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BRS DERMATOLOGY > Introduction to Dermatology 2 > Flashcards

Introduction to Dermatology 2 Flashcards

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1
Q

What external factors does the hair help protect against?

A

UV, things which may be crawling on us

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2
Q

What is the pilosebaceous unit?

A

the hair shaft, the hair follicle, the sebaceous gland, and the erector pili muscle

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3
Q

What does the pilosebaceous unit produce?

A

Sebum (oil)

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4
Q

What are the functions of the hair?

A
  1. Sexual /social interaction
  2. Source of epithelial and melanocyte stem cells
  3. Apocrine swear which is involved in thermoregulation
  4. Sebum production
  5. Protection against external factors
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5
Q

Where are terminal hairs found?

A

Scalp, eyebrows and eyelashes

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6
Q

Where are the vellus hairs found?

A

Found on the rest of the body, with the exception of the palms, soles and external genitalia, mucosal region of lips

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7
Q

What are the hairless genitalia in men and women?

A

Men - foreskin of the penis

Women- Labia minora

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8
Q

What are the three stages of the hair cycle?

A

Anagen
Catagen
Telogen

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9
Q

What phase of the hair cycle most of our hair in at any given time?

A

The anagen phase

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10
Q

How long does the anagen phase of the hair cycle last?

A

Lasts 2-6 years

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11
Q

What occurs in the catagen phase?

A

When the hair is shrinking / regressing back into the follicle

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12
Q

How long does the catagen phase last?

A

Lasts 3 weeks

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13
Q

What happens in the telogen phase?

A

The resting phase - hair is neither growing or shrinking

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14
Q

During states of illness, in what phase of the hair cycle can an increase in the amount of hair in this cycle be seen?

A

The telogen phase

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15
Q

How long does the telogen phase of the cell cycle last?

A

3 months

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16
Q

What happens to the hair after the telogen phase comes to a end?

A

The hair detaches and is lost

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17
Q

What are hair follicles?

A

Pockets of epithelium that are continuous with superficial epidermis

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18
Q

What is found at the base of a hair follicle?

A

A dermal papilla, made of dermis

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19
Q

Where does the arrector pili extend from?

A

The surface of the dermis to a point in the follicle wall

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20
Q

What is the purpose of the arrector pili muscle?

A

When they contract, they cause the hair to stand up

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21
Q

What type of muscle is the arrector pili?

A

Smooth muscle - controlled by autonomic nervous system

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22
Q

What type of secretion do sebaceous glands support?

A

Holocrine section

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23
Q

Where do the holocrine sebaceous glands open into?

A

pilary canal

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24
Q

In the axillae, what type of secretion are the glands found there associated with?

A

Apocrine glands

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25
Q

What are the two parts of the hair follicle?

A

Infundubulum and Isthmus

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26
Q

From what point does the infundubulum extent to and from?

A

The sebaceous gland to the surface of the skin

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27
Q

What points does the isthmus extend from?

A

Between the opening of the sebacous gland and the insertion of arrector pili muscle

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28
Q

What does epithelial keratinization begin with?

A

A lack of granular layer

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29
Q

What is trichilemmal keratinization?

A

Epithelium keratinisation begins with lack of granular layer names “trichilemmal keratinisation”

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30
Q

Where is the bulge located?

A

Just below the sebaceous gland

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31
Q

What cells reside in the bulge?

A

hair follicle stem cells

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32
Q

What forms when hair follicle stem cells migrate downwards?

A

New lower anagen hair follicles - they enter the hair bulb matrix, proliferate and undergo terminal differentiation to form hair shaft and inner root sheath

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33
Q

What forms when the hair follicle stem cells migrate upwards?

A

Form the sebaceous gland

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34
Q

Why are hair follicle stem cells important in injury?

A

They proliferate in response to wounding, and help healing response

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35
Q

What is the bulb?

A

The lower most portion of the hair follicle which includes the follicular dermal papilla and the hair matrix

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36
Q

What is the matrix?

A

The principal place where the hair shaft is being produced

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37
Q

What does the outer root sheath do?

A

Serves as a reservoir of stem cells

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38
Q

Where does the outer root sheath extend from?

A

From along the hair bulb to the epidermis

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39
Q

What is the purpose of the inner root sheath?

A

To guide and shape the hair

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40
Q

What is contained with the inner root sheath?

A

Follicular dermal papilla. mucopolysaccharide-rich strome, nerve fibre and capillary loop

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41
Q

What is the purpose of the mucopolysaccharide-rich strome found in the inner root sheath?

A

To give the inner root sheath strength

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42
Q

What do the nails protect?

A

The underlying distal phalanx

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43
Q

What are the functions of the nails?

A
  1. Protects underlying distal phalanx
  2. Counterpressure effect - important for walking and tactile sensation
  3. Increase dexterity / manipulation of small objects
  4. Enhance sensory discrimination
  5. Facilitate scratching / grooming
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44
Q

What is the nail plate?

