Skin Disorders

Question 1

What is psoriasis?

Answer 1

Chronic, auto-immune disorder
Caused by genetics and environmental triggers e.g. infection, trauma, medication
Leads to scaly, erythematous plaques
Psoriatic arthritis is the most common systemic manifestation

Question 2

What sites are commonly affected by psoriasis?

Answer 2

Scalp, elbows, knees followed by nails, hands, feet and trunk

Question 3

What is the pathophysiology of psoriasis?

Answer 3

Stressed keratinocytes release DNA/RNA and form a complex with antimicrobial peptides
This induces cytokine production (TNF-alpha, IL1 and IFN-alpha). These activate dermal dendritic cells
Dermal dendritic cells migrate to lymph nodes and promote Th1, Th17, Th22 cells which leads to chemokine release and the migration of inflammatory cells into dermis
This leads to keratinocyte proliferation and psoriatic plaque.

Question 4

How can psoriasis affect the nail?

Answer 4

Can cause pitting, onycholosis (nail lifting of bed) and nail psoriasis

Question 5

What is psoriasis that effects skin folds and genitalia called?

Answer 5

Flexural psoriasis

Question 6

What kind of psoriasis is followed by streptococcus infection?

Answer 6

Guttate psoriasis

Question 7

What is psoriasis that leads to red skin all around the body?

Answer 7

Erythroderma

Question 8

What is psoriasis that effects palms and soles called?

Answer 8

Palmoplantar psoriasis

Question 9

What are lifestyle changes that can be modified to manage psoriasis?

Answer 9

Alcohol

Smoking

Question 10

What are topical therapies used to treat psoriasis?

Answer 10

Vit. D analoges
Topical corticosteroids
Retinoids
Topical tacrolimus/pimecrolimus (T cell inhibitors)

Question 11

What are phototherapies used to treat psoriasis?

Answer 11

Causes T cell apoptosis
Narrowband UVB
PUVA (Psoralen and UVA)- goes deeper into skin than UVB but has risk of skin cancer

Question 12

What are second line treatments for psoriasis?

Answer 12

Acitretin
Systemic immunosuppression:
-Methotrexate
-Ciclosporin- inhibits T cells
Advanced therpapies:
- PDE4 inhibitors (Apremilax)
-Biologics (anti-TNFa, anti-IL17, anti-IL23)
-JAK inhibitors

Question 13

What is atopic eczema?

Answer 13

Chronic inflammatory condition
Complex genetic disease with environmental influences
Typically begins during infancy or early childhood
Often associated with other atopic disorders e.g. asthma
Atopic= itchy

Question 14

What parts of the body does atopic eczema affect?

Answer 14

Acute inflammation of cheeks, scalp and extensors in infants

Flexural inflammation and lichenification in children and adults

Question 15

What is eczema?

Answer 15

An umbrella term for:
Atopic eczema
seborrhoea dermatitis
venous stasis eczema
allergic contact dermatitis 
irritant contact dermatitis 

The term dermatitis is the same as eczema

Question 16

What is the pathophysiology of atopic eczema?

Answer 16

Barrier defect:
-filaggrin- bind and aggregate keratin bundles and intermediate filaments to form cellular scaffold in corneocytes (keratinocytes)
-reduced extracellular lipids and impaired ceramide allergens
-impaired protection against microbes and environmental allergens
Immune dysregulation:
-staphyloccal super antigens stimulate Th2 lymphocyte responses
-T cells infiltrate
-eosinophils

Question 17

What does infantile phase atopic eczema include?

Answer 17

Erythematous, oedematous papule and plaques and possibly vesiculation

Question 18

What do we term a gold crust appearance on skin cuased by s.aures?

Answer 18

Impetiginisation

Question 19

What is eczema heperticum?

Answer 19

Emergency
Caused by HSV
Erosions that don’t go all the way to the epidermis

Question 20

What are lifestyle managements for eczema?

Answer 20

Emollients (moisturises)

Omission of soap

Question 21

What is the role of a clinical nurse specialist in eczema?

Answer 21

Topical application technique
Daily treatment
Habit reversal

Question 22

What are other management techniques for eczema?

Answer 22

Patch testing
Biopsy
Topical therapy: topical corticosteroids, topical tacroliman
Phototherapy: Narrowband UVB and PUVA
Retinoids
Systemic immunosupressents: methotrexate, ciclosporin, azathioprine, mycophenolate mofetil
Advanced therapies: Biologics, JAK inhibitors

Question 23

What are adverse affects of topical corticosteroids?

Answer 23

Rare: skin atrophy, folliculitis, exacerbation of acne and rosacea
Very rare: perioral dermatitis, rebound syndrome, allergy
Extremely rare: hormonal imbalance, hirsutism

Question 24

What are adverse affects of calcineurin?

Answer 24

Burning sensation