BAD booklet stuff Flashcards
What is erythema nodosum & which diseases is it associated with
Blue/red painful lesions on shins, associated with sarcoid, strep infection and sulphonamides
What is erythema multiforme & what causes it
Symmetrical target lesions on palms soles and limbs. Caused by infections (HSV, mycoplasma) and drugs (SNAPP - sulphonamides, NSAIDs, allopurinol, penicillin, phenytoin)
What is Stevens Johnson syndrome?
More severe form of EM with mucosal involvement
What is Toxic Epidermal Necrolysis and how do you treat it?
Extreme form of SJS usually from a drug reaction, extensive mucosal ulceration and epidermal loss. Increased risk in HIV, treat with dexamethasone and IVIG
What is dermatitis herpetiformis and how do you treat it?
Itchy vesicles on extensor surfaces, associated with coeliac disease. IgA deposition. treat with dapsone.
What is pyoderma gangrenosum?
Wide, deep ulceration on legs associated with IBD, RA, wegeners. Treat with high dose steroids.
What is livedo reticularis?
Persistent red/blue mottled lesions that don’t blanch, usually on legs, triggered by cold. Associated with vasculitis, antiphospholipid syndrome
5 features of malignant melanoma
Asymmetry, Border irregular, Multiple colours, Diameter >6mm, Evolving/elevated
5 risk factors for malignant melanoma
Family history, fair skin, lots of moles, sun exposure, increasing age, immunosupression
5 classifications of malignant melanoma?
Superficial spreading, lentigo melanoma maligna, acral lentiginous, nodular melanoma, amelanotic
2 staging criteria for malignant melanoma?
Breslows depth and Clarks staging
Treatment of malignant melanoma
Depending on staging - excision, +/- lymphadenectomy +/- chemotherapy
What does SCC look like?
Ulcerated lesion with hard raised everted edges, on sun exposed areas. can bleed, itch and be painful.
7 risk factors for SCC
Sun exposure, smoking, fair skin, moles, outdoor occupation, pre malignant lesions, skin trauma, asbestos, arsenic
What are actinic keratotoses?
Pre malignant, irregular, crusty warty lesions. Treat with 5-fluouracil/diclofenac/imiquimod
What is the evolution of SCC?
Actinic keratoses -> Bowens -> SCC
Treatment of SCC?
Topical 5 fluouracil or salicylic acid, cryotherapy, excision
2 risk factors for BCC
Fair skin and sun exposure
What does BCC look like?
Typically a pearly nodule with a red, raised, rolled edge, telangiectasia,
Treatment of BCC?
Topical 5-fluouracil or salicylic acid, cryotherapy, excision
What are seborrhoeic keratoses?
Crusty, pigmented, wart like benign lesions
8 risk factors for cellulitis
Diabetes, skin breaks, insect bites, chronic venous insufficiency, IVDU, immunosuppression, varicose veins, lymphedema, age, fungal infections, obesity
2 common bacterial causes of cellulitis
Group a beta haemolytic strep - pyogenes and staph aureus
Presentation of cellulitis
Typically unilateral leg, erythema (rubor) warmth (calor) pain (dolor) swelling (tumor) - quick spreading.
Treatment of cellulitis?
General - analgesia, raise legs, ?tetanus booster
Admit if systemically unwell, unstable comorbidities, sepsis, immunocompromised etc etc. Fluclox/erythromycin oral in 1ry care, IV in hospital
6 acute and 2 chronic complications of cellulitis
Acute - nec fasc, osteomyelitis, abscess, sepsis, meningitis, post strep glomerulonephritis.
Chronic - persistent ulceration, lymphedema
Pathology of psoriasis
Chronic inflammatory skin condition. Hyperproliferation of keratinocytes and T cell driven inflammatory infiltration of dermis and epidermis
5 histopathological findings in psoriasis
Parakeratosis, acanthosis, T cells in upper dermis, lengthened retes ridges, absent granular layer, munro microabscesses, capillary loop dilatation
Presentation of psoriasis
Well circumscribed erythematous plaques with silver scaling. Kobner phenomenon. Extensor surfaces, scalp. Arthropathy. Nail changes.
4 nail changes in psoriasis
Beaus lines, pitting, onycholysis, subungual hyperkeratosis
4 other types of psoriasis
Guttate - follows strep infection
Palmo-planar pustular
Flexural
Erythrodermic - emergency - rx with methotrexate
Management of psoriasis
Emollients Vit D analogues Topical corticosteroids Salicylic acid Coal tar Dithranol Retinoids UVB
Epidemiology of psoriasis
Peaks in 20s and 50s
5 pillars of acne
Basal keratinocyte proliferation in pilosebaceous follicles Increased sebum production Propionibacterium acnes colonisation Inflammation Comedones blocking secretions
Treatment pathway of acne
Mild - topical benzoyl peroxide, azelaic acid, topical clindamycin
Moderate - topical benzoyl peroxide and retinoids, doxycycline/minocycline
Severe - isotretinoin
What is bullous pemphigoid?
Autoimmune subepidermal blistering due to IgG autoantibodies BP1 and BP2
How does bullous pemphigoid present?
Acute or insidious onset, thick tense blisters on flexural surfaces, self limiting
Treatment for bullous pemphigoid
Steroids & immunosuppresants, topical if localised systemic if severe
What is pemphigus vulgaris?
Autoimmune epidermal blistering due to IgG autoantibodies - keratinocyte surfaces (desmoglien)
How does pemphigus vulgaris present?
Age 40-60, mucosal, oral lesions, flaccid blisters. Nikolsky sign - slight rubbing exfoliates outer layer of skin
Causes of erythema nodosum
Idiopathic, Drugs, OCP, Sarcoid, UC/crohns/behcets, Microbiology - EBV/strep/mycoplasma
Presentation of lichen planus
Planus - Purple Pruritic Papular Polygonal rash on flexure surfaces, Wickhams striae on surface - white lace like
