Year 4 Passmedicine > Dermatology > Flashcards

Dermatology Flashcards

(227 cards)

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1
Q

Describe acanthosis nigricans

A

symmetrical, brown, velvety plaques

found on neck, axilla and groin

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2
Q

Causes of acanthosis nigricans

A 
T2DM
GI cancer 
obesity 
PCOS
acromegaly 
cushings disease 
hypothyroidism 
familial 
prader-willi 
COCP, nicotinic acid
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3
Q

Pathophysiology of acanthosis nigricans

A

insulin resistance
hyperinsulinaemia
stimulation of keratinocytes and dermal fibroblast proliferation via interaction with IGF-1

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4
Q

Features of acne rosacea

A 
nose, cheeks and forehead
flushing and telangiectasia
erythema, papules and pustules
rhinophymoma
blepharitis
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5
Q

first symptom of acne rosacea

A

flushing

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6
Q

what can exacerbate acne rosacea?

A

sunlight

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7
Q

management of acne rosacea

A

topical metrondiazole
topical brimonidine - flushing, no telangiectasia
oral tetracycline - severe
sunscreen, laser therapy

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8
Q

What is acne vulgaris?

A

face, neck an upper back
obstruction of pilosebaceous follicle with keratin plug
comedones, inflammation and pustules
activity controlled by androgen

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9
Q

acne vulgaris epidemiology

A

80-90% teenagers

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10
Q

acne vulgaris bacteria

A

P acnes

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11
Q

open vs closed comedones

A 
open = blackhead 
closed = whitehead
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12
Q

acne vulgaris scarring

A

ice pick and hypertrophic

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13
Q

drug induced acne

A

monomorphic - pustules with steroid use

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14
Q

acne fulminans

A

very severe acne and fever

oral steroids treatment

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15
Q

treating acne vulgaris

A 
topical benzyl peroxide
topical retinoid 
topical antibiotic 
oral tetracycline 
COCP - dianette
roaccutane
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16
Q

tetracycline caution

A

not used in pregnancy
instead use erythromycin
do not co-prescribe topical and oral antibiotics

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17
Q

Gram -ve folliculitis acne vulgaris

A

complication of long-term antibiotic use

high dose oral trimethoprim

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18
Q

isotretinoin side effects

A

dry skin, photosensitivity
teratogenic, depression, raised triglycerides
hair thinning, intracranial hypertension

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19
Q

actinic keratoses are a precursor of what?

A

SCC

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20
Q

actinic keratoses

A

small, crusty lesions
pink, brown or red
temples of head

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21
Q

management of actinic keratoses

A 
sun cream and avoidance
2-3 week 5FU (+ HCT as can make it worse initially)
topical diclofenac 
topical imiquimod 
cryotherapy 
curettage and cautery
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22
Q

