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Dermatology > Psoriasis & Acne > Flashcards

Psoriasis & Acne Flashcards

1
Q

What is the most common type of psoriasis?

A

Psoriasis vulgaris

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2
Q

What sites does Psoriasis commonly cover?

A 
Extensors (knee, elbows)
Scalp 
Sacrum 
Hands 
Feed 
Trunk 
Nails
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3
Q

What causes psoriasis?

A

Genetics
Environmental -> stress, drugs, infection
Trauma

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4
Q

What does psoriasis look like?

A

Sharply demarcated, scaly, erythematous plaques

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5
Q

What are all the types of psoriasis?

A

Vulgaris
Guttate (little circular lesions, raindrop like)
Nail disease
Erythrodermis / widespread pustular

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6
Q

What is Koebner Phenomenon?

A

Psoriasis builds due to trauma

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7
Q

What are the 4 signs of psoriasis in the nails?

A

Oncholysis
Nail pitting
Dystrophy
Subungal Hyperkeratosis

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8
Q

What is the main treatment and first line treatment for psoriasis?

A

Topical Emollients

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9
Q

What are the topical treatments for psoriasis?

A 
Vitamin D analoguse 
Coal tar
Steroid ointments
Dithranol 
Salicylic acid
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10
Q

What does the patient have to do before PUVA treatment?

A

Soak in bath of potassium permaganate for 15 mins

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11
Q

What are the systemic treatments for psoriasis (2nd line treatments)

A

Methotrexate

Ciclosporin

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12
Q

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?

A

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

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13
Q

What is acne vulgaris?

A

Chronic inflammatory disease of the pilosebaceous unit

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14
Q

What 4 things causes acne in the pilosebaceous unit?

A

Increased production of sebum
Sebaceous duct becomes blocked
Glands or ducts rupture and cause inflammation
Bacterial growth

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15
Q

What is the correct terminology for a black head?

A

Open comedone

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16
Q

What is the correct terminology for a white head?

A

Closed comedone

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17
Q

What is a closed comedone?

A

Oxidised kertain and sebum

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18
Q

Where does acne most commonly occur?

A

Face
Upper back
Anterior chest
[related to sites with most sebaceous glands]

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19
Q

What are the different kinds of acne?

A

Comedones
Pustules
Papules
Cysts

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20
Q

Which kind of acne is most likely to scar?

A

Pustule with lots of inflammation around them

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21
Q

What are the secondary features of acne?

A

Atrophic scars
Ice pick scars
Texture changes
Hypertrophy

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22
Q

What are the different acne gradings?

A

Mild: scattered papules and pustules, comedones
Moderate: numerous papules, pustules and mild atrophic scarring
Severe: as above, cysts, nodules and significant scarring

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23
Q

What are the topical treatments for acne? (1st line)

A

Keratolytics e.g. benzoyl peroxide
Topical retinoids e.g. tretinoin
Topical antibiotics e.g. erythromycin

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24
Q

What are the systemic treatments for acne? (3rd line)

A

Antibiotics

Isotretinoin (oral retinoid) -> effects sebaceous gland activity

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25
Q

What are the sides effect of Isotretinoin?

A

Initial aggravation of acne
Hepatitis
Dry lips

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26
Q

Where does rosacea affect the body?

A

Nose
Chin
Cheeks
Forehead

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27
Q

What is the difference between acne and rosacea?

A

Rosacea has no comedones

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28
Q

What causes prominent facial flushing in roscea?

A

Sudden change in temperature
Alcohol
Spicy food

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29
Q

Why should topical steroids be avoided in rosacea?

A

Makes it worse

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30
Q

What is the management for rosacea?

A 
Reduce aggravating factors: 
Reduce trigger factors 
Antibiotics e.g. metronidazole, tetracycline 
Isotretinoin 
Laser
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31
Q

What antibiotics are used to treat rosacea?

A

Topical Metronidazole

oral tetracylcine long term

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32
Q

Out of Bullous Pemphigoid and Pemphigus Vulgaris, which one is more common?

A

Pemphigus Vulgaris

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33
Q

Out of Bullous Pemphigoid and Pemphigus Vulgaris, which is affects the dermal-epidermal junction?

A

Bullous Pemphigoid

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34
Q

Out of Bullous Pemphigoid and Pemphigus Vulgaris, which is one is intra-epidermal?

A

Pemphigus Vulgaris

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35
Q

Who is mostly affected by bullous phemphigoid?

36
Q

What is Nikolsky sign?

A

A skin finding in which the top layers of the skin slip away from the lower layer when slighly rubbed

37
Q

Is bullous pemphigoid Nikolsky sign -ve or +ve ?

38
Q

Where does Pemphigus Vulgaris commonly affect?

A

Face
Scalp
Axilla
Groin

39
Q

Is Phemphigus Vulgaris Nikolsky sign -ve or +ve?

40
Q

Out of Bullous Pemphigoid and Pemphigus Vulgaris, which one has a higher mortality rate?

A

Pemphigus due to infection

41
Q

Treatment for Bullous Pemphigoid and Pemphigus Vulgaris?

A

Prednisolone
Immunosuppressive agents e.g. ciclosporin
Topicals

42
Q

What investigations are done to diagnose Bullous Pemphigoid and Pemphigus Vulgaris?

A

Skin biopsy with direct immunofluoresence
OR
Indirect immunoflurorsence

43
Q

What are Munro Microabcesses a cardinal sign for?

