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Disease and Defense III > Inflammatory skin disease > Flashcards

Inflammatory skin disease Flashcards

1
Q

Type of dermatitis often seen in association with other signs of venous insufficiency of the lower extremities

A

stasis dermatitis

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2
Q

complicating factors of stasis dermatitis (3)

A

dryness
itching
contact dermatitis (allergic due to use of topical preparations (i.e. topical antibiotics) (irritant due to wound exudates)

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3
Q

In what ways can contact dermatitis complicate stasis dermatitis?

A

allergic due to use of topical preps (i.e. antibiotics)

irritant due to wound exudate

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4
Q

Psoriasis may be associated with increased risk of?

A

cardiovascular disease

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5
Q

what type of immune response is allergic contact dermatitis -?

A

delayed type hypersensitivity - (type iv) -

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6
Q

how do we confirm allergic contact dermatitis

A

patch testing

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7
Q

which type of dermatitis is associated with asthma and allergic rhinitis

A

atopic dermatitis

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8
Q

etiology of allergic contact dermatitis

A

common allergens

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9
Q

etiology of irritant dermatitis

A

common irritants

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10
Q

common etiology of atopic dermatitis

A

filaggrin

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11
Q

common etiology of seborrheic dermatitis

A

malassezia furfur (a fungus)

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12
Q

common etiology of stasis dermatitis

A

lower extremity edema

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13
Q

common location of psoriasis

A

extensor surfaces

may include arthritis

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14
Q

common location of atopic dermatitis

A

flexor surfaces

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15
Q

common locations of seborrheic dermatitis

A

scalp

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16
Q

common location of stasis dermatitis

A

lower legs

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17
Q

venous stasis ulcers are frequently found in conjunction with?

A

stasis dermatitis

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18
Q

where are venous stasis ulcers primarily found?

A

found on the medial lower leg just above the ankle

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19
Q

what color are venous stasis ulcers?

borders?

A

red in color with yellow fibrinous base
borders are irregularly shaped
may be purulent if infected

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20
Q

treatment of stasis dermatitis?

A 
CAVETE
Compression 
Avoid allergens
Vascular surgery 
Elevation 
Topical Steroids
Exercise calf muscles
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21
Q

Morphology of Dermatitis vs Morphology of Cellulitis

A

Dermatitis = erythematous papules and thin plaques with scale

Cellulitis = warm, tender, erythematous patches or plaques

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22
Q

Locations of Dermatitis vs. Locations of Cellulitis

A 
Dermatitis = epidermis / dermis
Cellulitis = dermis and sub-cu
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23
Q

So, if we see a patient with erythematous papules and thin plaques with scale affecting the dermis and epidermis what would list as our most likely dx?

A

Dermatitis

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24
Q

So, if we see a patient with warm and tender erythematous patches or plaques affecting their dermis and sub-cu, what would be our most likely dx?

A

Cellulitis

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25
Q

Jane has a bilateral lower extremity edema and itchy rash. What is her most likely diagnosis

A

stasis dermatitis

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26
Q

When we talk about dermatitis, what type of dermatitis are we usually talking about?

A

Spongiotic dermatitis = nonspecific reaction pattern seen on skin biopsy

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27
Q

Will we be able to tell the type of dermatitis based on skin biopsy?

A

no, will need to know history

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28
Q

Whenever you see a rash on the leg and vericose veins, think?

A

stasis dermatitis

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29
Q

stasis ulcers generally develop where?

A

on the medial lower leg

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30
Q

the symmetric distribution with pitting edema noted from socks is classic in patients with?

A

stasis dermatitis

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31
Q

Pat has a chronic bilateral lower extremity rash with worsening erythema, swelling, warmth, and tenderness in the left leg over the past week. What is the most likely diagnosis?

A

cellulits

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32
Q

Unilateral rubor, calor, tumor, and dolor extending proximally up the leg is consistent with?

A

cellulitis

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33
Q

why don’t you get epidermal changes in cellulitis

A

because it is affecting the dermis - not the epidermis

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34
Q

What is atopic dermatitis and when does it usually begin?

A

Common skin disease, which may begin at any age, however a majority begin before 5

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35
Q

If we see bilateral symptoms are we thinking stasis dermatitis or cellulitis

A

bilateral is usually dermatitis… bilateral is uncommon in cellulitis

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36
Q

Atopic diathesis frequently associated with atopic dermatitis? (2)

A

asthma
allergic rhinitis
atopic dermatitis

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37
Q

Atopic dermatitis is usually considered a disease of?

A

childhood exzema

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38
Q

Where is atopic dermatitis usually localzied to?

A

flexures (i.e. anti-cubital fossa)

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39
Q

infantile (0-2) atopic dermatitis usually presents as?

A

dry, red scaly areas confined to the cheeks

becomes flushed with exposure to cold

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40
Q

atopic dermatitis (>2) characteristic involvement?

