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Skin MS: Week 3 > Inflammatory Dermatoses > Flashcards

Inflammatory Dermatoses Flashcards

1
Q

6 Ps of Lichen Planus

A

Planar, Purple, Polygonal, Pruritic, Papular, Plaques

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2
Q

Acute Inflammatory Dermatoses

A

Urticaria*** (Dermis)

Erythema Multiforme (Ep/Dermis)*

Stevens Johnson Syndrome/Toxic Epidermal Necrolysis* (Epi/Dermis)

Fixed Drug Eruption (Epidermis)

Panniculitis (Subcutaneous) - Erythema Nodosum, Erythema Induratum

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3
Q

Pruritic, Transient raised wheals

A

Urticaria

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4
Q

Common places for angioedema

A

Lip, eye, groin, palms, soles

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5
Q

Acute vs. Chronic Urticaria/Angioedema

A

Acute (⅔) → duration 6wks, cause often idiopathic, requires long term tx for suppression

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6
Q

Causes (U/A)

A 
Immune
-Type 1 IgE mediated
- Autoimmune
-Infection
Nonimmune
- Physical urticarias
- Direct Mast Cell Degranulation
- Foods w/ high histamine
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7
Q

Triggers of Type 1 IgE mediated U/A

A

Foods, latex, stinging insects, meds, aeroallergens

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8
Q

Types of physical urticarias

A

Solar, cholinergic, cold, dermographism, aquagenic, vibratory angioedema, pressure urticaria

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9
Q

Types of Autoimmune diseases –> U/A

A

Hashimoto’s immune thyroiditis, SLE, vasculitis

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10
Q

Direct mast cell degranulation triggers

A

Narcotics, aspirin, NSAIDs, radio-contract media, dextran, ACE inhibitor, vancomycin

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11
Q

Foods w/ high levels of histamine

A

Strawberries, tomatoes, shrimp, lobster, cheese, spinach eggplant

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12
Q

Basic lab eval for U/A

A

CBC, ESR, TSH, and basic chemistry panel

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13
Q

How to check for Lupus if seeing U/A

A

Anti-thyroid antibody and ANA

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14
Q

Therapy U/A

A

Avoid Allergen/triggers/alcohol

Antihistamines

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15
Q

Preferences of Antihistamines for Acute Urticaria

A

First - second generation non-sedating H1 blockers (i.e. Cetirizine = Zyrtec, Allegra, Clarinex…)

Then 1st gen sedating H1 blockers (Benadryl) –> H2 blocker (Zantac, Tagamet) –> H1/H2 combo blocker (Sinequan = treats anxiety too) –> Leukotriene modifier (Singular = montelukast)

Last resort = oral corticosteroid (prednisone)
Then immunosuppressives, immunology, etc

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16
Q

Target area, multiple involving extremities and mucous membranes

A

Erythema Multiforme

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17
Q

Etiology of Erythema Multiforme

A

Cutaneous rexn to variety of antigenic stimula
Drugs - sulfa, phenytoin, allopurinol
Infection - HERPES SIMPLEX VIRUS, mycoplasma
Idiopathic (common)

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18
Q

EM Minor vs Major

A

Minor - involving

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19
Q

Therapy for EM Minor, Major

A

Control underlying (i.e. herpes), for severe: glucocorticoids (prednisone)

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20
Q

EM vs. Hives

A

EM fixed and usually doesn’t itch

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21
Q

Stevens Johnson Syndrome

A

drug induced or idiopathic

skin tenderness/erythema –> extensive cutaneous and mucosa epidermal necrosis and sloughing

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22
Q

Differentiation of EM, SJS, TEN

A

Erythema Multiforme (1 mucosal membrane)

Stevens-Johnson Syndrome (SJS): Considered a Maximal Variant of EM Major (2+ mucosal membrane and

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23
Q

Risk factors for SJS/TEN

A

SEL, HLA-B12, HIV

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24
Q

SJS/TEN Etiology

A

Drugs (80% TEN, 50% SJS)

Cytotoxic immune rxn aimed at destroying keratinocytes expressing foreign drug-related antigens

