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Inflammatory conditions Flashcards

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Dermatology Board Prep flashcards
1
Q

Examples of inflammatory skin conditions

A
  • Psoriasis
  • Acne Vulgaris
  • Atopic Eczema
  • Rosacea
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2
Q

PSORIASIS

  • Definition
  • Aetiology
A
  • Chronic inflam condition that can be split into many subtypes
  • Not fully understood - multifactorial immune-mediated inflam condition
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3
Q

PSORIASIS

Epidemiology

A
  • Caucasian
  • affects 2% of population
  • No sexual predominance
  • Bi-modal peak incidence (15-25yr olds, 50-60yr olds)
  • Family Hx
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4
Q

PSORIASIS

Pathophysiology

A
  • No obvious trigger
  1. Activated T cells recruited to epidermis
  2. T cells cause proliferation of keratinocytes + subsequent formation of plaques
  3. Causes increase in pro-inflam mediators (eg/ IL-17, TNF-a)
  4. Hyper-proliferation of keratinocytes causes epidermal hyperplasia + improper cell maturation
  5. This causes parakeratosis
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5
Q

PSORIASIS
- Associated genes

A

HLA-B13
HLA-B17
HLA-Cw6

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6
Q

PSORIASIS

  1. Influencing environmental factors
  2. Aggravating environmental factors
  3. Improving environmental factors
A
  1. Underlying infection (eg.guttate psoriasis)
  2. Stress, Smoking, Alcohol
  3. Exposure to sunlight
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7
Q

PSORIASIS SUBTYPES

A
  • Plaque psoriasis
  • Guttate psoriasis
  • Pustular psoraisis
  • Palmoplantar pustolosis
  • Erythrodermic psoriasis
  • Psoriatic arthritis
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8
Q

PLAQUE PSORIASIS INFO

A
  • Most common
  • Includes scalp psoriasis
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9
Q

GUTTATE PSORIASIS
- When it happens
- Presentation
- Groups seen in
- Recovery

A
  • Occurs 7-10days post-strep/viral URTI infection or another illness/stress
  • Tear drop shaped, scaly papules over the trunk and limbs
  • Children + Young adults
  • Commonly clears spontaneously
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10
Q

PUSTULAR PSORIASIS
- Occurrence
- Presentation
- Other accompanying symptoms

A
  • Rare
  • Widespread, Tender, Erythematous skin w multiple small pustules common at flexures + genitalia
  • Systemic unwellness (malaise, fever)
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11
Q

PALMOPLANTAR PUSTOLOSIS
- Where does it occur

A

Hands + feet

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12
Q

ERYTHRODERMIC PSORIASIS
- Presentation
- associated symptoms

A
  • generalised erythematous skin, productive of a fine scale
  • Pain, Pruritus + irritation
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13
Q

PSORIATIC ARTHRITIS
- Linked gene
- X-ray finding
- Where on body does it affect
- Associated with
- Occurance

A
  • HLA-B27
  • Pencil in cup deformity
  • Distal joints (hands + feet)
  • Nail psoriasis
  • 10-40% of psoriasis patients
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14
Q

PSORIASIS

Histopathology

A
  • T cell infiltration
  • Parakeratosis (neutrophils present in epidermis)
  • Hyperkeratosis
  • Elongation of rete pegs
  • Epidermal hyperplasia
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15
Q

PSORIASIS

Presentation

A
  • for chronic plaques => Silver scales that affect extensor surfaces, scalp involvement = common
  • NAILS ( Pitting, Onycholysis, Subungal hyperkeratosis)
  • KOEBNER PHENOMENON
  • AUSPITZ SIGN (bleeding spots as psoriasis scales scraped off)
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16
Q

PSORIASIS

Diagnosis

A

normally clinical

(skin biopsy if unusual)

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17
Q

PSORIASIS

Management

A
  • Emollients (given to all patients)
  • Vit D analogue (eg. calcipotriol)
  • Coal tar preparations (exorex lotion)
  • Salicylic acid (if thick scales)
  • Dithranol preparations

+/- Mild, Moderate or potent topical steroids (not used in isolation unless on face or flexures as can cause rebound)

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18
Q

PSORIASIS

Drugs to avoid in patients w condition

A
  1. BB
  2. Lithium
  3. Anti-malarials (Eg.hydroxychloroquine)
19
Q

ACNE

General definition
Epidemiology

A
  1. Inflammatory disorder of the pilosebaceous unit
  2. Adolescents (may persist into adulthood - more common in males in adolescence + females in adulthood)
20
Q

ACNE VULGARIS

Aetiology

A

Multifactorial - caused by factors that trigger/exacerbate acne formation

  1. Hormonal influences (eg. PCOS, Hyperandroggenism, menstruation)
  2. Cosmetics (Eg. oil based products)
  3. Drugs (Eg. corticosteroids, lithium, ciclosporin)

potential genetic influence

21
Q

ACNE

Presentation

A
  • Found in areas with pilosebaceous units (Eg. face, neck, chest + back)
  • Seborrhoea n greasy skin
  • Open + closed comedones (black + white heads)
  • Inflamed lesions (papules, pustules, nodules, cysts)
  • Secondary lesions (Hyperpigmented macules, scars - atrophic/ice-pick or hypertrophic/keloid scars)
  • Anxiety
22
Q

