Common Skin Conditions Flashcards
Clinical features of atopic eczema/dermatitis
- Pruritus
- flexural
- can occur in response to triggers
What is atopic eczema/dermatitis?
Dry itchy inflammed skin
Erythema
Flaking
Common history of atopic eczema/dermaitis
- often begins in childhood
- atopy
- family history
- recent change in soaps, fabric softeners etc.
Presentation of eczema
- dry, red, itchy patches of skin
- often in flexor surfaces, face + neck
What could be a trigger for atopic eczema/dermatitis?
Smoke
Soap
Perfume
Excessively dry skin
Diagnosis of atopic eczema/dermatitis
Clinical diagnosis
Treatment of atopic eczema/dermatitis
- education + support
- avoidance of triggers
- systemic therapy
- topical: emollients, soap substitutes, steroids, phototherapy
Treatment of eczema flares
- thicker emollients
- topical steroids
- wet wraps
two types of emollients + examples
_Thin creams_
- E45
- cetraban cream
- aveeno cream
- eparderm cream
.
_Thick, greasy emollients_
- 50:50 ointment
- cetraban ointment
- epaderm ointment
- hydromol ointment
What advice should be given to a patient for emollient use?
- least to most effective: lotions > creams > ointments
- wash and dry hands thoroughly
- apply in the direction of hair growth
- if in a pot, do not use your fingers to remove - instead use a clean spoon or stick
Stepwise steroid ladder from weakest to most potent
- hydrocortisone 0.5%, 1%, 2.5%
- eumovate
- betnovate
- dermovate
What advice should be given to patients for topical steroid use?
- wash and dry hands thoroughly
- apply finger tip amount for area represented by both palms
- avoid using with emollients as it will dilute the steroid + reduce the effectiveness
- week on, week off schedule
What is eczema herpeticum?
viral skin infection in patients with eczema caused by herpes simplex virus or varicella zoster virus
Presentation of eczema herpeticum
- widespread, painful, vescicular rash
- lethargy
- fever
- reduced oral intake
- lymphoadenopathy
Management of eczema herpeticum
viral swabs of vesicles
aciclovir
Describe acne vulgaris
Formation of comedones, papules, pustules, nodules + cysts due to inflammation of pilosebaceous units
Causes of acne vulgaris
- increased sebum production
- excessive deposition of keratin in pores/pilosebaceous unit
- overgrowth of cutibacterium acnes
- pro-inflammatory chemicals released in skin
Diagnosis of acne vulgaris
Clinical diagnosis
Management of acne vulagris
- topical benzoyl peroxide
- topical retinoids
- topical antibiotics e.g. clindamycin
- oral antibioitcs e.g. lymecycline
- COCP
- oral retinoids as last line option e.g. isotretinoin/roaccunate - contraception needed in females
- consider psychological impact
Why is contraception needed if a woman is on isotretinoin?
it is highly teratogenic
Mechanism of action of isotretinoin/roaccutane
it is a retinoid
reduces sebum production
reduces inflammation
reduces bacterial growth
Side effects of isotretinoin/roaccutane
- dry skin + lips
- photosensitivity
- depression, anxiety, aggression
- suicidal ideation
What is the most effective combined contraceptive pill for acne + why?
Why is it not prescribed long term?
