pathogenesis Flashcards
scleredema: Px
↑collagen/mucin( increased synthesis-insulin/hypoxia/vascular damage, reduced degradation-collagenase) 1- post strep 2- monoclonal gammopathy, 3- diabeticorum(IDDM) irreversibly glycosylated collagen
scleromxydema Px
Px:mucin,Fibroblast proliferation;
- IgGlamda monoclonal gammopathy/plasma cell dyscrasia 2. circulating human factors
- absence thyroid disease
aGVHD: Px
1.HSCT, host APC activated 2. donor T cell proliferation(cytotoxic T/NK cells) 3. target tissue destruction(skin liver GIT)
cGVHD:Px
1.autoAb, sclerotic 2. BAFF(rituximab)
LSA
LSA: HLA DR1*12 , autoimmune(thyroid) ECM1, oxidative stress, infectious?borrelia, 8% SCC
EI
type4 CMI to Ag stimuli( infx-TB(
HV-
EBV, NKT lymphoma/hemophagocytosis; PMLE: persistent DTH response against photoinduced altered endogenous Ag; PCT:
actinic prurigo
-persistent PMLE variant, HLADR4, thalidomide anti TNFa, UVR
CAD -
1.UVB+UVA absorption by DNA/RNA; 2,DTH response(endog/photoinduced cutaneous Ag, CD8+ Infiltrate; 3.+photoallergy compositae/sunscreen, HIV(11% local)
phototoxic-
UVR activation , direct cellular injury; exagerrated sunburn,dose-dependent,photodistr telangiectasia(CCB); pseudoporphyria(frusemide, tetracycline, nalidixic acid) NSC: phenothiazine(chlorpromazine, promethazine); resolution time: T1/2 , persistent photoactive molecules(quinine, thiazide 9m)
photoallergy-
drug+photon->photoproduct+protein binding=Ag–>hypersensitivity e.g.
LABD
:LAD 97kDa ectodomain BP180
MMP-autoAb
BP180(BPAG2 C terminal), laminin 332(a3); a6b4(ocular MMP)
EBA
-acquired immune mediated, 290/145 kDa col7(anchoring fibril) autoab, HLADRB1501, response to immunosuppresion; A/W: crohn’s, SLE/RA/thyroiditis
Pvegetans-
drugs(ACEi), malignancy, dsg3
PNP:
BP230, dsg1/3, desmoplakins, envoplakin, periplakin/plectin,tumor Ag- NHL, CLL, castleman waldenstrom, thymoma sarcoma;
PV/PF-
dsg(desmosome) compensation theory blister localisation-expression: dsg1(supf dermis), dsg3(deep epidermis, mucosa); HLA susceptibility
DH:
HLA DQ0501/B102, gluten sensitive enteropathy, IgA anti TG3 Ab, neutrophilic, granular IgA, dapsone improves(anti-neutrophilic),iodide worsen
IgA pemphigus-
IgA desmocollin1 , dsg1/3, dapsone
EM
PGx: HLADQw3/drw53,HSV(REM-70%)/mycoplasma/drug-NSAID/AC/sulfonamide; IBD/Behcets
FDE- pGx:
1) resting lesion: quiescent primed intraepidermal CLA+CD8+ T cell;
2) activated by drug exposure, IFNy/cytotoxic granule release;
3) fully evolved- keratinocyte cytolysis;
4) resolution-Treg recruitment amelioration but memory cells persist