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DermJaz > Skin Conditions > Flashcards

Skin Conditions Flashcards

1
Q

Autoimmune condition that destroys the melanocytes in the skin

A

Vitiligo

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2
Q

Possible future Treatment for vitiligo =
Works by _____
May potentially cause increased risk of _____

A

Melanotan
Short tripeptide of hormone that stimulates melanin production
Melanoma

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3
Q

MSH excess from pituitary =

A

Nelsons syndrome - hyperpigmentation

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4
Q

AI loss of pilosebaceous units as follicles are attacked

A

Alopecia areata

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5
Q

Inherited DEJ disease 2 types =

A

Epidermolysis bullosa simplex and dystrophic (EBS and EBD)

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6
Q

Acquired DEJ conditions due to auto-antibodies

A

Pemphigoid
Pemphigus
Dermatitis herpetiformis

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7
Q

inherited condition that causes breakdown of the skin barrier due to impaired cholesterol synthesis

A

Steroid sulfatase deficiency X-linked ichthyosis

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8
Q

Psoriatic plaque eruption caused by minor skin trauma =

A

Koebner’s phenomenon

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9
Q

atopic eczema lesions usually contain:

A

Th2, dendritic cells, keratinocytes, macrophages and mast cells

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10
Q

Pemphigus/pemphigoid are examples of type __ hypersensitivity reaction

A

type 2

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11
Q

purpura/rash are examples of type ___ hypersensitivity reaction

A

3

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12
Q

urticaria is a type __ hypersensitivity reaction

A

1

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13
Q

erythema/rash is a type ___ hypersensitivity reaction

A

4

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14
Q

symmetrical skin erupion of sudden appearance - suspect ___

A

drug induced

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15
Q

exanthematous drug reaction is a type __ reaction that is ___ mediated
causes a ____ rash

A

type 4
t cell
widespread symmetrical

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16
Q

drugs that cause exanthematous drug reaction =

A 
penicillins
sulfonamide antibiotics
erythro/streptomycin
allopurinol
anti-epileptics (carbamazepine)
NSAIDs 
phenytoin
chloramphenicol
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17
Q

urticaria is usually a type __ hypersensitivity reaction mediated by ___ after rechallenge
examples of drugs that cause this =

A

1
IgE
beta lactam antibiotics, carbazepine

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18
Q

urticarial reaction on first exposure to the drug is caused by ___
examples of drugs that cause this =

A

mast cells releasing inflammatory mediators

vancomycin, NSAIDs, aspirin, opiates, muscle relaxants, quinolones

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19
Q

drugs that can cause acne as an adverse reaction

A

glucocorticoids, androgens, lithium, isoniazid, phenytoin

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20
Q

AGEP =

(very rare) drugs that cause this adverse reaction =

A

acute generalised exanthematous pustulosis

antibiotics, CCBs, antimalarials

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21
Q

drug induced bullous pemphigoid caused by

A

ACEI, penicillin, furosemide

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22
Q

drug induced linear IgA disease caused by

A

vancomycin

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23
Q

describe the appearance of fixed drug eruptions

A

well demarcated, round/ovoid plaques
red and painful
usually mild and a single lesion
can be eczematous, papules vesicles or urticaria

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24
Q

common locations of lesions of fixed drug eruptions

A

hands, genitalia, lips and occasionally oral mucosa

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25
Q

drugs that can cause fixed drug eruptions

A

vancomycin, doxycycline, paracetamol, NSAIDs, carbamezepine

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26
Q

DRESS stands for ___

it is a severe cutaneous adverse reaction, drugs that cause =

A

drug reaction with eosinophilia and systemic symptoms

sulfonamides, anticonvulsants, allopurinol, minocycline, dapsone, NSAIDs, abacavir, nevirapine, vancomycine

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27
Q

TEN and SJS are severe cutaneous adverse reactions

drugs that cause them =

A

Toxic epidermal necrolysis Stevens Johnson Syndrome

sulfonamide Abx, cefalosporins, carbamazepine, phenytoin, NSAIDs, nevirapine, lamotrigine, tramadol, pantoprazole

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28
Q

T/F phototoxic drug reactions can occur through windows?

