Finals > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

functions of the skin

A

STAIN B

Storage 
Thermoregulation 
Aesthetics + communication 
Immunological 
Neurological
Barrier/protection
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2
Q

describe a rash structure

A

distribution - where is it:

  • flexures/ extensors
  • dermatomal
  • intertriginous (folds of skin e.g. under breasts)
  • photodistribution

configuration - grouping of the rash:

  • linear
  • annular (ring shaped)
  • discoid (like a disc)
  • clusters (infections!)

morphology - describe it

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3
Q

describe a skin lesion struction

A 
Asymmetry
Border: irregular/regular 
Colour 
Diameter
Elevation/everything else
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4
Q

Eczema

aka

A

dermatitis

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5
Q

Eczema

acute dermatitis

A

rapidly evolving red rash which may be blistered or swollen

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6
Q

Eczema

chronic

A

longstanding irritable area

often darker, thickened (lichenified) and much scratched

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7
Q

Eczema

sub-acute

A

an inbetween state

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8
Q

Eczema

RFs (4)

A
  • allergic rhinitis
  • asthma
  • age <5yrs
  • FH of eczema
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9
Q

Eczema

where does it present in infants

A

extensors
cheeks
forehead
scalp

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10
Q

Eczema

where does it present in children and adults

A

flexures

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11
Q

Eczema

signs and symptoms

A
  • pruritis
  • xerosis (dry skin)
  • erythematous
  • scaly
  • excoriations
  • lichenification
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12
Q

Eczema

what does crust and weeping suggest

A

infections from staphylococcus

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13
Q

Eczema

what is atopic eczema

A
  • prevalent in children

- FH of dermatitis or asthma

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14
Q

Eczema

what is allergic contact dermatitis

A

skin contact with substances that most ppl don’t react to

  • nickel
  • perfume
  • rubber
  • half dye
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15
Q

Eczema

what is irritant contact dermatitis

A
  • provoked by bodily fluids, water, detergents, solvents/harsh chemicals, friction
  • worse if has atopic eczema
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16
Q

Eczema

what is seborrheic dermatitis

A

irritation from toxic substances produced by Malassezia yeasts that live on the scalp and face

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17
Q

Eczema

what is nummular dermatitis

A

aka discoid

  • may be set off initially by an injury
  • scattered coin-shaped irritable patches
  • persist for a few months
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18
Q

Eczema

what is gravitational dermatitis

A
  • arises on lower legs of elderly

- due to swelling + poorly functioning leg veins

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19
Q

Eczema

what is infective dermatitis

A

provoked by impetigo (bacterial infection) or fungal infection

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20
Q

Eczema

trx for an acute flare

A
  1. emollients TDS

and

  1. topical corticosteroids (intermittent) e.g. hydrocortisone BD
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21
Q

Eczema

trx for chronic

A
  • emollients
  • continuous low-mid potent topical corticosteroid
  • reduce exposure to triggers
  • immunosuppressive agents
  • biologics
  • antihistamines, phototherapy, abx
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22
Q

Psoriasis

what is it

A

chronic autoimmune disease characterised by well demarcated, erythematous scaly plaques

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23
Q

Psoriasis

what are the different types

A
  • chronic plaque
  • flexural
  • guttate
  • pustular
  • generalised/erythrodermic
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24
Q

