Psoriasis and eczema

Question 1

are plaques reversible in psoriasis

Answer 1

yes

Question 2

type of psoriasis that has circular lesions
classically triggered by what?
age group it commonly affects?

Answer 2

gutatte
bacterial infection (strep)
young adults

Question 3

drugs that can trigger psoriasis

Answer 3

beta blockers, lithium

Question 4

what play a central role in pathogenesis of psoriasis

Answer 4

TNFalpha
T cells (CD8+)
macrophages
dendritic cells

Question 5

what precedes psoriasis in many people

Answer 5

strep infection activating T cells

Question 6

micro abscesses of munro

Answer 6

psoriasis

Question 7

auspitz sign

Answer 7

pin point bleeding on scale removal

Question 8

what can pustular psoriasis affect

Answer 8

palms and soles

Question 9

topical treatments for psoriasis

Answer 9

vit D analogues - calcipotriol, calcitriol 
(caliptriol + betamethasone often used)
emollients 
coal tar 
keratolytics e.g. salicylic acid

Question 10

Side effect of dithranol

Answer 10

burning of skin

Question 11

percentage of psoriasis patients with depression

Answer 11

60%

Question 12

more severe psoriasis treatment

Answer 12

methotrexate
- avoid in young in view of long term risk of hepatic fibrosis
ciclosporin - s/e: increased BP, renal dysfunction
oral retinoid - acitretin - teratogenic

if no improvement, consider TNF blockers e.g. etanercept - also good for psoriatic arthropathy

Question 13

type of psoriasis that can be life threatening

Answer 13

erythrodermic/widespread pustular psoriasis

Question 14

what type of lymphocytes are overactive in atopic eczema and what do they produce? causing stimulation of…

Answer 14

TH2 lymphocytes

they produce IL4 and IL5, stimulating IgE

Question 15

what does RAST identify?

Answer 15

specific antigens eg. house dust mite

Question 16

mutations in what gene are associated with severe/early onset eczema?

Answer 16

filaggrin

Question 17

most children grow out of infantile eczema before 13 yrs

Answer 17

.

Question 18

in severe eczema what type of emollients are best?

Answer 18

greasy

Question 19

chronic changes to skin in atopic eczema

Answer 19

lichenification (thickening)
excoriation
secondary infection

Question 20

crusting in eczema

Answer 20

s aureus infection

Question 21

UK diagnostic criteria for atopic eczema

Answer 21

itching and 3 or more

• visible flexural rash
• history of flexural rash
• personal history of atopy
• generally dry skin
• onset before 2 yrs

Question 22

where can eczema affect in infants?

Answer 22

cheeks

extensor surfaces

Question 23

systemic treatment for eczema?

Answer 23

ciclosporin

Question 24

topical immunomodulator used in eczema

Answer 24

tacrolimus

Question 25

monomorphic punched out lesions

Answer 25

eczema herpeticum

Question 26

acanthosis

Answer 26

increased thickness of the epidermis

Question 27

parakeratosis

Answer 27

persistence of nuclei in the keratin layer

Question 28

what type of hypersensitivity is contact allergic dermatitis

Answer 28

IV

Question 29

discoid eczema
often atopic or not?
shape of lesions?
worsened by?

Answer 29

often atopic
round/oval itchy lesions
worsened by heat

Question 30

adult seborrhoeic keratitis
where does it affect?
severe if .. ?
treatment?

Answer 30

affects scalp (dandruff), eyebrows, nasolabial folds, cheeks, flexures

severe if HIV +ve

rx: mild topical steroid/antifungal preparations

Question 31

if a 1st degree relative has atopic disease, was can reduce risk of atopic eczema in a child?

Answer 31

breastfeeding for the first 3 months

Question 32

probiotics have been found to decrease incidence of IgE associated eczema in infancy

Answer 32

.

Question 33

what treatment may be needed in eczema herpeticum

Answer 33

IV acyclovir

Question 34

where does pompholyx eczema usually affect?

Answer 34

hands and feet

Question 35

spongiotic vesicles

Answer 35

pompholyx eczema

Question 36

using steroids in eczema
face, flexures, groin.. ?
elsewhere?

Answer 36

face, flexures, groin

• 1% hydrocortisone
• clobetasone 0.5% (1 step above hydrocortisone) - use on face for