Basic Derm 1 Flashcards

Question

You are suspecting an infectious cause of your patients rash. What are the common infectious conditions of the skin?

Answer 1

An IMP in a CELL finds a TIN CAN full of tomatoes - he has a TOMATO-FIGHT with the guard who PITYs him and gives him ROSES. He says PHEW. Bacterial: Impetigo, cellulitis Fungal: Tinea, Candidiasis, Dermatophytes, Pityriasis versicolor Viral: Pityriasis rosacea, HSV/HZV, Exanthema, Warts

Answer 2

Dermatophytes are fungal organisms that require keratin for growth. They cause superficial infections of hair, skin and nails. Spread by direct contact from people, animal, soils, clothes, utensils and furniture

Answer 3

By site: hair, hair follicles, perifollicular skin, keritanized epidermal skin, nail apparatus By species: Microsporum, Trichophyton, Epidermophyton

Answer 4

Tinea cruris is a common dermatophyte infection of the groin area caused by Tinea infection Usually young men esp. athletes Transmitted by towels and objects in locker rooms, saunas ad communal showers

Answer 5

Young males Groin area (untreated spreads to inner upper thighs, butt), usually scrotum spared Acute onset itchy rash. Scaling, especially at the margin. Well-defined margin. Clothing (tight pants, nylon jock straps) Hot months Physically active people

Answer 6

Soak area in arm bath and dry ++ Topical imidazole (Miconazole or Clotrimazole) BD for 3-4 weeks on rash and 2cm beyond border Prevent recurrence: Tolnaftate dusting powder BD when almost healed Consider skin scrapings from scaly area for microscopy, Woods light to differentiate from Erythrasma

Answer 7

Tinea pedis is a dermatophyte infection of the skin of the feet It is the most common fungal infection in humans Usually caused by Trichophyton rubrum Transmitted by walking barefoot in warm damp places or direct skin contact with someone else

Answer 8

Feet (soles and inbetween toes) Acute onset Itchy (especially between toes) Contacts: barefoot exposure in warm damp places or skin of affected person Examination: White and soggy top layer of skin. Scaling, maceration and fissuring of skin between toes 3/4/5

Answer 9

Education: dry feet, remove flaky skin and improve air circulation and reduce sweating Change shoes and socks daily Antifungal cream BD/TDS for 2-3 weeks

Answer 10

Pityriasis versicolor (aka Tinea versicolor) is a mild, chronic superficial yeast infection of the skin caused by Malassezia sp. Characterised by discrete or confluent, scale, discoloured or depigmented areas, mainly on the upper trunk It is NOT a dermatophyte infection Present worldwide, but more common in tropical climates Has 2 distinct presentations (red brown/hypopigmented area)

Answer 11

Young-middle aged adult (late teens, peaks early twenties) Mainly upper trunk, may involve neck, upper arms, face and groin Patches may coalesce Recurrent, especially in summer Mild irritation sometimes - sometimes itchy 2 distinct presentations: - Reddish brown, slightly scaly patches on upper trunk - Hypopigmented area that won't tan, especially in suntanned skin On examination: Brown on pale skin or white on tanned skin

Answer 12

First line treatment is topical antifungal therapy 1st line: Topical azoles BD for 2-3 weeks or Terbinafine cream 1% BD for 2-3 weeks or Ketoconazole shampoo twice weekly for 2-3 weeks or Selsun (25% selenium shampoo) 2nd daily for 2-3 weeks

Answer 13

Candidiasis is a fungal (yeast) infection due to any type of candida Most commonly it is a superficial infection of the skin and mucous membranes, but can also cause systemic disease

Answer 14

Rash in skin folds or where occlusion from clothing/dressings causes abnormally moist conditions Areas close to body orifices, fingers

Answer 15

Oral candidiasis: Mouthwash, topical antifungal | Skin: Careful drying of affected areas, topical antifungal

