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Inflammatory Skin Disease Flashcards

1
Q

What is rosacea

A

A condition where blood vessels of the face dilate.

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2
Q

Cause of rosacea

A

Unknown!

Certain triggers:
sunlight, alcohol, spicy food, stress

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3
Q

Presentation of rosacea

A 
Fixed central erythema of face 
Mild or moderate papules 
pustules 
Rhinophyma - skin thickening of nose 
Telangiectasia 
Ocular involvement - blepharitis, keratitis, conjunctivitis
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4
Q

Ix of roacea

A

Clinical diagnosis

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5
Q

Tx rosacea

A

Topical Abx for localised disease:

  • topical metronidazole
  • azelaic acid
  • brimonidine gel

Systemic Abx for more severe disease:

  • tetracycline
  • isotretinoin
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6
Q

3 main autoimmune causes of skin blistering

A

Pemphigus
Bullous pemphigoid
Dermatitis Herpetiformis

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7
Q

What skin level does blistering in pemphigus occur in

A

Intra-epidermal

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8
Q

What skin level does blistering in bullous pemphigoid occur in

A

Sub-epidermal

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9
Q

What skin level does blistering in dermatitis herpetiformis occur in

A

Sub-epidermal

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10
Q

Investigation for autoimmune causes of blistering

A

Biopsy with immunofluorescence

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11
Q

Most common autoimmune bullous disease

A

Bullous pemphigoid

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12
Q

Presentation of bullous pemphigoid

A

Large tense bullae on normal skin or erythematous base

Bullae burst to leave erosions - no scarring

Itchy erythematous plaques and papules may preceed bullae formation by 3-4 months (so may be the only presenting feature!)

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13
Q

How many biopsies are taken for the investigation of bullous pemphigoid and where are they taken from

A

1 for histology - taken from a small intact blister

1 for immunofluoresence - taken from normal skin adjacent to blister

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14
Q

Pathogenesis of bullous pemphigoid

A

Patients circulating IgG antibodies react with antigens in the BM and hemidesmosomes anchoring basal cells to BM
results in complement activation and deposition around the BM

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15
Q

Histological appearance of bullous pemphigoid

A

Subepidermal bullae with lots of eosinophils

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16
Q

IMF appearance of bullous pemphigoid

A

Linear deposition at DEJ

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17
Q

Tx of bullous pemphigoid

A

Localised disease:

  • topical steroids (clobetasol - v potent)
  • topical tacrolimus

Generalised disease:
- oral steroids (prednisolone) (0.5-1mg/kg) - 40-80mg/day

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18
Q

prognosis of bullous pemphigoid

A

chronic and self-limiting

most have remission in several months

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19
Q

What age group of patients usually get bullous pemphigoid

A

elderly

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20
Q

What age group of patients usually get pemphigus vulgaris

A

Middle aged

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21
Q

presentation of pemphigus vulgaris

A

flaccid blisters that can be burst easily to form erythematous erosions

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22
Q

most common locations for pemphigus vulgaris to present

A

face, scalp, axillae, oral mucosa, groin

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23
Q

What is Nikolsky sign

A

firm pressure to the top layer of skin detaches the top layer

  • positive in pemphigus
  • negative in bullous pemphigoid
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24
Q

Most common complication of pemphigus vulgaris

A

secondary infection of deroofed blisters

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25
Q

Histological appearance of pemphigus

A

cleavage within epidermis with eosinophil infiltration

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26
Q

Pathogenesis of pemphigus vulgaris

A

IgG antibodies are directed against intercellular adhesions - acantholysis

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27
Q

Immunofluorescence of pemphigus vulgaris

A

“chicken wire” appearance - due to acantholysis - lysis of intercellular adhesion sites

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28
Q

Tx of pemphigus vulgaris

A

Localised disease:
- topical steroids

Systemic disease (more likely to need this):
- oral steroids - prednisolone 
\+/- 
azothioprine 
dapsone 
ciclosporin 
plasmapharesis
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29
Q

what is dermatitis herpetiformis

A

autoimmune blistering disorder associated with COELIAC DISEASE

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30
Q

Common sites of involvement of dermatitis herpetiformis

A

extensor aspects of elbows and forearms
buttocks and scapulae
extensor aspects of knees
face and scalp

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31
Q

presentation of dermatitis herpetiformis

A

small blisters on erythematous urticarial base
itch - precedes blistering
excoriations - burst blisters
grouping of lesions (like herpes)

