CHHD Flashcards
What is the definition of a:
1) Macule?
2) Papule?
3) Nodule?
1) MACULE = Localised area of colour or textural change on skin
2) PAPULE = Small solid elevation of skin (less than 5mm diameter)
3) NODULE = Small solid elevation of skin (more than 5mm diameter)
Name 7 Nail Changes…
1) Finger Clubbing
2) Splinter Haemorrhages
3) Beau’s Lines
4) Nail Pitting
5) Koilonychia
6) Paronychia
7) Herpetic Whitlow
What is Finger Clubbing? How can it be practically measured/detected?
What are 7 diseases it may be seen in?
Rounded/Bulbous nails formed by the thickening of tissue beneath the fingertips
Practical: Normal “diamond” shape not seen when Px holds nails together
Possible diseases:
Congenital Heart disease, Lung cancer, Asbestos, Cystic Fibrosis, Inflammatory Bowel Disease (Crohn’s or Ulcerative Colitis), Liver Cirrhosis or GRAVE’S DISEASE
What is Koilonychia?
What are 3 possible causes?
Spoon-Shaped concavities in the nail
1) Trauma
2) Iron deficiencies - e.g. Microcytic anaemia
3) Haemochromatosis (Iron build up)
What are Splinter Haemorrhages?
What are 5 possible causes?
Red thin longitudinal lines on nails, caused by capillary leaks in the epidermal ridges. Causes: 1) Trauma - main 2) Infective Endocarditis 3) MI 4) Psoriasis 5) Pregnancy
What is meant by Nail pitting?
In what 3 conditions can this be found?
Pin-like depressions on nail surface
1) Psoriasis (along with Onycholysis - where nail separates from nail bed and yellows)
2) Reiter’s Syndrome (reactive arthritis - acquired)
3) Lichen Planus
What are Beau’s Lines and when may they occur (4)?
HORIZONTAL depression lines on the nail caused by disrupted nail growth.
Causes:
- Trauma
- Reduced nutritional intake (diet or during illness)
- High altitude
- Raynaud’s Phenomenon
What are the similarities between Lichen Planus and Lichenoid Reaction?
1) BOTH are types of “Mucocutaneous Lesion/Disorder” (grouped along with Discoid Lupus Erythematosus)
2) Presentation: Itchy red/purple patches which may have white “Whickham’s Striae” lines present
Name 2 drugs involved in the treatment of Psoriasis, what is their dental relevant side effects?
1) Methotrexate –> Ulceration
2) Cyclosporin –> Gingival Hyperplasia
What are the differences between Lichen Planus and Lichenoid Reaction?
1) Lichen Planus = Pre-malignant condition and believed to be Auto-Immune whereas Lichenoid Reaction is Drug or Dental material induced (e.g. Bis-GMA resin or metals) - withdrawal of drug is best diagnosis tool
2) Lichen Planus lesions are often symmetrical, Lichenoid reaction can be asymmetrical if in relation to Dental Material site
3) Lichenoid Reaction usually presents in/around mouth, Lichen Planus present in mouth, on skin or can spread to nasal, oesophageal or genital areas
“Vulvovaginal-Gingival Syndrome” = LP simultaneously in mouth and vagina
What are nail changes/effects associated with Lichen Planus?
1) Dystrophic - brittle, discoloured and poorly formed
2) Beau’s Lines
3) Pitting + possible blood pooling below nail
What is meant by “Koebner’s Phenomenon”?
Name 2 dermatological conditions in which this is evident?
Koebner’s Phenomenon = The increased likelihood of a condition to present in sites of trauma (e.g. flexor surfaces)
1) Lichen Planus
2) Psoriasis
What are the 5 main presentations (appearance) of Lichen Planus & Lichenoid Reaction?
N.B. Can present as multiple at one time
1) Reticular (lines - “Whickham’s Striae)
2) Atrophic/Erythematous (reddening and thinning)
3) Ulcerative/Erosive
4) Papular (flat topped and few mm wide)
5) Bullous (blister-like) - rare
What is “Psoriasis”?
How does it appear?
“A chronic, non-infectious and relapsing inflammatory condition associated with an increased production of skin/epidermal cells”
Appearance:
Red, flakey patches of skin with silver scaling - mainly associated with sites of trauma (“Koebner’s Phenomenon”)
Nail Changes = Pitting + Onycholysis
What are the main tongue, nail (2) and joint changes (3) associated with Psoriasis?
Tongue changes:
Geographic tongue!