A

True

Usually UVA or visible light

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29
Q

Phototoxic drug reactions are ___ mediated

mechanism behind them = appropriate wavelength hits ___ under surface releasing __+__

A

non-immunological
drug chromophore
free radicals and photoproducts

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30
Q

acute phototoxic drug reactions =

A

skin toxicity, systemic toxicity and photodegradation

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31
Q

chronic phototoxic drug reactions =

A

pigmentation, photoaging and photocarcinogenesis

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32
Q

typical manifestations of Type 1 hypersensitivity reaction

A 
anaphylaxis
eczema
asthma
hives
hayfever
urticaria
angioedema
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33
Q

dermatological examples of type 4 hypersensitivity reactions

A

contact dermatitis
tubercular lesions
graft rejection

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34
Q

In type 1 HS reactions: Th2 produces ++_ that stimulate B cells to produce ___ which then ___

A

IL4, 5 and 13
IgE
becomes Fce receptor on mast cell

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35
Q

In type 1 HS urticaria appears within __ and lasts for __

A

1hr

2-6/24 hrs

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36
Q

Investigations for suspected type 1 HS reaction

A

RAST - blood test for specific IgE
skin prick and if it is negative = challenge test
serum mast cell tryptase level (during anaphylaxis)

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37
Q

doses of adrenaline in epipens for anaphylactic shock

A 
adults = 300microg
kids = 150microg
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38
Q

Drugs that can be used day to day if have a type 1 allergy

A

mast cell stabilisers - sodium cromoglicate

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39
Q

In type 4 HS skin reactions: ___ T cells cause apoptosis of __ and produce ___+___ causing ____

A

CD8+
keratinocytes
chemokines and cytokines
leukocyte recruitment

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40
Q

Gold standard test for suspected allergic contact dermatitis

A

patch test

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41
Q

treatment for allergic dermatitis

A 
minimise exposure to allergen
emollients
topical steroids
UV phototherapy
immunosuppressants
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42
Q

mode of inheritance of tuberous sclerosis

A

auto-dom or de novo

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43
Q

earliest cutaneous sign of tuberous sclerosis

A

ash-leaf macule - depigmented

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44
Q

pathognomic of tuberous sclerosis

A

periungal fibromata

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45
Q

s+s of tuberous sclerosis

A 
infantile seizures
longitudinal nail ridging
periungal fibromata
facial angiofibroma
cortical tubers +//- calcification of falx cerebri may => seizures
angiomyolipomas
bone cysts
Shagreen patch
enamel pitting
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46
Q

3 types of epidermolyis bullosa

A

simplex
junctional
dystrophic

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47
Q

characteristic of simplex epidermolysis bullosa

A

epidermal
light grazes and blisters
doesn’t cause scarring

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48
Q

characteristics of junctional epidermolysis bullosa

A

blistering and ulcers

may scar

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49
Q

characteristics of dystrophic epidermolysis bullosa

A

dermal and causes scarring

digits shorten causing mitten hands if not bandaged separately

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50
Q

EB aquisita is rare and caused by ___

A

AI against collagen 17

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51
Q

cafe au lait spots, axillary freckling, optic glioma, Lisch nodules are characteristic of

A

NF1

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52
Q

filaggrin loss of function mutations can cause:

A

leratosis pilaris
hyperlinear palms
ichthyosis vulgaris ( auto dom - fish scaling due to loss of granules in granula layer)

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53
Q

filaggrin mutations increase your risk of : (3)

A

eczema x4
asthma and hayfever x3
peanut allergy x5

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54
Q

ratio of melanocytes:basal cells at DEJ

A

1:10

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55
Q

2 components of skin basement membrane

A

laminin and collagen 4

56
Q

an example of a spongiotic inflammatory skin reaction

A

eczema

57
Q

elongation of the rete ridges = ___ inflammatory skin reaction

A

psoriasiform

58
Q

auspitz sign in psoriasis =

A

pick off plaque and bleeds as vessels are close to surface

59
Q

pemphigus vulgaris is a loss of the integrity of ___

A

epidermal cell adhesion

60
Q

pemphigus vulgaris basis of AI =

A

IgG auto-Ig against desmoglein 3 (maintains desmosomal attachments) =>immune complexes> complement and protease > desmosomes disrupted > acanthosis

61
Q

Characteristic of lesions caused by pemphigus vulgaris

A

fluid filled blisters which rupture to cause shallow erosions

62
Q

bullous pemphigoid causes a ___ blister with no sign of ___

A

subepidermal

acanthosis

63
Q

AI basis of bullous pemphigoid =

A

IgG attack hemidesmosomes that anchor basal cells to basement membrane

64
Q

immunofluorescence in bullous pemphigoid shows:

