Psoriasis & Acne Flashcards
What is the most common type of psoriasis?
Psoriasis vulgaris
What sites does Psoriasis commonly cover?
Extensors (knee, elbows) Scalp Sacrum Hands Feed Trunk Nails
What causes psoriasis?
Genetics
Environmental -> stress, drugs, infection
Trauma
What does psoriasis look like?
Sharply demarcated, scaly, erythematous plaques
What are all the types of psoriasis?
Vulgaris
Guttate (little circular lesions, raindrop like)
Nail disease
Erythrodermis / widespread pustular
What is Koebner Phenomenon?
Psoriasis builds due to trauma
What are the 4 signs of psoriasis in the nails?
Oncholysis
Nail pitting
Dystrophy
Subungal Hyperkeratosis
What is the main treatment and first line treatment for psoriasis?
Topical Emollients
What are the topical treatments for psoriasis?
Vitamin D analoguse Coal tar Steroid ointments Dithranol Salicylic acid
What does the patient have to do before PUVA treatment?
Soak in bath of potassium permaganate for 15 mins
What are the systemic treatments for psoriasis (2nd line treatments)
Methotrexate
Ciclosporin
You get a patient with severe arthritis who is obese, smoke and drinks regularly - what advice would you give to him in terms of lifestyle advice?
There are link between obesity and psoriasis and also drinking and psoriasis. They could lose weight, stop drinking and as much and their psoriasis would improve
What is acne vulgaris?
Chronic inflammatory disease of the pilosebaceous unit
What 4 things causes acne in the pilosebaceous unit?
Increased production of sebum
Sebaceous duct becomes blocked
Glands or ducts rupture and cause inflammation
Bacterial growth
What is the correct terminology for a black head?
Open comedone
What is the correct terminology for a white head?
Closed comedone
What is a closed comedone?
Oxidised kertain and sebum
Where does acne most commonly occur?
Face
Upper back
Anterior chest
[related to sites with most sebaceous glands]
What are the different kinds of acne?
Comedones
Pustules
Papules
Cysts
Which kind of acne is most likely to scar?
Pustule with lots of inflammation around them
What are the secondary features of acne?
Atrophic scars
Ice pick scars
Texture changes
Hypertrophy
What are the different acne gradings?
Mild: scattered papules and pustules, comedones
Moderate: numerous papules, pustules and mild atrophic scarring
Severe: as above, cysts, nodules and significant scarring
What are the topical treatments for acne? (1st line)
Keratolytics e.g. benzoyl peroxide
Topical retinoids e.g. tretinoin
Topical antibiotics e.g. erythromycin
What are the systemic treatments for acne? (3rd line)
Antibiotics
Isotretinoin (oral retinoid) -> effects sebaceous gland activity
What are the sides effect of Isotretinoin?
Initial aggravation of acne
Hepatitis
Dry lips
Where does rosacea affect the body?
Nose
Chin
Cheeks
Forehead
What is the difference between acne and rosacea?
Rosacea has no comedones
What causes prominent facial flushing in roscea?
Sudden change in temperature
Alcohol
Spicy food
Why should topical steroids be avoided in rosacea?
Makes it worse
What is the management for rosacea?
Reduce aggravating factors: Reduce trigger factors Antibiotics e.g. metronidazole, tetracycline Isotretinoin Laser
What antibiotics are used to treat rosacea?
Topical Metronidazole
oral tetracylcine long term
Out of Bullous Pemphigoid and Pemphigus Vulgaris, which one is more common?
Pemphigus Vulgaris
Out of Bullous Pemphigoid and Pemphigus Vulgaris, which is affects the dermal-epidermal junction?
Bullous Pemphigoid
Out of Bullous Pemphigoid and Pemphigus Vulgaris, which is one is intra-epidermal?
Pemphigus Vulgaris
Who is mostly affected by bullous phemphigoid?
Elderly
What is Nikolsky sign?
A skin finding in which the top layers of the skin slip away from the lower layer when slighly rubbed
Is bullous pemphigoid Nikolsky sign -ve or +ve ?
-ve
Where does Pemphigus Vulgaris commonly affect?
Face
Scalp
Axilla
Groin
Is Phemphigus Vulgaris Nikolsky sign -ve or +ve?
+ve
Out of Bullous Pemphigoid and Pemphigus Vulgaris, which one has a higher mortality rate?
Pemphigus due to infection
Treatment for Bullous Pemphigoid and Pemphigus Vulgaris?
Prednisolone
Immunosuppressive agents e.g. ciclosporin
Topicals
What investigations are done to diagnose Bullous Pemphigoid and Pemphigus Vulgaris?
Skin biopsy with direct immunofluoresence
OR
Indirect immunoflurorsence
What are Munro Microabcesses a cardinal sign for?
