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Dermatology & Haematology > Assorted skin conditions > Flashcards

Assorted skin conditions Flashcards

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Dermatology Board Prep flashcards
1
Q

What age group is usually affected by atopic eczema?

A

Early childhood

Resolves during teen years but not always

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2
Q

Pathophysiology of atopic eczema?

A

Genetic predisposition
Causing defect in skin barrier function, specifically loss of function of the protein filaggrin. This makes the skin prone to inflammation.

Atopy (allergic rhinitis, asthma, eczema)

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3
Q

What are some exacerbating factors of eczema?

A

Chemicals
Food
Dust
Pet hair

Sweating
Heat
Stress

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4
Q

Presentation of eczema. Describe the rash? Where does it affect?

A

Papules and vesicles on an erythematous base

Itchy, erythematous, dry, scaly patches
Acute lesions may be vesicular and weepy

There may be excoriations and lichenification

May have nail pitting and ridging

More commonly on face and extensor aspects in limbs
Flexor aspects in children and adults

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5
Q

Management of atopic eczema?

A

Basic:

  • Avoid exacerbating agents
  • Use emollients and bath/shower substitutes

Topical:

  • Steroids for flare ups
  • Immunomodulatory

Oral:

  • Anti-histamines
  • Anti-microbials if 2ndary infection (fluclox, aciclovir)
  • Immunosuppressants (prednisolone, ciclosporin)

Phototherapy

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6
Q

What are the complications of eczema?

A

Secondary bacterial infection

Secondary viral infection:

  • Molluscum contagiousum
  • Eczema herpeticum

Erythroderma

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7
Q

What is acne? What’s the full name?

A

Inflammatory disease of the pilosebaceous follicle

Acne vulgaris

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8
Q

Who is affected by acne?

A

Teenagers 13-18

Over 80% of teenagers are affected

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9
Q

What is the pathophysiology of acne?

A

Inflammation of pilosebaceous follicle

Increased sebum production
Abnormal follicular keratinisation
Bacterial colonisation (P. acnes)

This all causes inflammation

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10
Q

Which bug is involved in acne?

A

Propionibacterium acnes

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11
Q

What skin lesions are seen in acne?

A 
Comedones (open and closed)
Papules
Pustules
Nodules
Cysts
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12
Q

Presentation of acne?

A

Lesions on face, chest, upper back

Open and closed comedones
Papules, pustules, nodules, cysts
Erythema
Soreness

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13
Q

What are comedones?

A

Plug in sebaceous follicle containing altered sebum, bacteria and cellular debris.

Open = blackheads
Closed = whiteheads
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14
Q

Management of acne?

A

Basic:
- Face washing

Topical:

  • Benzoyl peroxide
  • Antibiotics
  • Retinoids

Oral:

  • Antibiotics
  • Anti-androgens
  • Retinoids (isotretinoin)
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15
Q

Complications of acne?

A

Post-inflammatory hyperpigmentation
Scarring
Deformity
Psychological effects

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16
Q

Pathophysiology of psoriasis?

A

Chronic inflammatory condition

Interaction between genetic, immunological and environmental

Hyperproliferation of keratinocytes and inflammatory cell infiltration

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17
Q

Types of psoriasis? Briefly describe each.

A

Chronic plaque: most common

Guttate: raindrop lesions

Flexural: in skin folds

Pustular: pustules

Erythrodermic: all over redness

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18
Q

What % of population have psoriasis?

A

2%

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19
Q

What can precipitate a psoriasis flare up?

A

Trauma: Koebner’s phenomenon

Infection (tonsillitis)

Drugs
Stress
Alcohol

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20
Q

What is the course of eczema, psoriasis and acne?

A

Relapsing-remitting

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21
Q

Presentation of psoriasis?

Describe the rash?

A

Well demarcated erythematous scaly plaques

Lesions can be itchy, burny, painful

Common on extensor surfaces (elbows, knees) and scalp

Nail changes in 50%
Arthropathy in 8%

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22
Q

What is the scale made of in psoriasis?

A

Flakes of stratum corneum

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23
Q

What is Auspitz sign?

A

Scratching and gently removing scales causes capillary bleeding

24
Q

What nail changes to psoriasis patients suffer with?

A

Onycholisis

Pitting

25
Q

What arthropathy do psoriasis patients get? How does it present?

A

Psoriatic arthritis

Poly or Oligoarthritis
Distal interphalangeal disease
Spondylosis
Arthritis mutilans (deformity of distal interphalangeal joint, telescoping)

26
Q

Management of psoriasis?

A

Basic:

  • Avoid precipitators
  • Emollients

Topical:

  • Vitamin D analogues
  • Corticosteroids
  • Coal tar
  • Keratinolytics
  • Scalp preparations

Phototherapy:

  • UVB
  • PUVA (psoralen + UVA)

Oral:

  • Methotrexate
  • Retinoids
  • Ciclosporin
27
Q

What can cause blisters on the skin?

A 
Insect bites
Herpes simplex, zoster
Impetigo
Acute contact dermatitis
Burns
Pompholyx

Rarer:

  • Bullous pemphigoid
  • Pemphigus vulgaris
28
Q

What is pompholyx?

A

Vesicular eczema of hands and feet

29
Q

What is bullous pemphigoid?
Who gets it?
Pathophysiology?

A

A blistering skin disorder
The elderly
Auto-antibodies against antigens between epidermis and dermis, causing SUB-epidermal splitting

30
Q

Presentation of bullous pemphigoid? Describe the rash.

A

Tense, fluid filled blisters
Erythematous skin

Itchy, often preceded by non-specific itchy rash

Trunk and limbs

31
Q

Management of bullous pemphigoid?