Psoriasis

describe chronic plaque psoriasis

A

most common

  • symmetrical plaques
  • extensor (knees + elbows), scalp, lower back
  • itchy
  • well dermarcated circular to oval
  • bright pink elevated lesion (plaque) w/ overlying white/silvery scale
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25
Psoriasis describe flexural (inverse) psoriasis
- smooth, erythematous plaques without scale | - in flexures + skin folds
26
Psoriasis describe guttate psoriasis
- multiple, small tear dropped erythematous plaques - on trunk - after strep infection - young adults
27
Psoriasis describe pustular psoriasis
- multiple petechiae + pustules | - on palms + soles
28
Psoriasis what is generalised/erythrodermic psoriasis
- rare but serious form | - erythroderma + systemic illness
29
Psoriasis nail changes (3)
- nailbed pitting - onycholysis - sublungual hyperkeratosis
30
Psoriasis nail changes: what is nailbed pitting
superficial depression in nailbed
31
Psoriasis nail changes: what is onycholysis
seperation of nail plate from nail bed
32
Psoriasis nail changes: what is subungual hyperkeratosis
thickening of nailbed
33
Psoriasis RFs (4)
- FH - HIV - obesity - smoking
34
Psoriasis triggers
- skin trauma - infection: strep, HIV - drugs - withdrawal of steroids - stress - alcohol + smoking - cold/dry weather
35
Psoriasis what is Koeber phenomenon
skin lesions occur at sites of skin injury (inc lichen planus + vitiligo too)
36
Psoriasis which drugs can trigger psoriasis
BALI BB ACEi, anti-malarials (hydroxychloroquine) Lithium Indomethacin/NSAIDs
37
Psoriasis chronic plaque mnx 1st line
``` regular emollient + potent corticosteroid (topical) OD + vit D analogue (topical) OD ```
38
Psoriasis chronic plaque mnx 2nd line
vit D analogue BD
39
Psoriasis chronic plaque mnx 3rd line
potent corticosteroid BD for up to 4w or coal tar preparation (OD/BD) short acting dithranol can also be used
40
Psoriasis systemic trx
1st: methotrexate 2nd: ciclosporin 3rd: Acitretin
41
Psoriasis systemic trx: why monitor LFTs if giving methotrexate
hepatotoxicity
42
Psoriasis systemic trx: why monitor FBCs if giving methotrexate
myelosuppression --> pancytopenia
43
Psoriasis systemic trx: when can ciclosporin be used 1st line
``` if rapid control needed or palmoplantar pustulosis or considering conception ```
44
Psoriasis systemic trx: what are the SE's of ciclosporin
5 H's - hypertrophy of gums - hypertrichosis - HTN - Hyperkalaemia - Hyperglycaemia
45
Psoriasis systemic trx: what are the SE's of Acitretin
- teratogenic - hepatotoxicity - increased lipids
46
Psoriasis 1st line phototherapy
narrowband UVB
47
Psoriasis 2nd line phototherapy
psoralen + UVA (PUVA)
48
Psoriasis SE's of phototherapy
- skin aging | - squamous cell cancer (not melanoma)
49
Psoriasis what biological therapy can be used
- Infliximab - Etanercept - Adalimumab
50
Psoriasis biological therapy: what is associated with Adalimumab
reactivation of latent TB
51
Acne Vulgaris what is it
an inflammatory disease of the pilosebaceous unit
52
Acne Vulgaris what is the pilosebaceous unit
hair follicles and sebaceous gland
53
Acne Vulgaris how do non-inflammatory lesions present as
cornedones
54
Acne Vulgaris how do less severe inflammatory lesions present as
papules | pustules
55
Acne Vulgaris how do severe inflammatory lesions present
nodules cyst scarring
56
Acne Vulgaris what is mild acne
- non inflammatory lesions | - w/ sparse inflammatory lesions
57
Acne Vulgaris what is moderate acne
- widespread non inflammatory lesions | - w/ numerous papules + pustules
58
Acne Vulgaris what is severe acne
- extensive inflammatory lesions | - inc nodules, pitting and scarring
59
Acne Vulgaris aetiology
- ↑ sebum production - ↑ androgens -> hyperplasia of sebaceous glands - hyperactive immune response - bacterial colonisation
60
Acne Vulgaris complications
