Inflammatory Skin Disease Flashcards
Describe the pathogenesis of eczema, with reference to the barrier effect?
Inflammatory condition of the skin caused by a combination of genetic, immune and reactions to stimuli
The barrier effects leads to increased permeability and reduced antimicrobial activity
An inherited abnormality in Filaggrin expression is a primary cause of disordered barrier function in eczema. What is filaggrin?
A group of proteins which bind to keratin fibres in epidermal cells
What are the subtypes of endogenous eczema?
Atopic Seborrhoeic Discoid Varicose Pompholyx
What are the subtypes of exogenous eczema?
Contact (allergic)
Photoreaction
What other conditions is atopic eczema associated with?
Allergic rhinitis
Conjunctivitis
Hayfever
There are high levels of which antibody in atopic eczema?
IgE
Atopic eczema is common in infants and usually regresses by adolescence. T/F?
True
Most patients with atopic eczema have a family history of atopic illness. T/F?
True
What is the main symptom of atopic eczema?
Itchy rash
Atopic eczema often causes secondary infection. T/F?
True
Which sites are commonly affected by atopic eczema?
Face Flexor surfaces (elbows, backs of knees)
What foodstuffs can aggravate atopic eczema in infants?
Milk
Food can aggravate atopic eczema in adults. T/F?
False - this is important in infants but far less significant in adults
What are the potential complications of atopic eczema?
Bacterial infection with s.aureus Viral infection with molluscus, viral warts of eczema herpeticum Tiredness Growth reduction Psychological impact
How is atopic eczema treated?
Emollients Topical steroids Bandages Antihistamine Antibiotics/antivirals Education for parents and child Avoidance of exacerbating factors Systemic immunosupressants e.g. cyclosporin, methotrexate New biologic agents
Give examples of common allergens (and objects in which they are found) which can cause contact dermatitis
Nickel - jewellery, zips, scissors, coins
Chromate - cement, tanned leather
Cobalt - pigment, dyes
Colophony - glue, adhesive tape, plasters
Fragrance - cosmetics, creams, soaps
Describe the appearance of seborrhoeic dermatitis?
Chronic, scaly inflammatory condition
What type of eczema may occur in severe HIV?
Seborrhoeic dermatitis
What sites are commonly affected by seborrhoeic dermatitis?
Face
Scalp
Eyebrows
Occasionally the upper chest
What is the cause of seborrhoeic dermatitis?
Overgrowth of pittosporum ovale yeast
How is seborrhoeic dermatitis on the scalp treated?
Medicated anti-yeast shampoo containing ketoconazole
How is seborrhoeic dermatitis on the face treated?
Anti-microbial e.g. daktacort cream
Mild steroid
Simple moisturisers
What type of eczema is caused by underlying venous disease?
Venous dermatitis
What is the cause of venous dermatitis?
Underlying venous disease which results in incompetence of the deep perforating veins and increase hydrostatic pressure
How is venous dermatitis managed?
Emollients
Mild/moderate topic steroid
Compression bandaging
Consideration of early venous surgical intervention
What is psoriasis?
A chronic relapsing and reciting scaling skin disease
What are the two peaks of age at which psoriasis presentation is most prevalent?
20-30 years
50-60 years
Describe the pathogenesis of psoriasis?
T cell mediated autoimmune disease
Abnormal infiltration of T cells. results in release of inflammatory cytokines including interferon, interleukins and TNF and increased keratinocyte proliferation
What conditions are associated with psoriasis?
Psoriatic arthritis
Metabolic syndrome
Liver disease/alcohol misuse
Depression
There is a strong family history in psoriasis. T/F?
True
Which genes are associated with psoriasis?
PSORS genes
HLA-Cw0602
What are the treatment options for psoriasis?
Topical creams and ointments
Phototherapy light treatment
Systemic drugs / immunosuppressants
Biologic therapies
What topical therapies can be sued in the treatment of psoriasis?
Moisturisers to help reduce dryness and flaking
Steroids to reduce the autoimmune response, redness, itching and inflammation
Salicylic acid to dissolve thick dead skin
Vitamine D analogues/coal tar/dithranol to slow. down keratinocyte proliferation
What are the risks fo UV phototherapy in the treatment of psoriasis?
Burning
Risk of skin cancer
Describe the use of UV phototherapy in the treatment of psoriasis?
Reduces T cell proliferations, encourages vitamin D production and reduces skin turover
UVB light is commonly used
What systemic therapies can be used in the treatment of psoriasis?
Immunosuppressants - methotrexate, ciclosporin Acitretin Dimethyl fumarate Apremilast Adalimumab Ustekinumab
What are the potential side effects of systemic therapies used in the treatment of psoriasis?
Liver dysfunction
Hypertension
Increased risk of infection
What are the symptoms of psoriasis?
Itch
Occasional pain if thick plaques on hands and feet with fissuring
What pattern of join pains might be seen in a patient with psoriasis?
Small joint, digit arthritis with swelling, redness, arthralgia
Acial sacroiliac