ACNE

Management

A
  1. Single topical therapy (benzoyl peroxide or topical retinoid: adapalene or isotretinoin)
  2. Topical combination (topical antibiotic + previous therapies)
  3. Oral antibiotic
    (lymecycline, doxycycline)
  4. Oral retinoid
    (isotretinoin - nb, teratogenic so monitoring required)
23
Q

ACNE

what to avoid

A

Minocycline (could cause irreversible pigmentation of skin)

24
Q

ATOPIC ECZEMA

definition
epidemiology

A
  • chronic inflam skin disease associated with itch
  • mostly present in childhood and many grow out of it (can occur at any age),
  • ^ incidence in winter
25
Q

ATOPIC ECZEMA

Aetiology

A

Multifactorial/not full understood

  1. Genetic element (family hx of atopy = common)
  2. Environmental triggers
    - animal dander
    - dust/dust mites
    - aeroallergens (Eg. pollen)
    - stress
    - soap/detergents
    - heat
26
Q

ATOPIC ECZEMA

Pathophysiology
- What type of hypersensitivity
- brief overview

A
  • Type 1
  1. Skin barrier dysfunction due to mutation in filaggrin gene. So:
    - skin more sensitive to many diff antigens
    - Epidermis is dehydrated
  2. Immune response activated, releasing IgE + other inflam cells causing the cutaneous features of eczema (eg. pruritus + inflam)
27
Q

ATOPIC ECZEMA

Presentation

A
  • Ill-defined areas of erythema + scaly rash (flexural distribution, affects infants’ faces)
  • Extreme pruritis (can disturb sleep, causes psychosocial problem)
  • Generalised dry skin
  • Chronic skin changes (excoriation, lichenification)
  • Assoc. atopic disease (Asthma, allergic rhinitis)
28
Q

ATOPIC ECZEMA

Clinical diagnosis

A

Pruritis with 3+ of the following:

  1. Visible flexural rash (face and/or extensor surfaces in infants)
  2. History of flexural rash
  3. Generalised dry skin
  4. Onset before 2yrs old
  5. Personal history of atopy (or 1st degree relative if <4 years old)
29
Q

ATOPIC ECZEMA

Management

A
  1. Avoid triggers
  2. Moisturisers/emollients
  3. Topical steroids (potency depends on site + severity of disease)
  4. Topical calcineurin inhibitor (tacrolimus)
  5. Phototherapy
  6. Systemic immunosuppression (if v. resistant or chronic disease)
30
Q

ROSACEA

Definition

A

Chronic inflam. rash of face

31
Q

ROSACEA

Epidemiology

A
  • 1 in 10 ppl in UK
  • Bimodal peak incidence (20-30, 40-50 yr olds)
  • Women
  • Caucasians
32
Q

ROSACEA

Aetiology
1. Linked to?
2. Aggravating factors

A
  1. Unclear - linked to mites (demodex folliculorum)
  2. Caffeine, Spicy food, Alcohol, Meds that cause vasodilation, topical steroids, sun exposure
33
Q

ROSACEA

Pathophysiology

A

Not understood

34
Q

ROSACEA

Histopathology

A
  • Vascular ectasia
  • Perifollicular granulomas
  • Follicular demodex mites seen on microscopy
35
Q

ROSACEA

Presentation

A
  1. Frequent flushing (triggered by many diff aggravating factors)
  2. Erythema of face (starts intermittently - becomes chronic)
  3. Papules + pustules (without presence of comedones)
  4. Telangiectasia
  5. Rhinophyma (whisky nose, seen in men)
  6. Ocular issues (eg. gritty eyes + conjunctivitis)
36
Q

ROSACEA

Diagnosis

A

Clinical

37
Q

ROSACEA

Management

A
  1. Avoid aggravating factors (eg. diet, sun, topical steroids)
  2. Topical therapies
    - Metronidazole for small spots
    - Ivermectin for demodex mites
  3. Oral therapies
    - Tetracycline for long term use (eg. doxycycline)
    - Low dose isotretinoin
  4. Laser treatment
    - For telangiectasia
  5. Surgery/Laser shaving
    - For rhinophyma
38
Q

ACNE CLASSIFICATION

Mild

A
  • <20 comedones
  • <15 inflammatory lesions
  • or total lesion count <30

Mostly non-inflamed lesions w few inflam lesions

39
Q

What are closed and open comedones

A

Closed = whiteheads (contents aren’t exposed to skin)

Open = blackheads (dilated openings to skin allow oxidation of debris => black colour)

40
Q

ACNE CLASSIFICATION

Moderate

A
  • 20-100 comedones
  • 15-50 inflammatory lesions
  • or total lesion count 30-125

Increased no. Of inflam papules + pustules than mild acne

41
Q

ACNE CLASSIFICATION

Severe

A
  • > 5 pseudocysts
  • comedones count >100
  • inflammatory count >50

Widespread inflammatory papules, pustules, nodules or cysts + could have scarring

42
Q

ACNE

Common risks + side effects of isotretinoin (roaccutane)

A

Dry skin/eyes/nose/lips/mouth
Rash, itching
Sore throat
Headache
Myalgia

43
Q

ACNE

Severe risks + side effects of isotretinoin (roaccutane)

A
  • teratogenic
  • bruising
  • infections
  • bloody diarrhoea
  • acne/depression

Derm (8 decks)

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