Skin Disorders Flashcards
What is psoriasis?
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
What sites are commonly affected by psoriasis?
Scalp, elbows, knees followed by nails, hands, feet and trunk
What is the pathophysiology of psoriasis?
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.
How can psoriasis affect the nail?
Can cause pitting, onycholosis (nail lifting of bed) and nail psoriasis
What is psoriasis that effects skin folds and genitalia called?
Flexural psoriasis
What kind of psoriasis is followed by streptococcus infection?
Guttate psoriasis
What is psoriasis that leads to red skin all around the body?
Erythroderma
What is psoriasis that effects palms and soles called?
Palmoplantar psoriasis
What are lifestyle changes that can be modified to manage psoriasis?
Alcohol
Smoking
What are topical therapies used to treat psoriasis?
Vit. D analoges
Topical corticosteroids
Retinoids
Topical tacrolimus/pimecrolimus (T cell inhibitors)
What are phototherapies used to treat psoriasis?
Causes T cell apoptosis
Narrowband UVB
PUVA (Psoralen and UVA)- goes deeper into skin than UVB but has risk of skin cancer
What are second line treatments for psoriasis?
Acitretin Systemic immunosuppression: -Methotrexate -Ciclosporin- inhibits T cells Advanced therpapies: - PDE4 inhibitors (Apremilax) -Biologics (anti-TNFa, anti-IL17, anti-IL23) -JAK inhibitors
What is atopic eczema?
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
What parts of the body does atopic eczema affect?
Acute inflammation of cheeks, scalp and extensors in infants
Flexural inflammation and lichenification in children and adults
What is eczema?
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
What is the pathophysiology of atopic eczema?
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
What does infantile phase atopic eczema include?
Erythematous, oedematous papule and plaques and possibly vesiculation
What do we term a gold crust appearance on skin cuased by s.aures?
Impetiginisation
What is eczema heperticum?
Emergency
Caused by HSV
Erosions that don’t go all the way to the epidermis
What are lifestyle managements for eczema?
Emollients (moisturises)
Omission of soap
What is the role of a clinical nurse specialist in eczema?
Topical application technique
Daily treatment
Habit reversal
What are other management techniques for eczema?
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
What are adverse affects of topical corticosteroids?
Rare: skin atrophy, folliculitis, exacerbation of acne and rosacea
Very rare: perioral dermatitis, rebound syndrome, allergy
Extremely rare: hormonal imbalance, hirsutism
What are adverse affects of calcineurin?
Burning sensation