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32
Q

Ix for dermatitis herpetiformis

A

Coeliac serology

Skin biopsy with immunofluorescence

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33
Q

Histological appearance of dermatitis herpetiformis

A

Subepidermal blister

microabscesses in dermal papillae

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34
Q

Immunofluorescence appearance of dermatitis herpetiformis

A

granular IgA deposits in dermal papillary

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35
Q

Tx of dermatitis herpetiformis

A

gluten free diet

dapsone

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36
Q

complication of dermatitis herpetiformis

A

small bowel lymphoma

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37
Q

What is psoriasis

A

chronic relapsing and remitting inflammatory skin disorder where there is HYPERPROLIFERATION OF EPIDERMAL CELLS

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38
Q

Cause of psoriasis

A

Exact cause unknown

Gene variants + environmental insults

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39
Q

Pathogenesis of psoriasis

A

Increased number of epidermal cells entering cell cycle from the basal layer - therefore faster epidermal turnover time

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40
Q

Epidermal turnover time in psoriasis

A

5 days

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41
Q

Normal epidermal turnover time

A

25 days

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42
Q

Plaques in psoriasis - sterile or non-sterile

A

STERILE!! swabs will grow nothing if pustules are present

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43
Q

precipitating factors of psoriasis

A
  1. Emotional stress
    - infection
    - drugs
    - alcohol
    - trauma
    - smoking
    - HIV/AIDS
    - cold weather
44
Q

What drugs can precipitate psoriasis

A

Lithium **
B blockers ***
Anti-malarials

45
Q

Name for when there has been trauma to the skin, then psoriasis develops around it

A

Koebner phenomenon

46
Q

What are Munro microabscesses

A

Clumps of leucocytes in the stratum corneum - seen in psoriasis

47
Q

Histological appearance of psoriasis

A

Parakeratosis (i.e. nucleated keratinocytes in stratum corneum)

absence of granular layer

expanded prickle cell layer

elongation of rete ridges

leucocytes - munro microabscess in stratum corneum

48
Q

What causes elongation of rete ridges in psoriasis

A

large dilated vessels in papillary dermis

49
Q

List the 10 different possible presentations of psoriasis

A
  1. chronic plaque
  2. guttate
  3. flexural
  4. scalp
  5. palmoplantar
  6. palmo plantar pustolosis
  7. erythrodermic
  8. generalised pustular
  9. nail
  10. psoriatic arthritis
50
Q

What is Auspitz sign

A

sign in psoriasis -

removal of plaque reveals pin-point bleeding

51
Q

What other conditions can Koebner phenomenon occur in, other than psoriasis

A

Lichen planus

Vitiligo

52
Q

What is guttate psoriasis

A

raindrop shaped multiple small psoriatic lesions on trunk

53
Q

What is development of guttate psoriasis associated with

A

streptococcal sore throat 7-10 days before onset of symptoms

54
Q

Sites of flexural psoriasis

A

groin
axillae
inframammary areas

55
Q

Tx of flexural psoriasis

A

Mild topical steroid

56
Q

What can flexural psoriasis be misdiagnosed as

A

fungal infection

intertrigo

57
Q

Tx of palmoplantar psoriasis

A 
topical tar preparations 
salicylic acid 
topical steroids 
phototherapy 
systemic immunosuppressants
58
Q

What is erythrodermic psoriasis

A

Uncommon sub type of psoriasis where >90% of skin surface is red

59
Q

Causes of erythrodermic psoriasis

A

withdrawal of potent topical or systemic steroids, drug reactions, UV burns

60
Q

Complications of erythrodermic psoriasis

A 
hypothermia 
cardiogenic shock 
dehydration 
anaemia 
hypoproteinaemia
61
Q

Tx of erythrodermic psoriasis

A

fluid balance
bed rest
emollients
systemic immunosuppressants

62
Q

causes of generalised psutular psoriasis

A

withdrawal of steroids
infection
pregnancy
hypocalcaemia

63
Q

Common nail changes in psoriasis

A

nail pitting
onycholysis
“oil-drop” lesions
subungual hyperkeratosis

64
Q

1st line Tx of psoriasis

A

Emollients

65
Q

What do emollients do for psoriasis

A

Remove scaling

66
Q

Tx used for psoriasis along with emollients

A

Topical corticosteroids

67
Q

How long should potent TCS be used for psoriasis Tx

A

Max 8 weeks at a time

68
Q

How long should very potent TCS be used for psoriasis Tx

A

Max 4 weeks at a time

69
Q

What length of time should patient wait between courses of TCS for psoriasis

A

4 week breaks

70
Q

Tx of psoriasis on the face

A

Mild TCS - hydrocortisone

71
Q

Max length of time TCS can be used on the face for psoriasis, and why is there a max lengh

A

1-2wks/month maximum

Face is prone to steroid atrophy

72
Q

When is using potent steroids not suitable as a treatment for psoriasis

A

when the psoriasis is generalised – risk of rebound flare up (pustular, erythroderma)s

73
Q

If topical steroids do not work for psoriasis, what other topical Tx can be tried

A
  1. Vitamin D analogues (Calcipotriol, Calcitriol)
  2. Coal tar preparations
  3. Dithranol
74
Q

How do Vitamin D analogues work as a Tx for psoriasis?

