Primer-Allergic Skin Diseases

Question 1

In patients with only eyelid dermatitis what was the most common allergen according to study by NACDG?

Answer 1

Gold

Question 2

What is the histology in ICD vs ACD

Answer 2

ICD-spongiosis primarily neutrophilic infiltrates

ACD-spongiosis primarily lymphocytic infiltrates

Question 3

What medications are Patch testing results affected by?

Answer 3

Oral Corticosteroids >20mg qd, cancer chemo, or immunosuppressive drugs but NOT antihistamines.
Topical CS should be d/ced 5-7 days prior

Question 4

What foods have high nickel content?

Answer 4

Soybean, fig, cocoa, lentil, cashew, nuts and raspberry?

Question 5

Which are more sensitizing? Medicaments containing lanolin or cosmetics containing lanolin?

Answer 5

Medicaments

patients with chronic dermatitis, especially stasis dermatitis, are at higher risk of lanolin sensitivity

Question 6

What’s the most common cause of CD in hairdressers

Answer 6

PPD

Question 7

What does PPD cross react with?

Answer 7

COX2 inhibitor (celecoxib), sunscreens, and antioxidants used in manufacture of rubber products

Question 8

What is CAPB (cocamidopropyl betaine)?

Answer 8

CAPB is an amphoteric surfactant often found in shampoos, bath products, and eye and facial cleaners. CAPB allergy typically presents as eyelid, facial, scalp, and/or neck dermatitis.

Question 9

Psoriasis is TH1 or TH2 mediated?

Answer 9

TH1

Question 10

Atopic Dermatitis is TH1 or TH2 mediated?

Answer 10

TH2

Question 11

What is a superantigen thought to cause acute guttate psoriasis

Answer 11

Group A Strep

Question 12

In patients with AD, myeloid DCs upregulate?

Answer 12

myeloid DCs upregulate CCL17 and CCL18,

Question 13

In patients with psoriasis, myeloid DCs upregulate?

Answer 13

TNF-α and inducible nitric oxide synthase

Question 14

Keratinocytes produce which 2 TH17 cytokines :

Answer 14

IL-17A and IL-22.

Question 15

What is IL23’s role in psoriasis .

Answer 15

IL-23, which is overproduced by DCs and keratinocytes in patients with psoriasis, stimulates survival and proliferation of TH17 cells within the dermis and drives keratinocyte hyperproliferation.
TH17 cells have been implicated in the pathogenesis of psoriasis and other autoimmune inflammatory diseases.

Question 16

TH17 cells have been implicated in the pathogenesis of which diseases.

Answer 16

psoriasis and other autoimmune inflammatory diseases

Question 17

In pemphigus vulgaris (PV), autoantibodies target?

Answer 17

desmoglein adhesion molecule in the intercellular junctions and produce intraepithelial blisters

Question 18

In bullous pemphigoid (BP) and epidermolysis bullosa acquisita, subepidermal blistering is associated with autoantibodies against?

Answer 18

autoantibodies against the anchoring complex at the junction of the dermis and epidermis. Autoantibodies in patients with BP are formed against the basement membrane hemidesmosomal glycoproteins BP230 and BP180 and preferentially recognize phosphoepitopes in collagen XVII.

Question 19

What is treatment for Pemphigus vulgaris?

Answer 19

long-term use of systemic corticosteroids to diminish autoantibody production, and only about 10% of patients achieve complete remission after initial treatment

Question 20

What is the treatment for BP?

Answer 20

Mainstay of therapy in most patients with BP is oral corticosteroids at the lowest maintenance dose that will prevent new lesion formation and allow alternate-day therapy

Question 21

According to primer what is the breakdown of urticaria?

Answer 21

IgE-mediated urticaria (approximately 1% to 5%) or the physical urticarias (approximately 20%) and idiopathic urticaria (75% to 80%)

Question 22

What are the primary effector cells in patients with urticaria?

Answer 22

Mast cells

Question 23

What are 2 mediators released by mast cells in the immediate response

Answer 23

histamine and leukotriene C4 and prostaglandin D2

immediate products are responsible for pruritus, swelling, and erythema

Question 24

What are the mediators in the delayed response of urticaria?

Answer 24

TNF-α, IL-4, and IL-5.

later products lead to an influx of inflammatory cells

Question 25

What are the common labs to order in patients with chronic urticaria to assess autoimmunity?

Answer 25

anti-thyroid antibodies because results on these tests are abnormal in 15% to 20% of patients with otherwise idiopathic urticaria. Other tests for autoimmunity include the ASST and 2 new in vitro tests for antibodies that activate target basophils: the BHR test and a test for upregulation of the basophil surface marker CD203c

Question 26

What bacteria has been shown to be associated with CIU and eradication has been shown to improve symptoms?

Answer 26

Helicobacter pylori

Question 27

Beyond antihistamines what is the only drug proven to be effective in a double-blind, placebo-controlled study

Answer 27

cyclosporin A

Question 28

What are other options for treatment if H1 blockers don’t work?

Answer 28

common approach is to push the H1 blockade by using these agents at 2 to 4 times the FDA-approved dose. Other approaches include adding an H2 blocker, a leukotriene pathway modifier, or both

Question 29

Loss-of-function null mutations in the skin

barrier gene _____ have been repeatedly demonstrated to be a major risk factor for the development of AD?

Answer 29

Skin barrier gene filaggrin: This mutation contributes to the atopic march by increasing systemic sensitization through the skin

Question 30

Which TH2 cytokine is known to be pruritogenic?

Answer 30

IL 31

Question 31

What deficiency in the innate immune system contributes to eczema herpeticum and eczema vaccinatum in patients with underlying AD?

Answer 31

Cathelicidin and HBD-3 (human beta defensin) deficiency

Question 32

Reduced mobilization of _____ accounts for defective killing of S. aureus in patients with AD?

Answer 32

HBD3

Question 33

Low _____, ____, ____ leads to propensity for bacterial infections?

Answer 33

HBD2, HBD3 and LL-37

Question 34

Polymorphism within which gene leads to propensity for more severe AD?

Answer 34

TLR2

Question 35

Which cytokines are involved in acute atopic dermatitis?

Answer 35

Acute: IL-4, IL-13:“4 Suits with 13 cards each in a deck, including the aces.”
Increased levels of IL31 are found in acute atopic dermatitis skin lesions. IL31 is a pruritogenic TH2 cytokine that correlates with severity of atopic dermatitis.

Question 36

Which cytokines are involved in chronic atopic dermatitis?

Answer 36

Chronic: IL-5, IL-12, IFN-γ: “Education is chronic starting at 5 through Grade 12.”

Question 37

Which test is used to detect the presence of nickel. ?

Answer 37

The dimethylgloxime test is used to detect the presence of nickel.