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Locomotor 2 > Skin Inflammation > Flashcards

Skin Inflammation Flashcards

1
Q

what are the cardinal signs of acute inflammation

A
  • heat - caused by increased blood flow and vessel dilation
  • redness - caused by increased blood flow and vessel dilation
  • swelling - accumulation of fluid
  • pain - pressure on nerve endings
  • loss of function
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2
Q

What cells are found in skin during inflammation

A 
Neutrophil
Eosinophil
Lymphocyte
Plasma cell
Macrophage
Mast cell
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3
Q

where is the langerhans cells

A

In the epidermis

Dendritic cell- spine-like projections

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4
Q

what are langerhan cells used for

A

Efficient at presenting antigen to CD4+ helper T-cell

Pick up antigens that enter the skin and transport them to the lymph node

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5
Q

what are the different types of inflammation in the skin

A

(type 1)Mast cell mediated - urticaria

(type 2)Antibody mediated - pemphigus

(type 3) Immune complex mediated - vasculitis

(type 4) Delayed hypersensitivity - contact allergic dermatitis

(type 5)Granuloma formation - TB, sarcoidosis

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6
Q

describe what happens in mast cell mediated immunity

A

When an antigen is inhaled and comes in through the skin it is picked up by the APC and then presented to the T cell
In mast cell mediated immunity th2 cells produce IL-4, IL-5,
- Eosinophils – release granules
- B cells produce IgE which binds to mast cells and causes degranulation

Mast cell degranulation
- Released mediators such as histamine, leukotrienes, prostaglandins, platelet aggregating

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7
Q

what can cause mast cell degranulation

A
  • Drugs- aspirin, NSAID
  • Serum factors
  • Insect sting
  • Nuts
  • Shell-fish
  • House-dust mite
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8
Q

What are the effects of the mast cell degranulation on cellular components

A

Lipid mediators

  • recruitment and activation of monocytes and macrophages
  • migration and activation of dendritic cells

things such as histamine, heparin, proteases

  • recruitment and activation of T cells
  • recruitment and activation of neutrophils, basophils and eosinophils
  • phagocytosis
  • degradation of endogenous toxic mediators

Cytokines
- degradation of snake venom components

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9
Q 
what does 
- histamines and lipid mediators do 
- cytokines  and lipid mediators 
- Enzymes 
do
A
  • histamines and lipid mediators do = vascular leak and bronchoconstriction, intestinal hyper motility
  • cytokines and lipid mediators = inflammation
  • Enzymes = tissue remodelling
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10
Q

What is the central role of histamine

A

bronchospasm

stimulates sensory nerves; itchy flare

smooth muscle contraction; vessel leakage and oedema

arteriole dilation; headache and hypotension

modulation of immune response via H2 receptors

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11
Q

what is an example of an allergen

A

Der P1 is an enzyme allergen
from the faecal pellets
of the dust mite

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12
Q

describe the Der P1 allergen

A
  • easily aerosolized and inhaled.
  • Der P1 breaks down components of tight junctions
    which helps it to cross mucosa.
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13
Q

what are the local signs of a type I reaction

A

urticaria
asthma
hay fever

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14
Q

what is anaphylaxis

A

Generalised type I
- antigen released into blood stream, binds to IgE on basophils- massive release of inflammatory mediators- bronchospasm and circulatory collapse- known as ANAPHYLAXIS

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15
Q

What is the new treatment for resistant urticaria and asthma

A

omalizumab - binds to IgE and reduces expression of receptors

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16
Q

What is a risk factor for anaphylaxis

A

being an asthmatic

17
Q

describe the antibody mediated inflammation

A

Completed mediated lysis – completed antibody and antigen that is pahgocytosised by an extravascular macropahegs which causes antibody dependent cell mediated cytoxicity and receptor blockage

18
Q

What happens in pemphigus vulgarisms

A
  • affects the desmoglein-3
  • patients develops antibodies to the desmosome and the cells breakout
  • you get acantholysis
19
Q

what sign do you get in pemphigus vulgarisms

A

positive Nikolsky sign
- rub a red area of the skin and the skin comes of

  • can also get nasty blistering in the mouth
20
Q

What is acantholysis

A

loss of cohesion

between epidermal keratinocytes

21
Q

What does the histology of pemphigus vulgarisms look like

A

– loss of cohesion between the epidermal keratinocytes

-

22
Q

what happens in diluted pemphigus vulgaris serum

A 
Diluted pemphigus vulgaris serum binds to normal epidermis at 
intercellular junctions (where desmogleins are localised)
23
Q

What is the treatment of pempgius vulgaris

A

Oral steroids
Immunosuppresion c mycophenolate mofetil or azathioprine

Rituximab (targeting CD20 on B cells)

24
Q

describe immune complex mediated vasculitis

A
  • Get antibody forming an immune complex
  • This results in blood vessel reduction of complement
  • Aggravation of platelets
  • antigen antibody complexes binding to antibodies
  • Lysis of enzymes
  • This results in a leaky vessel
25
Q

what does immune complex mediated vasculitis look like

A

Early- erythema and oedema

Established - palpable purpura

Severe- ulceration and necrosis

26
Q

in systemic lumps erthematosus what is the antigen and antibody

A

Antigen - DNA

Antibody - Anti DNA

27
Q

What happens in delayed hypersensitive

A

allergen s picked up by the langerhans cells

transported to the lymph nodes

get a production of allergen specific T cells

the next time they are exposed to the allergen the allergen specific T cells are released

get lots of IL-2, IFN gamma release

28
Q

what is the most common type of contact dermatitis

A

nickel dermatitis

29
Q

What molecules are involved in delayed hyeprsenstivity

A
  • Promote Th1 response- secretion of IL-2, IL-3, GM-CSF, IFN-g, and TNF
  • Promote macrophage-rich response
  • Cause inflammation in skin- maximal 48 -72 h after challenge
30
Q

What are examples of contact allergens

A

Nickel- jewellery, watch straps, zips

Rubber- elastic in clothing

Topical antibiotics

Primula

31
Q

describe granuloma formation

A
  • get exposed to something that causes granulomas such as TB
  • get a clonal T cell expansion with production of TH1 and cytokines such as IL-2, IFN gamma and TNF
  • this causes production of macrophages
  • all these then help the formation of a granuloma
32
Q

what are the causes of granuloma formation

A

Tuberculosis

Sarcoidosis

Foreign body granuloma- eg tattoo

33
Q

What is an autoimmune disease

A

An autoimmune disease occurs when the immune system fails to recognise the body’s own tissue as ‘self’ and mounts an attack on it.

34
Q

What are the examples of autoimmunity in the skin

A

alopecia areata (hair follicle)

vitiligo (melanocyte).

35
Q

What are the treatments for alopecia arata and vitiligo

A

JAK inhibitors - inhibits chemokine production

Ruxolitinib

Locomotor 2 (30 decks)

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