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Skin/MS--Week 3 > Inflammatory Dermatosis and Blistering Diseases--Westra > Flashcards

Inflammatory Dermatosis and Blistering Diseases--Westra Flashcards

1
Q

Urticaria

A

Affects Dermis

Dermal edema

immunologic (IgE and histamine), mast cell–mediated condition that may be allergic or nonallergic.

Transient Wheals

Pruritic>(painful)

Ask about new exposures/medications

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2
Q

Angioedema

A

severe Urticaria

Intense dermal and subcutaneous swelling

Burning/Painful>pruritic

Laryngeal Involvement = Emergency

Typically a medication reaction

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3
Q

Urticaria and Angioedema–how would you begin to discover the cause?

A

Ask questions! Take a thorough history.

Medications, food, travel, physical stimuli

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4
Q

pruritic

A

itching

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5
Q

Urticaria and Angioedema: Immune causes

A

A. Type 1 IgE mediated

Foods: shellfish*, fish*, peanuts*, tree nuts*, eggs, milk, soy, wheat. (* seen in adults) (seen in kids)

Latex

Stinging insects including hymenoptera (bees, wasps, hornets), fire ants, bedbugs, fleas, mites.

Medications: penicillin, cephalosporin, sulfa
Aeroallergens: dust mites, pollens, molds, animal dander

B. Autoimmune disease: Hashimoto’s immune thyroiditis (production of anti-thyroid antibodies), SLE, vasculitis.
(there may be thyroid anti-autobodies in the absence of thyroid dysfunction)

C. Infection: viral (cytomegalovirus, Epstein-Barr, HIV, hepatitis A, B & C); parasitic, fungal or bacterial.

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6
Q

Urticaria and Angioedema: Non-immune causes

A

A. Physical urticaria
B. Direct mast cell de-granulation
C. Foods containing high levels of histamine

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7
Q

Small urticarial papules on red skin (axon reflex erythema) occurring on the neck within 30 minutes of vigorous exercise.

A

Cholinergic Uticaria

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8
Q

as it appeared 5 minutes after stroking the skin with a wooden stick. The patient had experienced generalized pruritus for several months with no spontaneously occurring urticaria.

A

Dermographism

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9
Q

Urticaria and Angioedema Laboratory Evaluation

A

Rule 1: don’t get carried away! Expensive lab evaluations usually have poor yields.

Punch biopsy to exclude vasculitis if lesion persists > 48 hrs or looks atypical

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10
Q

Urticaria and Angioedema Tx

A

Avoid agitating cause!

First choice: Second generation, non-sedating H1-blockers

Second choice: (if symptoms not controlled, add) first generation, sedating H1 blockers

…

Last choice: add oral corticosteroid. Prednisone 40 mg →5 mg (course tapered over 10-14 days)

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11
Q

Reaction pattern of blood vessels in the dermis

A

Erythema multiforme

erythematous iris-shaped papular and vesiculobullous lesions

an immune-mediated dermatologic disease of young adults and young children in which target lesions appear on the hands, feet, and the extensor surfaces of the limbs

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12
Q

EM minor

A

erythema multiforme minor

mild form involving 1 mucosal site. major cause is herpes simplex infection with onset of EM rash at day 10

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13
Q

EM major

A

erythema multiforme major

**severe with extensive skin and mucous membrane involvement. **

Stevens-Johnson Syndrome

Usually due to drugs (sulfa, PCN, dilantin) and after mycoplasma pneumoniae infection

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14
Q

Stevens Johnson Syndrome

and

Toxic Epidermal Necrolysis

A

SJS: a hypersensitivity reaction commonly caused by drugs; infection can also be a trigger

Skin Tenderness and Erythema of Skin and Mucosa

Extensive Cutaneous and Mucosa Epidermal Necrosis and Sloughing

Potentially Life Threatening

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15
Q

How do you differentiate between:

Erythema Multiforme

Stevens-Johnson Syndrome (SJS)

Toxic Epidermal Necrolysis

A

EM = 1 mucosal membrane

SJS = EM major (2+ mucosal membrane an <10% epidermal detachment)

TEN = maximal variant of SJS (2+ mucosal membrane and 30% epidermal detachment)

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16
Q

Fixed Drug Eruption

A

a localized, sharply demarcated erythematous patch that can itch, burn or be asymptomatic

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17
Q

Panniculitis

A

Major focus of inflammation: subcutaneous tissue

Described as lobular or septal depending on where disease process begins

Accurate diagnosis by skin biopsy

18
Q

Panniculitis:

Erythema Nodosum

A

Erythematous tender nodules

Typically ANTERIOR shins

Young women most common

Triggers
Infection (strep, TB, fungal)
Meds (OCP, Sulfa, NSAIDS)
Autoimmune (IBD, Sarcoid)

Treatment: rest, ice, pain control

19
Q

Panniculitis:

Erythema Induratum

A

Tender red nodules

Lobular panniculitis and vasculitis

Middle aged, usually female

Posterior legs>ant

Chronic, recurrent subcutaneous nodules and plaques with ulceration

Associated with TB

20
Q

6 Ps

A

LICHEN PLANUS (6 Ps)

  1. Planar (flat topped)
  2. Purple
  3. Polygonal
  4. Pruritic
  5. Papules
  6. Plaques

Erythematous to violaceous polygonal papules especially on the flexor areas such as wrists and ankles

21
Q

Subacute cutaneous lupus

A

A chronic multisystem autoimmune disease that predominantly affects the skin and joints, although any body system can be involved.

