224 Dermatology Flashcards by Jess Godfrey

Define macule

Flat localised area of colour/texture change

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Define papule

Elevation of skin

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Define nodule

Elevation of skin >5mm

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Define bulla

Blister within or below epidermis >5mm

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Define vesicle

Small blister

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Define pustule

Collection of pus within the epidermis/dermis

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Define cyst

Nodule of clear fluid/semi-solid material with an epithelial-lined cavity

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Define wheal

Compressible papule/plaque of dermal oedema. Usually signifies urticaria

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Define plaque

Palpable, plateau-like elevation of skin usually >2cm

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Define scale

Accumulation of thickened horn layer kertin - detatchable fragments e.g. in psoriasis

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Define ulcer

Skin loss extending to dermis due to impeded vascular supply

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When does eczema usually present?

In infants 4-6 months old

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What is the main R/F for an infant developing eczema?

1st degree relative with atopic disease

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Which bacteria can sometimes cause a secondary infection in atopic eczema?

Staph aureus

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How is eczema diagnosed?

Hx of itchy skin + 3 of the following: Involvement of skin creases/flexures Hx of asthma/hayfever FH in 1st degree relative (in infant) Dry skin in the past year Onset

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What is the treatment for mild atopic eczema?

Emoliants and mildly potent corticosteroids

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What is the treatment for moderate atopic eczema?

Emoliants + moderately potent corticosteroids +/- topical calcineurin inhibitors +/- bandages

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What is the treatment for severe atopic eczema?

Emoliants + potent corticosteroids +/- topical calcineurin inhibitors +/- bandages +/- phototherapy +/- systemic therapy

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What immunosuppressants are used to systemically treat atopic eczema?

Ciclosporin Azothioprine

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Name the topical corticosteroids used to treat atopic eczema in order of potency

Hydrocortisone 1% Eumovate 0.05% Betnovate Dermovate 0.05%

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Name 3 S/E of topical corticosteroids? (5 listed)

Skin thinning Hirsuitism Rebound flares Peri-oral dermatitis Systemic effects if area very large

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What are elidel cream and protopic ointment examples of?

Topical immunodilator - decrease T cell activation

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Name 2 complications of eczema

Eczema herpeticum Molluscum contagiosum

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What is the incubation period of varicella?

2 weeks

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In which viral infection are Koplic spots found?

Measles

Which parvovirus causes 5th disease?

B19

What physical signs can be seen in 5th disease?

Slapped cheeks + lacey rash

Which virus causes hand foot and mouth in children?

Coxackie A

What is permethrin used to treat?

Scabies

What can be added to permethrin to treat the symptoms of scabies?

Antihistamine to treat pruritis

What are benzoyl peroxide, topical retinoids and topical abx used to treat?

Acne vulgaris

What are the systemic treatments for acne?

PO abx e.g. tetracyclines/erythromycin OCP Isotretinoin

What should patients with acne vulgaris be advised when being treated with isotretinoin?

To use contraceptive methods as teratogenic (females)

In which group of patients is asteatotic eczema usually found?

Elderly

Which yeast is found in seborrhoeic eczema?

Melassezia furfur

Which antifungal is used to treat seborrhoeic eczema?

Ketoconazole

Which cytokines do keratinocytes express in eczema?

IL-1 IL-6 IL-8

Where is ICAM-1 expressed in eczema?

Endothelium

Which investigations can be performed to diagnose eczema?

IgE RAST Patch testing

What is rosacea?

Chronic inflammatory facial dematosis

Which topical antibiotic is used to treat rocacea?

Metronidazole

What can rosacea lead to?

Rhinophyma

Which abx are used to systemically treat rosacea?

Tetracyclines e.g. doxycycline

What is hidradenitis suppuritiva?

Acne inversa - recurrent boil-like lumps in apocrine sweat gland bearing skin e.g. axillae/groin. Can cause painful abscesses and scarring

What is lichen planus?

Itchy papular dematosis which affect wrists, palms, ankles, soles of feet and mucous membranes occasionally

What is this and how is it treated?

Erythroderma = derm emergency. Treat underlying cause e.g. atopic eczema, psoriasis etc + steroids and emmollients + supportive care - fluid loss

What emergency can be associated with this?

(Urticaria + angioedema) - associated with anaphylaxis.

What is the cause of urticaria?

Widespread mast cell degranulation due to Type 1 hypersensitivity reaction

What is the usual cause of this type IV sensitivity reaction?

Drug induced toxic epidermal necrosis/SJS

What is the cause of this?

Stevens Johnson syndrome/TEN caused by drug reaction

What is this?

Erythroderma multiforme - hypersensitivity reaction caused by HSV infection. Target/iris lesions

What is this and how is it treated initially?

Necrotising fasciitis = infection spreading along fascial planes Tx = urgent surgical debridement

What disease is this?

Epidermolysis bullosa - inherited blistering skin condition where there is skin shedding due to trauma (delicate) and blistering sub-epidermally

What is this and what is the treatment?

Bullous pemphigoid - either topical/Po steroids or immunosuppression eg MTX, azathioprine, mycophenolate mofetil)

What is the cause of bullous pemphigoid?

