Common Dermatological Problems Flashcards
What is eczema?
- inflammatory process affecting the skin due to various factors
- AKA dermatitis
- itchy skin condition
Infantile eczema
- widespread dry red scaly skin
- can be weeping
often cheeks affected first - nappy area spared
Toddler/Adolescent eczema
- more localised and thickened, leathery
- scratch marks
- elbows, knees, eyelids, ear creases, neck, scalp
Adult eczema
- commonly persistent localised eczema
- recurrent secondary staphylococcal infection
- major factor for irritant contact dermatitis - particularly in hands when washed a lot
Eczema Treatments
- Trigger avoidance
- Stop scratching - it causes the release of more histamine
- Regular emollients
- Soap substitutes - aqueous cream etc
- Bath moisturisers (oilatum)
- Topical steroids
What is Psoriasis?
A chronic inflammatory disorder
- 1-2% of the population
- Inflamed red skin with plaques covered in silvery scales
- Affects any age and gender
- Caused by a very fast skin turnover (6 days rather than 30)
- Leads to hyperproliferation and the thickening of the epidermis
- Symmetrical distribution
Treatments for Psoriasis
- Topical - emollients, topical steroids, coal tar, salicylic acid, Vit D analogues
- Physical - UV phototherapy
- Systemics - Ciclosporin, Methotrexate, Acitretin
- Biologics (Genetically-engineered proteins derived from human DNA)
What is Acne Vulgaris?
- Greasy skin condition
- affects the area of skin with dense populations of sebaceous follices (face, chest and back)
- Overactivity of pilo-sebaceous units due to hormonal stimulation (hence why it occurs in teenagers)
- Hyperproliferation of follicular epidermis + subsequent follicle plugging with bacteria
Grades of Acne severity
Grade 1 - multiple open comedones
Grade 2 - closed comedones, a few inflammatory papules and pustules (mild)
Grade 3 - extensive inflammatory papules and pustules (moderate)
Grade 4 - large nodules, cysts, often scarring (nodulocystic)
Acne treatments
- Topical retinoids
- Topical antibiotics
- Benzoyl peroxide
- Oral antibiotics
- Contraceptive pill
What is Impetigo?
- most common bacterial skin infection in children
- Single red macule –> vesicle or pustule –> ruptures
- exudate dries and gives golden crust
Impetigo treatment
- If mild, Fucidin
- If extensive, Flucloxacillin
What are Viral warts?
- Growths caused by HPV
- Spread by indirect or direct contact
- Incubation from a few weeks to over a year
- contagious but low risk of spread
Viral wart treatment
- Self-resolving
- Duct tape
- Salicylic acid
- Cryotherapy
What is Tinea/Ringworm?
- Very itchy, annular, scaly, red plaque
- Has well defined edges, but clear middle - assymetric
- Short history
Ringworm treatment
- Topical azole/allylamine
- Systemic therapy if extensive or resistance to topical treatment
What is Actinic Keratosis?
- Sun-induced scaly or hyperkeratotic lesion (can become malignant)
- 23% of UK pop. over 60
- Consequence of cumulative long-term sun exposure
- Risk from long-term phototherapy and immune suppressed patients
- Only occurs in epidermis
- If covers whole epidermis = Bowen’s
Actinic Keratosis treatments
- Emollients, cryotherapy, various creams
- Referral to dermatologist if suggestion of transformation into SCC
What is Basal Cell Carcinoma?
- Slow growing malignancy
- most common in head or neck
- appears as shiny, translucent nodule with rolled-edge
- Nests of basaloid tumour cells, surrounding cells at periphery
Basal cell carcinoma treatment
Routine dermatology referral (not 2ww)
Treatment usually by excision
GP follow up, education about sun awareness and skin surveillance
What is Squamous cell carcinoma?
- Result of cumulative sun exposure - incidence increases with age
- Sun-exposed sites - hands, forearms, ears, upper face and lower lip
- Arises de-novo, or from AK/Bowen’s
Refer immediately for 2 week referral - Invasion of islands of atypical squamous cells into the dermis
- Can be well, moderately or poorly differentiated
- Highest rate of metastasis to lymph nodes from lips and ears
How do we detect suspicious pigmented lesions?
Asymmetry Border irregularity Colour variation Diameter - >6mm Extra features - itching or bleeding
What is melanoma?
- 2nd most common cancer in 15-34 age group
- most common on trunk for males and legs for females
- Types - nodular, lentigo maligna, acral lentiginous, superficial spreading
- Always refer under 2ww
- atypical melanocytes arranged singly or in nests
- invasion into the dermis and subcutaneous fat
- depth of invasion is major indicator of prognosis
