Inflammatory Skin Diseases Flashcards
1
Q
What are inflammatory skin diseases?
A
Every condition in dermatology apart from skin cancer and infections / infestations.
2
Q
What are the different investigations used in dermatology?
A
- Skin swabs - bacteriology and for viral PCR.
- Skin scrapings / nail clippings - mycology.
- Skin biopsy - both for H&E and direct immunoflurescence.
- Patch tests - look for type 4 allergy.
- Bloods - to aid diagnosis and for drug monitoring.
- Urine analysis.
- Imaging - occasionally.
3
Q
What is psoriasis?
A
- A chronic relapsing and remitting scaling skin disease which may appear at any age and affect any part of the skin.
- Scaly plaques on extensor surfaces.
- Prevalence - 1.5-3%.
- Age of onset 20-30y or 50-60y.
4
Q
What causes psoriasis?
Give examples of other conditions linked to psoriases.
A
- T cell mediated autoimmune disease
- → increased keratinocyte proliferation.
- Environmental and genetic factors.
- Linked to:
- Psoriatic arthritis
- Metabolic syndrome
- Liver disease / alcohol misuse
- Depression
5
Q
Describe and classify this skin condition.
A
- Smaller, more diffuse plaques.
- Guttate psoriasis.
6
Q
Describe and classify this skin condition.
A
- Flexional psoriasis - affects inverse areas: groin crease, behind the ears, genitals.
- Because it is in a moist area there is no scales.
7
Q
What is this condition?
Describe it.
A
- Psoriases
- Nail starts to lift off the nail bed.
- Pitting = tiny spots indentation in the nails.
- Orange spoits = salmon spot or oil spot.
8
Q
What condition do 20% of patients with psoriasis develop?
A
Arthritis
9
Q
What is this skin condition?
How would the patient present?
A
- Pustular psoriasis - this is an emergency.
- Lots of cytokines, high fever and high CRP.
- Patients present septic.
10
Q
What are the management options for psoriasis?
A
- Topical treatment
- Emollient
- Corticosteroids
- Vitamin D analogues
- Tar
- Dithranol
- Phototherapy
- Narrow band UVB
- PUVA
- Acitretin
- Methotrexate
- Ciclosporin
- Fumaric acid esters
- Biological therapies
- Etanercept, infliximab, adalimumab, ustekinumab, secukinumab, ixekizumab.
11
Q
Describe the clinical presentation of eczema.
A
- Impaired skin barrier function
- Dryness
- Skin becomes more permeable to irritants / allergens / microbes
- Overactive immune response to these environmental triggers.
- Inflammation (red, hot, tiny blisters / oozing).
- Overactive immune response to these environmental triggers.
- Scratching
- Broken skin / more inflammation +/- infection.
12
Q
How is eczema diagnosed?
A
- The patient must report an ITCHY skin condition (or parental report of scratching or rubbing in a child) in the last 12 months, plus three or more of the following:
- History of involvement of the skin creases.
- Personal history of asthma or hayfever (or history of atopic disease in first degree relative if child under 4 years).
- History of generally dry skin in the last year.
- Onset under the age of 2 years (not used if child under 4).
- Visual flexural dermatitis (including dermatitis affecting forehead or cheeks and outer aspects of limbs in children under 4 years).
13
Q
What happens in patients with have eczema who scratch?
A
The skin undergoes lichenification. It becomes hardened.
14
Q
What is this skin condition?
A
- Discoid eczema.
- Often see infection over this type of eczema.
15
Q
Describe the management of atopic eczema.
A
- Avoid irritants
- Emollient
- Topical corticosteroid or calcinurin inhibitors
- Prompt management of infection
- Phototherapy
- Immunosuppression and novel therapies
16
Q
What is this skin condition?
How is it treated?
A
- Asteatotic dermatitis.
- Not very much steroid, really just needs moisturisation.
17
Q
What is this skin condition?
A
Seborrheic dermatitis
18
Q
What is urticaria?
What is angioedema?
A
- Urticaria = wheals i.e evanescent oedematous plaques which are very itchy.
- Angioedema = oedema in deeper tissues.
- Both usually mast cell / histamine driven.
19
Q
With respect to urticaria and angioedema, what time periods represent acute and chronic conditions?
What triggers these?
A
- Acute <6 weeks
- Chronic > weeks
- Acute urticaria usually riggered by infection, drug (e.g. NSAIDs) or contact.
- Food allergy is a cause of acute urticaria in children.
