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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
Q

Hallmark: Swelling/pain lips (burning)

A

Angioedema, considered emergency

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26
Q

Hallmark: 2> mucus membranes, 10% of skin, sloughing of skin, sulfa drugs

A

SJS

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27
Q

Hallmark: Target lesions, palms/soles, 1+ rash

A

Erythema mulitforma

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28
Q

Hallmark: 30% body covered in rashes, sloughing

A

TENS

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29
Q

Hallmark: One red spot, hyperpigmentation, sharp demarcation

A

Fixed drug eruption

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30
Q

Hallmark: Anterior shin nodule

A

Erythema nodosmi (septal)

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31
Q

Hallmark: Posterior leg, associated with TB

A

Erythema induratum (lobular)

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32
Q

Trigger: Erythema nodosum

A

Infection, meds, autoimmune

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33
Q

Trigger: Erythema induratum

A

TB

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34
Q

Hallmark: Scaling, auspitz sign, koebner

A

Psoriasis

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35
Q

Hallmark: Butterfly rash

A

SLE

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36
Q

Hallmark: 6Ps

A

Lichen Planus

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37
Q

Genetics of Psoriasis

A

Autosomal dominance, modifying features + environmental triggers

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38
Q

Clinical features psoriasis

A

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

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39
Q

Auspitz sign

A

bleeding after removing scale (psoriasis)

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40
Q

Koebner phenomenon

A

Lesions induced by trauma (psoriasis)

41
Q

Histopathology of Psoriasis

A

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
Q

Pathogenesis of Psoriasis

A

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
Q

Diagnosis of Psoriasis (differential)

A 
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
Q

Types of Psoriasis

A

Chronic
Inverse - skin folds
Guttate - post-strep
Pustular

45
Q

Treatment Psoriasis

A

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
Q

Wickham’s Stria

A

white lines visible in stria of papula of lichen planus

47
Q

IgM mediated chronic

A

Lichen Planus

48
Q

T cell mediated chronic

A

Psoriasis

49
Q

Cutaneous LP Forms

A

Linear, Annular, Atrophic, Hypertrophic, Vesicobullous, Erosive/ulcerative, scalp

50
Q

Oral LP forms

A

Reticular, atrophic, bullous, erosive

51
Q

Treatment of LP

A

Cutaneous may resolve on own in 1-2 years, relapse
Topical steroids, oral steroids
Phototherapy
Stop aggravating drug

52
Q

IgG mediated chronic

A

Systemic Lupus Erythematosus

53
Q

Acute, Subacute, Chronic SLE

A

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
Q

Lab Tests for SLE

A

CBC, ESR, Kidney/Liver tests, UA, ANA - antinuclear antibody (don’t forget urine when ruling out SLE)

55
Q

Treatment of SLE

A

NSAIDs, Antimalarials (plaquenil), Corticosteroids, immunosuppressants - cyclophosphamids (Cytoxan), azathaprine (imuran)

56
Q

Herpes Simples 1 vs. 2

A

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
Q

Tx HS1

A

Oral acyclovir (recurrent tx with acyclovir, famciclovir and valacylclovir)

58
Q

Tx HS2

A

Recurrent w/ no cure

Rx: Acyclovir, famciclovir, valacyclovir

59
Q

Varicella

A

Chickenpox
Herpes Varicella Zoster virus
dew drop on rose petal

60
Q

Incubation of VZ

A

14 days average, prodrome 2-3 days of fever/chills/malaise before rash

61
Q

Immunization for Chickenpox

A

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
Q

Herpes Zoster (shingles)

A

Recurrence of varicella

Following nerve root

63
Q

Tx shingles

A

Acyclovir, Prednisone, IV Acyclovir

64
Q

Immunization shingles

A

Immunization: Zostavax-live, attenuated vaccine for prevention of herpes zoster in patients aged 50 and over

65
Q

Why worry about tip of nose in shingles?

A

More likely to get to eye

66
Q

Impetigo types

A

Non-bullous (Group A strep pyogenes, coagulase positive staph aureus and mixed) - more common

Bullous - phage group II staph aureus, epidermolytic toxin mediated

67
Q

Etiology Nonbullous impetigo

A

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
Q

Etiology Bullous impetigo

A

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
Q

Tx Impetigo

A

Tx: Hygienic Measures, Topical Antibiotics, Oral Antibiotics

70
Q

Bullous Diseases

A

Bullous pemphigoid
Pemphis vulgaris
Dermatitis herpetiformis

71
Q

Bullous pemphigoid

A

IgG at basement membrane, AI, prednisone

72
Q

Pemphigus vulgaris

A

intracellular IgG pattern, AI, skin/muccous, flaccid blisters (Nikolsky sign = blister sliding)

73
Q

Dermatitis herpetiformis

A

IgA clumps basement membrane

Gluten sensitivity

74
Q

Porphyria Cutanea Tarda

A

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
Q

Hallmark: mouth lesions/vesicles, less recurrance

A

Herpes simplex 1

76
Q

Hallmark: STD, recurrent, viral

A

HS2

77
Q

Hallmark: “Dew drops on a rose petal”

A

Varicella

78
Q

Hallmark: Dermatomes and unilateral

A

Zoster

79
Q

Hallmark: Honey-colored crusting

A

Impetigo

80
Q

Hallmark: Tense blisters

A

bullous pemphigoid

81
Q

Hallmark: Celiac disease associated

A

dermatitis H

82
Q

Hallmark: Flaccid blisters

A

Pemphigus vulgaris

83
Q

Hallmark: Hyperpigmentation

A

Prophyria cutanea tarda

84
Q

Vancomycin “Red Man” Syndrome is an example of ______

A

Urticaria/Angioedema

d/t direct mast cell degranulation

85
Q

What should patient’s with type I IgE mediated hypersensitivities have (med)?

A

EpiPen

86
Q

Rash along with Herpes Simplex Virus? - but not the blisters (Hallmark)

A

Erythema Multiforme

87
Q

Major cause of EM minor

A

Herpes Simplex Virus

88
Q

Time from first drug exposure to SJS/TEN sxs

A

1-3 weeks

89
Q

Beginning of SJS/TENS

A

Fever, malaise, arthralgias (days to weeks after exposure) –> painful morbilliform rash –> confluent/bullous/exfoliative

90
Q

How to diagnose panniculitis?

A

skin biopsy (in subcutaneous)

91
Q

Nail pitting/onycholysis associated with ______

A

Psoriasis in 50%

92
Q

LP happens where in skin?

A

epidermis-dermis junction

93
Q

Hallmark of linear lichen planus

A

Wickham’s striae (white lines or grooves that cover surface of LP lesions)

94
Q

pinna

A

visible ear

95
Q

Hutchinson’s Sign

A

Shingles on tip of nose –> worry about eye involvement

96
Q

Nonbullous impetigo causative agent

A

Group A strep pyogenes, Coagulase positive staph or mixed

97
Q

Bullous impetigo causative agent

A

Phage group II Staph aureus (epidermolytic toxic)

98
Q

Nikolsky sign

A

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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