Dermatology

Question 1

ACNE

What is it and when is the normal onset?

Answer 1

Inflammation of pilosebaceous units

adolescence to early adulthood

Question 2

ACNE

Features of Acne?

Answer 2

1) Increased sebum production by sebaceous glands
2) Colonisation of pilosebaceous glands by Propionibacterium acnes
3) Follicular epidermal hyperproliferation + blockage of pilosebaceous ducts

Question 3

ACNE

Why is it more common during puberty?

Answer 3

• Androgen and progesterone production increases so sebum production increases

Question 4

ACNE

Types of Acne?

Answer 4

• Open comedones- blackheads- keratin

- Closed comedones- Whiteheads- sebum, keratin and deeper in ducts

Question 5

ACNE

What may closed comedones cause?

Answer 5

Inflammatory papules , nodules &cysts

Question 6

ACNE

First Line treatment?

Answer 6

Keratolytics (benzyl peroxide)- thins skin, clears pores, decreases bacteria
Topical Retinoids- (iso/tretinoin), topical erythromycin

Question 7

ACNE

Second Line treatment?

Answer 7

low does Abx ( Doxycycline/ erythromycin)

Question 8

ACNE

Third line treatment?

Answer 8

• Po retinoids (isotretinoin )

vitamin A analogues that affect cell growth and differentiation

Question 9

ECZEMA

Aetiology?

Answer 9

• Abnormal epithelial barrier function

- Allows antigens/irritants to penetrate skin & reach immune cells

Question 10

ECZEMA

Which cell(s) drive the acute phase?

Answer 10

Th-2 CD4 Lymphocytes

Question 11

ECZEMA
Which cell(s) drive the chronic phase?

Answer 11

Th0/Th1 CD4 lymphocytes

Question 12

ECZEMA

Exacerbating factors?

Answer 12

• animal hair
• strong detergents
• dietary allergens

Question 13

ECZEMA

Where is it normally found and what does it look like?

Answer 13

• usually found in flexures

- Itchy, erythematous, scaly patches

Question 14

ECZEMA

Management?

Answer 14

1) Emollient creams (hydrate)

2) Steroid creams e.g hydrocortisone/ betamethasone

Question 15

CONTACT DERMATITIS

Cause?

Answer 15

• CLeaning products
• Chemical irritants
• Type IV hypersensitivity

Question 16

CONTACT DERMATITIS

Features?

Answer 16

• Unusual rash, clear cut borders/ odd shaped areas of erythema/ scaling

Question 17

CONTACT DERMATITIS

Treat?

Answer 17

1) Remove cause
2) Steroids
3) Antipruritic agents `

Question 18

PSORIASIS

Cause and triggers?

Answer 18

• polygenic- 9 loci identified

1) Group A strep infection
2) UV light
3) Lithium
4) Alcohol
5) Stress

All T- lymphocyte driven

Question 19

PSORIASIS

What is plaque psoriasis?

Answer 19

found in kids/ adults

• Eruption of small circular plaques, on trunk, 2 weeks after strep infection (sore throat)

Question 20

PSORIASIS

What is Erythrodermic psoriasis?

Answer 20

severe and life threatening

• widespread intense inflammation of the skin- fever, malaise, circulating problems

Question 21

PSORIASIS

What may be seen if someone has psoriasis?

Answer 21

1) pitting/ onycholysis / yellow- brown nails

2) Psoriatic arthritis in 20% of patients

Question 22

PSORIASIS

Management? (1st and 2nd)

Answer 22

1st - emollient creams (hydrate)
2nd- Topical Agents - Vit D3 analogues (calcipotriol)
- Coal tar
- Retinoids (Tazorotene)
- Corticosteroids
- Salicylic acid

Question 23

PSORIASIS

3rd and 4th line treatment?

Answer 23

3rd- UV radiation - risk of skin cancer/ ageing

4th- Systematic therapy if all else fails and also erythrodermic psoriasis requires systematic therapy

• Oral retinoids
• Immunosuppression (methotrexate, azathioprine)
• Biological Agents (infliximab)

Question 24

SKIN CANCER

What is the most serious case of skin cancer?