A

Basic:

  • Dress wounds
  • Monitor for infection

Topical:
- Steroids

Oral:

  • Steroids
  • Antibiotics (tetracycline)
  • Immunosuppressants (methotrexate)
32
Q

Complications of psoriasis?

A

Erythroderma

Psychological

33
Q

What is pemphigus vulgaris?
Who gets it?
Pathophysiology?

A

Blistering skin disorder
Middle aged
Auto-antibodies attacking antigens within the epidermis, causing INTRA-epidermal splitting

34
Q

Presentation of pemphigus vulgaris?

A

Flaccid blisters
Easily ruptured so lead to erosions and crusts
Painful lesions

Often mucosal areas

35
Q

Management of pemphigus vulgaris?

A

Basics:

  • Wound dressing
  • Monitor for infection
  • Good oral care if affecting mouth

Oral:

  • Steroids
  • Immunosupressive (methotrexate)
36
Q

An 85 year old woman presents with blistery rash. It’s on her legs and stomach. The blisters are tense and very itchy.

What could it be?

A

Bullous pemphigoid

37
Q

A 45 year old woman presents with blistery rash. It’s on her legs and in her mouth. Many of the blisters have ruptured and have left erosions and crust.

What could it be?

A

Pemphigus vulgaris

38
Q

What are the differences between bullous pemphigoid and pemphigus vulgaris?

A

BP:

  • Elderly
  • Not usually mucosa
  • Tense blisters
  • Itchy

PV:

  • Middle age
  • Mucosa commonly involved
  • Flaccid, breakable blisters
  • Sore
39
Q

What are the 3 types of leg ulcer? What causes each?

A

Venous: venous disease such as varicose veins, DVT, chronic venous insufficiency

Arterial: arterial disease like atherosclerosis

Neuropathic: neurological disease, diabetes

40
Q

What info helps to differentiate between each type of leg ulcer?

PMH
Location of ulcer
Features of ulcer

A

V:

  • History of venous disease
  • Painful, esp on standing
  • Commonly medial malleolus
  • Large, shallow, irregular
  • Exudating and granulating

A:

  • History of arterial disease
  • Painful at night, worse when legs elevated
  • Pressure and trauma sites
  • Small, deep, punched out
  • Necrotic base

N:

  • History of neuro disease or diabetes
  • Painless + paraesthesia
  • Pressure sites: soles, heels, toes
  • Granulating
  • Surrounded by or underneath a callus (hyperkeratotic lesion)
41
Q

What is a callus?

A

A hyperkeratotic lesion

42
Q

What associated features are seen with each type of leg ulcer?

Skin temperature
Pulses
Skin condition

A

V:

  • Warm skin
  • Normal pulses
  • Oedema
  • Melanin deposition

A:

  • Cold skin
  • Weak or absent pulses
  • Shiny, pale, hairless skin

N:

  • Warm skin
  • Normal pulses
  • Neuropathy
43
Q

What investigation can you do to differentiate between each type of leg ulcer?

A

Ankle / brachial pressure index

Venous and neuropathic: ABPI normal

Arterial: ABPI lower than 0.8, which indicates weaker BP in ankle than arm, so there’s arterial insufficiency

44
Q

Management of each type of leg ulcer?

A

V: compression bandaging to force blood back up (ensure no degree of arterial insufficiency)

A: Vascular reconstruction, NOT compression bandaging, drug: naftidrofuryl oxalate

N: wound debridement, good footwear, checking feet, better diabetes control

45
Q

What is scabies?

How is it transmitted?

A

Infestation of a skin mite
It burrows into the skin causing severe itching

Skin-skin contact

46
Q

Presentation of scabies?

A

Itching, worse at night

Sides of fingers, finger webs, wrists, elbows, ankles, genitals

Visible linear burrows

47
Q

Investigations and management of scabies?

A

Skin scrape, extraction of mite

Scabicide: permethrin
Anti-histamines
Boil wash of bedding, towels, everything

48
Q

What is lichen planus?

A

Inflammatory disorder of skin and mucous membranes

49
Q

Presentation of lichen planus?

A

Lilac, flat topped papules
Symmetrical distribution
Forearms, wrists, legs

Nail changes and hair loss

Lacy white streaks on oral mucosa

50
Q

Investigations and management of lichen planus?

A

Skin biopsy

Corticosteroids
Anti-histamines

51
Q

What is lichen sclerosus?
Presentation?
Complications?

A

Inflammatory condition of skin around genitals and anus

Itching, excoriation and fissuring

White, thickened skin

Small (5%) chance of developing vulval cancer

52
Q

If you see a patient with purpuric rash what is the differential diagnosis?

A

Meningococcal sepsis

DIC

Vasculitis: Henoch-Shoenlein Purpura

Senile purpura

53
Q

What is senile purpura?

A

Benign condition

Formation of purpura, echymoses in sun-damaged skin of elderly

54
Q

Presentation of senile purpura?

Investigation and management?

A

Purpura and ecchymosis
Non-palpable
Atrophic, thin skin

Extensor surfaces of hands and forearms

None needed

55
Q

Is a positive rheumatoid factor result a definite diagnosis of RA?

A

No

Only 70% sensitive

56
Q

Difference between rheumatoid arthritis and psoriatic arthritis?

A

Rheumatoid: no DIP involvement, symmetrical

Psoriatic: DIP involement, dactylitis, pencil in cup deformity, skin lesions, nail changes

57
Q

Management of erythema nodosa?

A

NSAIDs
Cold compress
Elevate
Rest

Dermatology & Haematology (8 decks)

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