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S3 Case 4 - Endocrine > Skin Conditions > Flashcards

Skin Conditions Flashcards

1
Q

What is psoriasis?

A

Autoimmune disease mediated by T-lymphocytes = vascular + inflammatory changes

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2
Q

Where is psoriasis common?

A

Head
Knees
Elbows

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3
Q

What factors aggravate psoriasis?

A

Stress
Excessive alcohol consumption
Smoking

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4
Q

Who is psoriasis common in?

A

Adults

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5
Q

What is psoriasis thought to be?

A

Hereditary

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6
Q

What is psoriasis characterised by?

A

Thick, silvery scales

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7
Q

Who is eczema common in?

A

Children

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8
Q

What is eczema thought to be?

A

Environmental

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9
Q

What is eczema characterised by?

A

Red, inflamed skin

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10
Q

What can eczema be called?

A

Atopic dermatitis

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11
Q

What are the signs + symptoms of eczema?

A

Red, scaly
Extremely dry
Affect flexures
Vesicles + weeping
Excoriation + thickening of skin

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12
Q

What is eczema?

A

Nonspecific term that refers to group of inflammatory skin conditions characterised by pruritis (itching), erythema (red swelling) + scale

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13
Q

What is dermatitis?

A

Chronic, relapsing inflammation of skin
Broader term than eczema

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14
Q

What may be the causes of AD?

A

Allergy
Irritant
Photodermatitis (sunlight)

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15
Q

What is the pathogenesis of AD?

A

Multifactorial
Combo of genetic + environmental factors

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16
Q

What factors play a role in the pathogenesis of AD?

A

Genetics
Skin barrier dysfunction
Impaired immune response
Environment

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17
Q

What is the filaggrin gene?
Genetic factors of AD

A

Synthesis of a protein that holds the integrity of skin barrier

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18
Q

How many mutations is there of the filaggrin gene?

A

20

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19
Q

What are the environmental factors of AD?

A

Western lifestyle = low exposure to pathogens
Duration of breastfeeding = decreases risk
High social position of parents = in creased risk

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20
Q

What are the 2 hypotheses that have been proposed for pathophysiology of AD?

A

Immunological
Skin barrier

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21
Q

What is the immunological pathogenesis for AD?

A

Results from imbalance of T cells
Th2 predominates + leads to increased production of interleukins
= increased level of IgE + Th1

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22
Q

How many types of hypersensitivity reacts are there?

A

4

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23
Q

What is the timing of Type I hypersensitivity reaction?

A

30 mins

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24
Q

What is the antigen of Type I hypersensitivity reaction?

A

Induces IgE response

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25
Q

What is the timing of Type II hypersensitivity reaction?

A

Mins to hours

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26
Q

What is the antigen of Type II hypersensitivity reaction?

A

On cell surface

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27
Q

What is the timing of Type III hypersensitivity reaction?

A

3-8hrs

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28
Q

What is the antigen of Type III hypersensitivity reaction?

A

Extracellular-soluble

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29
Q

What is the timing of Type IV hypersensitivity reaction?

A

48-72hrs

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30
Q

What is the antigen of Type IV hypersensitivity reaction?

A

Induces T-cell

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31
Q

What is the skin’s functions?

A

Regulates body temp
Stores blood
Protects body from external environment
Detects cutaneous sensations
Excretes + absorbs substances
Synthesises vit D

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32
Q

What are the 3 layers of the skin?

A

Epidermis
Dermis
Hypodermis

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33
Q

What is the function of the epidermis?

A

Thin layer of dead cells
Defence against outside world

34
Q

What is the function of the dermis?

A

Made of collagen fibres
Keeps skin strong + flexible
Houses network of blood vessels = keeps our body temp constant despite external changes

35
Q

What is the function of the hypodermis?

A

Body fat is stored
= energy, sweat glands + new skin manufactured to repair cuts

36
Q

What are the 5 layers of epidermis?

A

Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale

37
Q

Describe filaggrin

A

Helps bind keratinocytes together = intact barrier hydrated stratum corneum
Mutation = less filaggrin
Itch = impairment of skin

38
Q

What are the 4 things that play into pathogenesis of pruritus?

A

Barrier dysfunction
Environmental factors
Immunological factors
Pruritus

39
Q

What is involved in barrier dysfunction?

A

Ceramide reduction = H2O retention = dry
Over-desquamation = over-shredding
Filaggrin deficiency

40
Q

What is involved in the immunological factors?

A

Th2 cells
Th17 cells
Eosinophils
Mast cells

41
Q

What is involved in environmental factors?

A

Climate
Smoking
Skin pH
Microbiome

42
Q

What can the skin be irritated by?

