1
Q
causes of acanthosis nigricans
A
- T2DM
- gastrointestinal cancer
- obesity
- PCOS
- acromegaly
- Cushing’s disease
- hypothyroidism
- familial
- Prader-Willi syndrome
- drugs
- COCP
- nicotinic acid
2
Q
name for whiteheads and blackheads
A
W- closed comedones
B- open comedones
3
Q
categories of acne
A
- Mild: open/closed comedones +/-sparse inflammatory lesions
- Moderate: widespread non-inflammatory lesions and numerous papules and pustules
- severe: extensive inflammatory lesions, which may include nodules, pitting, and scarring
4
Q
Mx of mild acne
A
Mild: 12 weeks topical combination therapy:
- topical adapalene with topical benzoyl peroxide
- topical tretinoin with topical clindamycin
- topical benzoyl peroxide with topical clindamycin
- topical benzoyl peroxide may be used as monotherapy if these options are contraindicated or the person wishes to avoid using a topical retinoid or an antibiotic
5
Q
Mx of moderate to severe acne
A
12-week course of one of the following options:
- topical adapalene with topical benzoyl peroxide
- topical tretinoin with topical clindamycin
- topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
- a topical azelaic acid + either oral lymecycline or oral doxycycline
can use COCP instead of abx in females
6
Q
when to refer acne to a dermatologist
A
- acne conglobate acne
- nodulocystic acne
- mild acne hasn’t responded to 2 trials of meds
- oral abx has not cleared it
- scarring or pigment changes
- psychological distress
7
Q
Condition associated with coeliac disease
A
dermatitis herpetiformis
8
Q
What is dermatitis herpetiformis
A
autoimmune blistering skin disorder due to IgA deposition
itchy, vesicular skin lesions on the extensor surfaces
Mx gluten free anad dapsone
9
Q
what are salmon patches
A
- Vascular birthmark in half of newborn babies (stork marks/bites)
- pink and blotchy on forehead, neck, eyelids
- fade over a few months, though marks on the neck may persist
10
Q
Psoriasis and subtypes
A
- red, scaly patches
- plaque psoriasis: MC! well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
- flexural psoriasis: skin is smooth
- guttate psoriasis: transient psoriatic rash triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
- pustular psoriasis: on palms and soles
11
Q
what exacerbates psoriasis
A
- trauma
- alcohol
- drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
- withdrawal of systemic steroids
12
Q
Mx of psoriasis
A
- emollients
- a potent corticosteroid applied once daily plus vitamin D analogue applied once daily for 4 weeks
13
Q
Mx of guttate psoriasis
A
- most resolve in 2-3 months
- can use psoriasis topical agents
- UVB phototherapy if necessary
14
Q
what is pityriasis rosea
A
- acute, self-limiting rash which tends to affect young adults
- recent viral infection
- herald patch then erythematous, oval, scaly patches in a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer.
