Sample Answer for NUR-631 Topic 14 DQ 2 Included After Question
Answer both of the following questions for your discussion response using the “Discussion Forum Sample.”
What is the pathological process in the development and presentation of eczema versus psoriasis?
Discuss the pathological process and presentation of atopic dermatitis and its relationship to asthma and allergies.
A Sample Answer For the Assignment: NUR-631 Topic 14 DQ 2
Title: NUR-631 Topic 14 DQ 2
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DS
What is the pathological process in the development and presentation of eczema versus psoriasis?
Maintaining skin integrity is important for overall health. The skin protects us from environmental hazards, allows us to sense temperature, maintains homeostasis, and creates an added layer of protection from pathogens. Certain dermatological conditions such as eczema and psoriasis create a disruption in the skin barrier. Eczema is a condition of the skin in which there is an inflammatory response either from a genetic or environmental allergen. Eczema is characterized by pruritus, lesions with indistinct borders, papules, erythema, and scales, it may also be chronic, acute, or subacute (McCance et.al, 2019). Eczema is directly related to an underlying cause. To compare, psoriasis clinically appears the same as eczema, it is however an inflammatory disorder. Psoriasis is a skin disorder that is triggered by some kind of physical injury such as streptococcal infections, medications, and the Koebner phenomenon (McCance et.al, 2019). When psoriasis is triggered, the inflammatory cascade is activated and it heavily involves interactions between macrophages, natural killer cells, fibroblasts, T helper cells, and regulatory T cells, it is important to note that psoriasis is a T helper cell-mediated autoimmune disease (McCance et.al, 2019). Both skin disorders require overtime observation for chronic conditions and exacerbations and medicated ointment, psoriasis treatment may require immunomodulatory.
Discuss the pathological process and presentation of atopic dermatitis and its relationship to asthma and allergies.
Atopic dermatitis (AD) is a form of eczema and a chronic skin inflammatory disease. The pathophysiological process behind AD begins with genetic and environmental factors. Typically, in AD, patients have an impaired skin barrier, either from trauma or cuts, and this leaves the skin susceptible to environmental irritants and allergens leading to dry, itchy, and inflamed skin (Kolb & Ferrer-Bruker, 2022). The impaired barrier of the skin is caused by decreased levels of ceramides (moisture barrier), leaving open areas for irritants and allergens, which causes an overactive Th2 response, and an increase in interleukin 4 and 5 cytokines in acute conditions, and Th1 response in chronic conditions (Kolb & Ferrer-Bruker, 2022). AD’s relationship with asthma is interchangeable, if there is an “atopic triad”, this means the patient is experiencing an acute condition of AD, allergic rhinoconjunctivitis, or asthma, they may start all together or one by one, mainly because it is the same pathological process in response to an allergen ( Kolb & Ferrer-Bruker, 2022). and AD may flare up in response to environmental allergens such as pen dander, fragrances, plants, clothes, foods, etc.
References:
Kolb L, Ferrer-Bruker SJ. Atopic Dermatitis. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448071/
McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S. (2019). Pathophysiology: The biologic basis for disease in adults and children (Eighth ed.). Elsevier.
REPLY
TG
Due to the extremely pruritic nature of atopic dermatitis and the fact that it is commonly found in children, it is very important to reduce the scratching and increase hand washing (McCance & Huether, 2018). Children tend to touch everything which increases the bacterial load on their hands and under their nails. Scratching and introduction of bacteria can lead to infection.
References
McCance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book (8th ed.). Elsevier Health Sciences.
REPLY
MH
Hi Tracy.