Answer 16

``` Candidiasis intertrigo (aka flexural candidiasis) is a superinfection of simple intertrigo with Candida albicans. It tends to affect obese or bedridden patients, especially if incontinent ```

Answer 17

Affects men and women equally Erythematous scale rash in the groin (margins are less well defined than Tinea) Satellite lesions

Answer 18

Treat underlying problem Imadazole (miconazole, clotrimazole) until 2 weeks after symptoms resolve Burow's solution 1:40 compresses to dry weeping area Short term hydrocortisone cream for itch or inflammation

Answer 19

Atopy is a hereditary or tendency to develop a group of conditions: allergic rhinitis, asthma, eczema, skin sensitivities and urticaria Allergic rhinitis is the most common manifestation Common (10% of population)

Answer 20

``` Eczema (aka dermatitis, atopic dermatitis) is an inflammatory epidermal rash characterised by vesicles (acute stage), redness, weeping, oozing, crusting, scaling and itch. Can be acute or chronic Multifactorial causes (not always allergic) ```

Answer 21

``` Exogenous vs endogenous "A SUN CONTACTS an ANVil with a LISP" Exogenous: - Light (photoallergic or phototoxic) - Contact: Allergens, irritant Endogenous: - Atopic, nummular (discoid), vesicular (hand/foot) - Lichen simplex chronicus - Seborrhoeic - Pityriasis alba ```

Answer 22

Age of onset can be in any age group, but most it will start <5 years old Infants: Head (cheeks, neck, scalp), limbs (extensor surfaces, can spread to flexures, groin) Affects 3% of infants Chronic relapsing course - signs appear between 3 months - 2 years Family history of atopy Dry skin

Answer 23

``` Children: cubital and popliteal fossae, hands and feet. Face often clears up if they had it as an infant. Chronic relapsing course, most start <5 years old Itchy Family history of atopy Evident trigger factors Dry skin Lichenification if chronic Flexures usually ```

Answer 24

``` Adults: Neck, groom, dorsum of hands, ankles, feet Chronic relapsing course. Onset is mostly <5 years old but can occur at any age Itchy Family history of atopy Evident trigger factors Dry skin Lichenifcation in chronic cases Usually affects flexures ```

Answer 25

ITCHy-Dick - Itch - Typical morphology and distribution - Chronic relapsing - History of atopy - Dry skin

Answer 26

Endogenous vs Exogenous Endogenous: a stressed emotional sweaty person with poor general health, scratching and rubbing themselves because of allergies Exogenous: A Micro-man made his skin irritated by being in a hot bubble bath full of sand and food

Answer 27

``` Education and reassurance Keep skin moist Pharmacological therapies Depends on stage of dermatitis: - Acute weeping: wet dressings - Acute: creams - Chronic: ointments +/- occlusion - Lichenified: Ointments under occlusion - Infection: Antibiotics Topical 2% mupirocin or oral ABx if unresponsive) - Moisturisers: use LOTIONS not creams ```

Answer 28

Reassure: does not normally scar or disfigure Avoid triggers: endogenous, exogenous (microbiological, manmade, irritants, environmental, food) Clothing: Wear light soft loose clothes (Cotton) and avoid people with sores

Answer 29

Soap substitute (Aqueous cream) and BD emollient (bath oil, aqueous cream, sir Ilene, paraffin cream)

Answer 30

Creams - Mild: +/- weak steroid (1% hydrocortisone) - Moderate: Moderate steroid to trunk and limbs, weak steroid to face and flexures. NSAID cream (pimecromilus) can be used for facial flares. Nocte antihistamine. - Severe: Potent steroids to worse areas, otherwise as above. Consider occlusive dressings and hospitalisation in very severe cases. - Weeping: crusts are often present due to exudate. Burow's solution 1:20 to soak affected areas, or saline dressings

Answer 31

OINTMENTS - Mild: +- weak steroid ointment (1% hydrocortisone) - Moderate: Moderate strength ointment to trunk and Limbs, weak to face and flexures. Regimen of 10 days on 4 days off. Nocte antihistamine. - Severe: Potent steroids to worse areas. Consider occlusive dressings, hospitalisation.

