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Dermatologic Immunology (Immune Dysfunction and skin disease (Atopic…
Dermatologic Immunology
Immunity
Lymphocyte activation
Langerhans
dermal dendritic cells
T-helper cell differentiation
TH1 cell: works through the INF-y, TNF to help initiate the cellular immunity
Allergic contact dermatitis
SJS, Psoriasis and Drug Exanthem
TH2: works through the IL-4, IL-5 and IL-10 to help initiate the humoral immunity(eosinophils, plasma cells and IgE)
Neutralization of toxins and parasites
contact dermatitis, urticaria and asthma
Mast cell activation:
and the TH1 predominance
preformed IgE antibodies coat the mast cells and basophils are cross linked by contact with the free antigen. her ell degranulatory and release of histamine and other inflammatory mediators
Immune Dysfunction and skin disease
Psoriasis
: interplay between the kertinaocytes, TH1 cells and TH17 cells
Clinical features: well demarcated, erythematous plaques with silvery micaceous scaling
Koebner phenomenon explains distribution
Urticaria
:
mediated by mast cells and histamine release with IgE mediated hypersensitivity (type I)
Clinical features:
evanescence lesions with itchy annular edematous pink wheals, angioedema through another mechanism
Atopic Dermatitis/Eczema:
TH2 predominance due to the imbalance of the immune system with no single allergen
Associations:
other forms of -atopy such as asthma, allergic rhinitis or pityriasis alba
colonization with staph aureus can lead to further inflammation
Mechanism: A Th2 predominance with a filigree defect and barrier dysfunction
Clinical features: scaly lichenified diffuse extensor arms, legs buttocks distribution
Drug Eruptions:
90% are mediated through the TH1 hypersensitivity leading to a systemic equivalent of contact dermatitis
SJS
exanthema drug eruptions
Allergic Contact Dermatitis
: TH1 hypersensitivity known as delayed type IV hypersensitivity
hapten and allergen sensitization
7-14 days needed for sensitization
24 to 48 hours to 4-7 days on reexposure
Mechanism
: TH1 hypersensitivity, cellular immunity, APC presentation of the happen and antibody sensitization
Clinical features:
erythematous papules and vesicles