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Dermatology > Chronic skin conditions > Flashcards

Chronic skin conditions Flashcards

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Dermatology Board Prep flashcards
1
Q

Eczema : Definition

A
  1. Atopic dermatitis - allergic chronic inflammatory skin condition characterised by dry, pruritic skin
  2. Associated with elevated serum IgE level
    * predisposition to IgE antibody release after trigger exposure
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2
Q

Eczema : Risk factors

A
  1. Family history of atopy : eczema, asthma, allergic rhinitis
  2. Environmental allergen sensitivity
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3
Q

Eczema : Clinical features

Acute + Chronic flares

A

Distribution :
* Adults : Flexural distribution,
* Children : Extensor surfaces, cheeks and scalp

Acute flares:
* Prurutic erythematous papule, vesicles with exudate, crusting

Chronic;
* Dry, excoriated erythematous papules,
* Scaling and lichenification

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4
Q

Eczema : Diagnosis

A
  • Bloods : Elevated IgE levels

Criteria of
* Itchy skin condition + 3> of the following;
1. Visible flexural eczema involving the skin creases
2. Hx of dry skin in the last 12 months
3. Personal hx of asthma, allergic rhinitis or atopic disease
4. Onset of signs and symptoms before 2 years of age

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5
Q

Mild eczema - Management

A
  1. Emollient
  2. Mild topical steroid - Hydrocortisone 1%
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6
Q

Moderate eczema - Management

A

Def : Areas of dry skin, frequent itching and redness
1. Emolient

  1. Moderate potent topic corticosteroid;
    * Betamethasome valerate 0.025%
    * Clobetasone butyrate 0.05%
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7
Q

Severe eczema : Management

A

Widespread areas of dry skin, incessant itching and redness
Excoriation/skin
Thickening/bleeding

  • Emolient

1 . First line : Potent topical corticosteroid
* Betamethasone valerate 0.1%
* Fluticasone propionate 0.05%

2 . Second line : Topical calcineurin inhibitor
e.g. Topical tacrolimus

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8
Q

Very Severe Eczema : Management

A

1 . First line :
Very potent topical steroid
* Clobetasol propionate 0.05% (Dermovate)

2 . Second line :
* Topical calcineurin inhibitor
e.g. Topical tacrolimus
* Indic : 2nd line tx of moderate to severe eczema

3 . Severe itching : Non sedating antihistamine
* Certrizine

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9
Q

Eczema : Maintainance therapy

A

1 . Minimal potency topical corticosteroid
* One class down from strength of corticosteroid used in flares

2 . Intermittent treatment
* Maintenance topical steroid used twice weekly (2 days a week)

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10
Q

Eczema : SE of steroid therapy

A
  1. Thinning of skin : improves after stopping
  2. Allergic contact dermatitis
  3. Acne vulgar
  4. Excessive hair growth at site of application

Systemic adverse effect:
1. Adrenal suppression
1. Cushing’s syndrome
1. Growth supressiion in children

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11
Q

p

Infected Eczema : Eczema Herpeticum

Cause, clinical features + Mx

A

Cause : Severe primary infection of the skin by HSV 1 or 2

Clinical features
1. Grouped vesicles and punched out erosions - circular depressed ulcerated lesions
2. Disseminated infection
* Wide spread lesions, bleeding areas extending all over the body.
* Fever, lymphadenopathy, malaise

Mx
IV Acyclovir - Hospital admission

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12
Q

Infected Eczema : Bacterial infection

A

Cause : Bacterial infection with Staphyloccus aureus

Clinical features
* Redness, oozing, crusting of skin

Mx
PO Flucloxacilln

  • Localised area of infection
    Mx : Topical Fusidic acid
  • Recurrent bacterial infection
    Mx : Refer to dermatology
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13
Q

Nummular dermatitis/discoid eczema : Clinical features

A

Chronic relapsing skin condition
Clinical features;
* Pruritic round eczematous plaques - scaly and dry
* Upper and lower extremities

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14
Q

Contact dermatitis : Definition

A

Skin disorder in which the skin reacts due to direct contact with causative agent

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15
Q

Contact dermatitis : Clinical features

A
  • Eczematous rash : blistering, dryness, peeling
  • Asymmetric distribution : Occurs on area of contact
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16
Q

Seborrheic dermatitis : Definition

A

Chronic dermatitis caused by inflammatory reaction to skin coloniser fungus

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17
Q

Seborrheic dermatitis : Clinical features

A
  • Eczematous, dry skin lesions } White/yellow scales of dry skin
  • Red, swollen skin
  • Itching

Location : Scalp, periorbital, auricular, Năsal folds } sebum rich area

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18
Q

Seborrheic dermatitis : Associated conditions

A
  1. HIV
  2. Parkinson’s disease
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19
Q

Seborrheic dermatitis : Management

A
  1. Ketoconzole } Shampoo or topical preparation
  2. Topical steroid
    * Chronic condition - likely to reoccur
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20
Q

Seborrheic dermatitis : Complication

A

Otitis externa and blepharitis are common complications of seborrhoeic dermatitis

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21
Q

Psoriasis : Definition

A

Psoriasis is a chronic inflammatory skin condition characterised by clearly defined, red and scaly plaques.