Co-cyprindiol (dianette)
due to its anti-androgen effects
Risk of thromboembolism
Common history of psoriasis
- chronic skin condition
- equally in men + women
- often between 20-30s + 50-60s
- genetic predisposition
- relapsing + remitting
- identify triggers or iatrogenic cause
Describe psoriasis
- White flaky scales
- raised rough plaques
- often over extensor surfaces + scalp
Name and describe 3 specific signs suggestive of psoriasis
- auspitz sign: small points of bleeding when plaques are scraped off
- koebner phenomenon: development of psoriatic lesions to areas of skin affected by trauma
- residual pigmentation of the skin after the lesions resolve
Associated changes/conditions of psorasis
- psoriatic arthrisits
- nail psoriasis > pitting, oncholysis, thickening, ridging
- psychological implications e.g. depression, anxiety
- increased risk of melanoma (SPF use)
Diagnosis of psoriasis
Clinical diagnosis
Types of psoriasis
- plaque psoriasis
- guttate psoriasis
- pustular psoriasis
- erythrodermic psoriasis
Cause of psoriasis
- chronic autoimmune condition
- T cell cytokine production is stimulated > keratinocytes proliferation
- rapid generation of new skin cells > abnormal build up + thickening of skin in those areas
Management of psoriasis
- dovobet + enstilar: potent steroid + vitamin D analogues
- topical steroids
- topical calcipotriol (vitamin D analogues
- topical tacrolimus in adults
- phototherapy with narrow band UVB light
- methotrexate, cyclosporine or retinoids if severe
Presentation of erythema nodosum
- red, raised, inflamed, subcutaneous nodules across both shins
- nodules can be painful + tender
Causes of erythema nodosum
NODOSUM
- NO cause
- Drugs
- Over counter prescriptions
- Sarcoidosis + Streptococcus
- Ulcerative colitis + Crohn’s disease
- Materinity Mycobacterium
Investigations if a person has erythema nodosum + why
- inflammatory markers
- throat swab - for strep infection
- chest X ray - for sarcoidosis or TB
- stool microscopy + culture- for salmonella or campylobacter
- faecal calprotectin - for IBD
Management of erythema nodosum
- investigations to find underlying conditions/cause
- rest + analgesia
Describe urticaria (hives)
- Central swelling of variable size (red or white) with area of erythema
- Itchy
- Wheels
- Wide distribution (often)
- Fleeting nature, with skin returning to normal within 1-24 hours
- Associated with angio odema + flushing
Pathophysiology of urticaria
Mast cell degranulation + histamine release > increased capillary permeability + leakage of fluid into surrounding tissue
Types of urticaria
acute urticaria (often allergies)
chronic urticaria (autoimmune)
Treatment of urticaria
- identify + avoid trigger
- general education
- H1 antihistamines fexofenadine
- add on H2 antihisatmine ranitidien if persists
- oral steroids for severe flares
What is molluscum contagiosum?
- Viral skin infection
- Small firm spots that have a dimple in the middle
- Often in children
- Due to pox virus
- self limiting
Treatment of molluscum contagiosum
Self limiting
What is shingles?
- Viral skin incfection
- Due to herpes zoster virus
- Painful rash
- Tingling sensation prior to rash
- Vesicles in dermatomal pattern
Treatment of shingles
- Antivirals
- Avoiding particular patient groups e.g. immunosuppressed, patient, not had chickenpox
What is hand, food and mouth disease?
presenation
- caused by coxsackie A virus
- starts with typical URTI symptoms
- 1-2 days later mouth ulcers appear
- then red blistering spots across the body
Management of hand, foot + mouth disease
- Supportive management with adequate fluid intake, simple analgesia
- highly contagious education for avoiding transmission
Types of viral skin infections
Shingles
Molluscum contagiosum
hand food + mouth
Types of bacteria skin infections
Impetigo
What is impetigo
- Bacterial skin infection
- highly contagious
- due to staph aureus or strep pyogenes
- in areas of broken skin
What is impetigo caused by?
Staph aureus (golden crust formation)
Strep pyogenes
management of impetigo
- topical mupirocoin antibiotic cream
- oral flucloxacillin if severe or widespread
- hydrogen peroxide cream if in one area (not commonly used)
- education on hand hygiene, avoid sharing towels + cutlery
- off school until lesions have healed
Types of fungal skin infections
Dermatophytosis infection
What is dermatophytosis infection?
- superficial fungal infection
- spread by direct contact
Treatment of dermatophytosis infection
- topical antifungals
- advice: wash towels often, keep skin dry
Types of skin cancer
Malignant melanoma
Squamous cell carcinoma
Basal cell carcinoma
Main cause of malignant melanoma
UV light exposure
Risk factors of malignant melanoma
Pale skin
Red/blonde hair
Lots of freckles
Family history
Sun exposure
Treatment of malignant melanoma
Surgery
Radiotherapy if spread
Avoid prolonged sun exposure + use sun protection
What is malignant melanoma?
Cancer from melanocytes
What is squamous cell carcinoma characterised by?
- abnormal + accelerated growth of squamous cells
- in areas exposed to sun
- non healing ulcer
Treatment of squamous cell carcinoma
- referral to specialist for skin biopsy to confirm
- avoid prolonged sun exposure + use sun protection
- surgery to remove lesion
- teach patient how to check their skin for new/changing lesions + taking photos of them with tape measure if found
Most common type of skin cancer
Basal cell carcinoma
What does basal cell carcinoma look like?
- shiny skin coloured bump
- is translucent
- glossy looking
Compare the age demographic effected between squamous and basal cell carcinoma
Squamous: middle age or older
Basal: older adults
Cause of basal cell carcinoma
When one of the skin’s basal cells develops a mutation in its DNA
Often due to UV radiation
Management of basal cell carcinoma
- referral to specialist for skin biopsy to confirm
- avoid prolonged sun exposure + use sun protection
- surgery to remove lesion
- teach patient how to check their skin for new/changing lesions + taking photos of them with tape measure if found