Nail Changes:
1) Nail pitting
2) Onycholysis - nail comes away from bed and yellowing
Joint Changes:
Associated with the 3 main types of Inflammatory Arthritis - Psoriatic Arthropathy (most common), Rheumatoid + Ankylosing Spondylitis
What is “Psoriasis”?
Therefore what are the treatment aims?
What are the 3 main types of treatment?
“A chronic, non-infectious and relapsing inflammatory condition associated with an increased production of skin/epidermal cells”
Treatment Aims = Reduce inflammation and slow skin cell production
1) Topical - Coal Tar, Corticosteroids, Dithranol or Vit D
2) Phototherapy (skin exposed to UV light)
3) Systemic - Methotrexate (ulceration risk), Cyclosporin (gingival hyperplasia risk), Retinoids or Hydroxyurea
What is Guttate Psoriasis?
Psoriasis (“chronic, non-infectious and relapsing inflammatory condition associated with an increased production of skin/epidermal cells”)
that is triggered by Streptococcal throat infection
(psoriasis sores produced are smaller than normal)
What is the definition of Eczema?
[Form of Dermatitis]
“A pattern of non-infective inflammatory response, characterised by Spongiosis (swelling) of epithelium in the acute stage and Lichenification (scaled, thickened, leathery) in chronic stage”
In Blistering conditions, what is the definition of a:
1) Vesicle?
2) Bulla?
1) Small fluid-filled blister (less than 5mm diameter)
2) Large fluid-filled blister (more than 5mm diameter)
How does Eczema presentation vary from Acute to Chronic stage?
Acute = Spongiosis (swelling) Chronic = Lichenification (scaled, thickened and leathery)
What are the main treatments for Eczema/Dermatitis? (3)
1) Topical emollients (moisturisers)
2) Corticosteroids (reduce swelling and redness)
3) Cyclosporin (Immunosuppressant - increased risk of gingival hyperplasia!)
What are 7 general characteristics of a Malignant Swelling?
1) Hard
2) Fixed to adjacent structure
3) Indurated
4) Poorly-defined margins
5) Nodular
6) Black/Brown
7) May bleed and crust
What is the difference between Basal Cell, Squamous Cell Carcinoma and Malignant Melanomas?
Basal Cell Carcinoma = Cancer of Epidermal Basal Cells
Squamous Cell Carcinoma = Cancer of Keratinocytes
Malignant Melanoma = Cancer of Melanocytes (in basement membrane)
What are 7 predisposing/risk factors for Basal + Squamous Cell Carcinoma?
(LEARN WELL)
1) UV Radiation
2) Ionising Radiation
3) Burn/ Vaccination Scars
4) Type I/2 (Freckles) Skin - Fitzpatrick Scale
5) Arsenic (chemical)
6) Immunesuppression
7) Smoking, Alcohol + Betel Quid Consumption
What are the 2 main types of Contact Dermatitis?
1) Contact ALLERGY = Type 4 (Delayed, T Cell mediated) Hypersensitivity reaction - most common is Nickel
2) Contact IRRITANT = Damage to skins barrier function (e.g. chemical)
What are the 2 main classifications of Eczema?
Which is most common? What causes this?
1) ENDOGENOUS
- Atopic (Most common)
- Seborrhoeic - hair follicles involved
- Disocoid
- Venous
- Discoid
- Asteatotic
2) EXOGENOUS
- Contact Allergen
- Contact Irritant
- Infective
What is the most common form of Eczema? What causes it and therefore what other conditions are these Px susceptible to (5)?
Atopic Eczema (Endogenous) Caused by high IgE levels --> Type I (Immediate) Hypersensitivity reaction Atopic Prone skin is susceptible to: 1) Dermatographism 2) Hay Fever 3) Asthma 4) Urticaria (Hives) 5) Oral Allergy Syndrome - allergic reaction in mouth after eating certain foods
What is “Seborrhoeic Dermatitis”?
Is it Endogenous or Exogenous?
What is the main cause and what are the main treatments?
ENDOGENOUS Dermatitis/Eczema with hair follicle involvement.
Cause: Pityrosporum Ovale yeast (therefore Immunosuppressed Px particularly susceptible)
Treatment: Anti-fungal (e.g. Nystatin) + Corticosteroid (reduce inflammation)
What are Basal Cell Carcinomas? How do they initially present?
What are the 2 main forms and how does their presentation differ based on this?
Cancers of the Epidermal Basal Cells.
Initial Presentation: Non-healing lump which ulcerates in centre and may crust or bleed. Most grow slowly and rarely metastasise.
