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Dermatology > Lichenoid Disorders > Flashcards

Lichenoid Disorders Flashcards

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1
Q

What is meant by a lichenoid disorder?

A

clinically - shiny flat topped itchy papular rash

histologically - band like inflammatory infiltrate in the upper dermis with basal cell necrosis

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2
Q

Name four lichenoid disorders

A
  • lichen planus
  • drug eruptions
  • graft vs host disease
  • pityriasis lichenoides
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3
Q

What is the name given to the appearance of basal cell necrosis?

A

Civatte bodies

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4
Q

Describe the aetiology of Lichen Planus

A

Genetic association & links to hepatitis C, T cell mediated autoimmune inflammatory condition

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5
Q

Describe the histological appearance of lichen planus

A

Acanthosis (irregular saw tooth thickening of epidermis) civatte bodies with lymphocytic infiltrate

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6
Q

Name the different types of lichen planus

A

Hypertrophic
Atrophic
Follicular
Mucosal

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7
Q

How does lichen planus present?

A

Shiny flat topped violaceous polygonal papules often very itchy

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8
Q

What is the name for the white lines with a lace like patten on surface of papules and bullae?

A

Wickham’s striae

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9
Q

How is Lichen Planus managed?

A

Can clear spontaneously but treatment is symptomatic and potent topical steroids. If unresponsive systemic therapies may be required.

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10
Q

What are the four types of immune mediated reactions?

A

I - anaphylactic
II - cytotoxic reactions
III - immune complex mediated
IV - cell mediated delayed

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11
Q

For each of the immune mediated reactions what is the typical corresponding dermatological presentation?

A

I - Urticaria
II - Pemphigus and Pemphigoid
III - Purpura/rash
IV - erythema/rash

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12
Q

Name the risk factors for a drug eruption

A
  • age
  • gender
  • genetics
  • concomitant disease (virus/CF)
  • immune status
  • drugs
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13
Q

What is the most common type of drug eruption?

A

Exanthematous type 4 hypersensitivity reaction

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14
Q

How does exanthematous type 4 hypersensitivity reaction present?

A

Widespread symmetrical rash with no mucosal involvement can be itchy but often associated with a mild fever, 4-21 days after taking first dose

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15
Q

What are the indications of a severe exanthematous reaction?

A
  • mucous/fascial involvement or oedema
  • confluent erythema
  • SOB/Wheeze/Lymphadenopathy
  • Blisters, purpura, necrosis
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16
Q

What antibiotics can cause an exanthematous reaction?

A 
SEPS 
sulphonamides
erythromycin  
penicillin
streptomycin
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17
Q

What anti-epileptic drugs can cause an exanthematous reaction?

A

Carbamazepine

Phenytoin

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18
Q

Other than anti - biotic and epileptic drugs what can cause an exanthematous drug eruption?

Study These Flashcards
A

allopurinol
NSAIDs
chloramphenicol for conjunctivitis

19
Q

When can a type 1 hypersensitivity reaction occur?

Study These Flashcards
A

First exposure - direct release of inflammatory mediators from mast cells
Re-challenge with drug

20
Q

Which drugs can cause a direct mast cell degranulation and thus anaphylactic shock?

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A

Morphine
NSAIDs
Codeine
Aspirin

21
Q

Which drugs can cause an IgE response and thus anaphylactic shock?

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A

Penicillins

Cephalosporins

22
Q

Name three drugs that can cause exanthematous pustulosis

Study These Flashcards
A

Antibiotics, Calcium channel blockers, antimalarials

23
Q

What drugs can induce bullous pemphigoid?

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A

ACE inhibitors, penicillin, furosemide

24
Q

What drug eruption can happen from glucocorticoids?

Study These Flashcards
A

Acneform no increased sebum or comedones

25
Describe fixed drug eruptions
Lesions occur in the same area each time a particular drug is taken - well demarcated round/ovoid plaques are red and painful
26
Name some common drugs that cause fixed drug eruptions
- tetracycline/doxycycline - paracetamol - NSAIDs - Carbamazepine
27
Name four very severe drug reactions
Stevens Johnson Syndrome Toxic Epidermal Necrolysis Drug Reaction with eosinophilia and systemic symptoms (DRESS) Acute generalised ezanthemaouts pustolosis (AGEP)
28
Describe Steven Johnson Syndrome
Life threatening much-cutanous exfoliation, severe variant of erythema multiform that leads to systemic complications
29
What are the extra-cutaneous manifestations of SJS?
Stomatitis, oesophagitis, diarrhoea, painful micturition, desquamation of respiratory tract
30
Describe Toxic Epidermal Necrolysis
Widespread erythema followed by epidermal necrosis with loss of large sheets of epidermis
31
Where must patients with TEN be managed?
HDU/Burns Unit
32
What is the biggest risk to patients with TEN?
Multi-organ failure due to loss of thermoregulation
33
What drugs can cause SJS and TEN?
``` Anti-biotics NSAIDs Anticonvulsants Anti-retroviral medication Opiates ```
34
How are SJS and TEN managed?
Withdraw underlying cause Prevent complications Fluid and electrolyte replacement Systemic antibiotics if evidence of infection Emollients TEN - IV immunoglobulins improve prognosis
35
What is a phototoxic drug reaction?
Some drugs will absorb UV, the drug will act as a chromophore leading to non-immunoligcal reactions if a patient is exposed to enough drug & light
36
Describe the features of acute phototoxic drug reactions
- photosensitivity - systemic toxicity - photo degradation
37
Describe the features of chronic phototoxic drug reactions
- pigmentation - photo ageing - photocarcinogenesis
38
What drugs would cause immediate prickling with delayed erythema?
Chlorpromazine and amiodarone
39
What drugs would cause exaggerated sunburn?
Quinine and thiazides
40
What drug would cause exposed telangiectasia?
CCBs
41
What drug would cause delayed pigmentation/erythema?
Psoralens
42
What drugs would cause increased skin fragility?
Tetracycline, naproxen, amiodarone
43
What reaction would azathioprine cause?
?
44
How should drug eruptions be managed?
Discontinue drug if severe Topical steroids Anti-histamine if Type 1 Allergy bracelet/yellow card scheme

Dermatology (13 decks)

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