Psoriasis
What are Munro Microabscesses?
collection of neutrophils in the stratum corneum
Why is Eryithodermis so life threatening?
Excess fluid coming from the skin putting patient at high risk of infection
What are the histological features of psoriasis?
Parakeratosis (nuclei in stratum corneum)
Thickened projections of prickle cell layer
No granular layer
Leukocytes and lymphocytes infiltrate dermis and epidermis
In acne, which part of the sebaceous duct gets blocked?
The neck
In rosacea you get Rhinophyma, what is this?
Thickening of the skin
What parasite can cause Roscea?
Follicular Demodex Mites
Does Pemphigus respond well the steroids?
Yes
What causes Pemphigus Vulgaris?
IgE autoantibodies made against desmoglein 3. Desmoglein 3 maintains desmosomal attachments => without it intraepidermal cells fall apart
Immune complexes form on cell surface, causing complement activation and protease release.
RESULTS IN ACANTHOLYSIS
What is Acantholysis?
Loss of intracellular connections, such as desmosomes, resulting in loss of cohesion between keratinocytes
Where does Pemphigus Vulgaris affect on the body?
Scalp Face Axillae Groin Trunk Sometimes mucosa e.g. mouth, resp tract
In Pemphigus, what happens when the fluid filled blisters burst?
Become shallow erosions
How to diagnose Pemphigus Vulgaris?
Take swab of blister that has not burst. Fluroescent labelled antibody used
What is the main difference between pemphigus vulgaris and bullous pemphigoid?
Pemphigus = Acantholysis Pemphigoid = NO Acantholysis
Which layer of the skin is affected in Bullous Pemphigoid?
Where the basal layer sticks to the basement membrane - becomes filled with fluid and some inflammatory cells
How to diagnose Bullous Pemphigus?
Swab of early lesion
Immunofluoresence
Why should you take a swab of a new lesion, not an old lesion in Bullous Pemphigoid?
Older lesions show re-epithelialisation of their floor, mimicking pemphigus vulgaris
What GI disease is strongly linked to Dermatitis Herpetiformis?
Coeliac disease
What haplotype is associated with Dermatitis Herpetiformis?
HLA-DQ2 haplotype
What parts of the body are affected by Dermatitis Herpetiformis?
Elbows
Knee
Buttocks
What is a key feature of Dermatitis Herpetiformis ?
It is symmetrical
Histologically, what is a hallmark of Dermatitis Herpetiformis?
Papillary Dermal Microabscesses
What immunoglobulin is found in the dermal papillae is Dermatitis Herpetiformis?
IgA
Treatment for Acne?
- topical retinoid
- benzoyl peroxide
- if neither of those work, azelaic acid
- combined oral contraceptive in women
- follow up in 6-8 weeks
What is the difference between dermatitis herpetiformis a and dermatitis herpeticum?
Dermatitis Herpetiformis is due to celiac disease whereas dermatitis herpeticum is lethal
What is the second line of treatment for acne?
Low dose oral antibiotic therapy for 3-4 months
- minocycline
- erythromycin
Oral contraceptive for females
What are the advantages of taking an oral contraceptive for acne?
Contraception
Antiandrogen activity
What are the disadvantages of taking an oral contraceptive for acne?
Increased DVT risk
Common in children, has a honey coloured crust?
Impetigo
What bacteria causes Impetigo?
Staph
OR
Group A beta-haemolytic strep
Treatment for Impetigo?
Stap - Flucloxacillin
Strep - Penecillin V
How to prevent Impetigo?
Good hygiene, washing hands etc.
What bacteria causes Scaled Skin Syndrome?
Toxin B which is produced by staph
If Scalded Skin Syndrome occurs in an adult, what diseases are associated?
Renal disease
Immunosuppression
How do you differentiate TED to SSSS?
i) Mucosal involvement only in TED
ii) SSSS is more superficial
If the lesions of Mollsum Contagiosum are >1cm, what is the disease now referred to as?
Giant Mollsum
What type of individual gets Giant Mollscum?
Immunosuppressed, esp HIV infected people
Treatment for Mollscum Contagiosum?
Should go away on its own
What is Mollsum Contagiosum transmitted?
Through direct contact
Commonly sexually transmitted
What is Cellulitis?
Acute infection of skin and soft tissues. Common on the legs
What pathogens causes Cellulitis?
Beta-haemolytic strep
Staph
Community acquired MRSA
Treatment for Cellulitis?
Benzypenecillin (or penecillin V) and flucoxacillin
If pen allergic then erythromycin
What is dermatitis herpeticum a complication of?
Atopic Eczema
Characteristics of dermatitis herpeticum?
Fever
clusters of itchy blisters or punched-out erosions
What pathogen causes dermatitis herpeticum?
HPV type 1 of 2