Alopecia areata

A

autoimmune

localised, well demarcated hair loss

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23
Q

Alopecia areata sign

A

exclamation mark hairs

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24
Q

Alopecia areata hair regrowth

A

50% in 1 year an 80-90% long-term

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25
Alopecia areata treatment
``` topical/intralesional CCS topical minoxidil phototherapy dithranol contact immunotherapy wigs ```
26
what causes athletes foot?
fungi - thrichophyton
27
features of tinea pedis
scaling, flaking and itching between toes
28
tinea pedis treatment
topical imidazole or terbinafine
29
BCC intro
slow-growth, local invasion, rare mets, most common skin cancer
30
BCC features
sun-exposed sites pearly rolled edge telangiectasia central crater/ulcer
31
BCC referral
routine
32
BCC management
surgical removal curettage, cryotherapy topical imiquimod/5FU
33
Bowens disease
precancerous dermatosis precursor to SCC SCC in situ
34
bowens disease
red, scaly patches, slow-growing, sun-exposed areas
35
treating bowens disease
topical 5FU - 2 daily for 4 wks topical steroids cryotherapy excision
36
bullous pemphigoid
autoimmune condition | sub-epidermal blistering
37
bullous pemphigoid antibodies
hemidesmosomal proteins
38
bullous pemphigoid features
elderly itchy, blisters around flexures no scarring no mucosal involvement
39
investigating bullous pemphigoid
immunofluorescence - IgG and C3
40
treating bullous pemphigoid
referral for biopsy | oral ccs, topical ccs, immunosuppressants
41
Immediate first aid - burns
ABC heat - remove source, cool water 10-30 mins cover burn with cling film layered chemical - brush off and irrigate with water
42
assessing extent of a burn
wallaces rule of nines
43
wallaces rule of nines
``` head and neck = 9% each arm = 9% each anterior leg = 9% each posterior leg = 9% anterior chest = 9% posterior chest = 9% anterior abdo = 9% posterior abdo - 9% ```
44
most accurate method for assessing burns
lund and browder chart
45
4 depths of burn
superficial epidermal partial thickness - superficial dermal partial thickness - deep derma full thickness
46
differentiating 4 depths of burns
``` 1 = red, painful 2 = pale pink, blister 3 = white, non-blanching erythema, reduced sensation 4 = white/brown/black, no blisters or pain ```
47
referring burns to secondary care
all deep dermal and full-thickness superficial >3% TBSA adults, 2% children superficial dermal burns - face, hands, feet, genitals circumferential burns inhalation, electrical, chemical NAI
48
treating superficial burns
analgesia, emollient, cleanse wound, leave blister intact, non-adherent dressing
49
Who needs IV fluids? burns
adult >15%, child >10%
50
calculating IV fluids, burn
parkland formula
51
parkland formula
volume of fluid = TBSA x weight x 4 | half of fluid in first 8 hours
52
managing more severe burns
parkland formula IV fluids urinary catheter analgesia burns unit
53
circumferential burns treatment
escharotomy | relieve compartment syndrome or improve ventilation
54
cherry haemangioma
benign skin lesions abnormal proliferation of capillaries advancing age
55
features of cherry haemangioma
erythematous, papular | 1-3mm, non-blanching
56
2 types of contact dermatitis
irritant | allergic
57
irritant contact dermatitis
common detergents, hands, erythema cement
58
allergic contact dermatitis
type 4 hypersensitivity hair dyes potent topical steroid
59
dermaititis herpetiformis
autoimmune, blistering condition coeliac disease igA deposition
60
features of dermaititis herpetiformis
itchy, vesicular | extensors
61
dermaititis herpetiformis diagnosis
skin biopsy - IgA deposition
62
dermaititis herpetiformis management
gluten free diet | dapsone
63
Eczema herpeticum cause
HSV 1 or 2
64
Eczema herpeticum who it affects
children with atopic eczema
65
Eczema herpeticum features
rapidly progressive and painful monomorphic punched out erosions 1-3mm
66
Eczema herpeticum treatment
admit for IV aciclovir
67
eczema prognostic markers severe disease
onset 3-6months severe in childhood high IgE, small family atopy
68
management of eczema
emollients topical steroids UV radiation immunosuppressants
69
topical steroid ladder
HCT eumovate betnovate dermovate
70
finger tip rule
1 FTU = 0.5g | treat area twice that of adult palm
71
how often can topical steroids be prescribed?
break of atleast 4 weeks
72
Erysipelas
localised skin infection S pyogenes superficial, limited tx = flucloxacillin
73
erythema ab igne
over exposure to infrared
74
erythema ab igne features
