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Assorted skin conditions 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
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)
26
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
27
What can cause blisters on the skin?
``` Insect bites Herpes simplex, zoster Impetigo Acute contact dermatitis Burns Pompholyx ``` Rarer: - Bullous pemphigoid - Pemphigus vulgaris
28
What is pompholyx?
Vesicular eczema of hands and feet
29
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
30
Presentation of bullous pemphigoid? Describe the rash.
Tense, fluid filled blisters Erythematous skin Itchy, often preceded by non-specific itchy rash Trunk and limbs
31
Management of bullous pemphigoid?
Basic: - Dress wounds - Monitor for infection Topical: - Steroids Oral: - Steroids - Antibiotics (tetracycline) - Immunosuppressants (methotrexate)
32
Complications of psoriasis?
Erythroderma | Psychological
33
What is pemphigus vulgaris? Who gets it? Pathophysiology?
Blistering skin disorder Middle aged Auto-antibodies attacking antigens within the epidermis, causing INTRA-epidermal splitting
34
Presentation of pemphigus vulgaris?
Flaccid blisters Easily ruptured so lead to erosions and crusts Painful lesions Often mucosal areas
35
Management of pemphigus vulgaris?
Basics: - Wound dressing - Monitor for infection - Good oral care if affecting mouth Oral: - Steroids - Immunosupressive (methotrexate)
36
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
37
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
38
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
39
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
40
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)
41
What is a callus?
A hyperkeratotic lesion
42
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
43
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
44
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
45
What is scabies? | How is it transmitted?
Infestation of a skin mite It burrows into the skin causing severe itching Skin-skin contact
46
Presentation of scabies?
Itching, worse at night Sides of fingers, finger webs, wrists, elbows, ankles, genitals Visible linear burrows
47
Investigations and management of scabies?
Skin scrape, extraction of mite Scabicide: permethrin Anti-histamines Boil wash of bedding, towels, everything
48
What is lichen planus?
Inflammatory disorder of skin and mucous membranes
49
Presentation of lichen planus?
Lilac, flat topped papules Symmetrical distribution Forearms, wrists, legs Nail changes and hair loss Lacy white streaks on oral mucosa
50
Investigations and management of lichen planus?
Skin biopsy Corticosteroids Anti-histamines
51
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
52
If you see a patient with purpuric rash what is the differential diagnosis?
Meningococcal sepsis DIC Vasculitis: Henoch-Shoenlein Purpura Senile purpura
53
What is senile purpura?
Benign condition | Formation of purpura, echymoses in sun-damaged skin of elderly
54
Presentation of senile purpura? Investigation and management?
Purpura and ecchymosis Non-palpable Atrophic, thin skin Extensor surfaces of hands and forearms None needed
55
Is a positive rheumatoid factor result a definite diagnosis of RA?
No Only 70% sensitive
56
Difference between rheumatoid arthritis and psoriatic arthritis?
Rheumatoid: no DIP involvement, symmetrical Psoriatic: DIP involement, dactylitis, pencil in cup deformity, skin lesions, nail changes
57
Management of erythema nodosa?
NSAIDs Cold compress Elevate Rest

Dermatology & Haematology (8 decks)

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