A

linear IgG and complement around basement membrane

lots of eosinophils

65
Q

histology of bullous pemphigoid shows:

A

fluid and inflam cells between basal cells and dermal papilla projectinto bulla

66
Q

dermatitis herpetiformis is associated with ___ disease and ___ gene

A

coeliacs

HLA-DQ2

67
Q

AI bullous disease that causes v itchy symmetrical lesions on elbow knees and buttocks

A

dermatitis herpetiformis

68
Q

hallmark of dermatitis herpetiformis

A

papillary dermal microabscesses - deposits of IgA

69
Q

Lichenoid inflammatory skin reactions are characterised by

A

damage to basal epidermis

70
Q

examples of lichenoid inflammatory skin reactions

A

lichen planus
discoid lupus
drug rashes

71
Q

characteristics of lichen planus =

A 
ithcy flat topped violaceous papules
irregular sawtooth acanthosis
hypergranulosis, orthohyperkeratosis
melanocytes drop out
upper dermal infiltrate of lymphocytes
cytoid bodies
72
Q

comedones =

A

build up of keratin and sebum in pilosebaceous units

73
Q

aggravators of rosacea

A

sunlight
alcohol
spicy foods
stress

74
Q

characteristics of rosacea

A

recurrent facial flushing
visible blood vessels
pustules
rhinophyma

75
Q

follicular ___ are often present in rosacea

A

dermodex mites

76
Q

histology of rosacea =

A

vascular ectasia
patchy inflam with plasma cells
perifollicular granulomas

77
Q

sites on the body of psoriatic plaques

A

extensor surfaces

scalp sacrum, hands, feet, trunk, nails

78
Q

auspitz sign is in ___ (condition)

caused by

A

psoriasis

dilated capillaries in elongated dermal papillae

79
Q

4 subtypes of psoriasis

A

vulgaris (chronic plaque)
guttate
palmoplantar pustular
erythrodermic/widespread pustular (rare)

80
Q

guttate psoriasis is commonly set off by

A

strep infection

81
Q

nail signs of psoriasis

A

pitting
dystrophy
onycholysis
subungal hyperkeratosis

82
Q

systemic factors associated with psoriasis

A 
increased systemic inflam markers
psoriatic arthritis
metabolic syndrome
Crohn's
cancer
depression
uveitis
83
Q

topical treatments for psoriasis

A 
vit D analogues (calcipotriol/calcitrol)
coal tar
dithranol
steroids
emollients
84
Q

treatments for psoriasis (non-topical)

A

Phototherapy (UVB narrowband and pUVA)
IS - methotrexate
biological agents

85
Q

features of mild acne -

A

scattered papules and pustules - mild atrophic scarring

86
Q

features of moderate acne -

A

numerous papules and pustules and mild atrophic scarring

87
Q

features of severe acne -

A

cysts nodules significant scarring

88
Q

topical treatments for acne

A

benzoyl peroxide
retinoids
tetracyclines

89
Q

properties of benzoyl peroxide that make it good for acne treatment

A

keratolytic

antibacterial

90
Q

systemic drugs for acne

A

antibiotics

isotretinoin

91
Q

type of drug that isotretinoin is and its effect in the Rx of acne

A

oral retinoid

affects sebaceous gland activity - initially aggravates acne - lots of side effects

92
Q

eye problems that can be ass with rosacea

A

conjunctivitis

gritty eyes

93
Q

topical treatments for rosacea

A

metronidazole

ivermectin

94
Q

mech of action of ivermectin in rosacea Rx

A

decreased dermodex mite population

95
Q

in rosacea there are no ___ on the skin as isnt a disease of pilosebaceous unit

A

comedones

96
Q

oral Rx for rosacea

A

tetracycline

isotretinoin low dose if severe

97
Q

Rx for 1 telangiectasia and 2 rhinophyma in rosacea

A

1 vascular laser

2 laser shaving/sx

98
Q

Wickham’s striae appearance

An example of a ___

A

white reticular network on

lichenoid eruption

99
Q

shiny flat-topped pink/purple papules and plaques = an example of a __

A

lichenoid eruption

100
Q

sites that lichen planus typically affects

A

volar wrist and forearm
shin
ankles

101
Q

lichen planus usually lasts ___

A

12-18mnths - burns itself out

102
Q

treatment of severe itch in lichen planus

A

topical potent steroid, oral if extensive

103
Q

which is deeper and which is more superficial out of bullous pemphigoid and pemphigus vulgaris