reticulated, erythematous patches hyperpigmentation telangiectasia
75
erythema ab igne risk
SCC
76
erythema multiforme
hypersensitivity reaction | infections - HSV
77
erythema multiforme features
target lesions back of hands/feet then torso upper limbs
78
causes of erythema multiforme
HSV | strep, mycoplasma, penicillin, NSAIDs, COCP, carbamazepine, SLE, sarcoidosis, malignancy
79
erythema multiforme major
mucosal involvement
80
erythema nodosum
inflammation of subcut fat tender, erythematoud, nodular lesions over shins resolves in 6 weeks
81
causes of erythema nodosum
``` infection = strep, TB sarcoidosis, IBD lymphoma penicillin, COCP pregnancy ```
82
erythrasma
asymptomatic, flat, slight scaly pink or brown rash | groin or axillae
83
erythrasma cause
overgrowth of diphtheroid | C. minutissimum
84
erythrasma investigation
woods light | coral red fluorescence
85
treating erythrasma
topical miconazole | oral erythromycin
86
erythroderma
>95% skin rash
87
causes of erythroderma
eczema, psoriasis gold lymphoma
88
erythrodermic psoriasis
triggered by withdrawal of systemic steroids
89
most common cause of fungal nail infection
90% dermatophyte = T rubrum | candida
90
fungal nail infection risk factor
DM and increasing age
91
fungal nail infection features
unsightly nails | thickened, rough, opaque nails
92
fungal nail infection differentials
psoriasis, repeated trauma | lichen planus
93
fungal nail infection investigation
nail clipping
94
fungal nail infection treatment
none if asymptomatic dermatophyte - oral terbinafine for 6 weeks - 3 months candida = topical amorolfine or oral itraconazole for 12wks topical = 6 months hand, 12 months toes
95
guttate psoriasis
strep infection 2-4 weeks prior
96
guttate psoriasis appearance
tear drop papules on trunk and limbs
97
managing guttate psoriasis
spontaneously resolve 2-3 months topical agents, UVB recurrent? tonsillectomy not antibiotics
98
Hereditary haemorrhagic telangiectasia
autosomal dominant | multiple telangiectasia over skin and mucous membranes
99
4 main diagnostic criteria Hereditary haemorrhagic telangiectasia
epistaxis telangiectasia - multiple visceral lesions eg GI, AVM FH
100
hidradenitis suppurativa
chronic, painful, inflammatory skin disorder | pubertal - recurrent furuncles or boils
101
hidradenitis suppurativa epidemiology
women, under 40
102
hidradenitis suppurativa risk factors
FH, smoking, obesity, PCOS, diabetes, mechanical stretching of skin
103
hidradenitis suppurativa clinical features
recurrent, painful inflammed nodules axilla, inguinal, inner thigh, perianal purulent, malodorous discharge
104
hidradenitis suppurativa scarring
plaques, sinus tracts and rope-like scars
105
hidradenitis suppurativa management
``` good hygiene and loose fitting clothes stop smoking and lose weight steroids or flucloxacillin (acute flare) topical clindamycin oral lymecycline ```
106
hidradenitis suppurativa complications
sinus tracts, fistula, comedones, scarring, contractures | lymphatic obstruction
107
hirsutism
androgen dependent hair growth in women
108
hypertrichosis
androgen independent hair growth
109
causes of hirsutism
PCOS | cushings, CAH, obesity, adrenal tumour, CCS
110
assessing hirsutism
ferriman gallwey score
111
managing hirsutism
weight loss dianette short term (VTE) topical eflornithine - facial waxing and bleaching
112
causes of hypertrichosis
ciclosporin | anorexai nervosa
113
hyperhidrosis
excessive sweating
114
treating hyperhidrosis
topical aluminium chloride ionotrophoresis botulinum toxin - axillary surgery = sympathectomy
115
side effect of topical aluminium chloride
skin irritation
116
Impetigo
superficial infection | staph aureus or s pyogenes
117
who does impetigo affect?
children, eczema/scabies warm weather face, flexures
118
impetigo incubation period
4-10 days
119
impetigo features
golden crust around mouth
120
impetigo first line treatment
topical hydrogen peroxide 1%
121
other impetigo treatments
topical fuscidic acid topical mupirocin oral flucloxacillin - severe
122
impetigo - school exclusion
48 hours after crusting of lesions or starting treatment
123
keloid scars
tumour like lesions arising from connective tissue extending beyond dimensions of original wound
124
keloid scar: predisposing factors
dark skin, young adult | sternum, shoulder, neck
125
treating keloid scars
intra-lesional steroids eg triamcinolone | excision
126
keratoacanthoma
benign epithelial tumour | elderly
127
keratoacanthoma features
volcano/crater | smooth dome then centre with keratin
128
keratoacanthoma treatment
often regress in 3 months | urgent excision to exclude SCC
129
