Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD2 Dermatology > Common Skin Conditions > Flashcards

Common Skin Conditions Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

What is discoid eczema?

A

Eczema which appears in annular disc-like patches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

DDx for annular disc-like patches

A

Discoid eczema

Psoriasis

Tinea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is discoid eczema treated?

A

Topical steroids (more potent than typical atopic eczema; e.g. clobetasol, fluocinonide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is asteatotic eczema?

A

Excessive drying of the skin causing itchiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

22 year old student presents with 3/12 of worsening rash not responding to 1% hydrocortisone cream

O/E: erythematous, ill defined, scaly, patches in flexures

Likely Dx?

A

Atopic eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the clinical features of atopic eczema (symptoms, appearance, distribution, exacerbating factors)?

A

Symptoms: itchy ++

Appearance: erythematous, scaly, diffuse, ill defined

Distribution: flexural (thinnest skin)

Exacerbating factors: worse in winter (dry) and summer (heat)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the atopic triad?

A

Atopic asthma

Allergic rhinitis

Atopic eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the major risk factors for atopic eczema?

A

Genetic predisposition (FHx)

Atopy (asthma, allergic rhinitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the “model” of atopic eczema

A

Genetic predisposition may include a filaggrin mutation, which leads to reduced barrier function of the skin

This predisposition combined with environmental triggers causes eczema to arise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List 6 environmental triggers for atopic eczema

A

Irritants (e.g. soaps)

Allergy

Weather: heat or dry

Infection (e.g. Staph)

“Itch-scratch cycle”

Stress, anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is lichenification and when is it seen?

A

Result of chronic rubbing and scratching

Can be seen with chronic eczema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In what patient populations (and what anatomical distribution) is asteatotic eczema seen?

A

Worse on front of legs of elderly patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What factors may exacerbate asteatotic eczema?

A

Seasonal: “winter itch” (heat and drying exacerbates, as for typical eczema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is asteatotic eczema treated?

A

Topical steroid ointment

Emollients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is pompholyx? Typical location?

A

Vesicular eczema of the hand and foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What factors may precipitate pompholyx?

A

Excessive washing and sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is pompholyx treated?

A

Potent topical steroid

Avoidance of detergents, soaps, other irritants

Regular emollients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is diffuse erythrodermic eczema?

A

Severe eczema affecting >90% BSA and associated with significant morbidity

Erythroderma can be caused by pre-existing dermatoses (dermatitis, psoriasis) but may also be the result of internal or haematological malignancy, GVHD or HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is diffuse erythrodermic eczema treated?

A

Intense topicals and systemic immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List 2 complications of eczema

A

Bacterial superinfection

Eczema herpeticum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is there risk of bacterial superinfection in eczema?

A

Eczematous skin lacks naturally occuring antibacterial peptides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which organism typically infects eczema? How does this appear?

A

Staph aureus

Produces a “golden crust”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is bacterial superinfection treated?

A

Successful treatment requires systemic anti-Staph Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is eczema herpeticum?

A

Secondary infection by HSV virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does eczema herpeticum present?

A

Sudden onset

Worsening of pre-existing eczema with painful vesicles and “punched out” erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why is eczema herpeticum considered a medical emergency?

A

Risk of corneal scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How is eczema herpeticum managed?

A

Needs assessment by opthalmologist

Systemic antiviral treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What types of contact dermatitis exist?

A

Irritant

Allergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is allergic contact dermatitis diagnosed?

A

Patch testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Describe some typical patterns for allergic contact dermatitis

A

Streaky dermatitis from plant allergy

“Belt buckle” dermatitis from nickel allergy

Eyelid dermatitis from allergy to formaldehyde in nail polish (don’t get rash where skin is thicker, get rash on face where you touch)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Describe 3 general measures for treatment of atopic eczema

A

Avoid soap (use soap substitute, non detergent)

Regular emollient (e.g. sorbolene cream)

Warm (not hot) showers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Describe 3 specific measures for treatment of atopic eczema

A

Topical steroid to inflamed areas (e.g. potent steroid to body)

Mild steroid for face, or non-steroid anti-inflamatory creams (e.g. pimecrolimus)

Treat infection if suspected with systemic Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What treatment options exist for atopic eczema?

