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Inflammatory dermatoses Flashcards

1
Q

What is the pilo-sebaceous unit?

A

Erector pili muscle, hair follice and sebaceous gland

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2
Q

Label this

A
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3
Q

What is the keratinocyte differentiation pathway?

A

basal cell -> prickle cell -> granular cell -> keratin.

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4
Q

What is the structure of the stratum corneum?

A
  • Composed of corneocytes (differentiated keratinocytes)
  • Lipids and proteins in between each of them.
  • One of these proteins is filagrin
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5
Q

How are sweat glands different to eachother?

A

Ecrine:

  • located all over the body

Apocrine:

  • located in the axilla and groin
  • Produce a viscous smelly sweat
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6
Q

What is sebum?

A

Oil that lubricates hair

Contains chemicals to suppress bacterial and fungal growth

Produced by sebaceous glands

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7
Q

What is the distinguishing feature of the stratum spinosum?

A

Spinous processes between keratinocytes

These are desmosomes

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8
Q

What is the distinguishing feature of the stratum granulosum?

A

Keratin hyaline granules in the cells

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9
Q

Label this

A
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10
Q

What is the function of the stratum corneum?

A

Barrier function

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11
Q

What is atopy?

A

tendency to develop hypersensitivity

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12
Q

Give 3 examples of atopic diseases

A
  • eczema,
  • asthma,
  • hayfever
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13
Q

What predisposes patients to atopic eczema?

A

Gene mutation in filaggrin - one of the proteins between corneocytes in the stratum cornea important for its integrity

Causes dry skin

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14
Q

How does atopic eczema develop?

A
  • Intrinsic factors e.g. filagrin mutation lead to defects in the epidermal skin barrier
  • Extrinsic factors take advantage of this. Exogenous agents e.g. allergens and pathogens penetrate the epidermis
  • Acutely this leads to activation of CD4+ lymphocytes and the Th2 immune response
  • This causes B-lymphocyte IgE antibody production, mast cell degranulation and subsequent histamine release
  • Chronically this causes activation of CD4+ and CD8+ lymphocytes and activation of the Th1 response
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15
Q

What is a sign of a filagrin gene mutation?

A

Palmar hyperlinearity

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16
Q

What is atopic eczema?

A
  • Defective skin barrier
  • Defective barrier then allows entry of irritants, allergens and pathogens
  • These then cause inflammation.
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17
Q

Are the areas of skin inflammation well defined in psoriasis and atopic eczema?

A

Psoriasis - well defined

Atopic eczema - not well defined

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18
Q

Where do infants commonly get atopic eczema?

A
  • Face
  • Elbows
  • Knees
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19
Q

Where do adults commonly get atopic eczema?

A

Flexural areas:

Elbows

Knees

Hands

Neck

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20
Q

What are the signs of chronic atopic eczema?

A

Lichenification - skin markings more visible, thickened leathery skin

Due to chronic scratching and rubbing

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21
Q

What is erythrodermic eczema?

A

Eczema and redness all over the body

Patient systemically ill

Often due to Staphylococcus infection because of the eczema

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22
Q

What is Eczema herpeticum?

A
  • Eczema with HSV infection
  • The eczema allows the HSV to spread on the skin’s surface
  • Results in fever, malaise
  • Punched out vesicles where blisters have broken down to form ulcers
  • Can become septic or result in Herpes encephalitis
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23
Q

What causes Seborrhoeic Eczema?

A

Overgrowth of Malassezia yeast causing the same thing as dandruff just more severe

Causes inflammation and shedding of the upper skin layers

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24
Q

Where does Seborrhoeic Eczema effect?

