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Derm > Nutrition & Skin > Flashcards

Nutrition & Skin Flashcards

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Dermatology Board Prep flashcards
1
Q

Describe how food allergy differs from food intolerance.

A

Allergy - symptoms are caused by an immune reaction - IgE mediated.
intolerance - a non-immune reaction e.g. lactose intolerance - excess unabsorbed lactose results in symptoms.

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2
Q

What is a lactose intolerance?

A

Deficiency in lactase enzyme leading to poor breakdown of lactose in the GI tract and the excess unabsorbed lactose results in symptoms.

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3
Q

How to diagnose a food allergy…

A

Allergy divided into IgE-mediated and non-IgE-mediated.
Allergy focused history to determine further tests.
If IgE-mediated Hx, skin-prick test or RAST.
If non-IgE-mediated Hx, trial elimination of suspected allergen for 2-6 weeks & then reintroduce post-trial.

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4
Q

What other tests can be done for IgE-mediated allergy, in certain conditions/circumstances?

A

Challenge test - only if there are facilities & specialists available for dealing with anaphylaxis.
Serum mast cell tryptase level can be measured during anaphylaxis.

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5
Q

Skin signs of an IgE-mediated food allergy?

A

pruritus
erythema
acute urticaria
acute angioedema - lips, face, around eyes

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6
Q

Skin signs of non-IgE-mediated food allergy?

A

pruritus
erythema
atopic eczema

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7
Q

GI signs & symptoms of IgE-mediated food allergy?

A 
angioedema of lips, tongue & palate
oral pruritus
nausea
colicky abdominal pain
vomiting 
diarrhoea
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8
Q

Signs & symptoms of non-IgE-mediated food allergy?

A 
GORD
loose of frequent stools
blood ± mucus in stools
abdominal pain
infantile colic
food refusal or aversion
constipation
perianal redness
faltering growth ± at least 1/+ GI symptoms of above (± significant atopic eczema)
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9
Q

What is the difference in timing of presentation of IgE-mediated and non-IgE-mediated food allergy?

A

IgE - acute and rapid onset

Non - delayed and non-acute reactions

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10
Q

What aspects of skin physiology does obesity effect?

A 
collagen structure & function and wound healing
barrier function
sebaceous glands
apocrine & eccrine glands
subcutaneous fat
lymphatics
circulation
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11
Q

Why is there reduced mechanical strength of skin in obesity?

A

failure of collagen deposition to match the increased surface area

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12
Q

Why does skin tend to be dry in obesity?

A

increased trans-epidermal water loss

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13
Q

Sebaceous glands stimulated more in obesity…

A

increased androgens produced in peripheral fat stimulate glands

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14
Q

How are the apocrine and eccrine glands related to increased skin irritation in obesity?

A 
increased gland activity in enlarged skin folds increases moisture.
skin maceration (breakdown due to prolonged exposure to moisture) and friction in folds increases irritation.
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15
Q

What is the effect of obesity upon lymphatics?

A

pressure from fat impedes lymphatic flow and causes leakage of protein rich lymphatic fluid into sub-cutaneous tissues.

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16
Q

Effect of obesity on circulation?

A

obesity is associated with microvascular dysfunction resulting in increased skin blood flow which may contribute to hypertension

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17
Q

Proper name for skin tags and where are they found?

A

acrochordons - axillae and neck areas

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18
Q

acanthosis nigricans?

A

velvety thickening and pigmentation of the skin folds, usually axillae

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19
Q

hirsutism?

A

increased hair in females in male distribution e.g. beard area

20
Q

Why is acne a direct skin manifestation of obesity?

A

due to increased sebaceous gland activity

21
Q

hirdradenitis suppurativa

A

a chronic inflammatory disease where boils and abscesses form and scar in apocrine gland areas (esp. groin, axillae)

22
Q

androgenic alopecia

A

male pattern of blading in men/women

23
Q

striae distensae

A

(stretch marks)
type of scarring associated with dermal connective tissue injury in response to local stretching forces, e.g. rapid weight gain in pregnancy and obesity

24
Q

Which skin manifestations are associated with insulin resistance?