- Has an ‘xmas tree’ appearance
- Mx self-limiting 6-12 weeks
15
Q
tinea capitis
A
- fungal infection
- flaky skin, itch, and hair loss
- kerion= raised, pustular, boggy masses which appear as numerous bright yellow areas with the skin surface surrounded by regions of hair loss and flakiness
- Mx- antifungal
16
Q
seborrhoeic dermatitis
A
- fungus called Malassezia furfur
- eczematous lesions on the sebum-rich areas: scalp, periorbital, auricular and nasolabial folds
- otitis externa and blepharitis may develop
- associated with HIV and parkinson’s
- ketoconazole cream or 2% shampoo
17
Q
Rosacea features and mx
A
- affects nose, cheeks and forehead
- flushing (first), telangiectasia, persistent erythema with papules and pustules, rhinophyma
- ocular involvement: blepharitis
- sunlight, exercise, alcohol may exacerbate symptoms
- Mx= suncream. Mild= topical brimonidine gel. Moderate= topical ivermectin. Severe= mod + oral doxycycline
18
Q
complication of acne rosacea
A
rhinophyma (mx is to remove)
19
Q
Toxic epidermal necrolysis (TEN)
A
life-threatening skin disorder that is most commonly seen secondary to a drug reaction
Drugs known to induce TEN
- phenytoin
- sulphonamides
- allopurinol
- penicillins
- carbamazepine
- NSAIDs
Mx- stop drug, supportive, IVIG
20
Q
Actinic keratosis
A
- pre malignant due to chronic sun exposure
- small, crusty, scaly, lesions, well demarcated, pink/red/brown/same colour as skin
- Mx: 2/3 wks fluorouracil cream, topical imiquimod, cryotherapy, curettage and cautery
21
Q
Athlete’s foot (tinea pedis)
A
- scaling, flaking, and itching between the toes
- topical imidazole, undecenoate, or terbinafine
22
Q
Fungal nail infection causative organisms
A
- dermatophytes (90%): mainly Trichophyton rubrum
- yeasts (5-10%) e.g. Candida
- non-dermatophyte moulds
23
Q
Ix for fungal nail infection
A
- nail clippings +/- scrapings
24
Q
Mx of mild fungal nail infection
A
Less than 50% nail effected or 2 or < nails effected
- topical treatment with amorolfine 5% nail lacquer; 6 months for fingernails and 9 - 12 months for toenails
25
Mx of more severe fungal infection
dermatophyte
- oral terbinafine 6 weeks - 3 months for fingernail + 3 - 6 months for toes
candida
- oral itraconazole
26
seborrhoeic keratosis
- benign epidermal skin lesions in elderly
- stuck on appearance
- colour from flesh to light-brown to black
- keratotic plugs may be seen on the surface
- Mx: reasurre, can remove by curettage, cryo or shave biopsy
27
Pityriasis versicolor
- Malassezia furfur
- scale, pruritis, patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
- ketoconazole shampoo
28
Lichen planus mx
potent topical steroids
29
erysipelas
- localised skin infection caused by Streptococcus pyogenes
- Mx flucloxacillin
30
Scabies
- burrows into the skin, laying its eggs in the stratum corneum
- pruritis, burrows in fingers
- Mx: permerthrin for child and household 2 doses one week apart
31
Four D's of pellagra (vitamin B3 deficiency)
Diarrhoea
Dermatitis
Dementia
Death
32
Periorificial dermatitis
- women aged 20-45 years old
- clustered erythematous papules, papulovesicles and papulopustules
most commonly in the perioral region but also the perinasal and periocular region
- skin immediately adjacent to the vermilion border of the lip is spared
- Mx: steroids may worsen sx, treat with topical or oral antibiotics
33
Sebaceous cysts
- most common scalp, ears, back, face, and upper arm
- contain a punctum
- excise to prevent recurrence
34
dermatofibroma
- solitary firm papule or nodule around 5-10mm in size
- typically on a limb
- overlying skin dimples on pinching the lesion
- precipitated by injury i.e. insect bite
35
impetigo
- Staphy aureus or Strep pyogenes
- 'golden', crusted skin lesions typically found around the mouth, very contagious
- Mx: hydrogen peroxide 1% cream
- exclude from school until lesions are crusted and healed or 48 hours after commencing abx
36
Vitiligo
- well-demarcated patches of depigmented skin
- peripheries most affected
- trauma may precipitate new lesions (Koebner phenomenon)
- Mx: suncream, camouflage make-up, topical corticosteroids may reverse the changes if applied early, phototherapy
37
isotretinoin side effects
- dry skin (MC)
- teratogenic
- low mood
- raised triglycerides
- hair thinning
- nose bleeds
- intracranial hypertension
- photosensitivity
38
Types of melanoma
- superficial spreading (MC)
- nodular
- lentigo maligna
- acral lentiginous
39
superficial spreading melanoma features
- 70% cases
- arms, legs, back, chest, young
- irregular borders with variation in
colour, growing
40
nodular melanoma features
- second commonest
- sun exposed skin, middle aged
- Red or black lump or lump which bleeds or oozes
- can occur on all sites
- most aggressive, metastasis early
41
lentigo maligna melanoma features
- less common
- chronically sun exposed, elderly
- Caucasians, flat,
slowly growing black lesion
42
acral lentiginous features
- rare
- Nails, palms or soles, People with darker skin pigmentation
- Subungual pigmentation (Hutchinson's sign) or on palms or feet
43
Kaposi Sarcoma
- Tumour of vascular and lymphatic endothelium.
