inflammatory and immunological skin disorders

Question 1

inflammatory skin diseases

Answer 1

eczema
occupational dermatitis
psoriasis

Question 2

Eczema features

Answer 2

inflammation of the skin
- becomes itchy, dry, flaky
- occasionally weeps

2 main types
- atopic and contact

usually affect flexor surfaces of skin or trunk e.g. neck, elbows, wrists, ankles

Question 3

atopic eczema

Answer 3

commonest form
- develops in childhood
- usually improves with age
- tends to run in families
- associated with other ‘atopic’ conditions - hay fever, asthma

Question 4

other eczema

Answer 4

contact - most likely for adult onset
- contact with allergy e.g. soaps, perfumes, detergents
- seborrheic - scalp and eye lashes - appears as severe form of dandruff
- discoid - circular patches on body
- gravitational - related to poor circulation in legs

Question 5

eczema - causes and management

Answer 5

triggers?
- can be stress, menstruation, illness, changes in the weather etc
management
- cotton clothing
- emollients - oily and prevent drying of the skin
- soap substitutes
- corticosteroids - usually topical

Question 6

occupational dermatitis

Answer 6

reaction to an environmental agent
usually results in a rash
- may blister or get urticarial swelling
- can be immediate or up to 72 hours exposure
usually an intense itch

Question 7

contact dermatitis - treatment

Answer 7

treatment is to remove source
- problem is identifying source
- apical steroid can help

Question 8

psoriasis - features

Answer 8

2% populaation
- cause unknown
dysregulated epidermal proliferation
- new cells produced faster than old cells lost
- skin surface build sup and thickens
red scaly patches - can itch

Question 9

psoriasis usually affects …

Answer 9

extensor surfaces of limbs and trunk

Question 10

psoriasis topical treatment

Answer 10

emollients
topical steroids
dithranol
tar
PUVA - psoralen uv light A
- topical drug activated by uV light

Question 11

psoriasis - systemic treatment

Answer 11

drugs to reduce cell turnover
methotrexate
ciclosporin
infliximab

Question 12

immunological skin disease

Answer 12

auto-antibody attack on skin components causing loss of cell-cell adhesion
‘split’ forms in skin
- fills with inflammatory exudate
- forms vesicle/blister

Question 13

blistering conditions

Answer 13

pemphigoid
pemhigus
epidermolysis bullosa

Question 14

pemphigoid - features

Answer 14

SUB epithelial antibody attack
thick walled blisters
- clear or blood filled

Question 15

pemphigoid management

Answer 15

immunosuppressants
- steroids
- steroid sparing drugs

Question 16

pemphigoid presentation

Answer 16

oral and skin lesions
- bulls - usually skin
- mucous membrane usually mouth/eye/genital
scarring a feature of some cases

Question 17

pemphigus features

Answer 17

vulgaris
- affects mucosa and skin
- usually oral lesions before skin
rarely see intact bulae/blister
- intra-epithelial blister
- surface easily lost
fatal disease without treatment

Question 18

epidermolysis bullosa features

Answer 18

collagen 7 immune disease
group of conditions
- some very mild - may appear later in life
- some incompatible with life - death in-utero or shortly after birth
genetically determined
- severity and scarring determined by epitopes involved

Question 19

epidermolysis bullosa - problems

Answer 19

infection
fluid loss
scarring