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Dermatology > Lecture: Autoimmune diseases > Flashcards

Lecture: Autoimmune diseases Flashcards

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Dermatology Board Prep flashcards
1
Q

Phemphigus complex

A
  • Autoimmune
  • antibodies produced against demogleins
    • causes acanthocytic cells
  • type II hypersensitivity
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2
Q

causes of pemphigus

A
  • idiopathic
  • drugs
  • neoplasia
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3
Q

Poster child for pemphigus foliaceous

A
  • butterfly pattern appears on the face
    • symmettrical
    • periocular, bridge of nose
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4
Q

P. foliaceous

A
  • most common type
    • dogs, cats, horses, goats
  • middle aged animal
  • target right below stratum corneum
  • primary lesion: pustule (very transient) starts on face
  • hyperkeratosis feet
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5
Q

P. Folaceous in cats

A
  • face
  • ear pinnae
  • nail bed
  • peri-nipple

*Strippers dz (face, nails, boobs)

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6
Q

DDX for PF

A
  • Superficial pyoderma
  • Dermatophytosis
  • Demodicosis
  • Seborrhea
  • Sterile pustular dz
  • SLE, MF
  • Hepatocutaneous syndrome (NME)
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7
Q

PF

DX

A
  • BX an intact pustule if possible
    • look for acantholytic cells inside the pustule
    • they can be on antibiotics, but NOT STEROIDS
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8
Q

Important points PF

A
  • Rule out pyoderma and deomdex
    • acantholytic cells
    • immunosuppressive therapy contraindicated
  • Make dx first: don’t attempt trial therapy
    • waxing and waning dz
    • long-term therapy can have serious side effects
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9
Q

Therapy for P. foliaceus

A
  • high doses of corticosteroids
  • Azathioprine: dogs
  • Chlorambucil: cats
  • Gold
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10
Q

Pemphigus erythematosus

about

A
  • cross over between pemphigus and lupus
  • milder than P. foliaceus
  • antibodies
    • intercellular spaces of epidermis (pemphigus)
    • basement membrane zone (lupus)
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11
Q

Clinical signs of P. erythematosus

A
  • pustular dermatitis
    • face
    • ears
  • nasal depigmentation
  • aggravated by UV light
  • no systemica signs
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12
Q

P. erythematosus

DX

TX

A
  • DX
    • same as PF
    • biopsy, but don’t do very often
  • TX
    • mild cases
      • topical steroids or tacrolimus
      • suncreen
    • severe cases
      • immunosuppressive therapy (same as PF)
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13
Q

Pemphigus vulgaris

about

A
  • rare in vet met
  • most common type in humans
  • acantholysis in lower epidermis: more severe lesions
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14
Q

P. vulgaris

CS

A
  • primary lesion is bulla
  • ulcerations and erosions in mouth
  • Animals are very ill
    • lethargy
    • fever
    • anorexia
  • common secondary infections
    • bacterial
    • yeast
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15
Q

DDX for PV

A
  • Drug eruption
    • Antibiotics
    • seizure meds
  • Mycosis fungoides (cutaneous lymphoma)
  • SLE
  • bullous pemphigoid
  • contact irritant
  • Burn
  • Candidiasis
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16
Q

DX and TX PV

A

same as all the other pemphiguses

-biopsy areas that have just started, not ser. ulcerated

Prognosis is gaurded to poor

fatal without therapy

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17
Q

Pemphigus vegetans

A
  • very rare
  • mild form of PV
  • Proliferative lesions
  • Scaling, crusting
    • Axillae
    • Groin
  • DX and TX same as PF
18
Q

DIscoid Lupus Erythematosus

A
  • face and nose
  • aggravated by UV
    • sunlight triggers new antigens
19
Q

Clinical signs of DLE

A
  • Nose
    • depigmentation
    • loss of normal appearance
    • erosions and ulcerations
  • Pinnae
  • Eyelids
  • Lips
  • Footpads (rare)
20
Q

DDX for depigmented/ulcerated nose

A
  • Pemphigus
  • Drug eruption
  • Mycosis Fungoides
  • VKH
  • Irritant contact dermatitis
  • Fungal infection
21
Q