A

The final product of proliferation and differentiation of nail matrix keratinocytes

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45
Q

What does the nail plate emerge from?

A

Proximal nail fold

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46
Q

What is the growth rate of the nail plate?

A

1-3mm a month

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47
Q

What is the point at which the nail plate detaches from the nail bed called?

A

Hyponychium

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48
Q

Where is the nail plate manufactured?

A

In the nail matrix

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49
Q

What is the lunula?

A

only visible portion of the nail matrix

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50
Q

Where is the nail matrix found?

A

Underneath the proximal nail fold, above bone of distal phalanx

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51
Q

How does the nail grow in the nail matrix?

A

Nail matrix keratinocytes differentiate, lose their nuclei and become filled with hard keratin and fill with hard keratin

52
Q

What does the nail matrix contain as well as keratinocytes?

A

Melanocytes

53
Q

Are the melanocytes found in the nail matrix active?

A

No

54
Q

What is an erythema?

A

A red, raised and large area of inflammed skin

55
Q

What type of disorder is Psoriasis?

A

An immune mediated disorder

56
Q

What features characterise the most common features of psoriasis?

A

Sharply demarcated, scaly, erythematous plaques, silvery plaques

57
Q

What are common sites for psoriasis flareups to occur?

A

Scalp, elbows, knees, nails, hands, feet and trunk

58
Q

What causes psoriasis?

A

Polygenic predisposition combined with environmental triggers eg trauma, infection or medication

59
Q

Describe how dermal dendritic cells are activated in the pathophysiology of Psoriasis?

A

Stressed keratinocytes release DNA which forms complexes with anti-microbial peptides

This induces cytokine production to activate the dermal dendritic cells

60
Q

Describe how the formation of dermal dendritic cells leads to the formation of a psoriasis plaque?

A

dDC’s migrate to the lymph nodes, and promote the release of cytokines from Th1, Th17 and Th22 cells

These migrate into the dermis and cause further cytokine production which causes the keratinocytes to proliferate and form a psoriasis plaque

61
Q

When dDC’s migrate to the lymph nodes, which T helper cells are activated?

A

Th1, Th17 and Th22

62
Q

When stressed keratinocytes release DNA and form complexes with antimicrobial peptides, the release of which cytokines is initiated?

A

TNF-alpha, IL-1 and IFN-alpha

63
Q

What are some clinical features of psoriasis?

A
  • Erythemas - may appear as pigmented areas on darker skin tones
64
Q

Why might you not see scales in areas of flexure?

A

Skin meets skin, and therefore due to friction there might not be scales present

65
Q

How is it possible to get psoriasis of the nails?

A

nails are made of nail matrix which contains keratinocytes, so can develop psoriasis

66
Q

What does psoriasis of the nails indicate?

A

That the patient is of increased risk of psoriatic arthiritis

67
Q

What is thickening under the nail called?

A

Subungual hyperkeratosis

68
Q

What is Onycholysis?

A

Detachment of the nail from the nail plate

69
Q

What is Erythrodermic psoriasis?

A

When you have a peeling rash covering more than 95% of your body surface area

70
Q

What is guttate psoriasis?

A

psoriasis that appears as small, round spots called papules that are raised and sometimes scaly.

71
Q

What lifestyle factors worsen psoriasis?

A

Alcohol, smoking and other co-morbidities

72
Q

What psychological conditions are you at an increased risk of when you suffer from psoriasis?

A

Suicide, depression and anxiety

73
Q

What other areas of your body might psoriasis affect?

A

Mental health, joints

74
Q

What are four topical therapies used to manage psoriasis?

A

Vitamin D analogues
Topical corticosteroids
Retinoids
Topical tacrolimus / pimecrolimus (immunosuppresants)

75
Q

When are topical therapies used to manage psoriasis?

A

When you have small patches of psoriasis over the body

76
Q

When is phototherapy chosen as a treatment for psoriasis?

A

When the psoriasis is too widespread over the body

77
Q

What does phototherapy involve?

A

Using Narrow band UVB rays to treat psoriasis

78
Q

What is Acitretin?

A

A vitamin A anaologue

79
Q

What are two systemic immunosuppresive drugs that can be given to treat psoriasis?

A

Methotrexate

Ciclosporin

80
Q

How are biologics used to treat psoriasis?

A

Anti-TNF, anti-IL-17 and anti-IL23 (these are all cytokines which are important in the onset of psoriasis

81
Q

What is eczema?

A

A chronic, inflmmatory condition which typically begins during infancy or early childhood, and is often associated with other atopic disoders like asthma and rhinoconjunctivitis

82
Q

What are the hallmarks of eczema

A

Acute inflammation of cheeks, scalp and extensors in children, and flexural inflammation and lichenification in children and adults

83
Q

What is eczema cmmonly referred to as?

