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Dermatology Diploma > Sunshine and the Skin > Flashcards

Sunshine and the Skin Flashcards

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1
Q

What happens to the skin upon chornic sun exposure?

A

It thickens

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2
Q

What is this?

How do you treat it?

A

Solar comedones

Usually due to chronic sun exposure and heavy smoking.

aka: Favre Racouchet syndrome - if skin has a yellow leathery texture.

Treatment:

  • Extraction
  • Topical retinoid.
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3
Q

What is this?

A

Solar Elastosis

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4
Q

Name the main 5 Idiopathic Photosensitivities

A
  • Polymorphic light eruption
  • Actinic prurigo
  • Hydroa vaccinforme
  • Solar urticaria
  • Chronic actinic dermatitis
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5
Q

What blood tests should be done when a photosensitivity reaction occurs?

A
  • Lupus Serology (ANA, ENA)
  • Porphyrin analysis if relevant.
  • HLA class II typping.
  • Biochemistry
  • Haematinics (B12, Folate, Iron)
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6
Q

What is the most common photosensitivity?

A

Polymorphic Light Eruption (PLE)

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7
Q

What is the treatment for PLE?

A

1/ Sun avoidance.

2/ Oral prednisolone. (30mg for 1 week)

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8
Q

What is this?

A

Acitinic Prurigo

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9
Q

Who gets Acinitic Prurigo?

90% of patients with Acinitic Prurigo have this particularly genetic serotype?

A

Children aged 3-10 years.

Females>Males

HLA DR4 Sublass II

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10
Q

What is Acitinic Prurigo related to?

What is it often confused with?

A

it is related to Polymorphic Light Eruption (PLE). The relationship with sun exsposure is much less clear than with Acitnic Prurigo.

It is often confused with unresponsive Eczema.

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11
Q

How long does Actinic Prurigo last for?

What is the treatment?

A
  • It lasts for months as an excoriated papular and eczematous reaction on the arms, face and legs. (PLE lasts for days/weeks)
  • Treatment
    • Sun avoidance and block.
    • Relief: Steroids
    • Prevention/Maintenance: Thalidomide.
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12
Q

What is this?

A

Hydroa Vacciniforme

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13
Q

How does Hydroa Vacciniforme differ from other photosensitivies?

A

It has distinct histological changes.

  • Intraepidermal vesicle formation.
  • Focal epidermal keratinocyte necrosis
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14
Q

What is the treatment for Hydroa Vacciniforme?

A

There is no proven treatment.

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15
Q

What are the investigations for solar urticaria?

A
  • Porphyrins - EPP (Erythropoietic protoporphyria) and PCT (porphyria cutanea tarda) can also present similarly.
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16
Q

What is the treatment for solar urticaria?

A
  • Sun avoidance
  • Antihistamines
  • Cyclosporin and plasmapharesis can be helpful in some cases.
17
Q

What is this?

A

Chronic actinic dermatitis (CAD)

18
Q

Who gets Chronic actinic dermatitis (CAD)?

A

Older (60 years plus) men

Chronically sun exposed or avid gardeners.

19
Q

Describe the course of Chronic actinic dermatitis (CAD).

A

It gets worse over the summer months and then resolves.

It usually occurs on sun exposed areas.

20
Q

Why is patch a good idea?

A
  • Often reveals multiple contact allergens
    • many to air born antigens, such as colophony (resin from pine trees and conifers) and compositae oleoresins (resin from balsam wood).
    • Contact allergy to sunscreens is also common in this population.
21
Q

What are the investigations for Chronic actinic dermatitis (CAD)?

A
  • Monochromatic phototesting - (Sensitive to UVB in particular)
  • Skin biopsy - helps to distinguish from mycosis fungoides or sezary syndrome (cutaneous lymphoma).
22
Q

What are the treatments for Chronic actinic dermatitis (CAD)?

A
  • Sun avoidance/ Sunblock
  • Topical steroids
  • Systemic therapy - either azathioprine, prednisolone, Cyclosporine, Mycofenolate mefotil.
23
Q

What is this?

A
24
Q

What are cutaneous porphyrias?

A

A group of inherited disorders of haem biosynthesis. They include:

  • Sporadic and familial porphyria cutanea tarda (PCT)
  • Hereditary erythropoietic porphyria (HEP)
  • Variegate porphyria
  • Erythropoietic protoporphyria.
25
Q

What do the cutaneous porphyrias look like clinically?

A
  • Painful photosensitivity
  • Skin fragility
  • Blistering
  • Scarring
  • Excess hair growth and pigmentation are also seen.

All are due to the itneraction of porphyrin with UV

26
Q

How are cutaneous porphyrias diagnosed?

A
  • Urine, blood and faecal tests looking for porphyrin.
  • Also test for iron overload
  • Haemochromatosis
  • Liver pathology (Hepatitis, Cirrhosis and Hepatoma)
  • HIV in selected patient.
27
Q

How are cutaneous porphyrias treated?

A
  • Strict sun avoidance
  • Venesection (to reduce iron load) & Low dose chloroquine in porphyria cutanea tarda (PCT).
  • Bone marrow transplant in selected patients.
28
Q

What drugs can cause easy sunburn?

A
  • Fluoroquinolone antibiotics
  • Tetracyclines
  • Chlorpromazine
  • Thiazide diuretics
  • Quinine
  • Amiodarone
  • Retinoids
29
Q

What causes pain or a burning sensation of the skin?

A
  • Amiodarone
  • Chlorpromazine
30
Q

What can cause solar urticaria?

A

Tetracyclines

31
Q

What can cause skin fragility and weakness when exposed to sunlight?

A
  • Tetracycline
  • Naproxen
  • Amiodarone
  • Furosemide
32
Q

What is xeroderma pigmentosum (XP)?

A
  • The body becomes less able to repair skin cells after DNA damage due to a mutation in one of the enzymes responsible for repair.
  • Autosomal recessive.
33
Q

How do patients with xeroderma pigmentosum (XP) present?

A
  • Present in childhood with easy sunburn.
  • Early freckling
  • Checkered pigmentation
  • Thin and dry skin
  • Frequent skin cancers.
34
Q
A
35
Q

What are some common photoaggravated conditions?

(Dermatological conditions worsened by sun exposure)

A
  • Lupus
  • Rosacea
  • Dermatomyositis
  • Acitinic lichen planus
  • Bullous Pemphigoid and pemphigus
  • Vitiligo
  • Melasma
36
Q

Describe the difference between organic and inorganic sunscreen?

A
  • Organic - absorb the UV.
    • UsePABA, PABA derivates, salicylates and cinnamates.
    • Cosmetically acceptable.
    • Can cause contact dermatitis
  • Inorganic - Reflects the UV.
    • Titanium, Zinc.
    • Excessively white.

Dermatology Diploma (39 decks)

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