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3rd yr- IWB- Pathology > Inflammatory skin diseases > Flashcards

Inflammatory skin diseases Flashcards

1
Q

What is the epidermis mainly composed of?

A

Epithelial cells

Melanocytes

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2
Q

What do epithelial cells do

A

They make keratin to make keratocytes

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3
Q

List the board categories non infectious inflammatory diseases can fall under

A
  1. Dermatitis/ psoriasis
    2, Blistering
  2. Connective tissue damage
  3. Skin lesions as a sign of systemic disease
  4. Skin lesions caused by metabolic disorders
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4
Q

Name the most common disease of the skin

A

Eczema/ dermatitis

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5
Q

What does eczema describe

A

A reaction pattern rather than a specific disease

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6
Q

How common is eczema in children

A

5% of children in the UK have eczema

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7
Q

What is another name for eczema?

A

Dermatitis

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8
Q

Name the stages of dermatitis

A
  1. Acute dermatitis
  2. Subacute dermatitis
  3. Chronic dermatitis
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9
Q

Describe the acute stage of dermatitis

A

Red skin
Weeping serous exudate
There may be some small vesicles

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10
Q

Describe the subacute phase of dermatitis

A

Skin is red and crusty
Less exudate
Very very itchy skin

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11
Q

Describe the chronic stage of dermatitis

A

Skin is thick and leathery

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12
Q

How does eczema look under a microscope during the acute phase?

A

You’ll see oedemas within the epidermis and fluid filled blisters (spongiosis)

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13
Q

How does eczema look under a microscope during the chronic stage

A

Epidermis has become thickened and and the normal undulations of the epidermis became quite pronounced
spongiosis is much less
Keratin layer is bigger and thicker

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14
Q

What is spongiosis

A

Intercellular oedema within the epidermis

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15
Q

Name the different types of of eczema

A
  1. Atopic eczema
  2. Contact irritant dermatitis
  3. Contact allergic dermatitis
  4. Dermatitis of unknown aetiology
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16
Q

Who usually has atopic eczema

A

Children with family history

Often associated with asthma and hay fever

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17
Q

What type of inflammatory disease is atopic eczema

A

A type 1 hypersensitivity reaction to an allergen

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18
Q

What is contact irritant dermatitis caused by

A

Direct injury to skin by irritant eg acid, alkali, strong detergent

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19
Q

What is contact allergic dermatitis caused by

A

Nickel, dyes, rubber

These act as happens which combine with epidermal protein to become immunogenic

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20
Q

What type of inflammatory disease is contact allergic dermatitis?

A

A delayed type 4 hypersensitivity reaction

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21
Q

What are dermatitis with an unknown aetiology categorised by?

A

Their morphological subtypes

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22
Q

List the 2 morphological subtypes dermatitis of unknown aetiology can fall under

A
  1. Seborrhoeic dermatitis

2. Nummular dermatitis

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23
Q

Describe seborrhoeic dermatitis

A

Dermatitis that affects areas rich in sebaceous glands

EG scalp, forehead, upper chest

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24
Q

Describe nummular dermatitis

A

Coin shaped lesions

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25
Q

How common is psoriasis

A

Affects 1-2% of population

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26
Q

Describe how psoriasis looks

A
  1. Well defined, red oval plaques on extensor surfaces (knees, elbows, sacrum)
  2. Fine silvery scale
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27
Q

What happens if you pick at a scale caused by psoriasis (what is this called)

A

Removal of scale causes small bleeding portitis

This is called Auspitz sign

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28
Q

List some associating symptoms that people may psoriasis may present with

A
  1. Pitting nails

2. Sero negative arthritis

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29
Q

Describe the appearance of psoriasis under a microscope

A
  1. Regular e longed club shaped rete ridges
  2. Thickening of epidermis over dermal papillae
  3. Parakeratotic (contains nuclei) scaled
  4. Collections of neutrophils in scale
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30
Q

What does parakeratoic mean

A

Contains nuclei

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31
Q

What is the appearance of psoriasis under a microscope called?

A

Psoriasiform hyperplasia

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32
Q

What do the clinical and microscopic features of psoriasis suggest?

