Inflammatory conditions Flashcards
Examples of inflammatory skin conditions
- Psoriasis
- Acne Vulgaris
- Atopic Eczema
- Rosacea
PSORIASIS
- Definition
- Aetiology
- Chronic inflam condition that can be split into many subtypes
- Not fully understood - multifactorial immune-mediated inflam condition
PSORIASIS
Epidemiology
- Caucasian
- affects 2% of population
- No sexual predominance
- Bi-modal peak incidence (15-25yr olds, 50-60yr olds)
- Family Hx
PSORIASIS
Pathophysiology
- No obvious trigger
- Activated T cells recruited to epidermis
- T cells cause proliferation of keratinocytes + subsequent formation of plaques
- Causes increase in pro-inflam mediators (eg/ IL-17, TNF-a)
- Hyper-proliferation of keratinocytes causes epidermal hyperplasia + improper cell maturation
- This causes parakeratosis
PSORIASIS
- Associated genes
HLA-B13
HLA-B17
HLA-Cw6
PSORIASIS
- Influencing environmental factors
- Aggravating environmental factors
- Improving environmental factors
- Underlying infection (eg.guttate psoriasis)
- Stress, Smoking, Alcohol
- Exposure to sunlight
PSORIASIS SUBTYPES
- Plaque psoriasis
- Guttate psoriasis
- Pustular psoraisis
- Palmoplantar pustolosis
- Erythrodermic psoriasis
- Psoriatic arthritis
PLAQUE PSORIASIS INFO
- Most common
- Includes scalp psoriasis
GUTTATE PSORIASIS
- When it happens
- Presentation
- Groups seen in
- Recovery
- 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
PUSTULAR PSORIASIS
- Occurrence
- Presentation
- Other accompanying symptoms
- Rare
- Widespread, Tender, Erythematous skin w multiple small pustules common at flexures + genitalia
- Systemic unwellness (malaise, fever)
PALMOPLANTAR PUSTOLOSIS
- Where does it occur
Hands + feet
ERYTHRODERMIC PSORIASIS
- Presentation
- associated symptoms
- generalised erythematous skin, productive of a fine scale
- Pain, Pruritus + irritation
PSORIATIC ARTHRITIS
- Linked gene
- X-ray finding
- Where on body does it affect
- Associated with
- Occurance
- HLA-B27
- Pencil in cup deformity
- Distal joints (hands + feet)
- Nail psoriasis
- 10-40% of psoriasis patients
PSORIASIS
Histopathology
- T cell infiltration
- Parakeratosis (neutrophils present in epidermis)
- Hyperkeratosis
- Elongation of rete pegs
- Epidermal hyperplasia
PSORIASIS
Presentation
- 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)
PSORIASIS
Diagnosis
normally clinical
(skin biopsy if unusual)
PSORIASIS
Management
- 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)
PSORIASIS
Drugs to avoid in patients w condition
- BB
- Lithium
- Anti-malarials (Eg.hydroxychloroquine)
ACNE
General definition
Epidemiology
- Inflammatory disorder of the pilosebaceous unit
- Adolescents (may persist into adulthood - more common in males in adolescence + females in adulthood)
ACNE VULGARIS
Aetiology
Multifactorial - caused by factors that trigger/exacerbate acne formation
- Hormonal influences (eg. PCOS, Hyperandroggenism, menstruation)
- Cosmetics (Eg. oil based products)
- Drugs (Eg. corticosteroids, lithium, ciclosporin)
potential genetic influence
ACNE
Presentation
- 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
ACNE
Management
- Single topical therapy (benzoyl peroxide or topical retinoid: adapalene or isotretinoin)
- Topical combination (topical antibiotic + previous therapies)
- Oral antibiotic
(lymecycline, doxycycline) - Oral retinoid
(isotretinoin - nb, teratogenic so monitoring required)
ACNE
what to avoid