A 
Deeper = pemphigoiD
Superficial = pemphiguS
104
Q

bullous pemphigoid causes a split in the __ pemphigus vulgaris in the ___

A 
BP = DEJ
PV = intra-epidermal
105
Q

nikolsky sign =

differentiates between __+__

A

when rubbed lightly on top the skin slips away
+ve = pemphigus vulgaris
-ve = pemphigoid bullosa

106
Q

large tense bullae on normal skin with erythematous base = ___ (condition)

A

pemphigoid bullosa

107
Q

mucosal lesions are unlikely in pemphigoid bullosa/pemphigus vulgaris

A

pemphigoid bullosa

it’s very common in PV

108
Q

flaccid vesicles/bullae that rupture to leave raw area with increased infection risk = ___ (condition)

A

pemphigus vulgaris

109
Q

PV and BP are ___ and last ___, remission on Rx in ___

A

self-limiting in months-yrs

3-6mnths

110
Q

mortality rates for BP and PV

A 
PV = high mortality if untreated
BP = lower risk
111
Q

Ix for BP and PV

A

biopsy with direct immunofluorescence

indirect immunofluoroscence

112
Q

treatments for BP and PV

A

systemic steroids
IS agents
topicals: emollients, steroids, antiseptics
tetracycline (BP)

113
Q

treatment for boil with surrounding cellulitis

A

flucloxacillin PO 1g qds

114
Q

pyoderma gangrenosum is ass with __+__ and usually affects the ++_

A

UC and Crohn’s

legs, trunk and stoma

115
Q

patient returns from abroad with a rash that after 1-2 days leads to painful sores =

A

hand, foot and mouth

116
Q

describe lesions of dermatitis and eczema

A

itchy, ill-defined, scaly and erythematous

117
Q

acute phase of dermatitis and eczema lesions=

A

papulovesicular, red, spongiosis, ooze/scale/crust

118
Q

chronic phase of dermatitis and eczema lesions =

A

lichenification, elevated plaques, increased scaling

119
Q

histology and pathogenesis of contact allergic dermatitis

A

type 4 hypersensitivity

spongiotic dermatitis

120
Q

histology and pathogenesis of contact irritant dermatitis

A

spongiotic dermatitis

trauma eg. soap and water

121
Q

histology and pathogenesis of atopic eczema

A

genes and envnt => inflam

spongiotic dermatitis

122
Q

histology and pathogenesis of drug induced dermatitis

A

type 1+4 HS reaction

spongiotic dermatitis with eosinophils

123
Q

histology and pathogenesis of photo-induced dermatitis

A

reaction to UV

spongiotic dermatitis

124
Q

histology and pathogenesis of lichen simplex dermatitis

A

physical skin trauma eg. scratching

spongiotic dermatitis and external trauma

125
Q

histology and pathogenesis of stasis dermatitis

A

physical skin trauma - hydrostatic pressure

spongiotic dermatitis and extravasation of RBCs

126
Q

atopic eczema distribution in babies

A

often wide spread

cheeks and extensors

127
Q

appearance of herpeticum =

caused by __ infected with ___

A

monomeric punched-out lesions

eczema infected by herpes simplex

128
Q

diagnostic criteria for eczema -

A 
itching +>= 3 of:
visible+/Hx of flexural rash
generally dry skin
Hx atopy
onset <2yo
129
Q

treatments for eczema

A 
emollients
topical steroids
treat infection
UVB mainly phototherapy
systemic IS
130
Q

appearance of discoid eczema

A

itchy, red, swollen and cracked in circular/oval patches

131
Q

chronic actinic dermatitis causes a photosensitive reaction in ____ = type __ HS

A

24-72hrs

type 4

132
Q

drug induced photosensitive eczema causes reaction in ___ type of reaction = ___

A

mins-hrs

exaggerated sunburn

133
Q

stasis eczema is 2ndry to ____

site = ___ and may lead to ___/___

A

hydrostatic pressure, oedema, RBC extravasation
lower legs
ulceration and hyperpigmentation

134
Q

cradle cap in infants or dandruff =

A

seborrhoeic eczema

135
Q

appearance of pompholyx eczema

A

spongiotic vesicles on hands/feet

DermJaz (9 decks)

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