people after streptococcal infection
  • Recurrent guttate psoriasis with recurrent tonsillitis can be treated with removal of tonsils
27
Q

What is palmoplantar pustulosis

A

Formation of pustules on the palms of hands and soles of feet
- predisposed by smoking

28
Q

What is generalised pustular psoriasis

A
  • Plaques and widespread superficial small pustules
  • Background of inflamed skin
  • Patient often unwell, malaise, tachycardic
  • Treated with immunosuppressants
29
Q

What does acne effect

A

The pilo-sebaceous unit (pilo erector, hair follicle, sebaceous gland)

30
Q

What is an effective treatment for acne and what must be monitored

A

Accutane - very effective treatment but can be teratogenic and requires monitoring of depression and cholesterol

31
Q

What is the pathogenesis of acne

A
  • Hyperkeratinisation of the epidermis in the infundibulum of hair follicles (comedone) -leads to accumulation of dead keratinocytes wihtin the hair follicle
  • Increase sebum production stimulated by androgens.
  • Proliferation of Propionibacterium acnes within pilosebaceous unit.
  • Rupture of inflamed pilosebaceous unit causes further inflammation of surrounding skin.
32
Q

Describe the clinical features of acne

A
  • White head is the closed comedone
  • Black head is the open comedone where you can see the dead keratinocytes
  • papule is a raised lesion
  • Pustule is when you can see pus
  • Nodule is a thickening of the skin
33
Q

Describe the pathogeneis of bullous pemphigoid

A
  • Autoantibody against a component of the basement membrane

- Causes splitting of the basement membrane which causes blistering

34
Q

What proteins hold the dermis and epidermis together

A
  • Tonofilaments

- Anchoring fibrils

35
Q

What is the treatment for bullous pemphigoid

A

Steroids suppress the immune attack allowing the skin to recover

36
Q

What causes epidermolysis bullosa

A

A genetic fault in one of the proteins that hold the basement membrane together

37
Q

Describe the pathogenesis of pemphigus vulgaris

A

Autoantibodies against desmosomes connecting the keratinocytes together

38
Q

Describe the clinical presentation of pemphigus vulgaris

A
  • More superficial than bullous pemphigoid

- Easily breakable superifical blisters that appear as erosions

Additional Flashcards (10 decks)

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