A

General measures

Specific measures

Wet dressings

Phototherapy with UVB

Systemic immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What options exist for systemic immunosuppression for treatment of atopic eczema?

A

Short term: oral pred

Medium to long term: azathioprine, cyclosporin A, methotrexate, mycophenolate mofetil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

42 year old man, 3 year Hx of worsening rash and significant arthritis in back, hips and knees

O/E: well demarcated plaques, extensor surfaces, very erythematous, scaly +++

Likely Dx?

A

Chronic plaque psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the clinical features of psoriasis (symptoms, appearance, distribution)?

A

Symptoms: can be itchy, but not as severely as eczema

Appearance: silvery scale +++ , well demarcated, “salmon pink” (very erythematous)

Distribution: extensor rash, symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is a major risk factor for psoriasis?

A

Genetic predisposition (FHx in 30% of patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the typical age of onset for psoriasis?

A

2 peaks: 20s and 50s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What symptoms occur alongside scalp psoriasis?

A

Scalp itch and irritation

Silvery scale ++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How is scalp psoriasis managed?

A

Responds to topical therapy with LPC, salicyclic acid, topical corticosteroids, calcipotriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What other sites (apart from extensor surfaces) can psoriasis occur?

A

Scalp psoriasis

Periauricular and auricular involvement

Flexural psoriasis (less scaly; “glazed” appearance)

Genital psoriasis (less scaly; “glazed appearance)

Palmar-plantar psoriasis

Nail psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What does guttate “raindrop” psoriasis indicate about a possible underlying cause?

A

May be triggered by streptococcal infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How does post-streptococcal guttate psoriasis present?

A

Occurs 1-2 weeks after Streptococcus URTI/tonsillitis

Sudden generalised onset of small plaque psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Describe the typical course of treated post-streptococcal guttate psoriasis

A

Most clears with treatment but recurs if patient acquires a Strep infection again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How is post-streptococcal guttate psoriasis treated?

A

Very responsive to phototherapy

46
Q

How does generalised pustular psoriasis present?

A

Acute pustular flare of psoriasis

Often accompanied by systemic Sx (fever, chills)

47
Q

What complications can occur in generalised pustular psoriasis and what is the mechanism of this?

A

Risk of pre-renal impairment, high output cardiac failure, sepsis

Due to loss of barrier function of the skin, loss of thermoregulation and protein loss

48
Q

What Mx is indicated in generalised pustular psoriasis?

A

Requires hospital admission to stablise

49
Q

When is there an increased risk of psoriatic arthritis?

A

If patient has nail psoriasis

50
Q

What % of patients develop psoriatic arthritis?

A

10%

51
Q

List 5 presentations of psoriatic arthritis

A

Oligoarthritis

Distal symmetrical polyarthritis

Ankylosing spondylitis

Rheumatoid-like

Arthritis mutilans

52
Q

How is psoriasis treated?

A

Topical: steroids, tars, calcipotriol, dithranol, keratolytics, emollients

Phototherapy: narrowband UVB treatment, PUVA

Systemic: oral acitretin, methotrexate, cyclosporin, biologic treatments

Often used in combination

53
Q

What is acne?

A

Disorder of pilosebaceous unit

54
Q

How common is acne?

A

Affects ~80% of post-pubertal individuals

55
Q

What proportion of cases of acne are classified as moderate to severe?

A

15-20%

56
Q

What is the typical age of onset for acne?