- Purple cutaneous nodules.
- Associated with immuno supression.
- Affects elderly males and is slow growing.
- Immunosupression form is much more aggressive and tends to affect those with HIV related disease. HHV8
44
Pyogenic granuloma
- Overgrowth of blood vessels.
- Red nodules.
- Usually follow trauma.
- May mimic amelanotic melanoma.
45
Hereditary haemorrhagic telangiectasia
Need 2-3/4 to diagnose:
1. epistaxis : spontaneous, recurrent
2. telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
3. visceral lesions: for example gastrointestinal telangiectasia (+/-bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
4. FH: a first-degree relative with HHT
46
Basal cell carcinoma features
- sun-exposed sites, especially the head and neck
- initially a pearly, flesh-coloured papule with telangiectasia
- may later ulcerate leaving a central 'crater'
47
Mx of basal cell carcinoma
- routine referral should be made
- surgical removal
- curettage
- cryotherapy
- topical cream: imiquimod, fluorouracil
- radiotherapy
48
Bowen's disease features
- precancerous dermatosis that is a precursor to squamous cell carcinoma
- red, scaly patches, slow growing, on sun exposed areas
49
Mx of bowen's disease
- topical 5-fluorouracil BD for 4 weeks
- meds often results in significant inflammation/erythema. Topical steroids are often given to control this
- cryotherapy
- excision
50
pathway of SCC formation
actinic keratosis --> bowen's --> SCC
51
erythema multiforme features
- hypersensitivity reaction
- target lesions
- initially seen on the back of the hands / feet before spreading to the torso
- upper limbs > lower limbs
- pruritus is occasionally seen and is usually mild
52
erythema multiforme causes
- viruses: HSV (most common), Orf
- idiopathic
- bacteria: Mycoplasma, Strep
- drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
- connective tissue disease e.g. SLE
- sarcoidosis
- malignancy
53
erythema multiforme major
more severe form
associated with mucosal involvement
54
Bullous pemphigoid features
- autoimmune condition causing sub-epidermal blistering of the skin
- itchy, tense blisters typically around flexures
- blisters usually heal without scarring
- stereotypically no mucosal involvement (i.e. the mouth is spared)
55
Ix for bullous pemphigoid
immunofluorescence shows IgG and C3 bind to hemidesmosomes of BM at the dermoepidermal junction
56
Mx of bullous pempihgoid
- referral to a dermatologist
- oral corticosteroids 1st line
- topical corticosteroids, immunosuppressants and antibiotics are also used
57
Pemphigus vulgaris features
- autoimmune disease
- Ashkenazi Jewish population
- mucosal ulceration is common
- flaccid, easily ruptured vesicles and bullae.
- painful non itchy lesions
- Nikolsky +ve
58
Ix for pemphigus vulgaris
IgG Abs bind to
desmoglein 1 & 3
(adhesion molecules desmosomes)
between keratinocytes
in stratum spinosum →
acantholysis
59
Mx of pemphigus vulgaris
- oral steroids
- immunosuppressants
60
rash with pain
shingles
61
complications is most associated with psoralen + ultraviolet A light (PUVA) therapy?
