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57 Cards in this Set

  • Front
  • Back
describe the epidemiology of psoriasis
- common (1-2% of people in the US)
- all ages
what other diseases is psoriasis commonly seen with?
- arthritis
- myopathy
- enteropathy
- spondylitic joint disease
which areas of the body does Psoriasis most commonly affect?
- skin of the elbows
- knees
- scalp
- lumbosacral areas
- intergluteal cleft
- glans penis
describe the nail changes seen with Psoriasis
- seen in 30% of patients
- yellow-brown discoloration with pitting, dimpling, and separation of the nail plate from the bed (onycholysis), thickening and crumbling
define: onycholysis
- separation of nail from nail bed
describe the morphology of psoriasis
- increased epidermal cell turnover -> marked epidermal thickening (acanthosis) with elongation of the rete ridges
- statum granulosma is THINNED OR ABSENT
what causes psoriasis?
- T cell mediated disease
- increased keratinocyte proliferation along with inflammation and angiogenesis
- thought that the interaction of CD4, CD8 T cells and dendritic cells give rise to a cytokine soup: IL-12, INF-g, TNF
what is the HLA association with psoriasis
what is a major mediator of psoriasis?
describe the skin changes seen following drug eruptions
- mrbilliform erythematous lesions initially involving the trunk and extending to the extremities
- papular, coalescing into plaques without well defined borders
list the acute inflammatory dermatoses
1. urticaria (hives)
2. acute eczematous dermatitis
3. erythema multiform
describe eczema
- patients often have strong family history
- lesions are lichenified
- typical location are flexural surfaces like the popliteal and antecubital fossas
describe Reiter Syndrome
- clinical trial of:
1. urethritis
2. conjunctivitis
3. arthritis
- can also involve skin, mucous membranes, GI tract and cardiovascular system
describe zinc deficiency
- most common in infants or patients on long term total parenteral nutritional supplements
- pustular and bullous dermatitis
what is Steven- Johnson syndrome?
- a symptomatic febrile form of erythema multiform that is often seen in children
- erosions and hemorrhagic crusts invovle the lips and oral mucosa
- may result in life-threatening sepsis
what is the prevalence of zinc deficiency?
- very rare b/c zinc is found in meats, fish, shellfish, whole grain cereals and legumes
what are most cases of zinc deficiency linked to?
1. total parenteral nutrition unsupplemented by zinc
2. failure to synthesize metallothionein -> blocks absorption of copper and zinc
what is metallothioneine?
- a metal binding protein
- found in intestinal mucosal cells
- blocks absorption of both copper and zinc
what is the clincial presentation of zinc deficiency?
- rash, around eyes, nose, mouth, anus, and distal parts -> ACRODERMATITIS ENTEROPTHICA
- anorexia and diarrhea
- growth retardation
- impaired wound healing
- hypogonadism with infertility
- altered immune function
- impaired night vision b/c of altered vit A metabolism
- depressed mental function
what is acrodermatitis enteropathica?
- rash around the eyes, nose, mouth, anus and distal parts
- seen in zinc deficiency
what should you suspect in a case with obscure growth retardation or infertility associated with a distinctive rash?
- acrodermatitis enteropathica
- zinc deficiency
define acanthosis
epidermal hyperplasia
what do you see on histology for psorasis?
- epidermal hyperplasia (acanthosis) with fusion of rete ridges
- presence of subcorneal and intracorneal pustules (microabscesses of Munro
describe the layers of the epidermis (from down to up)
- stratum basale
- stratum spinosum
- stratum granulosum
- stratum corneum
what is the statum basale?
- germinal layer of the epidermis
- mitotic actiity in this layer provides a constant supply of new keratinocytes to replace the ones that are lost
what is the stratum spinosum?
- cells in the process of growth and early keratin synthesis
what is the stratum granulosum?
- intracellular granules with contribue to the process of keratinisation
what is the stratum corneum?