A

They reflect massive cell turnover

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33
Q

Describe the pathogenesis of psoriasis

A

Trigger factor leading to a dysfunctional immune reaction

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34
Q

Talk through the aetiology of psoriasis

A
  1. Genetic factors

2. Environmental trigger factors such as infection, stress, trauma and drugs

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35
Q

Which gene may be responsible for genetic psoriasis

A

Theres multiple loci on the psoriasis susceptibility or PSORS genes
Many of these loci lie in the region of major histocompatibility complex on chromosome 6p2

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36
Q

Name some diseases that are associated with psoriasis

A
  1. Arthropathy (5-10% associated)
  2. Psychosocial effects
  3. Cardiovascular disease
  4. Cancer increased risk of non melanoma skin cancer
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37
Q

What is the most common treatment plan for psoriasis and what problems can this cease?

A

UV light is the main treatment option

This is a risk factor for developing skin cancer

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38
Q

How can psoriasis manifest in the oral cavity?

A
  1. Geographical tongue

2. Angry red patches on the hard palette

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39
Q

What is lupus erythematosus

A

It is an auto immune disorder primarily affecting connective tissues of the body

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40
Q

Which organ is mainly affected by lupus erythematosus

A

Can affect any part of the body but most importantly kidneys

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41
Q

What happens in lupus erythematosus

A

Autoantibodies are directed at various tissues

42
Q

Which parts of the body are affected by systemic lupus erythematosus

A

Can affect all parts of the body eg:

  1. Brain
  2. Skin
  3. Renal system
  4. Can cause fever
43
Q

Name the types of lupus erythematosus that affect the skin

A
  1. Discoid lupus erythematosus

2. Systemic lupus erythematosus

44
Q

Describe the clinical presentation of discoid lupus erythematosus

A

Affects only the skin

Leads to red scaly patches on sun exposed skin, can cause scarring

45
Q

what does scalp involvement in discoid lupus erythematosus cause

A

Alpoecia

46
Q

Describe the clinical presentation of systemic lupus erythematosus

A

It is a visceral disease that MAY involve the skin

Butterfly rashes on cheeks and nose

47
Q

Describe how lupus erythematosus looks under a microscope

A

Thin atrophic epidermis, inflammation and destruction of adnexal structures
IgG deposited in basement membrane

48
Q

How do we confirm a diagnosis of lupus erythematosus

A
  1. We create an antibody to the endogenous lupus antibodies
  2. Attach a fluorescent signal to the antibody
  3. Mix a sample of skin and the antibody
  4. if under a microscope you seen fluorescence then you have lupus erythematosus antigens in the sample
49
Q

Name a condition that can give an almost identical histological presentation to lupus erythematosus

A

Dermatomyositis

50
Q

What is Dermatomyositis

A

Peri ocular oedema and erythema (heliotropic rash)

51
Q

What can Dermatomyositis cause

A
  1. Erythema in photosensitive distribution

2. Myositis: proximal muscle weakness

52
Q

What is Dermatomyositis associated with in adults

A

In adults 25% of Dermatomyositis cases are associated with underlying visceral cancer

53
Q

What is Dermatomyositis characterised by?

A

heliotropic rash

54
Q

Describe the microscopy of Dermatomyositis

A

Very similar to lupus : 1. Thin atrophic epidermis, inflammation and destruction of adnexal structures
2. IgG deposited in basement membrane

Often there’s a lot of dermal mucin
Negative Immuno fluorescent test

55
Q

Describe the presentation of lichen planus

A

Appears on the flexor surfaces, mucous membranes and genitals of adults
Can last for 1-2 years or longer in the oral cavity

56
Q

What is lichen planus

A

A type 4 hypersensitivity reaction

57
Q

What is lichen planus associated with

A

Viral hepatitis. HIV and drug use

58
Q

How do bullous diseases manifest

A

Manifest as the formation of fluid filled blisters

59
Q

Name the 2 types of bullous skin diseases

A
  1. Pemphigus

2, Pemphigoid

60
Q

What is the difference in Pemphigus and Pemphigoid manifestation

A

Where the fluid filled blisters form in the epidermis

61
Q

Where do blisters form in Pemphigus

A

Blisters form within the epidermis (intra epidermal bulla)

62
Q

Where do blisters form in pemphigoid

A

Blisters form at the bottom of the epidermis (sub epidermal bulla)

63
Q

Describe pemphigus blisters

A

Quite fragile and can easily fall off

64
Q

Describe pemphigoid blisters

A

Quite tense and robust

65
Q

What type of diseases are bullous diseases

A

They are autoimmune diseases

66
Q

Where do antibodies form in pemphigus?