DLE

DX

TX

A
  • Diagnosis
    • histopath if not on steroids
  • TX
    • topical steroids or tacrolimus
    • sunscreens, vit. E
    • systemic therapy
      • steroids (low dose) or
      • tetracycline/niacinamide
22
Q

systemic lupus erythematosus

A
  • multisystemic disease
  • antibodies produced against different antigens
    • RBC
    • Platelet
    • Nuclear antigens
23
Q

Dermatological signs of SLE

A
  • Seborrhea
  • Vasculitis
    • necrosis of pinnae and tip of tail
    • footpads crusting and ulceration
  • nasal depigmentation and ulceration
  • mucocutaneous bullous dz
  • panniculitis (lupus profundus)
24
Q

Lupus is a type ____ hypersensitivity

A

type III

(something about stuff getting stuck in small vessels)

25
Q

DX of SLE

A
  • take a biopsy
  • baseline blood work
  • ANA
26
Q

SLE

Therapy

A
  • Immunosuppressive drugs
    • high doses steroids
    • azathioprine
    • chlorambucil

*Gold is contraindicated due to nephrotoxicity

27
Q

Bullous pemphigoid

A
  • looks like PV without the acantholytic cells
  • antibodies produced against basement membrane
28
Q

BP

CS

A
  • primary lesion: bulla (very transient)
  • ulcerations
  • fever, anorexia
  • distribution
    • oral cavity
    • axillae and groin
    • mucocutaneous junctions
    • nail beds
29
Q

BP

DX

A
  • BX close to ulcer
    • need epidermis (no epidermis in ulcer, I think)
30
Q

Erythema Multiforme

A
  • Immune mediated syndrome
  • usually secondary to drugs or infections
    • cephalosporins
    • TMP-sulfa
    • Levamisole
    • Gold
  • Acute, self-limited
  • usually not systemically ill
31
Q

Clinical signs of EM

A
  • Target lesions (bulls-eye)
    • Peripheral erythema and central clearing
  • Macules
  • Plaques
32
Q

Erythema multiforme

DX

A
  • DX
    • History, CS, Histopath
      • apoptotic cells
      • lymphoplasmacytic interface infiltrate
  • Therapy
    • Id underlying cause
    • supportive therapy: antibiotics for the secondary infection
    • Steroids: controversial
33
Q

Toxic Epidermal Necrolysis (TEN)

A
  • Severe cutaneous eruption
  • Systemically ill
  • full thickness necrosis and sloughing
  • Mucosal ulcerations
  • Fever
  • lethargy
  • arthralgia
34
Q

TEN

DX

A
  • DX
    • Histopath (early lesions)
    • Full thickness necrosis
  • TX
    • ID underlying cause
    • supportive care
    • steroids usually contraindicated
  • Prognosis
    • poor (high mortality 80-90%)
      • electrolyte loss
      • secondary infections
35
Q

Mycosis Fungoides (MF)

cancer

A
  • Cutaneous lymphoma (T cell)
  • Old animals
  • various clinical pres
    • erythema, pruritus and seborrhea
36
Q

Mycosis Fungoides

CS

DX

A
  • Depigmentation and ulcerations of mucous membranes and nose
    • bad breath
  • ​Gingivitis
  • Stomatitis and oral ulcerations
  • Plaques and nodules
  • DX
    • Biopsy
37
Q

Necrolytic migratory erythema

A
  • something about deficiency in amino acids
  • nutritional therapy
  • CS
    • erythema, ulcerations and crusting
      • pinnae
      • muzzle
      • footpads
      • lesions in genitalia are hallmarks
  • secondary bacterial and yeast infection
  • usually borderline diabetic
38
Q

NME

DX

A
  • Histopath
    • red-white-blue
      • red: hyperkeratosis
      • white: spongeosis
      • blue: hyperplasia of basal layer
39
Q

Not every crusty foot is….

A

PF

40
Q

Therapy and prognosis for NME

A
  • ID and correct, if underlying dz
  • Tx secondary infections
  • aminoacid (IV), zinc, fatty acid supplement
  • egg yolk
  • no glucocorticoids
  • poor prognosis
41
Q

Conclusions

A
  • always treat secondary infections
  • make lists of DDX for all problems
  • correct dx important
    • not everything that looks autoimmune needs steroids
    • BX epidermis before steroids

Dermatology (22 decks)

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