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25
Hallmark: Swelling/pain lips (burning)
Angioedema, considered emergency
26
Hallmark: 2> mucus membranes, 10% of skin, sloughing of skin, sulfa drugs
SJS
27
Hallmark: Target lesions, palms/soles, 1+ rash
Erythema mulitforma
28
Hallmark: 30% body covered in rashes, sloughing
TENS
29
Hallmark: One red spot, hyperpigmentation, sharp demarcation
Fixed drug eruption
30
Hallmark: Anterior shin nodule
Erythema nodosmi (septal)
31
Hallmark: Posterior leg, associated with TB
Erythema induratum (lobular)
32
Trigger: Erythema nodosum
Infection, meds, autoimmune
33
Trigger: Erythema induratum
TB
34
Hallmark: Scaling, auspitz sign, koebner
Psoriasis
35
Hallmark: Butterfly rash
SLE
36
Hallmark: 6Ps
Lichen Planus
37
Genetics of Psoriasis
Autosomal dominance, modifying features + environmental triggers
38
Clinical features psoriasis
Sharply demarcated erythema, usually with thick micaceous scale (i.e. silvery) Auspitz sign = bleeding after removal of scale Koebner phenomenon = lesions induced by trauma (if develop psoriatic lesion after trauma, have psoriasis) Nail disease up to 50% prevalence Rarely pustular
39
Auspitz sign
bleeding after removing scale (psoriasis)
40
Koebner phenomenon
Lesions induced by trauma (psoriasis)
41
Histopathology of Psoriasis
Extensive hyperkeratosis w/ parakeratosis (retained flat nuclei in keratinocytes) Uniform elongation of rete ridges Dermal papillae are edematous w/ suprapapillary thinning and dilated capillaries Neutrophils in epidermis Pustular Psoriasis composed of intraepidermal neutrophilic pustules- spongiform pustule
42
Pathogenesis of Psoriasis
Environmental Factors (ie. virus) → T cell produce cytokines → stimulate keratinocyte proliferation and production of antigenic adhesion molecules in dermal blood vessels → adhesion molecules further stimulate T cells to make cytokines...
43
Diagnosis of Psoriasis (differential)
``` Differential: Lichen simplex chronicus (neurodermatitis), nummular eczema (coin-shaped lesions), seborrheic dermatitis, tinea corporis Punch biopsy (if in doubt, usually use pattern recognition) Remember: chronic - if antifungal/antibiotic don’t help.... ```
44
Types of Psoriasis
Chronic Inverse - skin folds Guttate - post-strep Pustular
45
Treatment Psoriasis
Topicals → steroid, anthralin, tar, calcipotriol (Vit D), retinoids, tacrolimus System → retinoids, ciclosporin, PUVA/UVB/Narrow Band UVB, Methotrexate, Etanercept/Efalizumab/Alefacept (tumor necrosis factor block for AI diseases) Combination topical steroid and PUVA if >20% body Usually topical med to soften thick skin, systemic to control T cell response
46
Wickham's Stria
white lines visible in stria of papula of lichen planus
47
IgM mediated chronic
Lichen Planus
48
T cell mediated chronic
Psoriasis
49
Cutaneous LP Forms
Linear, Annular, Atrophic, Hypertrophic, Vesicobullous, Erosive/ulcerative, scalp
50
Oral LP forms
Reticular, atrophic, bullous, erosive
51
Treatment of LP
Cutaneous may resolve on own in 1-2 years, relapse Topical steroids, oral steroids Phototherapy Stop aggravating drug
52
IgG mediated chronic
Systemic Lupus Erythematosus
53
Acute, Subacute, Chronic SLE
Acute: Pauci-inflammatory (few, little) interface dermatitis; prominent dermal edema and dermal mucin Subacute: Prominent suprabasilar exocytosis of lymphocytes, prominent epidermal atrophy; lymphocytic infiltrate Chronic Cutaneous/Discoid: Very thick basement membrane, follicular plugging; Dense perivascular and peri-adenxal infiltrate
54
Lab Tests for SLE
CBC, ESR, Kidney/Liver tests, UA, ANA - antinuclear antibody (don’t forget urine when ruling out SLE)
55
Treatment of SLE
NSAIDs, Antimalarials (plaquenil), Corticosteroids, immunosuppressants - cyclophosphamids (Cytoxan), azathaprine (imuran)
56
Herpes Simples 1 vs. 2
HSV 1: Primary infection usually occurs in childhood with lesions on the lips or face - more common HSV 2: STD of adults involving the genital area, primary infection extensive, painful vesiculations and necrosis