Answer 32

3 stages: Anagen, Catagen and Telogen. - Anagen: active growth phase (3-5 years) - Catagen: Transition phase (2 weeks) - Telogen: Dormant phase and shedding of club hair (2-4 months). Once the club hair is shed the follicle then re-enters anagen. This results in every hair on the scalp being shed and replaced every 3-5 years.

Answer 33

Alopecia is a generic term for hair loss. Alopecia areata: aka spot baldness. Hair follicle disorder causing sudden onset of localised or diffuse hair loss. It is an autoimmune disorder with genetic component. Alopecia totalis: alopecia which extends over the whole scalp Alopecia universalis: alopecia includes eyebrows and eyelids

Answer 34

``` PAT the balding PANDA Post-febrile state Anagen effluvium Telogen effluvium Postpartum Telogen effluvium Androgenetic alopecia Nutritional (Zinc or iron deficiency, crash dieting or malnutrition) Drugs (eg. Cytotoxic) Alopecia areata ```

Answer 35

Triad of: - Patch of complete hair loss (small patch or can be diffuse) - Clean scalp - Exclamation mark hairs (esp around periphery) Pigmented hairs lost first Clean normal scalp Minimal to no inflammation Associated with loss of facial or body hair, as well as nail changes (dystrophy, pitting)

Answer 36

Depends if localised patches or extensive (50%) - Localised patches: topical steroids (potent class III) especially for children, topical irritants, intralesional steroids, minoxidil (once hair growing), DNCB antigen - Extensive loss: Counselling and support groups, cosmetic aids. Topic steroids are ineffective. Consider specialist referral for topical immunotherapy or psoralen and ultra violent A (PUVA) phototherapy. Systemic steroids only for active and progressive cases.

Answer 37

- Small patches: 80% may spontaneously recover (1/3 in 6 months, 1/2 in 12 months, 1/3 never recover). Most patients relapse. - Alopecia totalis: 50% recovery in fit adults - Poor prognosis if: multiple patches, alopecia unversalis, or if alopecia develops in childhood

Answer 38

Telogen effluvium is inreased shedding of hair in the Telogen phase. It is triggered by stressors, and one of the most common causes of diffuse hair loss.

Answer 39

Stressful insult --> Shunts hair follicles into premature Telogen phase (cessation of anagen and transition through Catagen) --> 2-3 month delay before shedding occurs. Any severe stress can cause it, but common ones include: - Childbirth - High fever - Weight loss, crash dieting, malnutrition - Trauma (inc. surgery, haemorrhage) - OCP cessation

Answer 40

``` Triad of: - Stress event 2-3 months prior - Diffuse hair loss - White bulbs Patients may describe large clumps of hair with white bulbs going out with gentle shampooing or tugging ```

Answer 41

Spontaneous recovery occurs within 6 months Chronic idiopathic form persists longer - episodes of dramatic shedding that recover but recur weeks-months later - is self limiting and does not usually require treatment. Consider androgenetic alopecia in these patients.

Answer 42

Education (esp. if <6 months since hair loss) Correction of stress factors Pharmacotherapy (if concerned) - Topical minoxidil x 4 months Specialist referral if relapsing or incomplete recovery

Answer 43

Hair loss during the anagen phase. It is caused by immediate metabolic arrest of hair follicles in the anagen phase, which can be caused by chemotherapy or radiotherapy to the scalp.

Answer 44

Triad of: - Recent chemotherapy/radiotherapy - Diffuse hair loss - Long pigmented hair bulb

Answer 45

Drugs cause alopecia by either: - Telogen effluvium - Anagen effluvium - Acceleration of androgenetic alopecia

Answer 46

Androgenetic alopecia