SCC
62
Urticaria features
- local or generalised superficial swelling of the skin
- due to allergy
- 'hives', 'wheals', 'nettle rash'
- pruritic
63
Mx of urticaria
- non-sedating antihistamines (e.g. loratadine or cetirizine) up to 6 weeks
- chlorphenamine may be used at night for troublesome sleep sx
- prednisolone is used for severe or resistant episodes
64
Eczema herpeticum
- severe primary infection of the skin by herpes simplex virus 1 or 2
- children with atopic eczema
- presents as a rapidly progressing painful rash
- monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm
65
Mx of eczema herpeticum
- refer to secondary care
- IV aciclovir
66
Cherry haemangioma features
- benign skin lesions which contain an abnormal proliferation of capillaries
- increasing age RF
- erythematous, papular lesions
typically 1-3 mm in size
- on-blanching
- not in mucous membranes
- Mx: nil
67
pyoderma gangrenosum features
- rare, non-infectious, inflammatory disorder
- very painful skin ulcer
- lower legs most common site
- can also have systemic sx
68
causes of pyoderma gangrenosum
- idiopathic 50%
- IBD
- RA and SLE
- haematological e.g. myeloproliferative disorders, lymphoma, myeloid leukaemias
- granulomatosis with polyangiitis
- PBC
69
Mx of pyoderma gangrenosum
the potential for rapid progression
- oral steroids
- immunosuppressive therapy in difficult cases
70
lichen sclerosis features
- itchy white lesion on elderly vulva
71
Mx of lichen sclerosis
topical steroids and emollients
72
what does lichen sclerosis increase risk of
vulval cancer
73
Hidradenitis suppurativa features
- chronic, painful, inflammatory skin disorder
- inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas (axilla MC)
- F > M , <40y/o
- 'rope-like' scarring
- sweat related
74
Mx of hiradenitis suppurativa
- good hygiene and loose-fitting clothing
- Smoking cessation
- Weight loss in obese
- Acute flares: steroids (intra-lesional or oral) or flucloxacillin. Surgical incision and drainage may be needed
- Long-term: topical (clindamycin) or oral (lymecycline or clindamycin and rifampicin) antibiotics.
- Lumps that persist are excised
75
Tinea corporis (ringworm)
- causes include Trichophyton rubrum and Trichophyton verrucosum (e.g. From contact with cattle)
- well-defined annular, erythematous lesions with pustules and papules
- Mx oral fluconazole
76
what burns needed fluid resus
> 15% body area
77
side effect of ketoconazole
gynaecomastia
78
livedo reticularis features
purplish, non-blanching, reticulated rash caused by obstruction of the capillaries --> swollen venules
79
causes of livedo reticularis
- idiopathic (most common)
- polyarteritis nodosa
- SLE
- cryoglobulinaemia
- antiphospholipid syndrome
- Ehlers-Danlos Syndrome
- homocystinuria
80
keratoacanthoma features
- benign epithelial tumour.
- common with advancing age
- look like a volcano or crater
- initially a smooth dome-shaped papule
- rapidly grows to become a crater centrally-filled with keratin
81
Mx of keratoacanthoma
- Spontaneous regression within 3 months is common, often resulting in a scar.
- Lesions should be urgently excised as it is difficult clinically to exclude squamous cell carcinoma
82
Keloid scars
- tumour-like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound
- common in darker skin
83
Mx of keloid scars
- early: intra-lesional steroids e.g. triamcinolone
- excision is sometimes required but can create further keloid scarring
84
Venous ulceration mx
- compression bandages
- oral pentoxifylline, a peripheral vasodilator, improves healing rate
85
how to differentiatie toxic epidermal necrolysis from Staphylococcal Scalded Skin syndrome
SSSS- neonates and young children
TEN- drug induced
86
uncircumcised man, who has developed a tight white ring around the tip of the foreskin and phimosis
lichen sclerosis
87
most effective treatment for prominent telangiectasia in rosacea
phototherapy
88
Erythema ab igne
caused by infrared radiation and is commonly associated with hot water bottles or open fires
89
single most important prognostic factor of melanom
depth
Breslow thickness
90
squamous cell carcinoma RFs
- excessive exposure to sunlight / psoralen UVA therapy
- actinic keratoses and Bowen's
- immunosuppression e.g. following renal transplant, HIV
- smoking
- long-standing leg ulcers (Marjolin's ulcer)
- genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
91
squamous cell carcinoma features
- sun-exposed sites
- rapidly expanding painless, ulcerate nodules
- cauliflower-like appearance
- there may be areas of bleeding
92
Mx of squamous cell carcinoma
Surgical excision
- 4mm margin if lesion <20mm
- >20mm then 6mm margin
- Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.