57
Tx HS1
Oral acyclovir (recurrent tx with acyclovir, famciclovir and valacylclovir)
58
Tx HS2
Recurrent w/ no cure | Rx: Acyclovir, famciclovir, valacyclovir
59
Varicella
Chickenpox Herpes Varicella Zoster virus dew drop on rose petal
60
Incubation of VZ
14 days average, prodrome 2-3 days of fever/chills/malaise before rash
61
Immunization for Chickenpox
Children who have never had chickenpox should receive 2 doses: 1st dose at 12-15 months, 2nd dose at 4-6 years People over 13 years of age who have never had chickenpox should receive 2 doses at least 28 days apart
62
Herpes Zoster (shingles)
Recurrence of varicella | Following nerve root
63
Tx shingles
Acyclovir, Prednisone, IV Acyclovir
64
Immunization shingles
Immunization: Zostavax-live, attenuated vaccine for prevention of herpes zoster in patients aged 50 and over
65
Why worry about tip of nose in shingles?
More likely to get to eye
66
Impetigo types
Non-bullous (Group A strep pyogenes, coagulase positive staph aureus and mixed) - more common Bullous - phage group II staph aureus, epidermolytic toxin mediated
67
Etiology Nonbullous impetigo
Nonbullous impetigo begins as single red macule/papule → quickly becomes vesicle → vesicle ruptures easily to form erosion → contents dry to form characteristic honey-colored crusts (HALLMARK) that may be pruritic
68
Etiology Bullous impetigo
Superficial vesicles progress to rapidly enlarging, flaccid bullae with sharp margins and no surrounding erythema → bullae rupture, yellow crusts with oozing result More on axillary, groin, fold areas
69
Tx Impetigo
Tx: Hygienic Measures, Topical Antibiotics, Oral Antibiotics
70
Bullous Diseases
Bullous pemphigoid Pemphis vulgaris Dermatitis herpetiformis
71
Bullous pemphigoid
IgG at basement membrane, AI, prednisone
72
Pemphigus vulgaris
intracellular IgG pattern, AI, skin/muccous, flaccid blisters (Nikolsky sign = blister sliding)
73
Dermatitis herpetiformis
IgA clumps basement membrane | Gluten sensitivity
74
Porphyria Cutanea Tarda
Deficiency in heme-synthesizing enzyme Blistering of skin, sun-exposed Hypertrichosis of forehead/cheeks, skin hyperpigmentation and urine discoloration RF: Hep c, hemochromatosis and alcoholism
75
Hallmark: mouth lesions/vesicles, less recurrance
Herpes simplex 1
76
Hallmark: STD, recurrent, viral
HS2
77
Hallmark: "Dew drops on a rose petal"
Varicella
78
Hallmark: Dermatomes and unilateral
Zoster
79
Hallmark: Honey-colored crusting
Impetigo
80
Hallmark: Tense blisters
bullous pemphigoid
81
Hallmark: Celiac disease associated
dermatitis H
82
Hallmark: Flaccid blisters
Pemphigus vulgaris
83
Hallmark: Hyperpigmentation
Prophyria cutanea tarda
84
Vancomycin "Red Man" Syndrome is an example of ______
Urticaria/Angioedema | d/t direct mast cell degranulation
85
What should patient's with type I IgE mediated hypersensitivities have (med)?
EpiPen
86
Rash along with Herpes Simplex Virus? - but not the blisters (Hallmark)
Erythema Multiforme
87
Major cause of EM minor
Herpes Simplex Virus
88
Time from first drug exposure to SJS/TEN sxs
1-3 weeks
89
Beginning of SJS/TENS
Fever, malaise, arthralgias (days to weeks after exposure) --> painful morbilliform rash --> confluent/bullous/exfoliative
90
How to diagnose panniculitis?
skin biopsy (in subcutaneous)
91
Nail pitting/onycholysis associated with ______
Psoriasis in 50%
92
LP happens where in skin?
epidermis-dermis junction
93
Hallmark of linear lichen planus
Wickham's striae (white lines or grooves that cover surface of LP lesions)
94
pinna
visible ear
95
Hutchinson's Sign
Shingles on tip of nose --> worry about eye involvement
96
Nonbullous impetigo causative agent
Group A strep pyogenes, Coagulase positive staph or mixed
97
Bullous impetigo causative agent
Phage group II Staph aureus (epidermolytic toxic)
98
Nikolsky sign
top layers of skin slip away from lower layers when slightly rubbed - maybe make blister Pemphigus vulgaris

Skin MS: Week 3 (14 decks)

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