Inflammatory Skin Disease

Question 1

Describe the pathogenesis of eczema, with reference to the barrier effect?

Answer 1

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

Question 2

An inherited abnormality in Filaggrin expression is a primary cause of disordered barrier function in eczema. What is filaggrin?

Answer 2

A group of proteins which bind to keratin fibres in epidermal cells

Question 3

What are the subtypes of endogenous eczema?

Answer 3

Atopic
Seborrhoeic
Discoid
Varicose
Pompholyx

Question 4

What are the subtypes of exogenous eczema?

Answer 4

Contact (allergic)

Photoreaction

Question 5

What other conditions is atopic eczema associated with?

Answer 5

Allergic rhinitis
Conjunctivitis
Hayfever

Question 6

There are high levels of which antibody in atopic eczema?

Answer 6

IgE

Question 7

Atopic eczema is common in infants and usually regresses by adolescence. T/F?

Answer 7

True

Question 8

Most patients with atopic eczema have a family history of atopic illness. T/F?

Answer 8

True

Question 9

What is the main symptom of atopic eczema?

Answer 9

Itchy rash

Question 10

Atopic eczema often causes secondary infection. T/F?

Answer 10

True

Question 11

Which sites are commonly affected by atopic eczema?

Answer 11

Face
Flexor surfaces (elbows, backs of knees)

Question 12

What foodstuffs can aggravate atopic eczema in infants?

Answer 12

Milk

Question 13

Food can aggravate atopic eczema in adults. T/F?

Answer 13

False - this is important in infants but far less significant in adults

Question 14

What are the potential complications of atopic eczema?

Answer 14

Bacterial infection with s.aureus
Viral infection with molluscus, viral warts of eczema herpeticum
Tiredness
Growth reduction
Psychological impact

Question 15

How is atopic eczema treated?

Answer 15

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

Question 16

Give examples of common allergens (and objects in which they are found) which can cause contact dermatitis

Answer 16

Nickel - jewellery, zips, scissors, coins
Chromate - cement, tanned leather
Cobalt - pigment, dyes
Colophony - glue, adhesive tape, plasters
Fragrance - cosmetics, creams, soaps

Question 17

Describe the appearance of seborrhoeic dermatitis?

Answer 17

Chronic, scaly inflammatory condition

Question 18

What type of eczema may occur in severe HIV?

Answer 18

Seborrhoeic dermatitis

Question 19

What sites are commonly affected by seborrhoeic dermatitis?

Answer 19

Face
Scalp
Eyebrows
Occasionally the upper chest

Question 20

What is the cause of seborrhoeic dermatitis?

Answer 20

Overgrowth of pittosporum ovale yeast

Question 21

How is seborrhoeic dermatitis on the scalp treated?

Answer 21

Medicated anti-yeast shampoo containing ketoconazole

Question 22

How is seborrhoeic dermatitis on the face treated?

Answer 22

Anti-microbial e.g. daktacort cream
Mild steroid
Simple moisturisers

Question 23

What type of eczema is caused by underlying venous disease?

Answer 23

Venous dermatitis

Question 24

What is the cause of venous dermatitis?

Answer 24

Underlying venous disease which results in incompetence of the deep perforating veins and increase hydrostatic pressure

Question 25

How is venous dermatitis managed?

Answer 25

Emollients Mild/moderate topic steroid Compression bandaging Consideration of early venous surgical intervention

Question 26

What is psoriasis?

Answer 26

A chronic relapsing and reciting scaling skin disease

Question 27

What are the two peaks of age at which psoriasis presentation is most prevalent?

Answer 27

20-30 years | 50-60 years

Question 28

Describe the pathogenesis of psoriasis?

Answer 28

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

Question 29

What conditions are associated with psoriasis?

Answer 29

Psoriatic arthritis Metabolic syndrome Liver disease/alcohol misuse Depression

Question 30

There is a strong family history in psoriasis. T/F?

Answer 30

True

Question 31

Which genes are associated with psoriasis?

Answer 31

PSORS genes | HLA-Cw0602

Question 32

What are the treatment options for psoriasis?

Answer 32

Topical creams and ointments Phototherapy light treatment Systemic drugs / immunosuppressants Biologic therapies

Question 33

What topical therapies can be sued in the treatment of psoriasis?

Answer 33

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

Question 34

What are the risks fo UV phototherapy in the treatment of psoriasis?

Answer 34

Burning | Risk of skin cancer

Question 35

Describe the use of UV phototherapy in the treatment of psoriasis?

Answer 35

Reduces T cell proliferations, encourages vitamin D production and reduces skin turover UVB light is commonly used

Question 36

What systemic therapies can be used in the treatment of psoriasis?

Answer 36

``` Immunosuppressants - methotrexate, ciclosporin Acitretin Dimethyl fumarate Apremilast Adalimumab Ustekinumab ```

Question 37

What are the potential side effects of systemic therapies used in the treatment of psoriasis?

Answer 37

Liver dysfunction Hypertension Increased risk of infection

Question 38

What are the symptoms of psoriasis?

Answer 38

Itch | Occasional pain if thick plaques on hands and feet with fissuring

Question 39

What pattern of join pains might be seen in a patient with psoriasis?

Answer 39

Small joint, digit arthritis with swelling, redness, arthralgia Acial sacroiliac