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Inflammation block > Inflammatory/ auto-immune skin disease > Flashcards

Inflammatory/ auto-immune skin disease Flashcards

1
Q

What are the characteristics of psoriasis

A
  • Chronic plaque
  • Nail changes
  • genetic association: 1/3 of patients (HLA Cw6)
  • Increased cell turnover,vasodilation
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2
Q

Outline the characteristics of genital psoriasis

A
  • Often missed
  • Significant impact on QoL, sexual function
  • May lack scale
  • Misdiagnosed as ‘candida’/fungal
  • Patient may be concerned about putting topical steroids in that area
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3
Q

How can sun affect psoriasis

A
  • Sunshine often makes it better but in some people it can make it worse
  • sunburn can injure the skin and worsen it
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4
Q

What is Koebner’s phenomenon & name 2 conditions it may be apparent in

A
  • Describes the formation of psoriatic skin lesions on parts of the body that aren’t typically where a person with psoriasis experiences lesions(injuries, insect bites,tattoos & sunburns can trigger new areas of psoriasis)
  • May be present in psoriasis and sarcoidosis
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5
Q

What are the precipitating factors of psoriasis

A
  • Streptococcal pharyngitis or other infection
  • Emotional stress
  • Physical trauma (Koebner phenomenon)
  • Drugs: lithium, B-blockers, NSAIDs & antimalarials
  • HIV infection: may be presenting manifestation
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6
Q

How can we assess the impact of psoriasis?

A
  • Dermatology life quality index (DQLI 0-30)
  • Patient health questionnaire(PHQ9)
  • Generalised anxiety disorder(GAD7)
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7
Q

Outline the 5 clinical types of psoriatic arthritis

A
  1. ) Asymmetric (60-70%): small joint involvement
  2. ) Symmetric (15%): RA -like but RF negative
  3. ) Distal interphalangeal joint disease (5%): classical type; ‘sausage digits’
  4. ) Ankylosing spondylitis(5%)
  5. ) Arthritis Mutilans(5%): osteolysis of small bones of hands and feet
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8
Q

What are the 1st line treatment options for psoriasis?

A
  1. ) home use/self care i.e TOPICALS
    - corticosteroids
    - Vitamin D analogues
    - Tar/retinoids
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9
Q

What are the second line treatment options for psoriasis

A
  1. )Day treatment setting/specialist nursing:
    - Phototherapy
    - Complex topicals: dithranol/tar
  2. )Hospital setting/shared care complex/high need psoriasis:
    - Methotrexate
    - Acitretin
    - Ciclosporin
    - Fumaric acid esters
    - (Apremilast)
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10
Q

What are the 3rd line treatment options for psoriasis?

A 
Biologics:
These are more expensive; monoclonal abs
-Human Secukinumab(anti IL-17)
-Human Ustekinumab (anti IL-12/23)
-Chimeric Infliximab (anti TNF-alpha)
-Human Adalimumab (anti TNF alpha)
-Fusion protein Etanercept (anti TNF alpha; completely binds to TNF to inhibit it's function)
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11
Q

What is erythroderma?

A

Being red from head to toe

  • 90% body SA involvement
  • unwell
  • issues with: temp regulation, fluid balance, hypovolaemia, hypoalbuminemia
  • Impatient admission
  • Bed rest
  • Topical emollients
  • Systemic/biologic therapy
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12
Q

What causes erythroderma?

A
  • Drug eruption
  • Dermatitis eg atopic dermatitis, seborrhoeic dermatitis, contact
  • psoriasis
  • Pityriasis rubra pilaris
  • Infection: staphylococcal scalded skin syndrome
  • Blistering disease- pemphigus& pemphigoid
  • Sezary syndrome (cutaneous T cell lymphoma)
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13
Q

What is atopic dermatitis?

A
  • Chronic, relapsing, skin disorder usually associated with a personal or family history of atopic disease
  • Atopic march
  • Intense pruritus
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14
Q

What is the cause of vesicles in an eczema patient?

A
  • Staph

- Hsv1 or Hsv2

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15
Q

What is eczema herpeticum?

A
  • Also known as a form of Kaposi varicelliform eruption caused by viral infection
  • A rare, painful skin rash usually caused by herpes simplex virus
  • Fluid filled areas
  • Papilla/vesicles
  • An extensive cutaneous vesicular eruption
  • Arises from pre-existing skin disease, usually atopic dermatitis
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16
Q

What is HSV keratitis

A
  • A form of keratitis caused by recurrent HSV infection in the cornea. It begins with infection of the epithelial cells on the surface of the eye and retrograde infection of nerves serving the cornea
  • If untreated it may cause blindness
  • More likely with people with eczema, particularly those on systemic treatment & in those with ichthyosis vulgaris
  • If someone has had it before you need to make sure they know and go through the complications
  • Treatment= oral acyclovir
17
Q

What T helper cell response is related to eczema

A

Th2

18
Q

What causes AD?

A
  1. ) Environmental factors:
    - allergens
    - irritants
    - dietary factors
    - infections
    - pollutants
    - stress
    - weather change
  2. ) Immunologic factors:
    - Abnormal Th2 immune response IgE
  3. ) Genetic factors:
    - Family history
    - Gene predisposition
    - Defective skin barrier
19
Q

How does the Filaggrin gene mutation contribute to AD?

A
  • Filaggrin deficiency can cause AD
  • imagine it as ‘cracks in the bricks and weak mortar being the cause of it’
  • The allergens get in their and bind to the antigen presenting cell resulting in a Th2 immune response leading to asthma or allergic rhinitis
  • They release a lot of proteases in response to this, this further breaks down the barrier and so more allergens get in,worsening the whole thing
20
Q

What is Filaggrin?

A
  • Filament aggregating protein
  • A filament associated protein that binds to keratin fibres in epithelial cells
  • Its upper horny layer seals your epidermis
  • When Filaggrin breaks down it makes the skin moisturising product
  • The keratohyaline granules are the protein that preserve the barrier in the skin
  • To restore the skin barrier we use moisturisers and topical steroids
21
Q

What is ichthyosis vulgaris

A
  • Dry, thickened scaly skin
  • A type of ichthyosis, a group related skin conditions that interfere with the skin ability to shed dead skin cells, causing extremely dry, thick skin
22
Q

Describe how the distribution of eczema varies with age

A
  1. ) Infant:
    - more generalised-in more places
    - nappy area typically spared cos nappy offers some moisture
  2. )Child
    - More in flexures
  3. ) -Head and neck
    - Hand cos you’re washing hands a lot more
    - Knees and glexures
23
Q

What bacteria tends to cause infections in eczema

A
  • Staphyloccocous aureus
  • eczema and staph go hand in hand
  • ‘staph’= often present in the skin ‘aureus’=cos of the golden colonies seen
  • an increasing amount of patients will have MRSA
  • To eradicate the staph infection we will also be looking at eradicating near the nose cos this is a common site for staph
24
Q

Describe the course & complications of atopic dermatitis

A
  • Chronic disease with recurrent flares
  • Most children (90%) outgrow the disease,but as adults may continue to have localized problems with dermatitis,especially hand dermatitis
  • Frequent skin infections and higher rate of colonization with S.aureus
  • Herpes simplex infection may result in eczema herpeticum
25
Q

How can we treat atopic dermatitis?

A

skin care: emollients, baths

  • Topical steroids (weak vs potent)
  • wet dressings
  • Avoidance of environmental factors that trigger disease
  • Severe cases: PUVA, UVB, MTX, Azathioprine, mycophenolate mofetil, cyclosporine
  • Biologics

Inflammation block (27 decks)

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