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LOCO 2 > Skin Inflammation > Flashcards

Skin Inflammation Flashcards

1
Q

What cells are found in the skin during inflammation? (6)

A 
Neutrophil
Eosinophil
Lymphocyte
Plasma cell
Macrophage
Mast cell
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2
Q

Where is the Langerhans cell found? Describe its appearance.

A

In the epidermis

Dendritic cell with spine-like projections

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3
Q

What does the Langerhans cell do?

A

Presents antigen to CD4+ helper T-cell - picks up antigens that enter the skin and transports them to the lymph node

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4
Q

What other cell in the epidermis also has spine-like projections?

A

Melanocyte

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5
Q

There are various types of inflammation in the skin that all arise from…

A

Naïve CD4 cells

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6
Q

If there is an excess of Th17 CD4 cells, what is the result? What is this for?

A

Neutrophilic inflammation/microbicidal i.e. for extracellular bacteria and fungi, and in psoriasis.

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7
Q

If there is an excess of Th1 CD4 cells, what is the result? What is this for?

A

Monocytic inflammation/intracellular killing i.e. for intracellular bacteria, protozoans, and viruses.

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8
Q

If there is an excess of Th2 CD4 cells, what is the result? What is this for?

A

Eosinophilic, basophilic, mast cell inflammation/mucosal clearance i.e. for Helminths. It is seen in eczema and allergies.

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9
Q

What are the cardinal signs of acute inflammation? Why do they each happen? (5)

A

Redness (increased blood flow and vessel dilatation)
Heat (as above)
Swelling (accumulation of fluid – exudate)
Pain (pressure on nerve endings)
Loss of function

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10
Q

What are the different types of inflammation in skin? (5)

A 
Mast cell mediated
Antibody mediated
Immune complex mediated
Delayed hypersensitivity
Granuloma formation
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11
Q

Give an example of mast cell mediated inflammation.

A

Urticaria

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12
Q

Give an example of antibody mediated inflammation.

A

Pemphigus

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13
Q

Give an example of immune complex mediated inflammation.

A

Vasculitis

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14
Q

Give an example of delayed hypersensitivity inflammation.

A

Contact allergic dermatitis

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15
Q

Give an example of granuloma formation inflammation.

A

TB, sarcoidosis

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16
Q

Explain the process of mast cell-mediated inflammation.

A

Inhale something/exposed to allergen/antigen
Antigen is picked up by APC and presented to TH2 cells
Th2 cells produce IL 4, 5 which stimulates B cells to produce lots of IgE, which attaches to mast cells
Mast cells produce histamine, IL-3, and IL-5 which recruits eosinophils
Th2 cells also produce IL-5 and GM-CSF which recruits eosinophils
Eosinophils release granules (include pro-inflammatory factors)

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17
Q

What promotes mast cell degranulation? (6)

A 
Drugs – aspirin, NSAIDs
Serum factors
Insect sting
Nuts
Shell-fish
House-dust mite
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18
Q

What do mast cells release?

A

Histamine, leukotrienes, prostaglandins, platelet aggregating factor, antimicrobial peptides, proteases, heparin, TNF, chondroitin sulphate, cytokines, chemokines, angiogenic and growth factors…

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19
Q

What are the effects of mast cell degranulation on cellular components? (5)

A
  • Recruitment and activation of monocytes and macrophages, T cells, neutrophils, basophils and eosinophils
  • Migration and activation of dendritic cells
  • Phagocytosis and/or antimicrobial activity
  • Effects on epithelial cells, tight junction proteins, etc
  • Degradation of endogenous toxic mediators
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20
Q

Mast cell degranulation releases biogenic amines and lipid mediators. What does this cause? (3)

A

Vascular leak, broncho-constriction, intestinal hypermotility

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21
Q

Mast cell degranulation releases cytokines and lipid mediators. What does this cause?

A

Inflammation

22
Q

Mast cell degranulation releases enzymes. What does this cause?

A

Tissue remodelling

23
Q

What are the effects of histamine? (5)

A

Bronchospasm
Modulation of immune response via H2 receptors
Arteriole dilatation (headache and hypotension)
Smooth muscle contraction (vessel leakage and oedema)
Stimulates sensory nerves (itch flare)

24
Q

What is the proper name for the common dust mite?

A

Dermatophagoides pteronyssinus

25
Q

What is Der P1?

A

An enzyme allergen from the faecal pellets of the dust mite.

26
Q

How do you test for house dust mite allergy?

