Session 5.5a - Transatlantic Journey Flashcards
4:00 - bottom left
Describe the appearance of this image.
Little grouped vesicles all next to each other.
4:00 - bottom left
Give a differential diagnosis.
Cold sore virus caused by HSV.
4:00 - middle right
Describe the appearance of this image.
Little shiny, a bit umbilicated lesions.
4:00 - middle right
Give a differential diagnosis.
Molloscum contagiosum
4:00 - middle right
Give an age group these lesions are common in.
Molloscum contagiosum - common in children
4:00 - middle right
What type of infection is this?
Molloscum contagiosum - viral rash
4:00 - middle right
What is the normal treatment for this patient?
Molloscum contagiosum - normally goes away on its own
4:00 - top right
Give a differential diagnosis for this condition
Kaposi’s sarcoma
4:00 - top right
Which group of patients are most likely to get Kaposi’s sarcoma?
A condition that HIV patients can have
4:00 - top right
What is Kaposi’s sarcoma?
A rare type of malignant condition (cancer) that HIV patients can have
4:00 - top right
What colour are Kaposi’s sarcoma lesions?
Quite purple, these ones are a bit red but they can be quite purple too.
4:00 - top left
What is this?
Leukoplakia on the inside of the cheek
4:00 - top left
What is leukoplakia?
Leukoplakia generally refers to a firmly attached white patch on a mucous membrane which is associated with an increased risk of cancer - pre-malignant cells
4:00 - top left
Is leukoplakia cancerous?
They are pre-malignant cells
4:00 - top left
What colour is leukoplakia?
white areas
4:00 - top left
What type of leukoplakia is common to those with HIV?
Hairy leukoplakia - type of leukoplakia caused by the Epstein-Barr virus.
It often affects people with a weakened immune system, particularly those with HIV and AIDS or who have had an organ transplant and are taking immunosuppressant medication.
4:00 - middle left
Give a differential diagnosis.
Candida (oral thrush)
4:00 - bottom right
Give a differential diagnosis
Folliculitis
4:00 - bottom right
What is folliculitis?
Where hair follicles become inflamed - ingrown hairs
4:00 - middle bottom
Give a differential diagnosis.
Dry skin
4:00
Categorise these into:
non-malignant
pre-malignant
malignant
Non-malignant
- Oral thrust (middle left)
- Cold sores (bottom left)
- Molloscum contagiosum (middle right)
- Folliculitis (bottom right)
- Dry skin (middle bottom)
Pre-malignant
- Leukoplakia (top left)
Malignant
- Kaposi’s sarcoma (top right)
4:00
What do all of these images have in common?
They are all infectious diseases (except dry skin)
What is phototherapy?
The term phototherapy is a form of treatment where fluorescent light bulbs are used to treat skin conditions. Natural sunlight has been known to be beneficial in certain skin disorders for thousands of years, and it is the ultraviolet part of the radiation produced by the sun that is used in phototherapy, in particular the ultraviolet A (UVA) and ultraviolet B (UVB) wavelengths of light.
What conditions is phototherapy used to treat?
To name a few, psoriasis and atopic eczema.
[UVB - psoriasis, atopic eczema, polymorphic light eruption, generalised itching, pityriasis lichenoides, cutaneous T cell lymphoma, lichen planus, vitiligo and other less common conditions.
PUVA - chronic plaque psoriasis (if UVB ineffective), vitiligo, polymorphic light eruption and cutaneous T-cell lymphoma.
PUVA is often used second line if UVB is ineffective.
PUVA is favoured over UVB for some indications, such as mycosis fungoides
beyond patch stage, adult pityriasis rubra pilaris, hand and foot eczema.]
What does phototherapy involve?
Going to a ‘sunbed’ twice a week
Both UVA and UVB treatments are given in a hospital outpatient department in a walk-in light box containing fluorescent light bulbs. The treatment schedule varies from two to three times a week and an average course lasts between 15 and 30 treatments. There are no limits to the numbers of treatments patients may have over their lifetime. Having more than 200 PUVA or over 500 UVB treatments means that you will need annual skin checks to look for skin cancer.
8:00 - top right
What does this show?
Normal skin
Pink stains are Langerhans cells (dendritic cells which are part of the immune system)
8:00 - bottom left
These show an experiment assessing the skin damage in phototherapy for exposed areas and non exposed areas. What does this tell you?
Photo-damaged skin does not have as many Langerhans cells.
8:00 - bottom left
Using this image, explain why it is thought you are more likely to get a cold sore if you are exposed to the sun a lot?
There are less Langerhans cells present in sun damage, which are dendritic immune cells, thus you are more likely to get an infection
What is type I hypersensitivity?
Type I hypersensitivity (or IMMEDIATE hypersensitivity) is an ALLERGIC reaction provoked by reexposure to a specific type of antigen referred to as an allergen.
What is type IV hypersensitivity?
Type IV hypersensitivity is often called DELAYED type hypersensitivity as the reaction takes several days to develop. Unlike the other types, it is not antibody-mediated but rather is a type of CELL-MEDIATED response.
Give some examples of type I hypersensitivity reactions.
Type I hypersensitivity reactions are allergies:
e. g.
- grass and tree pollen – an allergy to these is known as hay fever (allergic rhinitis)
- dust mites
- animal dander (tiny flakes of skin or hair)
- food – particularly nuts, fruit, shellfish, eggs and cows’ milk
- insect bites and stings
- medication – including ibuprofen, aspirin and certain antibiotics
- latex – used to make some gloves and condoms
- mould – these can release small particles into the air that you can breathe in
- household chemicals – including those in detergents and hair dyes
What can a severe type I hypersensitivity reaction lead to?
Anaphylaxis
What is anaphylaxis?
Anaphylaxis is a severe and potentially life-threatening reaction to a trigger such as an allergy.
What are Carba mix and Thiuram mix found in?
The manufacturing of rubber
If a patient is allergic to Carba mix and/or Thiuram mix what does this indicate?
They have a type IV hypersensitivity (allergy) to products related to rubber (i.e. not latex itself but products used to manufacture it)
What are some products that may contain carba mix?
Antabuse (medication for alcoholism) - disulfiram Mancozeb Fungicides Rubber Goods • Boots • Bottle nipples • Condoms • Diaphragms • Ear-and headphones • Elastic • Goggles • Hoses • Masks • Racquet and club handles • Rubber bands • Shoes • Swimwear • Toys • Tubing • Utility gloves • Wetsuits • Other products made of natural rubber, butyl rubber, nitrile, or neoprene Zineb Fungicides
What are some products that may contain thiuram mix?
Animal Repellent Antabuse Medication for Alcoholism - disulfiram Chemicals Used to Prevent Mildew or Mold Fungicides and Pesticides Products Made with Natural Rubber, Butyl Rubber, Nitrile or Neoprene • Adhesives • Anesthesia equipment • Aprons • Condoms and diaphragms • Cords • Dental dams • Ear and headphones • Erasers, mats, and utility gloves • Gloves • Goggles • Hoses • Insulation • Masks • Mats • Plugs • Racquet and club handles • Respirators • Rubber bands • Sheeting • Shoes/boots • Swimwear • Toys • Tubing • Utility gloves • Wetsuits Yard Care • Seed protectant
How is allergic contact dermatitis diagnosed?
The best way to test for a reaction to allergens is by patch testing.
What is patch testing used for?
To determine what allergens can cause a type IV hypersensitivity reaction in the patient (allergic contact dermatitis).