In reading your post and the debate as to whether favors an “inside-out” in the explanation with immunologic dysregulation leading to epidermal barrier abnormality or is because of “outside-in,” and regardless of the debate, the focus is on the barrier protection to the client (McCance & Huether, 2018). In contrast, the research on molecule sensitized pattern of atopic dermatitis patients who co-sensitized to shrimp, cockroaches, crab, and house dust mites is an interesting research article that make makes the correlation of exacerbation in these patients and are able to promote the development of clinically accurate diagnosis and treatment and thus the results show that 70.6% of patients were positive for more than one allergen component, 52.9% for more than two components, 17.6% for more than five components and 2.9% for more than ten components. In addition, the cross-reaction between insects and pollen allergens is considered in research. Moreover, the IgE cross-reaction demonstrates that they have similar epitopes in the clinical diagnosis and meet the requirements of the Abs IgE cross-reaction. (HU,2021).
McCance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book (8th ed.). Elsevier Health Sciences.
Hu, H., Hou, X., Luo, W., Li, Y., Huang, H., Huang, X., Sun, B., & Zhang, X. D. (2021). The Molecule Sensitized Pattern of Atopic Dermatitis Patients Who Co-Sensitized to Shrimp, Cockroaches, Crab and House Dust Mites. Journal of Asthma and Allergy, 14, 993-997. https://doi.org/10.2147/JAA.S326411
REPLY
JS
Eczema (atopic dermatiti):
Pathology-
Immunological Dysregulation: Eczema is primarily driven by an abnormal immune response and produces inflammation in the skin.
Barrier Dysfunction: There is a compromised skin barrier function in eczema patients.
Genetic Predisposition: Eczema often runs in families and has a strong genetic component. Mutations in genes related to the skin barrier function and immune response contribute to its development.
Allergic Sensitization: Allergens, such as pollen, dust mites, and certain foods, can trigger an allergic response in individuals with eczema, leading to skin inflammation and itching.
Th2 Immune Response: Eczema is associated with an overactive Th2 immune response. This contributes to the inflammation and itching characteristic of eczema.
Presentation-
Eczema typically presents as dry, itchy, inflamed skin with redness, swelling, and sometimes oozing or crusting. The affected areas can vary widely and may include the face, hands, elbows, knees, and other body parts. Scratching the affected areas can worsen the condition and lead to more inflammation and potential secondary infections.
Psoriasis:
Pathology-
Immune System Activation: Psoriasis is an autoimmune disorder causing rapid skin cell turnover and inflammation.
Hyperproliferation of Keratinocytes: In psoriasis, there is an overproduction of skin cells (keratinocytes) in the epidermis. These cells accumulate on the skin’s surface, leading to the formation of raised, scaly patches known as plaques.
Cytokine Release: Immune cells release inflammatory molecules called cytokines, such as tumor necrosis factor-alpha (TNF-alpha) and interleukins, which contribute to the inflammatory response and skin cell turnover.
Genetic Factors: Genetic predisposition plays a significant role in psoriasis. Certain genes are associated with an increased risk of developing the condition.
Environmental Triggers: Factors such as stress, infections, and certain medications can trigger or exacerbate psoriasis flare-ups.
Presentation-
Psoriasis lesions are distinct from eczema and are characterized by well-defined, red, raised plaques covered with silvery-white scales. These plaques often appear on the elbows, knees, scalp, lower back, and other areas. Psoriasis can also affect nails, joints (psoriatic arthritis), and other body parts.
Nemeth V, Evans J. Eczema. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/
Rendon, A., & Schäkel, K. (2019). Psoriasis Pathogenesis and Treatment. International journal of molecular sciences, 20(6), 1475. https://doi.org/10.3390/ijms20061475
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
REPLY
RM
Hello Joe. To add to your post. In our text, Nicol and Huether state, atopic dermatitis, which is also known as atopic eczema, is the most common cause of eczema in children. Onset is from 2 to 6 months of age, and occur within the first 5 years of life for most cases. Allergies can be developed, such as, asthma later in life for more than half of the individuals with AD. This includes foods and inhalant allergens in approximately 80% of affected individuals (Nicol & Huether, 2019).
References:
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier. ISBN-13: 978032340281