A

Reduce cell division and differentiation - help with plaque removal but not erythema

75
Q

Advantages of Vitamin D analogues for psoriasis Tx

A

clean and no odour
can be used long term unlike TCS
adverse s/e uncommon

76
Q

How does coal tar work as a Tx for psoriasis

A

Reduces DNA synthesis and epidermal proliferation

77
Q

Disadvantages of coal tar for psoriasis Tx

A

brown, smelly

can stain and irritate

78
Q

How does Dithranol work as a Tx for psoriasis

A

Anti-mitotic effect - only used on stable plaque psoriasis

79
Q

Disadvantages of Dithranol for psoriasis Tx

A

can only be used for short contact regimes - burns skin

stains clothing and bedding purple

80
Q

Specialist Tx available for psoriasis

A

Phototherapy

Systemic Tx

81
Q

phototherapy Tx for psoriasis

A

Phototherapy (UVB)
- 3x week for 6-8 weeks

Photochemotherapy (UVA)
PUVA = psoralen + UVA
2x week

82
Q

Adverse effects of PUVA Tx

A

skin ageing

SCC

83
Q

Systemic Tx for psoriasis

A
  1. Methotrexate
  2. Ciclosporin
  3. Retinoids
  4. biologics
84
Q

What is pityriasis rosea

A

An acute self-limiting rash

85
Q

Cause of pityriasis rosea

A

Unknown!

?Association with Herpes Hominis Virus 7 (HHV-7)

86
Q

Presentation of pityriasis rosea

A

Herald patch - early single lesion

then scaly, oval erythematous patches with “fir tree” appearance of distribution

87
Q

Tx of pityriasis rosea

A

None - self limiting that resolves in around 6 weeks

88
Q

What is pityriasis rosea often misdiagnosed as

A

Guttate psoriasis

89
Q

what is acne

A

common skin disorder characterised by keratin plugging of pilosebaceous units resulting in comedones, inflammation and pustules

90
Q

What characterises mild acne

A

open and closed comedones (white and black heads) mostly, with some papules and pustules

91
Q

Tx of mild acne

A

single topical Tx

  • topical retinoid
  • benzoyl peroxide
92
Q

what characterises moderate acne

A

papules and pustules predominate

93
Q

Tx of moderate acne

A

combined topical treatments
or
combine topical Tx and oral Abx

94
Q

what characterises severe acne

A

nodules and cysts and inflammatory papules and pustules

95
Q

Tx of severe acne

A

oral isotretinoin

96
Q

What is erythema nodosum

A

Inflammation of subcutaneous fat

97
Q

Causes of erythema nodosum

A

Infection - TB, Streptococci

Systemic disease - IBD, sarcoidosis, Behcet’s

Malignancy

Drugs - sulphonamids, COC

Pregnancy

98
Q

Presentation of erythema nodosum

A

Tender erythematous nodular lesions

Usually on shins - can also be forearms and thighs

99
Q

Tx of erythema nodosum

A
  1. Bed rest and elevation, Tx of underlying cause, analgesia
  2. Potassium iodide
  3. Intralesional corticosteroid injection
100
Q

What is lichen planus

A

An inflammatory skin disorder of unknown cause!

101
Q

Presentation of lichen planus

A

Pruritic, Purple, Polygonal shaped Papular rash (4 p’s of lichen planus)

102
Q

Appearance of Lichen planus in the mouth

A

Wickham’s striae - white lace pattern of surface

103
Q

Presentation of lichen planus in the nails

A

nail plate thinning, longitudinal ridging

104
Q

What is Lichen Sclerosus

A

itchy white spots typically on the vulva of elderly women

105
Q

Drugs causing lichenoid drug eruptions

A

Gold
Quinine
Thiazides

106
Q

Management of lichen planus

A
  1. Topical corticosteroids (clobetasol)
    +
    Antihistamines (chlorphenamine)
107
Q

Tx of oral lichen planus

A

benzydamine mouthwash

Dermatology (20 decks)

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