A

flexural skin

  • atecubital fossa
  • popliteal fossa
  • neck
  • wrist
  • ankles
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41
Q

To diagnose atopic dermatitis, your patient must have X + 3

A

Must have: Itchy skin + 3

  • Onset under 2
  • Hx of involvement of skin creases
  • Personal hx of asthma or hay fever
  • Hx of dry skin within last yr
  • Visible flexural eczema
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42
Q

Frequent sites of atopic dermatitis in adults?

A

eyelid
hand (palm)

*in addition to flexural

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43
Q

Associated features of atopic dermatitis

A

dry skin (xerosis)
keratosis pilaris
ichtyosis vulgaris
hyperlinearity of the palms

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44
Q

The itch that rashes =

A

atopic dermatitis

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45
Q

70% of patients with atopic dermatitis have a mutation in?

A

filaggrin

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46
Q

Ichthyosis vulgaris is a defect in

A

filaggrin

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47
Q

What skin condition is the number one global burden of disease?

A

eczema

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48
Q

Is the global burden of eczema increasing or decreasing?

A

increasing

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49
Q

What would we call a non-immunologically mediated reaction resulting from a direct cytotoxic effect?

A

irritant contact dermatitis

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50
Q

are irritant contact dermatitis from repeated or single exposures?

A

could be from either…since it is non-immunologically mediated

51
Q

how do we test for irritant dermatitis?

A

there is no specific test for irritant dermatitis

52
Q

what is the most common type of contact dermatitis?

A

irritant contact dermatitis

53
Q

strong vs weak irritants

A

strong can damage skin even in small amounts - weak are harmless by themselves but repeated contact may damage

54
Q

examples of weak irritants?

A 
soap
skin products
perfumes
wool
raw food (meat, fruit, veggies)
body secretions (feces, urine, saliva, sweat)
friction
55
Q

What is intertrigo?

A

Intertrigo (intertriginous dermatitis) is an inflammatory condition of skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation.

56
Q

What does allergic contact dermatitis require?

A

Requires contact exposure of an allergen, immune response, and development of “memory” T cells

57
Q

What type of immune response is allergic contact dermatitis?

A

Type Iv

58
Q

When does reaction usually manifest in allergic contact dermatits?

A

Type IV, delayed type hypersensitivity reaction usually starts 24-48 hours after exposure to the allergen, but it can be delayed longer

59
Q

What is a contact allergy?

A

Delayed type hypersensitivity reaction

60
Q

Poison ivy would be an example of?

A

Delayed type hypersensitivity

61
Q

ACD what are allergens usually?

A

small chemical molecules (haptens) usually

62
Q

ACD… the small size of allergens (haptens) enables?

A

penetration through the skin

63
Q

ACD… how are allergens presented to the immune system?

A

Langerhans cells present allergen to T cells

64
Q

ACD…exposures to develop sensitization?

A

most haptens are weak allergens and require repeat exposures prior to sensitization

65
Q

ACD…what actually causes the inflammation?

A

elicitation of ACD caused by inflammatory cytokines including TNF-alpha and IL-1

66
Q

What is the gold standard test for diagnosing ACD?

A

Patch testing

67
Q

Top 3 contact allergens?

A

Nickel
Balsam of Peru (fragrance)
Neomycin

68
Q

Risk factors for Nickel sensitivity? (3)

A

Female

Young (

69
Q

Is nickel contact dermatitis increasing or decreasing?

A

increasing

70
Q

Europe and Nickel?

A

EU put up regulations on the amt of nickel in products –> the rate of nickel contact dermatitis declined

71
Q

Fragrance and contact allergens - unscented products?

A

May still have masking fragrance and cause dermatitis

72
Q

EU and US fragrance

A

EU requires labeling of fragrance allergens of certain concentrations

US FDA bans 10

73
Q

Common topicals that cause allergen dermatitis?

A

Bacitracin and Neomycin - often occur together

can see co-sensitization

wide-spread use has lead to increase in sensitization

74
Q

What is the most common type of drug reaction in skin?

A

Drug eruptions - eczematous eruptions

75
Q

What is the usual kind of drug eruption?

A

Cell-mediated type IV hypersensitivity

76
Q

Are drug eruptions usually localized?

A

no, generalized

77
Q

Drug eruption time course

A

7-14 day after starting a new medication

78
Q

When would a drug eruption start sooner than 7-14 days?

A

in cases of receiving an “old” medication (i.e. inadvertent re-challenge)

79
Q

what is an exanthem?

A

is a widespread rash usually occurring in children but can occur in adults. An exanthem can be caused by toxins, drugs, or microorganisms, or can result from autoimmune disease.

80
Q

Exanthematous eruption

what percent in children are drug induced
what percent in adults are drugs induced?

A

10-20% in children (exanthem in children is more likely to be virus because they are ooey… medical term :))
50-70% in adults

81
Q

Drugs responsible for exanthematous eruptions?