- post inflammatory pigmentation - scarring - deformity - psychological + social effects
61
Acne Vulgaris 1st line (mild) mnx
topical benzoyl peroxide
62
Acne Vulgaris 2nd line (mild) mnx
topical abx or topical retinoid
63
Acne Vulgaris 3rd line (mod) mnx
- PO tetracyclines or - PO anti-androgens
64
Acne Vulgaris 3rd line (mod) mnx: name some tetracyclines
- lymecyline - oxtetracycline - doxycycline
65
Acne Vulgaris 3rd line (mod) mnx: CI's of tetracyclines
avoid in pregnant/breastfeeding women avoid if <12 years
66
Acne Vulgaris 3rd line (mod) mnx: which abx can you used instead of tetracyclines in pregnant/breastfeeding women
erythromycin
67
Acne Vulgaris 3rd line (mod) mnx: what is the max duration of PO abx
3m
68
Acne Vulgaris 3rd line (mod) mnx: SE of long term abx use and what do you give if it occurs
gram -ve folliculitis give high dose PO trimethoprim
69
Acne Vulgaris 3rd line (mod) mnx: name some PO anti-androgens
- OCP | - spironolactone
70
Acne Vulgaris 4th line (severe) mnx
PO retinoid | e.g. isotretinoin
71
Acne Vulgaris 4th line (severe) mnx: SEs of PO retinoid
- highly teratogenic - hepatitis (moniter LFTs) - dry mucous membrane - headache - hair thinning/loss
72
Rosacae features
- 1st sx: flushing - then persistent erythema w/ pustules + papules - telangiectasia - rhinophyma (large, red, bumpy nose)
73
Rosacae where does it typically affect
nose, cheeks, forehead
74
Rosacae how does it involve the eye
blepharitis
75
Rosacae epidemiology
30-60yrs F>M common in pale skins
76
Rosacae exacerbating factors
- sunlight - hot weather - warm baths - stress - spicy foods
77
Rosacae mnx (general measures)
- camourflage creams - sun protection - avoid exacerbating factors - emollient as a soap substitute if skin is dry
78
Rosacae 1st line mnx (mild)
topical metronidazole
79
Rosacae what classes it as mild
limited number of papules and pustules and no plaque
80
Rosacae 2nd line mnx (for predominant flushing but limited telangectasia)
topical Azelaic acid / Brimonidine / Ivermectin
81
Rosacae what can be used to manage persistent telangiectasia
laser therapy
82
Rosacae mnx for severe cases
systemic abx: PO tetracyclines e.g. ocytetracycline
83
Viral Warts where can they present on the body
cutaneous (aka veruca papilloma) mucosal
84
Viral Warts describe a cutaneous wart
- hard keratinous surface | - papillary capillaries (tiny red/black dots visible on wart)
85
Viral Warts cause
- infection by HPV | - direct skin to skin contact or autoinoculation
86
Viral Warts common wart
cauliflower like papulae
87
Viral Warts plantar
- sole | - caused by HPV1, 2
88
Viral Warts plane
- multiple small flat topped skin coloured papules | - often spread shaving
89
Viral Warts filiform
- cluster of fine fronds emerging from pedicle base | - face
90
Viral Warts butcher's
HPV 7 infecting butcher's hand
91
Viral Warts epidermodysplasia veruciforms
- rare autosomal recessive
92
Viral Warts mnx
- topical paints containing salicylic acid or podophyllin - cryotherapy - electrosurgery (curettage + cautery) for large resistant warts
93
cause of genital warts
HPV 6 or 11 | spread by skin to skin contact
94
mnx of epidermoid and pilar cysts
none - most disappear | if red hot --> infected --> flucloxacillin
95
epidermoid cyst location
face, neck, trunk
96
epidermoid cyst central punctum?
yes
97
epidermoid cyst origin
epithelium or hair follicle infundibulum
98
epidermoid cyst cyst wall
delicate and prone to rupture
99
epidermoid cyst histology
granular layer
100
epidermoid cyst which syndrome is it present in
Gardner Syndrome
101
pilar cyst location
scalp and scrotum
102
pilar cyst central punctum?
no
103
pilar cyst origin
outer root sheath
104
pilar cyst cyst wall
thick + not prone to rupture
105
pilar cyst histology
granular layer is absent
106
pilar cyst what does it contain
keratinous material
107
