Psoriasis and eczema Flashcards
are plaques reversible in psoriasis
yes
type of psoriasis that has circular lesions
classically triggered by what?
age group it commonly affects?
gutatte
bacterial infection (strep)
young adults
drugs that can trigger psoriasis
beta blockers, lithium
what play a central role in pathogenesis of psoriasis
TNFalpha
T cells (CD8+)
macrophages
dendritic cells
what precedes psoriasis in many people
strep infection activating T cells
micro abscesses of munro
psoriasis
auspitz sign
pin point bleeding on scale removal
what can pustular psoriasis affect
palms and soles
topical treatments for psoriasis
vit D analogues - calcipotriol, calcitriol (caliptriol + betamethasone often used) emollients coal tar keratolytics e.g. salicylic acid
Side effect of dithranol
burning of skin
percentage of psoriasis patients with depression
60%
more severe psoriasis treatment
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
type of psoriasis that can be life threatening
erythrodermic/widespread pustular psoriasis
what type of lymphocytes are overactive in atopic eczema and what do they produce? causing stimulation of…
TH2 lymphocytes
they produce IL4 and IL5, stimulating IgE
what does RAST identify?
specific antigens eg. house dust mite
mutations in what gene are associated with severe/early onset eczema?
filaggrin
most children grow out of infantile eczema before 13 yrs
.
in severe eczema what type of emollients are best?
greasy
chronic changes to skin in atopic eczema
lichenification (thickening)
excoriation
secondary infection
crusting in eczema
s aureus infection
UK diagnostic criteria for atopic eczema
itching and 3 or more
- visible flexural rash
- history of flexural rash
- personal history of atopy
- generally dry skin
- onset before 2 yrs
where can eczema affect in infants?
cheeks
extensor surfaces
systemic treatment for eczema?
ciclosporin
topical immunomodulator used in eczema
tacrolimus
monomorphic punched out lesions
eczema herpeticum
acanthosis
increased thickness of the epidermis
parakeratosis
persistence of nuclei in the keratin layer
what type of hypersensitivity is contact allergic dermatitis
IV
discoid eczema
often atopic or not?
shape of lesions?
worsened by?
often atopic
round/oval itchy lesions
worsened by heat
adult seborrhoeic keratitis
where does it affect?
severe if .. ?
treatment?
affects scalp (dandruff), eyebrows, nasolabial folds, cheeks, flexures
severe if HIV +ve
rx: mild topical steroid/antifungal preparations
if a 1st degree relative has atopic disease, was can reduce risk of atopic eczema in a child?
breastfeeding for the first 3 months
probiotics have been found to decrease incidence of IgE associated eczema in infancy
.
what treatment may be needed in eczema herpeticum
IV acyclovir
where does pompholyx eczema usually affect?
hands and feet
spongiotic vesicles
pompholyx eczema
using steroids in eczema
face, flexures, groin.. ?
elsewhere?
face, flexures, groin
- 1% hydrocortisone
- clobetasone 0.5% (1 step above hydrocortisone) - use on face for