A

Soap
Detergents
Wool clothing
Hot weather
Emotional stress
Exposure to triggers

43
Q

Where is AD most common in infants?

A

Face first
Then hands + feet

44
Q

Where is AD most common in older children?

A

Skin folds (elbows, behind knees)

45
Q

Where is AD most common in adults?

A

Face + hands

46
Q

What are the side effects of steroids?

A

Weight gain
Osteoporosis
Think skin
Psychosis

47
Q

What are the aims of treatment for AD?

A

Treat + control symptoms - eg. itching, pain + discomfort
Reduce inflammation
Reduce lost moisture
Inhibit scratching = decrease infection
Improve QoL

48
Q

What are the different treatments for AD?

A

Reduce contact with irritants (soap substitutes)
Identify + reduce exposure to allergen
Emollients
Topical steroids
Antihistamines
Antibiotics
Systemic steroids
Other (herbal/soaps)

49
Q

How do you reduce contact with irritants?

A

Avoid overheating
Avoid direct skin contact with rough fibres
Avoid dusty conditions
Avoid cosmetics
Avoid soap
Use gloves to handle chemicals

50
Q

What do emollients do?

A

Hydrate + soften skin
= restore/replace epidermal barrier
= protection against pathogen bacterial colonisation

51
Q

What do topical steroids/steroids do?

A

Up-regulates the expression of anti-inflammatory proteins
+ represses the expression of proinflammatory proteins in cytosol
= prevents translocation of transcription factors

52
Q

What do antihistamines do?

A

Antagonists acting via histamine H1 receptor

53
Q

What do antibiotics do?

A

Anti-bacterial properties

54
Q

What are the 4 major components of AD treatment?

A

Anti-inflammatory
Anti-pruritic
Moisturiser
Anti-bacterial

55
Q

What treatments should be used initially?

A

Topical skin applications

56
Q

What are ointments for?

A

Very dry skin

57
Q

What are the properties of ointments?

A

Greases
Occlusive

58
Q

What are pastes?

A

Ointment suspensions
Application of noxious chemicals for localised delivery

59
Q

What are creams for?

A

Less dry skin

60
Q

What are the properties of creams?

A

Emulsions
Quick absorption

61
Q

What are lotions for?

A

Less dry skin

62
Q

What are the properties of lotions?

A

Less messy on wet/hairy surfaces
Cooling effect

63
Q

What are the properties of gels?

A

Hydrophilic/hydrophobic
High H2O content

64
Q

What are the properties of emollients?

A

Hydrophobic
Paraffin derivatives
Aq. cream alternative

65
Q

What should be used of a corticosteroid ointment if used long term?

A

Low-potency
= decreases risk of side effects

66
Q

What is tachyphylaxis?

A

More used = daily = less effective
= change to weekly = can use longer
Even if dose increased wont change the effectiveness

67
Q

What are calcineurin inhibitors?

A

Steroid free alternative

68
Q

What is an example of calcineurin inhibitors?

A

Pimecrolimus

69
Q

What are the side effects of calcineurin inhibitors?

A

Local burning
Skin malignancy
Infection risk

70
Q

What are tar band properties?

A

Anti-inflammatory + anti-pruritic

71
Q

What is phototherapy?

A

Narrow-band UVB

72
Q

What is the aim when using emollients?

A

To reduce skin H2O loss = protective film

73
Q

What should emollients be used instead of?

A

Soap
Add to bath water/use in shower

74
Q

How do you use emollients?

A

Use all the time not just with symptoms
Large amount at least BD
Use after bath/shower
Pat dry skin + apply whilst skin is moist
Smooth onto skin = do NOT rub
Use spoon/pump dispenser
Never share

75
Q

What are the different strengths of topical CCS?

A

Very mild = hydrocortisone
Moderate = clobetasone
Strong = mometasone
Should be prescribed weakest effective treatment to control symptoms

76
Q

How do you use topical CCS?

A

OD/BD for 1-2 weeks
Affected areas
Smooth onto skin in direction of hair growth
Use emollients first the 30mins later = CCS

77
Q

What is FTU?

A

Fingertip units
500mg amount required to squeeze a line from tip of adult finger to crease

78
Q

How much topical CCS should be used?

A

1 FTU to treat area of skin size of two palms

79
Q

What are the side effects of topical CCS?

A

Burning/stinging = improves with use
Less common = inflamed hair follicles, thinning of skin, contact dermatitis, acne + changes in skin colour

80
Q

What are examples of systemic therapy?

A

Sedative antihistamines = help sleep
Immunosuppressant = resistant/rapid relapse
Antibacterials = secondary infection

81
Q

What is the treatment for contact dermatitis?

A

Barrier to irritant
Dilute topical CCS
Potassium permanganate soaks

S3 Case 4 - Endocrine (17 decks)

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