A
  • nasolabial folds,
  • eyebrows,
  • scalp,
  • central chest,
  • axilla
  • groin
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25
Is seborrhoeic eczema itchy?
No
26
How do you treat Seborrhoeic Eczema?
Topical sterioids Anti-fungals
27
What are the types of eczema?
* Atopic * Seborrhoeic * Allergic contact * discoid
28
What is Allergic contact eczema?
Physical skin contact with a product causes inflammation Atopic eczema pre-disposes Nickel and rubber common
29
What is discoid eczema?
Specific pattern of eczema - discs scattered around the body
30
What causes discoid eczema?
Age Overwashing - wash natural skin lipids away making the skin dry
31
How does psoriasis present?
Plaques: * slightly raised * salmon pink * silvery scale * well defined * Sore and itchy
32
What causes psoriasis?
Genetic susceptibility needed Environmental trigger needed e.g. infection, drugs, stress, alcohol, smoking
33
What is the pathophysiology of psoriasis?
* T cells in the dermis stimulate cytokine release of TNF alpha * Neutrophil infiltration into the epidermis * Overproduction of keratinocytes * Stiffening and thickening of the epidermis * Top layer of epidermis has neutrophils - abnormal * Blood vessels become dilated
34
How would you describe the histology of psoriasis?
* Hyperkeratosis - overproduction of keratinocytes * Parakeratosis - Stratum corneum retains neutrophils * Acanthosis - Epidermal thickening * Inflammation * Dilated blood vessels
35
Where are you likley to get psoriasis?
* Scalp * Face * Armpits * Elbows * Trunk * Buttocks * Groin and genitals * Nails * Knees
36
How can you tell the difference between psoriasis soles and fungal foot infection?
Fungal infections usually asymetircal whereas this can be symmetrical
37
38
Where do the plaques appear in psoriasis of the soles?
On sites of pressure
39
What are the features of nail psoriasis?
* Subungual hyperkeratosis * Dystrophic nail and loss of cuticle * Onycholysis (nail lifted away from the nail bed) * Pitting
40
What is the difference between psoriasis of the nails and a fungal infection of the nail?
Fungal infections only involve some of the nails whereas psoriasis effects all the nails
41
What is palmoplantar pustulosis?
* Psoriasis of the hands and feet * Often dont have psoriasis in other places * Being a smoker pre disposes
42
What can cause pustules?
Infection Psoriasis Drug reaction
43
What are the different types of psoriasis?
* Soles psoriasis * Nail psoriasis * Guttate psoriasis * Palmoplantar pustulosis * Generalised pustular psoriasis
44
What are the side effects of Roaccutane?
* Depressant * Teratogenic * Hypercholesterolaemia
45
How does acne develop?
* Hyperkeratinisation of the follicle neck (comedone formation) * Increased androgen production - stimulation increases sebum production * Accumulation of dead cells and sebum * 'Propionibacteria acnes' proliferate - pimple forms * Inflammation * Cyst forms * Rupture of follicle canal cyst * More inflammation
46
What are the skin changes in psoriasis?
Scales and plaques that flake off Inflamed upper skin layer Thickening of epidermis
47
How is psoriasis treated?
Topical corticosteroids Immunosupressants
48
What is guttate psoriasis?
Small raindrop like pattern of papular psoriasis plaques
49
Who is more likley to develop guttate psoriasis?
Young people Often following a streptococcal infection (after tonsillitis)
50
What are the different acne lesions?
* Whitehead - comedome covered with skin * Blackhead - comedome open, can see dead keratin within it * Papule - raised inflammatory lesion * Pustule - pus filled comedome * Nodule - inflammatory thickening of the skin
51
How is acne treated?
Topical antibiotics - benzoyl peroxide Systemic antibiotics - erythromycin, clindomycin Contraceptive pill - Yasmin, dianette Isotretinoin (Roaccutane)
52
What is bullous pemphigoid?
Autoantibody is produced against a component of the basement membrane Causes the basement membrane to split Subepidermal tense blister
53
How does the basement membrane attach the dermis to the epidermis?
Tonofilaments attach the epidermis to the basement membrane Anchoring fibrils attach the basement membrane to the dermis
54
Why does the basement membrane need to have specialised attachment methods?
Epidermis is derived from the ectoderm Dermis is derived from the mesoderm Dont naturally stick together
55
What proteins are targetted in bullous pemphigoid?
BPAg1 and/or BPAg2 These are components of hemidesmosomes attaching epidermis to BM
56
What conditions develop when there is a genetic defect in BM proteins vs when an autoantibody is produced against BM proteins?
Genetic defect - Epidermolysis bullosa Autoantibody - Bullous pemphigoid
57
How does Pempigus vulgaris present?
Superficial blisters that break easily leading to skin erosions
58
What is pempigus vulgaris?
Autoantibody produced against desmosome connecting keratinocytes to eachother in the epidermis Attack desmoglein 1 & 3 -components of desmosomes
59
What is the difference in histology of pemphigus vulgaris and bullous pemphigoid?
Pemphigus Vulgaris splits more superficially above the basement membrane
60
How do you treat Pempigus vulgaris and bullous pemphigoid?
Topical corticosteroids Systemic immunosupressants

Y2 Immuno (MCD) (5 decks)

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