pilar cyst inheritance pattent
often autosomal dominant
108
Seborrhoeic Keratosis what is it
a harmless warty spot and a common sign of skin ageing
109
Seborrhoeic Keratosis presentation
- 'stuck on' appearance - large variation in colour from flesh to light-brown to black - fissured keratin surface.
110
Seborrhoeic Keratosis mnx
- leave alone - cryotherapy - shave biopsy - curettage
111
Dermatofibroma what is it
a common benign fibrous nodule usually found on the skin of the lower legs occurring at sites of previous trauma (insect bite)
112
Dermatofibroma size
7-10mm
113
Dermatofibroma presentation
- tethered to skin surface + mobile over sc tissue - sometimes painful, tender, itchy - Pinch Sign - solitary dermal nodules
114
Dermatofibroma what is Pinch Sign
the overlying skin dimples on pinching the lesion
115
Dermatofibroma mnx
reassure
116
Dermatofibroma histology
- proliferating fibroblasts | - merging w/ sparsely cellular dermal tissues
117
Shingles cause
reactivation of the varicella zoster virus which an lie dormant in nerve ganglia following primary infection (chickenpox)
118
Shingles commonly effects who?
elderly + young adults
119
Shingles prodromal period features
- burning pain over affected dermatome | - fever, headache, lethargy
120
Shingles which is the most commonly affected dermatome
T1-L2
121
Shingles describe the rash
initially erythematous, macular rash over affected dermatome becomes vesicular well demarcated by the dermatome doesn't cross midline
122
Shingles whom should pts avoid
pregnant women + the immunosuppressed
123
Shingles when are pts infectious till
until the vesicles have crusted over usually 5-7d following onset
124
Shingles mnx to reduce risk of spread
cover lesions
125
Shingles mnx: analgesia
1st line: NSAIDs + paracetamol consider amitriptyline severe + immunocompetent: PO corticosteroids 2w
126
Shingles mnx
antivirals within 72hrs (aciclovir) unless <50y + mild truncal rash w/ mild pain + no underlying RFs
127
Shingles what is the most common complication
post herpetic neuralgia
128
Shingles complications other than post herpetic neuralgia
herpes zoster opthalmicus herpes zoster oticus (Ramsay hunt syndrome) - HHV3 infection of the facial nerve
129
Shingles what is herpes zoster opthalmicus
a complication. shingles affecting the ocular division of the trigeminal nerve
130
Lichen planus what is it
an autoimmune condition that causes localised chronic inflammation
131
Lichen planus describe the rash
itchy, papular rash polygonal in shape Wickham's striae: white lines pattern on the surface Koebner phenomenon
132
Lichen planus where is the rash most common
on the palms, soles, genitalia and flexor surfaces of the arms
133
Lichen planus what may be seen in the mouth
white-lace pattern on the buccal mucosa
134
Lichen planus nail features
longitudinal ridging (onychorrhexis) thinning of nail plate
135
Lichen planus lichenoid drug eruption causes
- gold - quinine - thiazides
136
Lichen planus mnx
- potent topical steroids
137
Lichen planus mnx for oral lichen planus
benzydamine mouthwash or spray
138
Actinic Keratoses what is it
a common premalignant skin lesion that develops as a consequence of chronic sun exposure pre cursors for SCCs
139
Actinic Keratoses RFs
- type I or II skin - hx of sunburn - outdoor occupation or hobbies - immunosuppression
140
Actinic Keratoses describe it
thickened papules or plaques w/ surrounding erythematous skin + a keratotic, rough warty surface
141
Actinic Keratoses common location
- temple of head | - back of head
142
Actinic Keratoses mnx for localised lesions
cryotherapy, curettage or surgical excision
143
Actinic Keratoses mnx for larger lesions
- topical S-Fluorouracil (cytotoxic agent) - topical imiquimod (modifies immune response) - topical diclofenac (NSAID for mild AK)
144
Bowen's disease what is it