93
signs of zinc deficiency
- Dermatitis (red crusted lesions) in acral, peri-orificial and perianal distribution
- alopecia
- short stature
- hypogonadism
- hepatosplenomegaly
- geophagia (ingesting clay/soil)
- cognitive impairment
94
niacin deficiency (pellagra)
- vitamin b3 def
- diarrhoea, dermatitis, and dementia
95
vitamin c deficiency
- scurvy
- ecchymoses, perifollicular haemorrhages, and corkscrew hairs and purpura.
96
Stevens-Johnson Syndrome causes
- severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction
- penicillin
- sulphonamides
- lamotrigine, carbamazepine, phenytoin
- allopurinol
- NSAIDs
- oral contraceptive pill
97
Features of Stevens-Johnson Syndrome
- rash (<10% BDSA) is maculopapular with target lesions being characteristic
may develop into vesicles or bullae
- Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently
- mucosal involvement
- systemic symptoms
98
actinic keratosis vs seborrhoeic keratosis
AK: pre-malignant, red rough scaly patches
SK: benign, brown stuck on appearance
99
how to assess depth of burns
1. Superficial epidermal: 1st degree Red and painful, dry, no blisters
2. Partial thickness (superficial dermal): 2nd degree
Pale pink, painful, blistered. Slow capillary refill
3. Partial thickness (deep dermal): 2nd degree
Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure
4. Full thickness: 3rd degree
White ('waxy')/brown ('leathery')/black in colour, no blisters, no pain
100
Causes of pruritis
- liver disease
- iron deficiency anaemia
- polycythaemia
- CKD
- lymphoma
101
erythroderma features
when more than 95% of the skin is involved in a rash of any kind.
102
causes of erythroderma
- eczema
- psoriasis
- drugs e.g. gold
- lymphomas, leukaemias
- idiopathic
103
conditions that psoriasis increases the risk of
cardiovascular disease
lymphoma
non-melanoma skin cancer
104
erythema nodosum features
- inflammation of subcutaneous fat
- tender, erythematous, nodular lesions
- over shins, also elsewhere (e.g. forearms, thighs)
- usually resolves within 6 weeks
lesions heal without scarring
105
causes of erythema nodosum
NODOSUM
No- idiopathic
D- drugs (penicillins, sulphonamides)
O- oral COCP/pregnancy
S- sarcoidosis
U- UC/Crohn's Behcet's
M- microbiology infection (streptococci, TB, brucellosis), malignancy
106
port wine stain
- vascular birthmarks that tend to be unilateral
- deep red or purple
- do not spontaneously resolve, darken and become raised over time
107
Port wine stain mx
cosmetic camouflage or laser therapy (multiple sessions are required)
108
Hyperhidrosis
excessive sweat production
109
Mx for hyperhidrosis
- topical aluminium chloride 1st line SE skin irritation
- iontophoresis: useful for patients with palmar, plantar and axillary hyperhidrosis
- botulinum toxin: for axillary sx
- surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating
110
Strawberry naevus
- not present at birth but may develop rapidly in the first month of life
- erythematous, raised and multilobed tumours
- increase in size until around 6-9 months before regressing over the next few years
111
mx of cellulitis
flucloxacillin
calirthromycin or doxycycline if penicillin allergy
erythromycin if pregnant
Finals
flashcards
Decks in class (26)
# Cards
-
Rheum134
-
Ophthalmology164
-
ENT215
-
Urology128
-
Breast73
-
Vascular108
-
Bit of everything131
-
Gastro243
-
Palliative18
-
Oncology62
-
Resp159
-
Ortho198
-
Psych additional81
-
Paeds additional117
-
Renal81
-
Cardio226
-
O&G51
-
PSA13
-
Derm111
-
Endo143
-
Neuro229
-
Gen Surg114
-
Infectious Diseases65
-
Haem56
-
CPSA1
-
Statistics14