A

Teenage disease, but can persist into adulthood

57
Q

Explain the pathophysiology of acne and exacerbating factors

A

Starts in adolescence with increasing sebum production

Strong genetic component

Can be flared by hormonal factors (menstruation), picking and emotional stress

Can be exacerbated by topic occlusion (“oily” makeup, moisturisers, headwear, hairstyling)

Can be caused by medications (e.g. lithium, anabolic steroids, topical corticosteroids)

58
Q

What are the 4 pathophysiological components of acne?

A

Abnormal keratinisation of sebaceous duct

Colonisation with bacteria (propionobacterium acnes)

Increase in androgen levels leading to increased sebum production

Inflammation

59
Q

Describe the appearance of acne

A

Non-inflammatory lesions: open (oxidised sebum) and closed comedones

Mild-moderate inflammatory lesions: papules and pustules

Nodular cystic acne: nodules, cysts, pustules, scarring

Severe cystic acne (acne conglobata)

60
Q

Acne conglobata

A

Severe cystic acne

61
Q

Describe the temporal profile of adult onset acne in females

A

Premenstrual flare

62
Q

What is the typical distribution seen in adult onset acne?

A

Mainly lower face

63
Q

How is adult onset acne treated?

A

Anti-androgenic OCP +/- anti-androgen

64
Q

When should you consider PCOS in a patient with adult onset acne?

A

If associated with other signs of androgenisation e.g. hirsutism, androgenetic alopecia

65
Q

What options exist for topical treatment of acne?

A

Keratolytics

Comedolytic

Anti-bacterial treatments

Combination treatments

66
Q

What keratolytic is used in the management of acne? What is the mechanism of action?

A

Salicylic acid

Dissolves comedones

67
Q

What comedolytics are used in the management of acne? What is the mechanism of action?

A

Retinoic acid, adapalene

Dissolves comedones

68
Q

What anti-bacterial treatments are used in the management of acne?

A

Benzoyl peroxide

Topical erythromycin

Topical clindamycin

69
Q

What combination treatments are used in the management of acne?

A

Adapalene and benzoyl peroxide

Clindamycin and benzoyl peroxide

70
Q

What systemic treatments are used in the management of acne?

A

Systemic Abx

Anti-androgenic OCP

Anti-androgens

Systemic retinoids

71
Q

What systemic Abx are used in the management of acne?

A

Doxycycline 50mg daily

Minoxycline 50mg bd

Erythromycin 400mg bd

Others e.g. trimethoprime 300mg daily

72
Q

What is the rationale of systemic Abx use in the management of acne?

A

Active against Propionibacterium acnes

Useful against pustular acne

73
Q

What is the limitation of systemic Abx use in the management of acne?

A

Resistance can develop

Acne recurs on cessation

74
Q

What anti-androgenic OCPs are available for use in acne management?

A

Ethinyl oestradiol + cyproterone acetate

Ethinyl oestradiol + drosperinone

75
Q

What is the rationale behind use of anti-androgenic OCPs in the treatment of acne?

A

Reduces sebum secretion

Useful against hormonal acne

76
Q

What anti-androgens are used in the management of acne?

A

Spironolactone

Cyproterone acetate

77
Q

What is the rationale behind the use of anti-androgens in the management of acne?

A

Reduces sebum secretion

Very helpful against hormonal acne

Causes menstrual irregularities

78
Q

What systemic retinoids are used in the management of acne?

A

Isotretinoin

79
Q

What is the rationale behind the use of systemic retinoids in the management of acne?

A

Comedolytic

Reduces sebaceous gland activity

80
Q

Who can prescribe systemic isotretinoin?

A

Specialist use only

81
Q

What is the typical duration of a course of systemic isotretinoin?

A

6-12 months

82
Q

Adverse effects of systemic isotretinoin

A

Teratogenic ++

Significant mucocutaneous side effects: dryness, photosensitivity (monitoring required)

Controversial association with depression

83
Q

How effective is systemic isotretinoin for the management of severe acne?

A

60-70% cured after first course

84
Q

What is rosacea?