Minocycline (could cause irreversible pigmentation of skin)
ATOPIC ECZEMA
definition
epidemiology
- 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
ATOPIC ECZEMA
Aetiology
Multifactorial/not full understood
- Genetic element (family hx of atopy = common)
- Environmental triggers
- animal dander
- dust/dust mites
- aeroallergens (Eg. pollen)
- stress
- soap/detergents
- heat
ATOPIC ECZEMA
Pathophysiology
- What type of hypersensitivity
- brief overview
- Type 1
- Skin barrier dysfunction due to mutation in filaggrin gene. So:
- skin more sensitive to many diff antigens
- Epidermis is dehydrated - Immune response activated, releasing IgE + other inflam cells causing the cutaneous features of eczema (eg. pruritus + inflam)
ATOPIC ECZEMA
Presentation
- 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)
ATOPIC ECZEMA
Clinical diagnosis
Pruritis with 3+ of the following:
- Visible flexural rash (face and/or extensor surfaces in infants)
- History of flexural rash
- Generalised dry skin
- Onset before 2yrs old
- Personal history of atopy (or 1st degree relative if <4 years old)
ATOPIC ECZEMA
Management
- Avoid triggers
- Moisturisers/emollients
- Topical steroids (potency depends on site + severity of disease)
- Topical calcineurin inhibitor (tacrolimus)
- Phototherapy
- Systemic immunosuppression (if v. resistant or chronic disease)
ROSACEA
Definition
Chronic inflam. rash of face
ROSACEA
Epidemiology
- 1 in 10 ppl in UK
- Bimodal peak incidence (20-30, 40-50 yr olds)
- Women
- Caucasians
ROSACEA
Aetiology
1. Linked to?
2. Aggravating factors
- Unclear - linked to mites (demodex folliculorum)
- Caffeine, Spicy food, Alcohol, Meds that cause vasodilation, topical steroids, sun exposure
ROSACEA
Pathophysiology
Not understood
ROSACEA
Histopathology
- Vascular ectasia
- Perifollicular granulomas
- Follicular demodex mites seen on microscopy
ROSACEA
Presentation
- Frequent flushing (triggered by many diff aggravating factors)
- Erythema of face (starts intermittently - becomes chronic)
- Papules + pustules (without presence of comedones)
- Telangiectasia
- Rhinophyma (whisky nose, seen in men)
- Ocular issues (eg. gritty eyes + conjunctivitis)
ROSACEA
Diagnosis
Clinical
ROSACEA
Management
- Avoid aggravating factors (eg. diet, sun, topical steroids)
- Topical therapies
- Metronidazole for small spots
- Ivermectin for demodex mites - Oral therapies
- Tetracycline for long term use (eg. doxycycline)
- Low dose isotretinoin - Laser treatment
- For telangiectasia - Surgery/Laser shaving
- For rhinophyma
ACNE CLASSIFICATION
Mild
- <20 comedones
- <15 inflammatory lesions
- or total lesion count <30
Mostly non-inflamed lesions w few inflam lesions
What are closed and open comedones
Closed = whiteheads (contents aren’t exposed to skin)
Open = blackheads (dilated openings to skin allow oxidation of debris => black colour)
ACNE CLASSIFICATION
Moderate
- 20-100 comedones
- 15-50 inflammatory lesions
- or total lesion count 30-125
Increased no. Of inflam papules + pustules than mild acne
ACNE CLASSIFICATION
Severe
- > 5 pseudocysts
- comedones count >100
- inflammatory count >50
Widespread inflammatory papules, pustules, nodules or cysts + could have scarring
ACNE
Common risks + side effects of isotretinoin (roaccutane)
Dry skin/eyes/nose/lips/mouth
Rash, itching
Sore throat
Headache
Myalgia
ACNE
Severe risks + side effects of isotretinoin (roaccutane)
- teratogenic
- bruising
- infections
- bloody diarrhoea
- acne/depression