A

Form in intercellular junctions

67
Q

Where do antibodies form in pemphigoid?

A

In the basement membrane

68
Q

What is pemphigus

A

It’s a group of disorders characterised by loss of cohesion between keratinocytes resulting in an intraepidermal blister

69
Q

What do all types of pemphigus cause

A

Cause fragile blisters/ bullae which rupture easily

Can be extensive and may involve the mucous membrane

70
Q

Describe the pathogenesis of pemphigus

A

Autoantibodies are directed against intercellular materials

71
Q

How can pemphigus be detected

A

By imminofluoresecence (IMF)

72
Q

What is bullous pemphigoid

A

A disease characterised by subepidermal blisters

These blisters are large and tense and down rupture easily

73
Q

Describe the pathogenesis of bullous pemphigoid

A

Autoantibodies to glycoprotein in basement membrane that can be detected by IMF

74
Q

What is dermatitis herpetiformis

A

Small intensely itchy blisters associated with the deposition of IgA

75
Q

Who is dermatitis herpetiformis most common in

A

Young people

76
Q

What is dermatitis herpetiformis associated with

A

Coeliac disease

77
Q

Describe the histopathology of dermatitis herpetiformis

A

Neutrophil micro-abscesses in dermal papillae

78
Q

Where do blisters caused by dermatitis herpetiformis form

A

They form sub epidermally and cause IgA in dermal papillae

79
Q

Why is it hard to get a biopsy of a blister caused by dermatitis herpetiformis ?

A

As they are incredibly itchy and people often scratch away at them before they can be inspected

80
Q

List some skin lesions that are a sign of systemic disease

A
  1. Dermatomyositis
  2. dermatitis herpetiformis
  3. Ancanthosis nigricans
  4. Necrobiosis lipoidica
  5. Erythema nodosum
81
Q

What can Dermatomyositis a sign of

A

Can be a sign of visceral cancer

82
Q

What can dermatitis herpetiformis be a sign of?

A

Coeliac disease

83
Q

Describe ancanthosis nigricans

A

Dark warty lesions in the armpits

84
Q

What does IMF stand for

A

imminofluoresecence

85
Q

What can ancanthosis nigricans be a sign of

A

Intermal malignancy

86
Q

Describe Necrobiosis lipoidica

A

Red and yellow plaque on legs

87
Q

What can Necrobiosis lipoidica be a sign of

A

Diabetes melitus

88
Q

Describe Erythema nodosum

A

Red tender nodules on the shins

89
Q

What can Erythema nodosum be a sign of

A

Associated with infections elsewhere especially lungs

90
Q

Name the 2 form of inflammatory bowel disease

A
  1. Ulcerative colitis
  2. Crowns disease
    (But can be hard to differentiate between the 2)
91
Q

What are inflammatory bowel diseases?

A

They are chronic idiopathic inflammatory diseases

92
Q

What does ulcerative colitis usually effect?

A

The colon

93
Q

What is ulcerative colitis

A

Inflammation of the rectum followed by CONTINUOUS inflammation through the large bowel

94
Q

Where is inflammation caused by ulcerative colitis often confined to?

A

Confined to the most superficial layer of the bowel wall

95
Q

Talk through some extra gastrointestinal manifestation of ulcerative colitis

A
  1. Skin: pyoderma gangrenosum
  2. Joints: large joint arthritis, ankylosing spondylitis
  3. Liver: primary sclerosing cholangitis
96
Q

How do we treat ulcerative colitis

A

Removing the colon

97
Q

Where can crohns disease arise?

A

From mouth to anus

98
Q

Describe the inflammation caused by crohns disease

A

DEEP inflammation that tends to be patchy

99
Q

State the histological hallmark for crohns disease

A

Non caseating granulomas

100
Q

What are granulomas?

A

Aggregations of certain inflammatory cells

3rd yr- IWB- Pathology (11 decks)

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