problem with oral ketoconazole
hepatic toxicity
130
koebner phenomenon
skin lesion appear at site of injury
131
koebner phenomenon seen in
``` psoriasis vitiligo warts lichen planus and sclerosis molluscum contagiosum ```
132
leukoplakia
premalignant white, hard spots on mucous membranes smokers
133
leukoplakia diagnosis
exclusion consider candidiasis and lichen planus if it can be rubbed off biopsy - SCC
134
Lichen planus
purple, pruritic, polyglonal, papular wickhams striae oral involvement
135
Lichen planus causes
gold, quinine, thiazides
136
managing Lichen planus
potent topical steroids benzydamine mouthwash oral CCS or immunosuppression
137
Lichen sclerosus
genitalia, elderly female atrophy and white plaques itchy
138
managing lichen sclerosus
topical steroids and emollients
139
Lichen sclerosis follow up
increased risk of vulval cancer
140
lipoma
subcut tissue, 1 in 1000 | smooth, mobile, painless
141
liposarcoma
size >5cm, pain, deep location, increasing size
142
4 types of melanoma
superficial spreading nodular (aggressive) lentigo maligna acral lentingous
143
superficial spreading melanoma
70% arms, legs, back, chest young people
144
melanoma in soles and feet of people with dark skin
acral lentigous
145
melanoma diagnosis
``` major = change in size, shape or colour minor = >7mm, oozing, bleeding, altered sensation ```
146
treating melanoma
excision biopsy sentinel LN biopsy dissection of regional LN
147
melanoma prognosis
breslow thickness
148
milia
small, benign keratin filled cysts on face | newborn
149
molluscum contagiosum
MCV | children, 1-4yrs
150
molluscum contagiosum features
pink/pearly white papules central umbilication clusters on body - trunk, flexures
151
molluscum contagiosum management
``` self-limiting contagious - avoid sharing towels, clothing do not scratch piercing lesions after bath cryotherapy ```
152
when to refer molluscum contagiosum
HIV eyelid/ocular anogenital
153
mycosis fungoides
rare T cell lymphoma affecting the skin
154
mycosis fungoides features
itchy, red patches | different colours
155
nickel dermatitis
type 4 hypersensitivity jewellery skin patch test
156
pellagra
nicotinic acid (niacin) deficiency
157
pellagra features
3 Ds = dermatitis, dementia and diarrhoea
158
what can cause pellagra?
isoniazid deficiency | alcoholics
159
pemphigus vulgaris
autoimmune mucosal ulceration, skin blistering nikolskys signs steroids and immunosuppressants
160
pityriasis rosea - what is it and its cause
acute, self-limiting rash in young adults | HHV-7
161
pityriasis rosea features
recent viral infection herald patch on trunk red, oval, scaly patches fir-tree appearance
162
pityriasis rosea management
self-limiting 6-12wks
163
Pityriasis versicolor - what is it and its cause
superficial fungal infection | malassezia furfur
164
Pityriasis versicolor features
trunk hypopigmented, pink or brown scale mild pruritus
165
Pityriasis versicolor predisposing factors
healthy, immunosuppressed, malnutrition, cushings
166
Pityriasis versicolor management
topical antifungal - ketoconazole shampoo | scraping and oral itraconazole
167
polymorphic eruption of pregnancy
pruritic - 3rd trimester appear in abdominal striae spares periumbilical region emollients, topical steroids, oral steroids
168
pompholyx
type of eczema | hands and feet
169
pompholyx precipitants
humidity and high temp
170
pompholyx features
small blisters on palms and soles | pruritic
171
managing pompholyx
cool compress emollients topical steroids
172
Porphyria cutanea tarda summary
inherited defect/liver damage photosensitive rash, blistering, hypertrichosis urine and wood lamp, serum ferritin chloroquine and venesection
173
port wine stain
vascular unilateral birthmark deep red or purple laser therapy
174
5 main causes of pruritus
``` liver disease iron deficiency anaemia polycythaemia - ruddy complexion, after bath, gout CKD - lethargy, oedema, HTN lymphoma - b symptoms, LN ```
175
stigmata of chronic liver disease
liver flap, encephalopathy, jaundice, ascites, spider naevi, palmar erythema, bruising
176
types of psoriasis
plaque, flexural, guttate, pustular, nail, scalp
177
psoriasis complications
psoriasis, CVD, VTE, psychological stress
178
psoariatic arthropathy nail changes
pitting onycholysis subungual hyperkeratosis loss of nail
179
psoriasis exacerbating factors
trauma, alcohol beta blockers, lithiu,, NSAIDs, ACEI, infliximab, antimalarial withdrawal of systemic steroids strep infection - guttate
180
treating psoriasis - 1st line
regular emollients potent topical CCS and vit D analogue applied separately -1 morning and 1 evening up to 4 weeks
181