The most common presentation is a butterfly rash on the face, low-grade fever, and nondeforming arthritis

22
Q

Psoriasis (General)

A

common chronic skin disorder characterized by excessive proliferation of keratinocytes, resulting in the formation of thickened, scaly plaques, and inflammation, resulting in erythema and often pruritus

Risk factors: 30% genetic, stress, medications, infections, drugs (beta blockers, antimalarials)

23
Q

Post strptococcal infection

A

Psoriasis:

Guttate Type

Post strptococcal infection

children or young adults

eruptive trunkal dermatosis

24
Q

What is this?

A

Psoriasis: Pustular type

Generalized: Potentially life threating; Small pustules becoming generalized with fever

Localized: Hand and foot form involves the palms and soles. May be termed Pustular Psoriasis of Barber

25
Q

Hallmark of hives?

A

wheals

26
Q

Butterfly rash across the nose and the cheeks.

Photosensitive pattern of erythema accross upper chest and extensor areas.

Triggers: Sunlight and Medications (anti-seizure, antibiotics, BP Rx)

Treat with NSAIDs, antimalarials, corticosteroids

A

Systemic Lupus Erythematosus (SLE)

27
Q

Hallmark is development of Wickham’s Striae

Chronic, inflammatory, autoimmune disease

Association with Hepatitis C (HCV)

Location: wrists, shins, mucous membranes, Wickham’s stria (lacy, reticular, white lines)

A

lichen planus

28
Q

Group of vesicles on a red base which rapidly become purulent and crusted

Two types

A

Herpes Simplex

29
Q

“dew drop on a rose petal”

Incubation: average 14 days

fever, chills, malaise, 2-3 days before onset of rash

A

Varicella – Zoster virus (Chickenpox)

30
Q

Primary infection usually occurs in childhood with lesions on the lips or face

A

HSV 1

31
Q

Disease of adults involving the genital area, primary infection extensive, painful vesiculations and necrosis

Recurrent, lifelong disease with no cure

A

HSV 2

32
Q

Follows nerve root – single dermatome.

Prodrome: pain along nerve root up to 5 days prior to rash

Recurrence of varicella

A

Herpes Zoster (Shingles)

Treatment options: Acyclovir, Prednisone,
IV Acyclovir

33
Q

Bullae (bull’s eye filled with fluid), blisters occurring in the axillary, groin, fold areas most commonly.

Superficial vesicles progress to rapidly enlarging, flaccid bullae with sharp margins and no surrounding erythema. When the bullae rupture, yellow crusts with oozing result.

A

Bullous Impetigo

Caused by toxin producing Staph

Treat with:

Hygenic Measures
Topical Antibiotics
Oral Antibiotics

34
Q

Begins as a single red macule or papule that quickly becomes a vesicle. The vesicle ruptures easily to form an erosion, and the contents dry to form characteristic honey-colored crusts that may be pruritic.

A

Nonbullous Impetigo

70% of cases of impetigo are nonbullous

35
Q

Erythema, small pustules, fringe of white scale.

Cutaneous and mucosal (thrush, vulval vaginitis)

A

Yeast-Candida Albicans

36
Q

Common in skin folds and on mucous membranes.

Bright beefy red dermatitis surrounded by satellite micropustules

or

Infections can produce superficial blisters or pustules

A

Fungal Infections

Candida Albicans

Dermatophytes

37
Q

Autoimmune
Tense bullae (grouping) on normal or erythematous skin
Age: 60-80 years
Diagnosis based on histological exam.

A

Bullous pempigoid

Treat with:

Prednisone is the cornerstone of treatment

Topical cortisone for mild cases

38
Q

Autoimmune condition typified by clusters of erythematous papules, excoriations and vesicles that arise as a consequence of gluten sensitivity.

Most patients are between 20 and 40 years of age, but the condition may occur at any age.

Pruritic and distributed symmetrically along extensor surfaces

A

Dermatitis herpetiformis

Associated with Celiac Disease

39
Q

Autoimmune disease that affects the skin and mucous membranes. The predominant skin lesions are flaccid blisters.

The blisters are located on the head, trunk and intertriginous areas.

40 and 60 years of age.

Associated with Nikolsky sign (top layers of the skin slip away from the lower layers when slightly rubbed and may create a blister) and has a mortality rate of 5 to 15 %

A

Pemphigus vulgaris

40
Q

skin hyperpigmentation and urine discoloration (increased uro and coproporphyrins in the urine)

Blistering of the skin occurs on sun-exposed areas, especially the hands and forearms and occasionally face.

Patients may also exhibit hypertrichosis (growth of hair) of the forehead and cheeks.

Risk factors for the disease include Hepatits C, hemochromatosis and alcoholism.

A

Porphyria Cutanea Tarda

Results from a deficiency in a heme-synthesizing enzyme.

41
Q

history findings and associated shoulder Disorders:

Diabetes or thyroid disorders

A

Adhesive capsulitis

42
Q
A

Skin/MS--Week 3 (8 decks)

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