SM_256a: Eczema and Itchy Skin Flashcards Preview

MSK/Derm > SM_256a: Eczema and Itchy Skin > Flashcards

Flashcards in SM_256a: Eczema and Itchy Skin Deck (29)
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1

Eczema presentation is ____, ____, ____, ____, ____, and ____

Eczema presentation is typically symmetric, poorly defined, erythematous, patches or plaques, lichenification, and erosions

2

Describe age-related changes of atopic dermatitis distribution

Atopic dermatitis age-related changes of distribution

  • Infany: facial and scalp dermatitis
  • Toddler: extensor dermatitits
  • Older children / adults: flexural distribution
  • Adults: more head and neck leasons

3

___ is pathognomonic for atopic dermatitis

Flexural distribution is pathognomonic for atopic dermatitis

4

Early eczema histology includes ____, ____, and ____

Early eczema histology includes spongiosis, perivascular infiltrate, and eosinophils

 

  • Spongiosis: fluid between cells
  • Perivascular infiltrate: inflammation around blood vessels
  • Eosinophils

5

Chronic eczema presentation includes ____ and ____

Chronic eczema presentation includes parakeratosis and acanthosis

 

  • Perakeratosis: scale
  • Acanthosis: thickening of the epidermis

6

Atopic dermatitis diagnosis mainly involves ____ but this can only narrow the diagnosis to ____

Atopic dermatitis diagnosis mainly involves biopsy but this can only narrow the diagnosis to the eczema family

 

 

(no biomarkers, no blood tests, food allergy testing not generally indicated)

7

Atopic dermatitis includes ____ and ____

Atopic dermatitis includes barrier and inflammation

8

Atopic dermatitis barrier mechanism invovlves mutations in ____

Atopic dermatitis barrier mechanism invovlves mutations in Filaggrin 1

 

 

  • Filaggrin 1 is responsible for production of Filaggrin protein: major component of natural moisturizing factor and responsible for maintaining skin barrier function

9

Atopic dermatitis inflammation mechanism is mediated by pro-inflammatory cytokines ____ and ____

Atopic dermatitis inflammation mechanism is mediated by pro-inflammatory cytokines IL-4 and IL-13

 

  • Increased IgE, increased Th2 differentiation, decreased filaggrin, decreased antimicrobial peptides

10

People with atopic dermatitis are likely to have ____, ____, and ____

People with atopic dermatitis are likely to have asthma, respiratory allergies, and food allergies

11

Atopic dermatitis include ___, ___, ___, ___, ___, and ___

Atopic dermatitis include sleep problems, obesity (central obesity), increased BP, T2DM, HLD, and osteoporosis and boen fractures

12

Atopic dermatitis is associated with ___ quality of life

Atopic dermatitis is associated with poor quality of life

13

Barrier disruption in atopic dermatitis leads to ____

Barrier disruption in atopic dermatitis leads to transcutaneous sensitization

 

  • Genetically predisposed: filaggrin loss-of-function mutations
  • Acquired: cutaneous inflammation results in downregulation of filaggrin

14

Lower irritant thresholds lead to ____

Lower irritant thresholds lead to irritant contact dermatitis

15

Allergens cross the impaired barrier and reach antigen presenting cells (e.g. Langerhans cells), causing ____ and ____

Allergens cross the impaired barrier and reach antigen presenting cells (e.g. Langerhans cells), causing class switching and production of IgE and cell-mediated immune responses

 

  • IgE: asthma, hay fever, food allergy, urticaria
  • Cell-mediated immune response: allergic contact dermatitis

16

Atopic dermatitis has a ____ irritant threshold

Atopic dermatitis has a low irritant threshold

 

 

(rates also higher in patients with allergic respiratory disease in the absence of dermatitis)

17

Eczema prevalence is greater in ____ climates

Eczema prevalence is greater in colder climates

 

 

(also influenced by small particle air pollution, hard water, bacteria / viruses / fungi, and stress)

18

Atopic dermatitis treatment includes ____, ____, ____, and ____

Atopic dermatitis treatment includes topical agents, systemic agents, light therapy and lasers, and dupilumab

 

  • Topical: corticosteroids, calcineurin inhibitors
  • Systemic: corticosteroids, cyclosporine, mycophenolate mofetil, tacrolimus, methotrexate, azathioprine
  • Light therapy and lasters: NBUVB, excimer, and PUVA

19

____ is a novel treatment for atopic dermatitis

Dupilumab is a novel treatment for atopic dermatitis

 

 

(side effects of conjunctivitis, injection-site reaction, and allergic conjunctivitis)

20

Contact dermatitis includes ____, ____, and ____

Contact dermatitis includes irritant contact dermatitis, allergic contact dermatitis, and systemic contact dermatitis

 

 

(irritant contact dermatitis is most common)

21

Irritant contact dermatitis requires ____, involves ____, and often occurs in atopic dermatitis due to ____

Irritant contact dermatitis requires no sensitization, involves infrequent exposure to strong irritants or frequent exposure to mild irritants, and often occurs in atopic dermatitis due to impaired barrier and lower irritant threshold

22

Irritant contact dermatitis common exposures include ____, ____, ____, and ____

Irritant contact dermatitis common exposures include frequent hand washing, hand sanitizers, harsh soaps, and heavily fragrant skin care products

23

Allergic contact dermatitis requires ____, can be caused by ____ exposures, and involves ____

Allergic contact dermatitis requires previous sensitization, can be caused by minimal exposures, and involves delayed reactions involving lymphocyte recruitment and expansion

24

Allergic contact dermatitis most common causes are ____ worldwide and ____ in the US

Allergic contact dermatitis most common causes are nickel worldwide and poison ivy in the US

25

Irritant contact dermatitis mechanisms include ____ and ____

Irritant contact dermatitis mechanisms include TNF-alpha and non-specific release of junk from damaged cells

26

Allergic contact dermatitis mechanism involves ____ and cytokines ____ and ____

Allergic contact dermatitis mechanism involves allergen crossing skin barrier -> binding to Langerhans cells (APCs) -> specific recruitment and expansion of T cells and cytokines IL-9 and IL-17

27

Contrast allergic contact dermatitis and food/seasonal allergies

Allergic contact dermatitis and food/seasonal allergies

  • Allergic contact dermatitis: delayed reaction, lymphocyte mediated, no risk of anaphylaxis
  • Food seasonal allergies: immediate reaction, mast cell / IgE / histamine mediated, risk of anaphylaxis

28

____ testing is used for diagnosis of allergic contact dermatitis

Patch testing is used for diagnosis of allergic contact dermatitis

 

  • Doubtful or irritant reaction: erythema alone
  • +: erythema and infiltration, rare papules
  • ++: erythema, infiltration, and multiple papules
  • +++: erythema, infiltration, and vesicles or spreading papules

29

____ involves adverse skin reactions to medications and is most often caused by ____

Drug-induced eczema involves adverse skin reactions to medications and is most often caused by calcium channel blockers

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