- flattened, fused cell remnants composed mainly of the fibrous protein, keratin
what are rete ridges?
Rete ridges (epidermal ridges) found in the deepest part of the epidermis are projections of the avascular epidermal tissue into the vascularized dermis below. Rete ridges interdigitate with dermal papilla to help nourish the epidermis.
what are munro microabscesses?
- minute microabscesses of neutrophils within the superficial epidermal layer
- seen in psoriasis
- can sometimes be seen directly beneath the statum corneum
what should you think of if you see basal cell liquefaction with band-like chronic inflammatory infiltrate in the papillary dermis
lichen planus and other lichenoid lesions
what should you think of if you see hyperkeratosis with intra-epidermal clefts containing 'corps ronds'?
Darier's disease
what should you think of if you see a large intraepidermal cleft in the suprabasal region?
Pemphigus vulgaris
what should you think of if you see a large subepidermal blister with sparse inflammatory infiltrate?
bullous pemphigoid
describe what you see for lichen planus on histology
- desne, continuous infiltrate of lymphocytes along the dermoepidermal junction
- saw-toothing frmo the destrictive infiltration of lymphocytes
what is the first line treatment for psoriasis?
- topical corticosteroid application
for which skin condition do you use antibiotics to treat?
- eczema augmented by superinfection with gram-pos bugs
which medications exacerbate psoriatic lesions?
- beta blockers
- lithium
what is commonly seen in psoriatic patients with cutaneous and/or nail findings?
- psoriatic arthritis
- usually presents as asymmetrical distal interphalangeal joint involvement with nail damage
what skin conditions are often associated with asthma?
- eczema or atopic dermatitis and hay fever- the triad of atopy
what can be a complication of therapy for psoriasis?
- hepatitis and renal failure
which variant of psoriasis can be exacerbated by upper respiratory infection?
- guttate psoriasis
why do you see Raynaud's phenomenon in scleroderma?
- subintimal hyperplasia of small vessels can reduce the luminal diameter by more than 75%
what is the CREST sydrome?
- aka limited cutaneous scleroderma
- esophageal dysfunction
- raynaud's phenomenon
- skin changes limited to being distal to the elbow or knee
- calcified noduesl on the extensor surfaces of the forearms
- telangiectasias on the forearms
does Scleroderma with CREST sydnrome have a good prognosis?
- it has a better prognosis than scleroderm that also involves the trunk (diffuse scleroderma)
what is Bauer syndrome?
- aortitis and aortic endocarditis
- complication of RA
what is charcot syndrome?
- intermittent claudation
what is Crigler-Najjar syndrome?
- severe familial liver disease
what is Dandy-Walker syndrome?
- malformation of the CNS
what do you see on histology for patients with scleroderma? (early stage)
- in early stages (when hands look swollen instead of with tight, thick skin), you see edema with perivascular infiltrates of the CD4+ T cells
- collagen fibers are swollen and beginning to degenerate
- smaller vessels show basal lamina thickening, endothelial cell damage and proliferation
what do you see on histology for patients with scleroderma? (late stage)
- see the characteristic marked dermal fibrosis
- it narrows the rete pegs and attach the dermis tightly to subcutaneous tissues
when do you see Anti-Scl-70 antibodies in scleroderma patients?
- you see it in diffuse scleroderma
- DO NOT see in CREST sydrome
what autoantibody is seen in CREST sydrome, and not in diffuse scleroderma?
- anti-centromere
what can be used to treat scleroderma?
- glucocorticoids and azathioprine can suppress the inflammatory complications
- penicillamine: inhbits collagen cross-linking
- NSAIDS: pain
- ACE inhibitors: protect the kidney if hypertension or renal damage occurs
what is anti-DNA topoisomerase I?
- aka anti-Scl-70
- seen in diffuse scleroderma
where do you see anti-double-stranded DNA?
- fairly specific to SLE
- only occurs in 50-60% of SLE cases however
where do you see anti-golgi antibodies?
- Sjogren syndrome