other treatments psoriasis
``` vit D analogue 2 daily potent CCS 2 daily topical tar dithranol PUVB 3 x weekly, PUVA - SCC ```
182
psoriasis systemic therapy
oral MTX ciclosporin retinoids infliximab
183
treating scalp psoriasis
potent topical CCS | salicyclic acid
184
causes of purpura
``` meningococcal septicaemia ALL HSP ITP bone marrow failure ```
185
Pyoderma gangrenosum features
lower limbs, small red papule deep, red, necrotic ulcer systemic symptoms
186
causes of Pyoderma gangrenosum
idiopathic | IBD, SLE, lymphoma, PBC
187
management of Pyoderma gangrenosum
oral steroids | ciclosporin + infliximab
188
pyogenic granuloma
bengin, raised red/brown head and neck area spherical in shape ulcerate and bleed
189
pyogenic granuloma associations
trauma pregnancy women and young adults
190
treating pyogenic granuloma
curettage and cauterisation, cryotherapy, excision
191
salmon patches
stork mark - forehead, eyelid and nape of neck | pink and blotchy
192
cause of scabies and how it spreads
sarcoptes scabei | prolinged skin contact, children
193
scabies - what is it
scabies burrows into stratum corneum and lays eggs type 4 hypersensitivity - delayed 30 days
194
features of scabies
widespread pruritus linear burrows - fingers, webs excoriation
195
managing scabies
``` 5% permethrin malathion 0.5% avoid close contact treat all household contact clean bedding, towels etc ```
196
how to apply scabies medication
apply to dry skin, leave for 8-12hrs then wash off | repeat 7 days later
197
crusted scabies
HIV - ivermectin tx
198
sebaceous cysts
epidermoid and pilar scalp, back, face - punctum excision
199
seborrhoeic dermatitis
malassezia furfur | sebum-rich area eg sclap, nasolabial folds, otitis externa
200
seborrhoiec dermatitis treatment
OTC zinc pyrithione and tar ketoconazole selenium sulphide topical ccv
201
seborrhoeic keratoses
benign, epidermal skin lesions older people, stuck on appearance reassurance
202
shingles
VZV reactivation HZV | increasing age, HIV, steroids
203
features of shingles
prodrome = burning pain dermatome, fever, headache | rash - red, vesicular, does not cross midline
204
treating shingles
``` avoid pregnant women infectious until crusted over paracetamol and NSAIDs amitriptyline oral ccs - immunosuppressed antivirals within 72 hours ```
205
shingles - prescribing antivirlals
less incidence of post hepatic neuralgia
206
ramsay hunt syndrome
herpes zoster oticus | ear lesions and facial paralysis
207
atopic eruption of pregnancy
commonest, eczema red itchy rash - no treatment
208
pemphigoid gestationalis
pruritic blistering lesions peri-umbilical, trunk, back 2nd or 3rd trimester oral CCS
209
4 skin changes with SLE
photosensitive butterfly rash discoid lupus alopecia livedo reticularis
210
renal transplant skin risk
SCC
211
types of BCC
``` nodular superficial morpheaform cystic basosquamous ```
212
fitzpatrick skin type
``` 1 = never tans, ginger, pale 2 = usually tans, always burn 3 = always tan, sometimes burn = dark hair and brown eyes 4 = always tans - olive skin 5 = sunburn and tanning - indian 6 = afro-caribbean ```
213
spider naevi vs telangiectasia
spider naevi fill from centre
214
spider naevi
blanch, upper body | liver disease, COCP, pregnant
215
SCC risks
UVA, sun, actinic keratoses | bowens disease, HIV, renal tranplant, smoking
216
SCC treatment
surgical excision | mohs micrographic surgery
217
SJS features
maculopapular rash target lesions vesicles, bullae, fever, mucosal
218
SJS causes
``` penicillin sulphonamides lamotrigine, phenytoin, carbamazepine allopurinol NSAIDs, OCP ```
219
strawberry naevus
``` 1st month of life - red, raised increase until 6 months then regress face, scalp and back 10% white toddlers - CVS obstruct vision or airway tx = topical beta blockers ```
220
tinea
ix = woods lamp, scrapings oral terbinafine oral fluconazole
221
TEN
+ve nikolskys sign, pyrexia phenytoin, penicillin, NSAIDs, stop drug, ICU, fluids, IVIG plasmapheresis
222
nikolskys sign
epidermis separates with mild lateral pressure
223
vasculitides
large = GCA, takayasu medium = polyarteritis nodosa, kawasaki small = c-ANCA (wegner), churg-strauss HSP, goodpastures (anti-GBM)
224
venous ulceration
above medial malleolus ix = ABPI compression bandage oral pentoxifylline
225
vitiligo
``` autoimmune loss of melanocytes - well demarcated peripheries koebner phenomenon 20-30yrs ```
226
vitiligo associations
T1DM addisons, pernicious anaemia autoimmune thyroid
227
management of vitiligo
sunblock topical CCS topical tacrolimus phototherapy
Year 4 Passmedicine
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