44
Q

What are Munro Microabscesses?

A

collection of neutrophils in the stratum corneum

45
Q

Why is Eryithodermis so life threatening?

A

Excess fluid coming from the skin putting patient at high risk of infection

46
Q

What are the histological features of psoriasis?

A

Parakeratosis (nuclei in stratum corneum)
Thickened projections of prickle cell layer
No granular layer
Leukocytes and lymphocytes infiltrate dermis and epidermis

47
Q

In acne, which part of the sebaceous duct gets blocked?

48
Q

In rosacea you get Rhinophyma, what is this?

A

Thickening of the skin

49
Q

What parasite can cause Roscea?

A

Follicular Demodex Mites

50
Q

Does Pemphigus respond well the steroids?

51
Q

What causes Pemphigus Vulgaris?

A

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

52
Q

What is Acantholysis?

A

Loss of intracellular connections, such as desmosomes, resulting in loss of cohesion between keratinocytes

53
Q

Where does Pemphigus Vulgaris affect on the body?

A 
Scalp 
Face
Axillae
Groin 
Trunk
Sometimes mucosa e.g. mouth, resp tract
54
Q

In Pemphigus, what happens when the fluid filled blisters burst?

A

Become shallow erosions

55
Q

How to diagnose Pemphigus Vulgaris?

A

Take swab of blister that has not burst. Fluroescent labelled antibody used

56
Q

What is the main difference between pemphigus vulgaris and bullous pemphigoid?

A 
Pemphigus = Acantholysis 
Pemphigoid = NO Acantholysis
57
Q

Which layer of the skin is affected in Bullous Pemphigoid?

A

Where the basal layer sticks to the basement membrane - becomes filled with fluid and some inflammatory cells

58
Q

How to diagnose Bullous Pemphigus?

A

Swab of early lesion

Immunofluoresence

59
Q

Why should you take a swab of a new lesion, not an old lesion in Bullous Pemphigoid?

A

Older lesions show re-epithelialisation of their floor, mimicking pemphigus vulgaris

60
Q

What GI disease is strongly linked to Dermatitis Herpetiformis?

A

Coeliac disease

61
Q

What haplotype is associated with Dermatitis Herpetiformis?

A

HLA-DQ2 haplotype

62
Q

What parts of the body are affected by Dermatitis Herpetiformis?

A

Elbows
Knee
Buttocks

63
Q

What is a key feature of Dermatitis Herpetiformis ?

A

It is symmetrical

64
Q

Histologically, what is a hallmark of Dermatitis Herpetiformis?

A

Papillary Dermal Microabscesses

65
Q

What immunoglobulin is found in the dermal papillae is Dermatitis Herpetiformis?

66
Q

Treatment for Acne?

A
  • topical retinoid
  • benzoyl peroxide
  • if neither of those work, azelaic acid
  • combined oral contraceptive in women
  • follow up in 6-8 weeks
67
Q

What is the difference between dermatitis herpetiformis a and dermatitis herpeticum?

A

Dermatitis Herpetiformis is due to celiac disease whereas dermatitis herpeticum is lethal

68
Q

What is the second line of treatment for acne?

A

Low dose oral antibiotic therapy for 3-4 months

  • minocycline
  • erythromycin

Oral contraceptive for females

69
Q

What are the advantages of taking an oral contraceptive for acne?

A

Contraception

Antiandrogen activity

70
Q

What are the disadvantages of taking an oral contraceptive for acne?

A

Increased DVT risk

71
Q

Common in children, has a honey coloured crust?

72
Q

What bacteria causes Impetigo?

A

Staph
OR
Group A beta-haemolytic strep

73
Q

Treatment for Impetigo?

A

Stap - Flucloxacillin

Strep - Penecillin V

74
Q

How to prevent Impetigo?

A

Good hygiene, washing hands etc.

75
Q

What bacteria causes Scaled Skin Syndrome?

A

Toxin B which is produced by staph

76
Q

If Scalded Skin Syndrome occurs in an adult, what diseases are associated?

A

Renal disease

Immunosuppression

77
Q

How do you differentiate TED to SSSS?

A

i) Mucosal involvement only in TED

ii) SSSS is more superficial

78
Q

If the lesions of Mollsum Contagiosum are >1cm, what is the disease now referred to as?

A

Giant Mollsum

79
Q

What type of individual gets Giant Mollscum?

A

Immunosuppressed, esp HIV infected people

80
Q

Treatment for Mollscum Contagiosum?

A

Should go away on its own

81
Q

What is Mollsum Contagiosum transmitted?

A

Through direct contact

Commonly sexually transmitted

82
Q

What is Cellulitis?

A

Acute infection of skin and soft tissues. Common on the legs

83
Q

What pathogens causes Cellulitis?

A

Beta-haemolytic strep
Staph
Community acquired MRSA

84
Q

Treatment for Cellulitis?

A

Benzypenecillin (or penecillin V) and flucoxacillin

If pen allergic then erythromycin

85
Q

What is dermatitis herpeticum a complication of?

A

Atopic Eczema

86
Q

Characteristics of dermatitis herpeticum?

A

Fever

clusters of itchy blisters or punched-out erosions

87
Q

What pathogen causes dermatitis herpeticum?

A

HPV type 1 of 2

Dermatology (10 decks)

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