Assorted skin conditions Flashcards
What age group is usually affected by atopic eczema?
Early childhood
Resolves during teen years but not always
Pathophysiology of atopic eczema?
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)
What are some exacerbating factors of eczema?
Chemicals
Food
Dust
Pet hair
Sweating
Heat
Stress
Presentation of eczema. Describe the rash? Where does it affect?
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
Management of atopic eczema?
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
What are the complications of eczema?
Secondary bacterial infection
Secondary viral infection:
- Molluscum contagiousum
- Eczema herpeticum
Erythroderma
What is acne? What’s the full name?
Inflammatory disease of the pilosebaceous follicle
Acne vulgaris
Who is affected by acne?
Teenagers 13-18
Over 80% of teenagers are affected
What is the pathophysiology of acne?
Inflammation of pilosebaceous follicle
Increased sebum production
Abnormal follicular keratinisation
Bacterial colonisation (P. acnes)
This all causes inflammation
Which bug is involved in acne?
Propionibacterium acnes
What skin lesions are seen in acne?
Comedones (open and closed) Papules Pustules Nodules Cysts
Presentation of acne?
Lesions on face, chest, upper back
Open and closed comedones
Papules, pustules, nodules, cysts
Erythema
Soreness
What are comedones?
Plug in sebaceous follicle containing altered sebum, bacteria and cellular debris.
Open = blackheads Closed = whiteheads
Management of acne?
Basic:
- Face washing
Topical:
- Benzoyl peroxide
- Antibiotics
- Retinoids
Oral:
- Antibiotics
- Anti-androgens
- Retinoids (isotretinoin)
Complications of acne?
Post-inflammatory hyperpigmentation
Scarring
Deformity
Psychological effects
Pathophysiology of psoriasis?
Chronic inflammatory condition
Interaction between genetic, immunological and environmental
Hyperproliferation of keratinocytes and inflammatory cell infiltration
Types of psoriasis? Briefly describe each.
Chronic plaque: most common
Guttate: raindrop lesions
Flexural: in skin folds
Pustular: pustules
Erythrodermic: all over redness
What % of population have psoriasis?
2%
What can precipitate a psoriasis flare up?
Trauma: Koebner’s phenomenon
Infection (tonsillitis)
Drugs
Stress
Alcohol
What is the course of eczema, psoriasis and acne?
Relapsing-remitting
Presentation of psoriasis?
Describe the rash?
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%
What is the scale made of in psoriasis?
Flakes of stratum corneum
What is Auspitz sign?
Scratching and gently removing scales causes capillary bleeding
What nail changes to psoriasis patients suffer with?
Onycholisis
Pitting
What arthropathy do psoriasis patients get? How does it present?
Psoriatic arthritis
Poly or Oligoarthritis
Distal interphalangeal disease
Spondylosis
Arthritis mutilans (deformity of distal interphalangeal joint, telescoping)
Management of psoriasis?
Basic:
- Avoid precipitators
- Emollients
Topical:
- Vitamin D analogues
- Corticosteroids
- Coal tar
- Keratinolytics
- Scalp preparations
Phototherapy:
- UVB
- PUVA (psoralen + UVA)
Oral:
- Methotrexate
- Retinoids
- Ciclosporin
What can cause blisters on the skin?
Insect bites Herpes simplex, zoster Impetigo Acute contact dermatitis Burns Pompholyx
Rarer:
- Bullous pemphigoid
- Pemphigus vulgaris
What is pompholyx?
Vesicular eczema of hands and feet
What is bullous pemphigoid?
Who gets it?
Pathophysiology?
A blistering skin disorder
The elderly
Auto-antibodies against antigens between epidermis and dermis, causing SUB-epidermal splitting
Presentation of bullous pemphigoid? Describe the rash.
Tense, fluid filled blisters
Erythematous skin
Itchy, often preceded by non-specific itchy rash
Trunk and limbs
Management of bullous pemphigoid?
Basic:
- Dress wounds
- Monitor for infection
Topical:
- Steroids
Oral:
- Steroids
- Antibiotics (tetracycline)
- Immunosuppressants (methotrexate)
Complications of psoriasis?
Erythroderma
Psychological
What is pemphigus vulgaris?
Who gets it?
Pathophysiology?
Blistering skin disorder
Middle aged
Auto-antibodies attacking antigens within the epidermis, causing INTRA-epidermal splitting
Presentation of pemphigus vulgaris?
Flaccid blisters
Easily ruptured so lead to erosions and crusts
Painful lesions
Often mucosal areas
Management of pemphigus vulgaris?
Basics:
- Wound dressing
- Monitor for infection
- Good oral care if affecting mouth
Oral:
- Steroids
- Immunosupressive (methotrexate)
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?
Bullous pemphigoid
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?
Pemphigus vulgaris
What are the differences between bullous pemphigoid and pemphigus vulgaris?
BP:
- Elderly
- Not usually mucosa
- Tense blisters
- Itchy
PV:
- Middle age
- Mucosa commonly involved
- Flaccid, breakable blisters
- Sore
What are the 3 types of leg ulcer? What causes each?
Venous: venous disease such as varicose veins, DVT, chronic venous insufficiency
Arterial: arterial disease like atherosclerosis
Neuropathic: neurological disease, diabetes
What info helps to differentiate between each type of leg ulcer?
PMH
Location of ulcer
Features of ulcer
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)
What is a callus?
A hyperkeratotic lesion
What associated features are seen with each type of leg ulcer?
Skin temperature
Pulses
Skin condition
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
What investigation can you do to differentiate between each type of leg ulcer?
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
Management of each type of leg ulcer?
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
What is scabies?
How is it transmitted?
Infestation of a skin mite
It burrows into the skin causing severe itching
Skin-skin contact
Presentation of scabies?
Itching, worse at night
Sides of fingers, finger webs, wrists, elbows, ankles, genitals
Visible linear burrows
Investigations and management of scabies?
Skin scrape, extraction of mite
Scabicide: permethrin
Anti-histamines
Boil wash of bedding, towels, everything
What is lichen planus?
Inflammatory disorder of skin and mucous membranes
Presentation of lichen planus?
Lilac, flat topped papules
Symmetrical distribution
Forearms, wrists, legs
Nail changes and hair loss
Lacy white streaks on oral mucosa
Investigations and management of lichen planus?
Skin biopsy
Corticosteroids
Anti-histamines
What is lichen sclerosus?
Presentation?
Complications?
Inflammatory condition of skin around genitals and anus
Itching, excoriation and fissuring
White, thickened skin
Small (5%) chance of developing vulval cancer
If you see a patient with purpuric rash what is the differential diagnosis?
Meningococcal sepsis
DIC
Vasculitis: Henoch-Shoenlein Purpura
Senile purpura
What is senile purpura?
Benign condition
Formation of purpura, echymoses in sun-damaged skin of elderly
Presentation of senile purpura?
Investigation and management?
Purpura and ecchymosis
Non-palpable
Atrophic, thin skin
Extensor surfaces of hands and forearms
None needed
Is a positive rheumatoid factor result a definite diagnosis of RA?
No
Only 70% sensitive
Difference between rheumatoid arthritis and psoriatic arthritis?
Rheumatoid: no DIP involvement, symmetrical
Psoriatic: DIP involement, dactylitis, pencil in cup deformity, skin lesions, nail changes
Management of erythema nodosa?
NSAIDs
Cold compress
Elevate
Rest
