Common Dermatological Problems

Question 1

What is eczema?

Answer 1

• inflammatory process affecting the skin due to various factors
• AKA dermatitis
• itchy skin condition

Question 2

Infantile eczema

Answer 2

• widespread dry red scaly skin
• can be weeping
  often cheeks affected first
• nappy area spared

Question 3

Toddler/Adolescent eczema

Answer 3

• more localised and thickened, leathery
• scratch marks
• elbows, knees, eyelids, ear creases, neck, scalp

Question 4

Adult eczema

Answer 4

• commonly persistent localised eczema
• recurrent secondary staphylococcal infection
• major factor for irritant contact dermatitis - particularly in hands when washed a lot

Question 5

Eczema Treatments

Answer 5

• Trigger avoidance
• Stop scratching - it causes the release of more histamine
• Regular emollients
• Soap substitutes - aqueous cream etc
• Bath moisturisers (oilatum)
• Topical steroids

Question 6

What is Psoriasis?

Answer 6

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

Question 7

Treatments for Psoriasis

Answer 7

• 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)

Question 8

What is Acne Vulgaris?

Answer 8

• 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

Question 9

Grades of Acne severity

Answer 9

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)

Question 10

Acne treatments

Answer 10

• Topical retinoids
• Topical antibiotics
• Benzoyl peroxide
• Oral antibiotics
• Contraceptive pill

Question 11

What is Impetigo?

Answer 11

• most common bacterial skin infection in children
• Single red macule –> vesicle or pustule –> ruptures
• exudate dries and gives golden crust

Question 12

Impetigo treatment

Answer 12

• If mild, Fucidin

- If extensive, Flucloxacillin

Question 13

What are Viral warts?

Answer 13

• 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

Question 14

Viral wart treatment

Answer 14

• Self-resolving
• Duct tape
• Salicylic acid
• Cryotherapy

Question 15

What is Tinea/Ringworm?

Answer 15

• Very itchy, annular, scaly, red plaque
• Has well defined edges, but clear middle - assymetric
• Short history

Question 16

Ringworm treatment

Answer 16

• Topical azole/allylamine

- Systemic therapy if extensive or resistance to topical treatment

Question 17

What is Actinic Keratosis?

Answer 17

• 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

Question 18

Actinic Keratosis treatments

Answer 18

• Emollients, cryotherapy, various creams

- Referral to dermatologist if suggestion of transformation into SCC

Question 19

What is Basal Cell Carcinoma?

Answer 19

• 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

Question 20

Basal cell carcinoma treatment

Answer 20

Routine dermatology referral (not 2ww)
Treatment usually by excision
GP follow up, education about sun awareness and skin surveillance

Question 21

What is Squamous cell carcinoma?

Answer 21

• 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

Question 22

How do we detect suspicious pigmented lesions?

Answer 22

Asymmetry
Border irregularity
Colour variation
Diameter - >6mm
Extra features - itching or bleeding

Question 23

What is melanoma?

Answer 23

• 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