A

Dermatitis

84
Q

What are some different types of eczema?

A

Atopic eczema, allergic contact eczema, venous stasis eczema, irritant contact dermatitis

85
Q

What is the key defining principle of atopic dermatitis?

A

Itchy skin

86
Q

What is seborrhoiec eczema?

A

Dandruff

87
Q

What are the two components of the pathophysiology of eczema?

A

Barrier defects and immune dysregulation

88
Q

what is the function of filaggrin?

A

To bind and aggregate keratin bundles and intermediate filaments to form cellular scaffolds in corneocytes

89
Q

What are corneocytes?

A

Cells found in the stratus cornea

90
Q

What happens when there is a mutation causing the filaggrin to function incorrectly?

A

There is reduced extracellular lipids and impaired ceramide production

Increased transepidermal water loss

Impaired protection against microbes and environmental allergens

91
Q

What is transepidermal water loss?

A

Loss of water across the epideral barrier

92
Q

how does immune dysregulation lead to eczema?

A

Straphylococcal superantigens overstimulate Th2 lymphocyte responses and subvert T-reg cells

93
Q

What happens to the microbiome during eczema?

A

It is imbalanced

94
Q

What are the clinical features of infantile atopic dermatitis?

A

Erythematous, oedematous papules and plaques with or without vesiculation

95
Q

How does the area eczema impacts change as you go from infant to child>

A

Changs from scalp and cheeks to affect the flexures like behind the knees and inner arms

96
Q

what happens to people with pigmented skin during eczema?

A

Hyperpigmentation

97
Q

What is lichenification?

A

Thickening of skin and skin lesions

98
Q

What is fissuring?

A

When you get cracks in the skin forming

99
Q

What is contact dermatitis?

A

When you get inflammation of the skin due to your skin reacting with something which it has come into contact with

100
Q

What is impetiginisation?

A

When there is a superficial infection of the skin, usually seen with a gold crust and a Staphylococcus aureus infecion

101
Q

How does venous stasis eczema arise?

A

Due to a build up of fluid due to venous incompetance of the skin which compromises the barrier, leading to trans epidermal waterloss

102
Q

How do you treat Venous stasis eczema?

A

Stockings and compression - responds to steroids but doesn’t stay responding

103
Q

What condition does someone have when they present with monomorphic punched out erosions with their eczema?

A

Eczema herpeticum

104
Q

Which type of eczema is considered an emergency?

A

Eczema herpeticum

105
Q

What soap should eczema patients use?

A

Dermol 500, with cold showers

106
Q

What does soap do to eczema patients?

A

Aggrevates the barrier defect

107
Q

What is nipple eczema until proven otherwise?

A

Pagets disease of the nipple - presents in a very similar manner to eczema so it is always important to be biopsied

108
Q

What can pagets disease suggest?

A

Breast cancer

109
Q

When might a biopsy of atopic eczema be taken?

A

If it is on the nipple, or there could be a cutaneous lymphoma

110
Q

What is PUVA used for?

A

Treating hand dermatitis and some forms of psoriasis

111
Q

What topical therapies can be used for the treatment of eczema?

A

Topical corticosteroids and topical tacrolimus

112
Q

What unit is used to describe the amount of topical steroids which should be used to treat eczema?

A

Fingertip units

113
Q

What can the over use of topical steroids cause?

A

Tachphylaxis (drug tolerance) and adverse effects

114
Q

What is the order of topical steroids in terms of potency?

A

Hydrocortisone
Clobetasone
Betamethasone
Momentasone
Clobetasol (Dermovate)

115
Q

Which areas are bethmethasone and momentasone used in?

A

The non-flexure areas of the skin like limbs and trunk in adults

116
Q

Which topical steroid is used when there is lichenification of the skin?

A

Clobetasol (Strongest)

117
Q

What are the rare effects of topical immunomodulatories?

A

skin atrophy, folliculitis, exacerbation of acne and rosacea, infection

118
Q

What are the very rare side effects of topical immunomodulatories?

A

Perioral dermatitis (around mouth), rebound syndrome and allergy to steroid

119
Q

What are the extremely rare effects of topical immunomodulatories?

A

hormonal imbalance, suppression of hypothalamic-pituitary-adrenal axis, hirsuitism

120
Q

What is hirsuitism?

A

condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back

121
Q

What is perioral dermatitis?

A

SKIN RASH around the mouth

122
Q

which type of eczema are retinoids used to treat?

A

hand Dermatitis

123
Q

What are some drugs used for systemic immunosuppression in the treatment of eczema?

A

Methotrexate
Ciclosporin
Azathioprine
Mycophenolate mofetil

124
Q

what biologics are used in the treatment of eczema?

A

Duplimab - Anti-IL-4alpha and anti-IL13

125
Q

When can biologics be used to treat eczema?

A

When patients have not responded to other treatments

BRS DERMATOLOGY (9 decks)

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