- Chronic urticaria - spontaneous or inducible.
20
Q
What are the forms of chronic urticaria?
A
- Spontaneous
- No clear trigger
- Approx. 50% thought to be ‘autoimune’
- Inducible
- Dermographism
- Cholinergic urticatia
- Cold urticaria
- Delayed pressure urticaria
21
Q
What are the treatments for urticaria?
A
- H1 antagonists - up to 4x the licensed dose.
- H2 antagonists e.g. ranitidine
- Montelukast
- Phototherapy
- Omalizumab - anti-IgE monoclonal antibody
- Immunosuppression
22
Q
What are the possible causes of angioedema without wheals?
A
- Think drugs - usually ACE inhibitors.
- Rarely, C1 esterase inhibitor deficiency - inherited angioedema.
23
Q
Describe the properties of acne.
A
- Variable severity
- Significant psychological effect
- Can be iatrogenic
- Treatment:
- Topical - BPO, antibiotics, retinoids
- Oral antibiotics
- Cyproterone acetate (ocp)
- Systemic retinoids (TERATOGENIC)
24
Q
What are these skin lesions?
A
Comedones (blackheads).
25
What is this skin condition?
* **Acne Rosacea**
* Different demographic
* No comedones and more redness
26
What is this skin condition?
How is it treated?
* Bullous pemphigoid
* Tense fluid-filled blisters on urticated base
* Treatment:
* Oral steroids +/-
* Dozycycline +/-
* Immunosuppression
27
What is this skin condition?
How is it treated?
* **Pemphigus**
* Acquired raw, eroded skin
* Mucosal involvement is common
* Treatment:
* High dose steroids +/-
* Immunosuppression +/-
* Rituximab
28
What is this skin condition?
How is it treated?
* **Dermatitis herpetiformis**
* Itchy vesicles on elbows, knees and sacrum.
* Possibly associated with GI symptoms
* Treatment:
* Gluten free diet +/-
* Dapsone
29
Give examples of minor and severe cutaneous adverse drug reactions.
* Minor cutaneous adverse drug reactions:
* Exanthematous drug eruption (classic 'maculopapular' rash.
* Urticarial drug eruption.
* Severe cutaneous adverse drug reactions (SCARS)
* Erythroderma
* AGEP
* DRESS
* SJS/TEN
30
What is this skin condition?
* **Viral exanthem**
* Reaction to underlying viral infection, e.g.
* EBV (glandular fever)
* HIV
* Usually self-limiting
31
What is this skin condition?
What investigations are required?
* **Cutaneous vasculitis**
* Palpable purpura
* Usually 'reactive' to infection / drugs
* 50% no clear trigger
* Need to screen for primary vasculitides - check immunology.
* ALWAYS check BP and urinalysis looking for associated renal vasculitis.
32
What is this skin condition?
* **Erythema multiforme**
* Usually triggered by infection (occasionally drugs)
* Typically HSV or mycoplasma
* Minor - just affects the skin
* Major - mucosal involvement (similar presentation to SJS)
* Often get mouth ulcers and eye lesions
* Often recurrent
33
What is this skin condition?
What are the common things associated with this condition?
* **Erythema nodosum**
* Tender nodules / plaques, usually on the shins
* Common associations:
* COCP
* Prgnancy
* Streptococcal URTI
* Sarcoidosis
* IBD
34
What is this skin condition?
* **Porphyria cutanea tarda**
* Most common subtype of porphyria
* Photosensitivty
* Commonest cause in the UK is hepatocellular damage from ETOH \> UROD deficiency.
35
What skin condition is this?
What conditions are associated with this skin disease?
* **Pyoderma gangrenosum**
* Painful ulcers, with violaceous borders
* Associations:
* IBD
* Rheumatoid arthritis
* Haematological dyscrasias
36
What is this skin condition?
What other conditions are associated with this skin disease?
* **Vitiligo**
* Organ specific autoimmune disease
* Associations:
* Thyroid disease
* T1DM
* Pernicious anaemia
* Atopy
37
What is this skin condition?
**Xanthelasma**
38
What is this skin condition?
* **Erythema nodosum**
* Axillary freckling in NF1.
* Not strictly an inflammatory dermatosis but a good example of skin signs in systemic disease.
39
What is this skin condition?
**Necrobiosis lipoidica**
40
What is lupus?
* Skin only disease vs systemic disease
* Photosensitivity key feature of cutaneous lupus
* Different morphologies