Answer 24

MALIGNANT MELANOMA

Metastases early and hard to treat after this

Question 25

SKIN CANCER Criteria of malignant melanoma?

Answer 25

``` Asymmetry of mole Border irregularity Colour variation Diameter >6mm Evolution ```

Question 26

SKIN CANCER | List the Glasgow 7 point Criteria

Answer 26

MAJOR - Change in size shape colour MINOR - diameter >6mm - inflammation/bleeding - mild itch/ altered sensation

Question 27

SKIN CANCER | Name 4 types of melanoma?

Answer 27

Superficial Spreading Melanoma Nodular Melanoma Lentigo Malignant Melanoma Acral Lentiginous Melanoma

Question 28

SKIN CANCER What is Superficial Spreading Melanoma (70% of melanomas)

Answer 28

Large, flat, irregular pigmented lesion that grows out before deep

Question 29

SKIN CANCER What is Nodular Melanoma? (15% of all melanomas)

Answer 29

- rapidly growing pigmented nodule that bleeds/ ulcerates

Question 30

SKIN CANCER What is Lentigo Malignant Melanoma?

Answer 30

- Patch of 'lentigo melanoma'- slow growing lesion on face of elderly

Question 31

SKIN CANCER WHat is Acral Lentiginous Melanoma?

Answer 31

Pigmented lesions on palm, sole or under nail

Question 32

SKIN CANCER Treat?

Answer 32

- excision | - mets treated with chemo

Question 33

What is Basal Cell Carcinoma?

Answer 33

- most common malignant skin tumour - occurs later in life on sun exposed skin - shiny nodule which may ulcerate

Question 34

Treatment of basal cell carcinoma and squamous cell carcinoma?

Answer 34

- excision | - radiotherapy to treat mets/ recurrence

Question 35

What is Squamous Cell Carcinoma?

Answer 35

- more dangerous than BCC as it can metastasise | - ulcerated lesion with hard, raised edges at sun exposed sites

Question 36

SKIN ULCERS What are they?

Answer 36

Abnormal breaks in epithelial surface

Question 37

SKIN ULCERS Different classes?

Answer 37

- Venous (70%) - Mixed A+V (15% ) - Arterial (2%) - neuropathic, diabetic, traumatic, infective, lymphoedema

Question 38

SKIN ULCERS | Where is a common site for a venous skin ulcer and how does it occur?

Answer 38

1) Incompetence of valves in lower legs 2) Blood pooling and varicose veins 3) They aren't drained fast enough- dies and sloughed off leaving ulcer, commonly just above medial malleolus

Question 39

SKIN ULCERS | Cause of Arterial Skin Ulcer?

Answer 39

- Atheroma - More painful and shallow - NEVER use compression bandaging

Question 40

SKIN ULCERS Management?

Answer 40

1) prevent smoking, adequate nutrition, good nursing care | 2) Compression bandaging if ABPI okay don't cut off blood supply! this is a cause

Question 41

CELLULITIS What is it

Answer 41

- spreading infection involving deep subcutaneous layer

Question 42

CELLULITIS Causes

Answer 42

Group A strep / s pyogens/ s aureus

Question 43

CELLULITIS Lower limb risks?

Answer 43

- lymphoedema - ulcer - trauma - athletes foot

Question 44

CELLULITIS Features

Answer 44

- Erythema, poorly marked margins, warmth, swell, tender, maybe a fever

Question 45

CELLULITIS Ix?

Answer 45

- FBC - Cultures - swab at rash/ point of entry

Question 46

CELLULITIS Treatment?

Answer 46

- Phenoxymethylpenicillin/ Flucloxacillin (erythromycin if allergic)

Question 47

NECROTIZING FASCIITIS What is it?

Answer 47

Rapid deep fascia infection = necrosis of subcutaneous tissue

Question 48

NECROTIZING FASCIITIS Features?

Answer 48

- pain - erythema - systemic toxicity

Question 49

NECROTIZING FASCIITIS Treat?

Answer 49

-benzylpenicillin and surgical debridement