1) NODULAR (Most common) - Pearly papule with rolled edge, spider veins (telangiectasia) and centrally indurated (with or without ulceration)
2) SUPERFICIAL - Slow-growing pink patch (mimics appearance of Psoriasis or Eczema)
What is Lupus Erythematosus?
What are the 2 main forms and which is more severe?
Autoimmune Disease
1) SYSTEMIC LE - most severe
2) DISCOID LE
What Drugs can induce Lichenoid Reaction? (9)
1) Beta-Blockers (“-olol”)
2) ACE Inhibitors (“-prils”)
3) NSAIDs
4) Diuretics (e.g. Furosemide, Chlortalidone, Indapamine etc)
5) Rheumatoid arthritis treatment (Gold Salts or Penicillamine)
6) Oral hypoglycaemics - DM type 2 treatment
7) Anti-malarials
8) Allopurinol - Gout treatment
9) Methyldopa - Hypertension treatment
What is Systemic Lupus Erythematosus?
What can be seen for definitive diagnosis?
Using SOAPBRAIN Pnuemonic, what are the possible systemic side effects?
Multi-systemic autoimmune reaction - autoantibodies produced include anti-dsDNA
Diagnosis: Positive detection of anti-nuclear antibodies (ANA) or ANCA
Serositis (inflammation of serious tissue, may lead to pleurisy or pericarditis)
Oral ulcers!!!!!
Arthritis in joints
Photosensitivity - sun exposure triggers acute response (e.g. characteristic facial butterfly red rash)
Blood disorders - vasculitis
Renal
ANA
Immune
Neurological - seizures or psychosis
What is Discoid Lupus Erythematosus?
How does it present?
How is it treated (3)?
Lupus Erythematosus (Autoimmune condition) which is defined to the skin and triggered by UV (e.g. Sun exposure!)
Presentation: Red, oval/round, scaly, atrophic plaques on sun exposed areas (mainly face)
Treatment:
1) SUN PROTECTION + AVOIDANCE
2) Anti-malarials
3) Corticosteroids
What are the 4 main Autoimmune Blistering conditions?
1) Pemphigus vulgaris
2) Bullous Pemphigoid
3) Mucous membrane Pemphigoid
4) Dermatitis Herpetiformis
What is Dermatitis Herpetiformis?
How does it present normally?
Who is susceptible?
Autoimmune blistering condition (Type III Hypersensitivity) Presentation:
- Chronic pruritic (itchy) papulo-vesicular rash on buttocks, elbows and (rarely) knees
- Urticated base (hives) with superficial blisters
Oral presentation = Transient superficial blisters which develop into tender, non-specific ulcers
Susceptible:
Younger Px, Native Irish + Coeliac’s (gluten sensitive enteropathy) Treatment = Gluten free diet!
What features would you expect in an Alcohol dependent Px (physical, psychological and social)?
In what ways may this affect their dental treatment?
Features:
1) Increased tolerance to alcohol
2) Loss of control and pre-occupation to drink
3) Withdrawal symptoms - Sweating, tachycardia, nausea, hallucinations and seizures
4) Liver problems
5) Social - Family problems and increased accident risk (drink driving or frights)
Dental Relevance:
1) Reduced motivations to attend and upkeep OH
2) Liver problems –> Increased bleeding tendency and reduced drug metabolism
3) DO NOT PRESCRIBE METRANIDAZOLE
4) Maxillo-facial trauma risk (fights)
What 2 drugs can be used in the Management of Alcohol Dependency?
(HINT: 2 “Chlor-“)
Chlormethiazole + Chlordiazepoxide
What type of drug is Warfarin and what is its MOA?
What are 3 medical conditions it may be prescribed for and how is its use monitored?
Anticoagulant - Vitamin K antagonist
THEREFORE: Affects reversed when Vit K given
1) Atrial fibrillation
2) Prosthetic heart valves
3) Deep vein thrombosis
Monitored using INR (International Normalised Ratio)
What Anti-microbials (3 main types) react with Warfarin and therefore cannot be prescribed?
What is an example of a drug that REDUCES the anti-coagulant effect of Warfarin?
Anti-microbials:
1) ANTI-BACTERIAL NITROMIDAZOLES: Metronidazole
2) ANTI-BACTERIAL MACROLIDES: Clarithromycin, Azithromycin + Erythromycin
3) AZOLE ANTI-FUNGALS: Flucoazole + Miconazole
Carbamazepine REDUCES the anticoagulant effect (may be prescribed for Trigeminal Neuralgia)
