Urticaria Flashcards
Name the term that means “increased thickness of keratin layer”
Hyperkeratosis
Name the term that means “increased turnover of keratinocytes/persistence of keratin nuclei”
Parakeratosis
Name the term that means “increased thickness of epithelium”
Acanthosis
Define “papillomatosis” and name a condition it is present in
Irregular epithelial thickening
Acanthosis nigricans
Define “spongiosis”
Oedema between keratinocytes
In psoriasis, what is the basic pathology that is occuring?
Parakeratosis in the corneal layer
What is meant by the Koebner phenomenon?
Trauma to a site of the body can stimulate skin lesions in that particular area
Neutrophils are present in the corneal layer in psoriasis. True/False?
True
Unusual but true
What is Auspitz sign in psoriasis?
Bleeding spots when psoriasis scales are scraped off
Where does acne vulgaris tend to affect?
Sites of high sebaceous gland concn
face, neck, upper back, chest
How does sebum, produced by sebaceous glands, lead to acne?
Sebum builds up in the hair follicle, increasing pressure to cause rupture
What are comedones?
Keratin and sebum build up in hair follicles, producing whiteheads and blackheads
Rosacea is commoner in males. True/False?
False
Commoner in females (typically middle age)
What are the facial features of rosacea?
Flushing
Visible blood vessels
Pustules
Thickened skin (rhinophyma)
List some triggers of rosacea
Alcohol
Sunlight
Spicy food
Stress
Which mites are often present in rosacea?
Demodex mites
Name 3 examples of immunobullous diseases
Pemphigus
Bullous pemphigoid
Dermatitis herpetiformis
What is the most common subtype of pemphigus?
Pemphigus vulgaris
Pemphigus vulgaris is an autoimmune condition. What happens?
IgG antibodies made in response to desmoglein 3 - this is the glue that maintains desmosomal attachments
In bullous pemphigoid, where does the blistering develop?
Underneath the epidermis
Split is Deeper through the DEJ
Acantholysis (loss of desmosomal attachments in epidermis) occurs in bullous pemphigoid. True/False?
False
Bullous pemphigoid is an autoimmune condition. What happens?
IgG produces antibodies against hemidesmosomes
Causes epidermis to separate from basement membrane (at the DEJ)
Dermatitis herpetiformis is linked to which GI disease?
Coeliac disease
How is dermatitis herpetiformis produced in coeliac patients?
IgA against wheat cross-reacts against connective tissue matrix proteins
What is the commonest form of psoriasis?
Chronic plaque psoriasis (psoriasis vulgaris)
Psoriasis usually affects flexor surfaces. True/False?
False, affect extensor surfaces
List treatment for psoriasis
Vitamin D analogue Coal tar Dithranol Steroid ointment Emollients Phototherapy Immunosupression Biological ointment
Give examples of vitamin D analogues
Calcipotrol (Dovonex)
Calcitrol (Silkis)
What is the basic function of retinoids in psoriasis?
Reduces skin turnover (reduces parakeratosis)
Which organism can colonise the hair follicle duct, causing acnes?
Propionibacterium acnes
Open comedones are called blackheads/whiteheads
Closed comedones are called blackheads/whiteheads
Open comedones are called blackheads, closed comedones are called whiteheads
List topical treatment for acne
Benzoyl peroxide
Adapalene
Topical antibiotic (Duac)
What does benzoyl peroxide do?
Keratolytic + antibacterial
What type of drug is adapalene?
Topical retinoid (dries skin)
Name an oral retinoid that can be used for systemic treatment of acne
Isotretinoin
Comedones are present in rosacea. True/False?
False
Outline treatment for rosacea
Reduce triggers Topical metronidazole Low dose isotretinoin if severe Vascular laser fro telangectasia Rhinoplasty
Bullous pemphigoid is a deep blister; pemphigus is a superficial blister. True/False?
True
BP goes through DEJ; pemphigus is intra-epidermal between keratinocytes (more fragile blisters)
What is Nikolsky sign?
Top layers of the skin slip away from the lower layers when slightly rubbed; i.e., popped blister
Which disease - bullous pemphigoid or pemphigus vulgaris - is Nikolsky positive?
Pemphigus vulgaris
Outline treatment for pemphigus and pemphigoid
Steroids
Immunosuppressives
Tetracyline in pemphigus
What are the most common causes of psoriasis?
Stress
Infection
Drugs - B blockers, lithium
What are the characteristics of psoriasis?
Symmetrical
Sharply demarcated
Scaly, erythematous plaques
What is guttate psoriases?
Widespread psoriasis, small dots, presents acutely
What is erythrodermic psoriasis?
Top-toe red psoriasis, inflammation, presents as sheets
What are the features of psoriatic nail disease?
Onchyolysis (lifting of plate from bed)
Nail pitting
Dystrophy
Subungal hyperkeratosis (thickening under nail)
What are some non-pharmacological treatments for acne
Wash face 2x a day
OTC scrubs (Clearasil)
Reduce sun exposure to skin
What are the side effects of isotrentoin
Nose bleeds Dry lips Hair loss Depression Teratogenic (MUST BE ON ORAL CONTRACEPTIVE)
What are the features of lichen planus and how is it treated?
Violaceous, flat topped shiny papules - commonly on limbs - fine lacy pattern
Intensely itchy
Topical or oral steroids
What is the difference between bullous pemphigoid and pemphigus vulgaris?
PEMPHIGOID: Large tense bullae on normal skin or erythematous base; typically in elderly
PEMPHIGUS: Flaccid vesicles, thin-roofed, prone to rupture; typically younger people
How are bullous pemphigoid and pemphigus vulgaris investigated and what are the results?
Skin biopsy with immunofluorescence
PEMPHIGOID: straight lines
PEMPHIGUS: mesh-like appearance
What are the features of dermatitis herpitiformes?
Itchy, symmetrical lesions found on the elbows, knees +/- buttocks
How is dermatitis herpitiformes treated?
Dapsone cream
Coeliac management