IgG and T-lymphocytes attacking components of the BM, particularly BP1280 (BP antigen)

What is this and what is the cause?

Pemphigus vulgaris - autoimmune disease with blistering and erosions on skin and mucous membranes. IgG binds to desmoglein 3 on desmosome

Which bacteria causes impetigo, scalded skin syndrome and cellulitis (occasionally)?

Staph A

What is the cause of staphylococcal scalded skin syndrome?

Exfoliative exotoxins released from toxigenic strains of the bacteria - attacks the desmosomes

What is bactroban (mupirocin) used to treat?

Staph skin infecion e.g. MRSA

Which bacteria can cause toxic shock syndrome and what is the mechanism?

Staph aureus or Strep pyogenes. Super antigen toxin causing polyclonal T cell activation

What is this and which bacteria normally causes?

Ecthyma - skin infection characterised by crusted sored beneath which ulcers form - deep form of impetigo. Normally caused by Strep pyogenes and/or Staph aureus

Define furuncle

Small abscess formed by infection or \>1 hair follicle i.e. boil

Define carbuncle

Multiple heads of a boil, with abscess caused usually by Staph A

What is erysipelas?

Superficial form of cellulitis (infection of dermis and subcut tissue) usually on face. Has a well demartated, raised border

Which bacteria can cause cellulitis in the young?

Haemophilus influenzae

Where do corenbacterium usually cause infection?

Moist areas of skin

Name 2 corenbacterium infections

Erythrasma Pitted keratolysis

What is erythrasma?

Hyperpigmented macular patches caused by corenbacterium infection which is well demarcated and lichenified. Thickening of stratum corneum can be seen,

What is this and whats the cause? Tx?

Pitted keratolysis - corenbacterium infection. Tx = fusidic acid / metronidazole +/- antifungals

What is this and which spirochete causes it?

Chancre (painless non-bleeding ulcer at the site of initial infection) - caused by syphilis

What is the treatment of syphilis?

Penicillin

How many months following chancre formation does the secondary rash happen in syph?

2-4 months

What does borellia burgdoferi cause?

Lyme disease caused by tick bite - affects any part of the body. Growing bullseye with central clearance (erythema migrans) seen on skin.

What is the treatment of Lyme disease?

Penicillin / Doxycyclin

What is this and what is the cause?

Lupus vulgaris - persistent and progressive form of cutaneous TB. Small sharply defined reddish-brown lesions with gelatinous consistency. Lesions can persist for years and can lead to skin Ca

Which organism causes this? Tx?

Mycobacterium marinum Minocyclin

What type of rash is seen in candidiasis?

Vesiculo-pustular rash

What are the treatments for oral candidiasis?

Amphotericin / nystatin

What is the treatment for cutaneous candidiasis?

Clotrimazole

What is the systemic treatment for candidiasis? (3 listed)

Voriconazole / caspofungin / flucytosine + amphotericin

Which yeast causes Pityriasis versicans?

Malassezia furfur

What is the microscopic appearance of Pityriasis versicans?

Spaghetti and meatballs

What type of fungus causes tinea corporis etc?

Dermatophyte - hyphal fungi

What is the treatment for tinea corporis?

Clotrimazole

What should be used to treat tinea unguium?

Systemic antifungals eg. terbenafine / itraconazole

What does paramyxoviridae cause?

Measles

Does measles virus have DNA or RNA?

-ve ss RNA

Which DNA virus causes Kaposi's sarcoma?

HSV8

Which antiviral is used to treat HSV infections?

Aciclovir

Which HPV causes the common wart?

HPV-2

Which HPV infections are associated with CIN?

16 and 18

Which HPV is sometimes treated with trichloracetic acid?

Genital warts i.e. HPV 1, 6, 16, 18

What in headlice infestation causes pruritis?

Saliva

Name 2 types of pre malignant skin lesions

Bowen's disease Actinic keratoses

What percentage of Bowen disease progresses into invasive SCC?

What is this?

Actinic keratosis

What is this?

Intraepidermal SCC (Bowen disease)

Where are 80% of BCCs found?

Face and neck

Which mutation can cause SCC?

TP53

What is 5 flurouracil cream used to treat?

Skin ca - SCC and BCC

What are the surgical margins for excising a melanoma?

~ 3 cm

What is the 5year survival rate for a melanoma \>3.5mm?

37%

Name 2 R/F for developing melanoma

Family history \>50 ordinary naevi

What does Breslow thickness measure?

Invasive melanomas. Measures the vertical thickness in mm from the top of the granular layer to the deepest point of tumour involvement. Strong predictor of outcome.

What is Clark level of invasion?

Measures the anatomic plane of invasion i.e. related to the layers of skin: ## Footnote 1. In situ melanoma 2. Melanoma has invaded papillary dermis 3. Melonoma has filled papullary dermis 4. Melanoma has invaded reticular dermis 5. Melanoma has invaded subcut tissue

What is the treatment fot superficial spreading melanoma?

Surgical excision

What are vemurefenib and dabrafenib used to treat?

Immune therapy for melanoma