a type of precancerous dematosis that is a precursor to SCC | more common in older patients
145
Bowen's disease features
- irregular, red, scaly plaques - often 10-15mm - on sun exposed areas: temple, neck, lower limbs - slow growing
146
Bowen's disease mnx
- top 5-flurouracil - top steroids - cyro, excision
147
what is the most common form of skin cancer
BCC
148
Basal Cell Carcinoma which type of BCC is most common and name some others
``` most common: nodular superficial pigmented cystic keratotic morphoeic ```
149
Basal Cell Carcinoma presentation of a nodular BCC
- Pearly / shiny nodule with a smooth surface - small, skin coloured/pink nodule w/ central depression - surface telangiectasia - head + neck
150
Basal Cell Carcinoma mnx
- surgical excision w/ 4mm margin - curettage + cautery - cryo - top: imiquimod, fluorouracil - radiotherapy
151
Squamous Cell Carcinoma presentation
- irregular ill-defined red nodule - scale + ulceration - rapidly growing
152
Squamous Cell Carcinoma causes
- UV light - human wart virus - burns - genetic lead to DNA mutations
153
Squamous Cell Carcinoma what makes it a good prognosis
- well differentiated tumour - <20mm in diameter - <2mm deep - no associated diseases
154
Squamous Cell Carcinoma what makes a bad prognosis
- poorly differentiated tumours - >20mm in diameter - >4mm deep - immunosuppression
155
Squamous Cell Carcinoma mnx
- lesion <20mm: surgical excision w/ 4mm margin - >20mm: surgical excision w/ 6mm margin - Mohs micrographic surgery if in cosmetically important sites
156
Malignant Melanoma if any lesion has ____, you should refer urgently under 2w wait pathway
``` Asymmetry Border irregularity Colour variation Diameter >6mm Evolves over time ```
157
Malignant Melanoma what are the types
- superficial spreading - nodular - lentigo maligna - acral lentiginous
158
Malignant Melanoma superficial spreading: - common?
yes 70% of cases
159
Malignant Melanoma superficial spreading: typically affects?
- young ppl | - arms, legs, back, chest
160
Malignant Melanoma superficial spreading: appearance
- growing moles | - usually grows horizontally first
161
Malignant Melanoma dx
- dermatoscope | - excisional biopsy --> histology for dx + establish Breslow thickness
162
Malignant Melanoma trx
- wider excision margin around lesion
163
Malignant Melanoma trx for stage III + IV (metastatic)
- adjuvant immunotherapy + chemo
164
Malignant Melanoma further inx if Breslow Thickness >1mm
sentinal node biopsy (to look for metastases + stage the cancer)
165
Scabies cause
by the mite Sarcoptes scabiei
166
Scabies pathphysiology
- Sarcoptes scabiei burrows into skin - lays eggs in the stratum corneum - 30d later: delayed type 4 hypersensitivity reaction to mites/eggs - intense puritis
167
Scabies features
- widespread pruritis - linear burrows on hands - classically worse at night - excoriation, infection due to scratching - papular vesicular
168
Scabies 1st line trx
top permethrin 5% leave on for 12h before washing off for 7d
169
Scabies 2nd line trx
malathion 0.5% leave on skin for 24h
170
Scabies trx for all contacts
all should be treated even if asymptomatic
171
Tinea what is it
dermatophyte fungal infections
172
Tinea what are the types
- tinea capitis (scalp ringworm) - tinea corporis (ringworm) - tinea pedis (athlete's foot) - tinea incognita
173
Tinea what is tinea corporis (ringworm)
itchy annular lesions with clear, defined, raised, scaly edge
174
Tinea what is tinea capitis
Scalp ringworm: Patches broken hair, scaling and inflammation
175
Tinea what is tinea pedis
athlete's foot: Moist scaling and fissuring in toewebs
176
Tinea what is tinea incognita
inappropriate treatment of tinea with corticosteroids, causing a different appearance may occur when rash is wrongly diagnosed as dermatitis initially
177
Tinea establish dx with?
skin scraping, swabs or hair/nail clippings