A 
aminopenicillins
sulfonamides
cephalosporins
anticonvulsants 
allopruinol
82
Q

Exanthematous drug eruption…
treatment?
resolution?

A

treatment

  • discontinue offending medication
  • supportive care with topical steroids

resolution
- usually 1-2 weeks after stopping drug but can take up to 3 months

83
Q

What is urticaria?

A

hives / wheals

84
Q

We see urticaria in what kind of hypersensitivity?

A

Immediate type I

mediated by IgE

85
Q

How long does each lesion in urticaria last?

A

less than 24 hours

86
Q

What layer of skin is affected in urticaria?

A

dermis… so we won’t see scale / blisters

87
Q

In type I drug sensitivity - what does first exposure generate?

A

IgE antibodies

88
Q

In type I drug hypersensitivity - what does re-exposure do?

A

antigen binds to IgE on mast cells and basophils causing degranulation with release of mediators such as histamine

89
Q

How do we treat urticaria?

A

antihistamines

90
Q

acute urticaria? how long present?

A

urticaria present less than 6 weeks - 2/3 new onset urticaria will resolve within this time frame

91
Q

chronic urticaria? how long last?

A

present for most days, for a period greater than 6 weeks

92
Q

Top 3 causes of chronic urticaria?

A

72% idiopathic / autoimmune
20% physical urticaria
2% tie food/vasculitis

93
Q

chronic urticaria is or is not usually due to food/med

A

not

94
Q

What are some examples of physical urticarias?

A 
dermagraphism (stroke)
delayed pressure
vibratory 
exercise induced
cold
solar
aquagenic
95
Q

What is nummular dermatitis

A

due to dry skin / excess use of soap

also called discoid eczema

96
Q

Where is nummular dermatitis most common?

A

legs, but can also be on arms and trunk

97
Q

who most susceptible to nummular dermatitis?

A

men>50

98
Q

nummular dermatitis appearance?

A

patches which may be red and scaly (discoid) and may become crusty - tends to be stubborn
stop soap use corticosteroids

99
Q

what is dandruff of the scalp called?

A

seborrheic dermatitis

100
Q

what do we call seborrheic dermatitis in bambinos?

A

cradle cap

101
Q

what does seborrheic dermatitis look like?

A

(flaky whit to yellowish oily scale scalp)

can become confluent with thick scale covering most of scalp

102
Q

when does seborrheic dermatitis start?

A

begins 1 week after birth and may persist for several months (cradle cap version)

103
Q

Seborrheic dermatitis in adults

- facial involvement?

A

usually symmetric facial involvement over the medial eyebrows and nasolabial folds
- occurs in areas rich in sebaceous glands (scalp/face/ears/chest)

104
Q

What characterizes seborrheic dermatitis?

A

flaky / greasy scales

105
Q

What is seborrheic dermatitis though to be due to?

A

a combination of an over production of skin oil and irritation from a yeast called MALASSEZIA FURFUR

106
Q

What has seborrheic dermatitis been linked to?

A

Neurologic conditions - including parkinsons / head injury / stroke
HIV

107
Q

How would you distinguish psoriasis dandruff from seborrheic dermatitis dandruff?

A

seb derm is more diffuse with lesion of finer scale

108
Q

what percent of population has psoriasis?

A

2

109
Q

what percent of patients with psoriasis have +FH?

A

36

110
Q

Histology of psoriasis?

A

hyperproliferation of the epidermis with elongation of the rete ridges, neutrophils and dilated capillary loops in the dermal papillae

111
Q

4 subtypes of psoriasis?

A

chronic plaque disease
guttate
erythroderma
pustular psoriasis

112
Q

guttate psoriasis is associated with?

A

strep

113
Q

what percent of patients with psoriasis get psoriatic arthritis?

A

5-20

114
Q

comorbidities of psoriasis?

A

persistent low grade inflammation favors the development of insulin resistance, obesity, and metabolic syndrome

115
Q

psoriasis is an independent risk factor for?

A

cv disease

116
Q

patients in their 40s with psoriasis

increased risk for MI?

A

Severe 2x

mild 1.2x

117
Q

psoriasis localized disease treatment?

A 
Calcipotriol (VitD3)
corticosteroids
topical retinoids
phototherapy 
- UVB. PUVA
118
Q

psoriasis widespread disease treatment?

A 
methotrexate
cyclosporin
systemic retinoids
biologics 
- anti T-lymphocyte 
- anti TNF alpha
119
Q

Seborrheic dermatitis is usually a result of sensitivty to ?

A

Yeast (MALASSEZIA FURFUR)

120
Q

Psoriasis vs Seborrheic dermatitis

A

size of scale

121
Q

psoriasis tends to occur on which surfaces?

A

extensor

122
Q

psoriasis WBC character?

A

neutrophils

123
Q

Psoriasis onset usually 2 things?

A

genetic predisposition with environmental trigger

124
Q

psoriasis is independent risk factor for metabolic syndrome due to …

A

systemic inflammation

Disease and Defense III (11 decks)

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