A

skin tags and acanthosis nigricans

25
Q

Name some skin diseases aggravated by obesity.

A 
lymphoedema
chronic venous insufficiency
skin infections
intertrigo 
psoriasis
26
Q

End result of obesity aggravating lymphoedema is: warty, thick skin and the lower leg and foot are permanently enlarged.
How does this happen?

A

reduced lymphatic drainage due to increased subcutaneous fat pressure -> swelling.
Gradually worsening swelling -> chronic inflammation -> fibrosis
reduced tissue oxygenation -> bacterial overgrowth
cellulitis develops easily -> further lymphatic damage
downward spiral if left untreated -> end result

27
Q

Abdominal obesity can result in venous dermatitis.. what is it?

A

abdominal obesity resists venous return from legs; veins dilate, valves incompetent, varicose veins develop;
increased hydrostatic pressure -> RBC leakage into tissue -> swelling, haemosiderin pigmentation & inflammation (due to breakdown products)

28
Q

Obesity increases tendency to which type of infections?

A

bacterial, fungal and yeast

29
Q

What is intertrigo?

A

macerated red plaques which develop in skin folds due to high moisture levels, friction, increased pH and reduced barrier function
prone to secondary infection

30
Q

What are the 2 forms of protein energy malnutrition (PEM)?

A

Marasmus

Kwashiorkor

31
Q

Child is very thin with muscle wasting, no oedema, dry skin, thin & brittle hair which easily falls out resulting in alopecia….?

A

Marasmus

32
Q

Children develops enlarged ‘pot belly’, skin has patchy discolouration, their dark skin has split over stretched skin on belly showing pale areas between the cracks….?

A

Kwashiokor

33
Q

What causes Marasmus?

A

global nutrient deficiency causing weight loss by fat breakdown

34
Q

What causes Kwashiokor?

A

low protein intake with reasonable carbohydrate intake

35
Q

Name the 2 main fat soluble vitamins which if deficient affect the skin.

A

vitamin A and vitamin K

36
Q

Name the main water soluble vitamins essential for skin health.

A 
Vitamin B2 (Riboflavin)
Vitamin B3 (Niacin)
Vitamin B6
Folate
Biotin 
Vitamin C (Ascorbic acid)
37
Q

Which mineral is required for structure and function of skin and therefore wound healing?

A

zinc

38
Q

what is cheilosis and angular stomatitis?

A

lesions of the margins of lips; and corners of the mouth

seen in vitamin b2 deficiency

39
Q

Pellagra is a deficiency disease seen in high grain / low meat areas, e..g Indo-China….what does it involve?

A

Vitamin B3 deficiency - 4Ds:
Dermatitis (bilateral, symmetrical, itchy, red rash, worse on sun exposed areas)
Delirium (headaches, irritable, anxiety, depression, memory impaired)
Diarrhoea (+ abdo pain, nausea, vomiting)
Death (in 4-5yrs if untreated)

40
Q

What is the treatment for Niacin deficiency?

A

nicotinamide supplementation - rapid improvement

41
Q

In which vitamin deficiency is glossitis seen?

A

vitamin B6

42
Q

Which water soluble nutrient is an essential co-factor for carboxylase enzymes?

A

Biotin - produced by GI bacteria

43
Q

Which vitamin is an essential co-factor in collagen formation (hair and for bone & teeth health)?

A

vitamin C

44
Q

What is Acrodermatitis enteropathica?

A

an autosomal recessive condition causing lack of zinc absorption
infants develop diarrhoea, alopecia, dry/brittle hair, perioral/facial and acral dermatitis

45
Q

What can cause acquired zinc deficiency?

A

increased elimination of zinc secondary to burns or infection

Derm (7 decks)

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