178
Tinea mnx
- top antifungal: terbinafine cream, ketoconazole/selenium sulphate shampoo - PO antifungal: itraconazole, fluconazole
179
Impetigo clinical features
- golden crusted lesions around mouth - pruritic rash - v. contagious
180
Impetigo common cause
staph aureus strep pyogenes
181
Impetigo who is it common in
children
182
Impetigo mnx for pts NOT systemically unwell/high risk of complications
hydrogen peroxide 1% cream
183
Impetigo mnx
- top fusidic acid - intranasal mupirocin - PO flucloxacillin
184
Impetigo what should children do about school
exclude from school until lesions are crusted and healed or 48h after abx trx
185
Cellulitis & Erysipelas what is the difference
cellulitis: acute bac infection of dermis + SC tissue erysipelas: more superficial infection
186
Cellulitis & Erysipelas organisms
staph aureus, strep pyogenes
187
Cellulitis & Erysipelas presentation
- warmth, pain, erythema, swelling - blisters may form - usually lower limb - generally unilateral
188
Cellulitis & Erysipelas inx
- FBC (raised WCC) - blood culture - purulent focus culture - CT/MRI if orbital cellulitis suspected
189
Cellulitis & Erysipelas mnx
flucloxacillin PO
190
Cellulitis & Erysipelas comlications
- local tissue damage - sepsis - orbital cellulitis
191
well-defined circular papules on which evolve at different stages to form a 'target-shaped' lesion of three concentric rings of different colours. The rash starts on the palms/soles and spread up the limbs to the trunk. what is it
erythema multiforme (could be caused by HSV)
192
what is psoriasis relieved by
exposure to sun
193
pruritic papulovesicular lesions over the buttocks and extensor surfaces of the arms, legs, and trunk. Diarrhoea for a few months. What could this be
dermatitis herpetiformis (assc w/ coeliac disease)
194
mnx of pruritic sx of Dermatitis Herpetiformis
Dapsone (an abx) | and a gluten free diet
195
mnx of staph scalded skin syndrome
IV vancomycin
196
trx of psoriasis on scalp
3% salicylic acid cream in combination with a tar-containing shampoo.
197
Pemphigus vulgaris what is it
an autoimmune disease caused by antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule
198
Pemphigus vulgaris which molecule is affected by the attacking antibodies
desmoglein 3
199
Pemphigus vulgaris which population is commonly affected
Ashkenazi Jewish population
200
Pemphigus vulgaris features
- mucosal ulceration - skin blistering - flaccid, easily ruptured vesicles and bullae - typically painful but not itchy - Nikolsky sign positive
201
Pemphigus vulgaris what will biopsy show
acantholysis (loss of coherence between epidermal cells due to the breakdown of intercellular bridges)
202
Pemphigus vulgaris mnx
steroids are first-line | immunosuppressants
203
Bullous pemphigoid what is it
an autoimmune condition causing sub-epidermal blistering of the skin
204
Bullous pemphigoid which proteins are attacked by antibodies
hemidesmosomal proteins BP180 and BP230
205
Bullous pemphigoid who is it more common in
elderly patients
206
Bullous pemphigoid features
- itchy, tense blisters typically around flexures - blisters usually heal without scarring - no mucosal involvement (i.e. the mouth is spared)
207
Bullous pemphigoid what will skin biopsy show
immunofluorescence shows IgG and C3 at the dermoepidermal junction
208
Bullous pemphigoid mnx
- PO corticosteroids | - topical corticosteroids, immunosuppressants and antibiotics are also used
209
Bullous pemphigoid complications
- Bacterial staph + strep skin infection, and sepsis - Viral infection with herpes simplex, varicella or herpes zoster - Complications of treatment
210
Bullous pemphigoid inx
- Direct immunofluorescence staining of a skin biopsy | - bloods: indirect immunofluorescence test for circulating pemphigoid BP180 antibodies
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