A

Measure IgE to Der P1

27
Q

How does Der P1 get inside the body?

A

Allergen is easily aerosolized and inhaled.
Der P1 breaks down components (occludin) of tight junctions which helps it to cross mucosa (and creates leaky epithelium).

28
Q

Local mast-cell mediated inflammation examples. (3)

A

Urticaria, asthma, hay fever

29
Q

Generalised mast-cell mediated inflammation example.

A

Anaphylaxis

30
Q

Explain the process of anaphylaxis.

A

Antigen released into blood stream, binds to IgE on basophils and there is a massive release of inflammatory mediators, causing bronchospasm and circulatory collapse.

31
Q

What can cause urticaria?

A

Reaction to food, medicine, exercise, sunlight, water. It can also be idiopathic.

32
Q

Explain the process of antibody mediated inflammation.

A

Complement-mediated lysis
Phagocytosis by extravascular macrophage
Antibody-dependent cell-mediated cytotoxicity
Receptor blockage

33
Q

What happens to desmosomes in Pemphigus Vulgaris?

A

Desmosomes join keratinocytes together (contains desmoglein-3). In Pemphigus Vulgaris, IgE antibodies and complement bind to keratinocytes and cells start to move away from each other. It causes blistering, and skin comes off and leaves erosions.

34
Q

How is Pemphigus Vulgaris diagnosed?

A

Diagnosed by taking blood and incubate serum with normal skin. Diluted pemphigus vulgaris serum binds to normal epidermis at intercellular junctions (where desmogleins are localised) to give ‘chicken wire staining’.

35
Q

How is Pemphigus Vulgaris treated?

A

Treat by immunosuppression, and high dose steroids.

36
Q

What is seen on histology of Pemphigus Vulgaris? (2)

A

Suprabasal splitting in PV

Acantholysis (loss of cohesion between epidermal keratinocytes)

37
Q

Describe the process of Immune Complex Mediated Vasculitis.

A

There are immune complexes, and you get secretion of complement. This results in recruitment of neutrophils. There is leakage of platelets forming micro-thrombi, which block the vessel wall and cause necrosis of vessel wall. Neutrophils secrete lysosomal enzymes, which cause leakiness between the cells of the endothelium, resulting in swelling/oedema. Proteases degrade wall. There is also deposition of fibrin around blood vessel.

38
Q

What are the early cutaneous manifestations of vasculitis?

A

Erythema and oedema

39
Q

What are the established cutaneous manifestations of vasculitis?

A

Palpable purpura

40
Q

What are the severe cutaneous manifestations of vasculitis?

A

Ulceration and necrosis

41
Q

Give two examples of human immune complex disease in skin.

A

Systemic lupus erythematosus

Polyarteritis nodosa

42
Q

What is the antigen and antibody in SLE?

A

DNA

Anti-DNA

43
Q

What is the antigen and antibody in polyarteritis nodosa?

A

HBsAg

Anti-HBs Ab

44
Q

Explain the process of delayed hypersensitivity.

A

Get sensitised to an allergen e.g. metal in cheap earrings. Langerhans cells come into epidermis, these come to the lymph node and you get antigen-specific T cells. If exposed again, you get IL-2 and IFN-gamma which promote a Th1 response. This causes secretion of IL-2, IL-3, GM-CSF, IFN-gamma, and TNF. This promotes a macrophage-rich response and causes inflammation in skin (maximal 48-72 hours after challenge).

45
Q

Give some examples of contact allergens. (4)

A

Nickel in jewellery, watch straps, zips
Rubber/elastic in clothing
Topical antibiotics
Primula

46
Q

Explain the process of granuloma formation.

A

Get mycobacterium TB for example, which causes clonal expansion of T cells. This leads to secretion of Th1 cytokines (IL-2, TNF, IFN-gamma), which causes formation of macrophages. Macrophages can transform into histiocytes (epithelioid macrophages), fuse to form giant cells (Langhans or foreign body), and all these join together to form a granuloma.

47
Q

What can cause a foreign body granuloma to form?

A

Tattoo

48
Q

What is lupus vulgaris caused by?

A

Cutaneous TB

49
Q

When does an autoimmune disease occur?

A

When the immune system fails to recognise the body’s own tissue as ‘self’ and mounts an attack on it.

50
Q

Give two examples of autoimmune skin diseases.

A 
Alopecia areata (hair follicle)
Vitiligo (melanocyte)

LOCO 2 (28 decks)

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