22
Q

Psoriasis : Pathophysiology

A
  1. It is classified as an immune-mediated genetic skin disease.
  2. Abnormal T cell activity stimulates keratinocyte proliferation.
23
Q

Psoriasis : Clinical features

A
  1. Sites : most common sites are the scalp, elbows and knees
  2. Clinical features
    * Red, scaly plaques with well-defined edges.
    * Scale is typically silvery white.
    * Mild itching
    * Hypopigmentation on clearing
24
Q

Guttate psoriasis : Clinical features

A
  1. Trigger : Post-strepococcal infection
  2. Clinical Features :
    * Wide spread read plaques - ‘raindrops;

Often resolves after several months

25
Q

Plaque Psoriasis : Features

A
  1. Sites : Most often affects elbows, knees, and lower back
  2. Clinical features;
    * Plaques >3 cm
    * Thicker plaques, more pronounced silver scale
    * Post inflammatory hypo or hyperpigmentation
26
Q

Flexural psoriasis : Features

A
  1. Sites : Affects body folds and Genitals
  2. Clinical features
    * Smooth, well-defined patches
    * Complication : Candida infection
27
Q

Nail Psoriasis : Clinical features

A

Associated : Psoriatic arthritis/arthropathy

Clinical Features
* Pitting
* Onchylosis - separation of the nail from the nail bed

28
Q

Psoriasis : Associated diseases

A
  • Inflammatory Bowel disease
  • Uveitis
  • Coeliac’s disease
29
Q

Psoriasis : Risk factors/Triggers

A
  1. Streptococcal tonsillitis
  2. Injuries : cuts, abrasions
  3. Lifestyle : smoking, alcohol, obesity, stress
  4. Medication
    * Corticosteroid withdrawl
    * Lithium
    * NSAID
    * Beta blockers
    * Quinine
30
Q

Plaque Psoriasis : Management

A
  • Emolient therapy

First line
1. Topical Potent Corticosteroid + Vitamin D analogue
* Apply separately OD

Second line
1. Vitamin D analogue (Calcitriol) BD

Third line
1. Topical Potent corticosteroid BD
2. Coal tar preparation
3. Short acting dithranol

31
Q

Psoriasis : Secondary care management

A
  1. Phototherapy : UV light

Systemic therapy
First line : Oral methotrexate

Second line:
* Ciclosporin
* Systemic retinoids
* Biologic agent

32
Q

Scalp Psoriasis : Management

A

1 . First line
* Topical Potent Corticosteroid } 4 weeks

2 . Second line
* Change formulation : Potent corticosteroid as a shampoo or mousse
+
* Salicylic acid/Emolient : exfoliation to remove scales before applying steroid

33
Q

Face, Flexure, Gential Psoriasis : Management

A
  1. Mild - Moderate Topical Corticosteroid
    * BD for 2 weeks max } more prone to skin atrophy
34
Q

Psoriasis : Issues with management therapies

A

1 . Corticosteroid : 4 week gap between initating 2nd course
* Not to be used >8 weeks at a time

2 . Vitamin D analogues
* Can be used long term
* Avoid in pregnancy

35
Q

Psoriasis : Complications

A
  1. Psoriatic Arthropathy (around 10%)
  2. increased incidence of metabolic syndrome
  3. increased incidence of cardiovascular disease
  4. increased incidence of venous thromboembolism
36
Q

Vitiligo : Definition

A

Autoimmune skin condition which results in the loss of melanocytes and depigmentation of the skin

37
Q

Vitiligo : Associated conditions

A
  • Type 1 diabetes mellitus
  • Addison’s disease
  • Autoimmune thyroid disorders
  • Pernicious anaemia
  • Alopecia areata
38
Q

Vitiligo : Management

A
  1. Topical corticosteroid - if applied early onset of disease
39
Q

Acanthosis nigricans : Clinical features

A

Features : Symmetrical, brown velvety plaques
Distribution : Neck, axilla and groin

40
Q

Acanthosis nigricans : Cause

A
  • Insulin resistance leads to hyperinsulinaemia
  • Stimulation of keratinocytes and fibroblast proliferation by interacting with excessive insulin like growth factor receptor
41
Q

Acanthosis nigricans : Associated condition

A

Conditions which cause hyperinsulinaemia;
* Type 2 diabetes mellitus
* PCOS, Obesity
* Acromegaly. Cushings

MAY BE 2ND TO GASTRIC CANCER

42
Q

Hyperhidrosis : Definition

A

describes the excessive production of sweat.

43
Q

Hyperhidrosis : Management

A

First line : topical aluminium chloride preparations
2 . iontophoresis: Electric current to deliver medication

  • particularly useful for patients with palmar, plantar and axillary hyperhidrosis

3 . botulinum toxin: currently licensed for axillary symptoms
4 . surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating

44
Q

hereditary haemorrhagic telangiectasia (HHT) - definition

A
  • autosomal dominant condition
  • multiple telangiectasia - over the skin and mucous membranes.
45
Q

hereditary haemorrhagic telangiectasia (HHT) - Clinical features

A

3> indicate diagnosis
* Epistaxis : spontaneous, recurrent nosebleeds
* telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
* visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
* family history: a first-degree relative with HHT

46
Q

Strawberry naevi (capillary haemangioma) - clinical features

A

Bright red tumor appearing in the 1st month of life

  1. erythematous, raised and multilobed tumours.
  2. Increase in size till 9 months - then regress } spontaneously resolve
  3. Common sites include the face, scalp and back.
47
Q

Spider naevi (also called spider angiomas) : Clinical features

A
  • central red papule with surrounding capillaries.
  • blanch upon pressure.
    Spider naevi are almost always found on the upper part of the body.

*When pressed : Spider naevi fill from the centre, telangiectasia from the edge *.

48
Q

Spider naevi : Associations

A
  • liver disease
  • pregnancy
  • combined oral contraceptive pill
49
Q

Port wine stains : Clinical features

A
  • Present at birth
  • vascular red/purple birthmarks that tend to be unilateral.
  • May darken and become raised
  • Life long condition } does not spontaneously resolve
50
Q

Port wine stains : Managementt

A

cosmetic camouflage or laser therapy

Dermatology (4 decks)

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