Primer-Allergic Skin Diseases Flashcards
In patients with only eyelid dermatitis what was the most common allergen according to study by NACDG?
Gold
What is the histology in ICD vs ACD
ICD-spongiosis primarily neutrophilic infiltrates
ACD-spongiosis primarily lymphocytic infiltrates
What medications are Patch testing results affected by?
Oral Corticosteroids >20mg qd, cancer chemo, or immunosuppressive drugs but NOT antihistamines.
Topical CS should be d/ced 5-7 days prior
What foods have high nickel content?
Soybean, fig, cocoa, lentil, cashew, nuts and raspberry?
Which are more sensitizing? Medicaments containing lanolin or cosmetics containing lanolin?
Medicaments
patients with chronic dermatitis, especially stasis dermatitis, are at higher risk of lanolin sensitivity
What’s the most common cause of CD in hairdressers
PPD
What does PPD cross react with?
COX2 inhibitor (celecoxib), sunscreens, and antioxidants used in manufacture of rubber products
What is CAPB (cocamidopropyl betaine)?
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.
Psoriasis is TH1 or TH2 mediated?
TH1
Atopic Dermatitis is TH1 or TH2 mediated?
TH2
What is a superantigen thought to cause acute guttate psoriasis
Group A Strep
In patients with AD, myeloid DCs upregulate?
myeloid DCs upregulate CCL17 and CCL18,
In patients with psoriasis, myeloid DCs upregulate?
TNF-α and inducible nitric oxide synthase
Keratinocytes produce which 2 TH17 cytokines :
IL-17A and IL-22.
What is IL23’s role in psoriasis .
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.
TH17 cells have been implicated in the pathogenesis of which diseases.
psoriasis and other autoimmune inflammatory diseases
In pemphigus vulgaris (PV), autoantibodies target?
desmoglein adhesion molecule in the intercellular junctions and produce intraepithelial blisters
In bullous pemphigoid (BP) and epidermolysis bullosa acquisita, subepidermal blistering is associated with autoantibodies against?
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.
What is treatment for Pemphigus vulgaris?
long-term use of systemic corticosteroids to diminish autoantibody production, and only about 10% of patients achieve complete remission after initial treatment
What is the treatment for BP?
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
According to primer what is the breakdown of urticaria?
IgE-mediated urticaria (approximately 1% to 5%) or the physical urticarias (approximately 20%) and idiopathic urticaria (75% to 80%)
What are the primary effector cells in patients with urticaria?
Mast cells
What are 2 mediators released by mast cells in the immediate response
histamine and leukotriene C4 and prostaglandin D2
immediate products are responsible for pruritus, swelling, and erythema
What are the mediators in the delayed response of urticaria?
TNF-α, IL-4, and IL-5.
later products lead to an influx of inflammatory cells
What are the common labs to order in patients with chronic urticaria to assess autoimmunity?
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
What bacteria has been shown to be associated with CIU and eradication has been shown to improve symptoms?
Helicobacter pylori
Beyond antihistamines what is the only drug proven to be effective in a double-blind, placebo-controlled study
cyclosporin A
What are other options for treatment if H1 blockers don’t work?
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
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?
Skin barrier gene filaggrin: This mutation contributes to the atopic march by increasing systemic sensitization through the skin
Which TH2 cytokine is known to be pruritogenic?
IL 31
What deficiency in the innate immune system contributes to eczema herpeticum and eczema vaccinatum in patients with underlying AD?
Cathelicidin and HBD-3 (human beta defensin) deficiency
Reduced mobilization of _____ accounts for defective killing of S. aureus in patients with AD?
HBD3
Low _____, ____, ____ leads to propensity for bacterial infections?
HBD2, HBD3 and LL-37
Polymorphism within which gene leads to propensity for more severe AD?
TLR2
Which cytokines are involved in acute atopic dermatitis?
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.
Which cytokines are involved in chronic atopic dermatitis?
Chronic: IL-5, IL-12, IFN-γ: “Education is chronic starting at 5 through Grade 12.”
Which test is used to detect the presence of nickel. ?
The dimethylgloxime test is used to detect the presence of nickel.