A

Common skin disease (1-2% of population) characterised by vascular reactivity and inflammatory rosacea

85
Q

List 4 risk factors for rosacea

A

Gender (women > men)

Middle aged

Sun-damaged skin

Celtic

86
Q

What complication of rosacea is exclusive to men?

A

Tissue hyperplasia (rhinophyma)

87
Q

What clinical features of vascular reactivity and inflammatory rosacea are seen in rosacea patients?

A

Vascular reactivity: redness, flushing

Inflammatory rosacea: papules, pustules

88
Q

What features are seen in erythrotelangiectatic (vascular) rosacea?

A

Easy flushing

Background telangiectasia

89
Q

List 7 triggers of vascular reactivity in rosacea

A

Sunlight

Alcohol

Hot foods and drinks

Spicy foods

Emotion

Heat

Topical steroids may worsen rosacea

90
Q

List 2 long term complications of rosacea

A

Vascular dilatation (redness, telangiectasia)

Tissue hypertrophy (rhinophyma)

91
Q

How common is ocular rosacea?

A

Occurs in 20-40% of patients with cutaneous rosacea

92
Q

List 4 symptoms of ocular rosacea

A

Grittiness

Stinging

Dryness

Itching

93
Q

What signs are seen in mild ocular rosacea?

A

Watery, bloodshot appearance with interpalpebral conjunctival hyperaemia

94
Q

List 5 general treatments for rosacea

A

Sun avoidance, SPF 30+ sunblock daily

Avoid spicy foods, EtOH

Avoid topical steroids

Skin care advice: use mild cleansers and bland, non-perfumed moisturisers

Stress management

95
Q

List specific treatments for rosacea and its complications

A

Vascular rosacea: vascular laser

Inflammatory rosacea: topical metronidazole, topical azaleic acid, systemic Abx (e.g. doxycycline, minocycline), systemic isotretinoin

Rhinophyma: ablative laser or surgery

96
Q

55 year old patient presents with 2/12 Hx of intensely itchy rash

Likely Dx?

A

Scabies

97
Q

Describe the clinical features of scabies (symptoms, distribution, exacerbating factors, contacts)

A

Symptoms: intensely itchy rash, often starting on hands, interdigital spaces and feet

Distribution: spreads to genital areas, generalised body rash; spares face and head in adults

Exacerbating factors: itch worse at night

Contacts: often close contacts develop itch after a few weeks (incubation period 4-6 weeks)

98
Q

Describe the rash(es) seen in scabies

A

Scabies burrows: serpiginous scaly lines, inflammatory scaly papules on hands, feet, interdigital areas, genitals (this is where the mites live!)

Non-specific eczematous rash: secondary hypersensitivity reaction, occurs later

99
Q

How is scabies diagnosed?

A

Skin scraping of burrow and examination under light microscopy for egg, scabies mite and/or scabies faeces

NOTE: demonstration of mite takes skill, usually treatment is recommended where clinical suspicion is high

100
Q

How is scabies treated?

A

Treat index case and all close contacts (sexual and household) with 5% permethrin cream applied all over from neck down (especially hands, genitalia and under nails with nailbrush); cream gets left on overnight (8 hrs) and is washed off in the morning (if immunoosuppressed may need oral ivermectin)

Infants >6 months and children need to treat scalp as well

Clothing needs hot wash and tumble dry (or to be put away for a fortnight for the mites to die)

Index case and all symptomatic cases are retreated after one week

Post-scabetic itch can take weeks to settle

After scabicide treatment, eczema needs to be treated; recommend potent topical steroid with emollients and oral antihistamines

Treat secondary infection if present with Abx

101
Q

How effective is permethrin in treating scabies?

A

Cure rate >90% if applied properly

102
Q

What causes the itching in a scabies infection?

A

Allergy to mite faeces

103
Q

Azathioprine

A

Purine analogue and systemic immunosuppressant

104
Q

Cyclosporin A

A

Systemic immunosuppressant (targets T cells)

105
Q

Methotrexate

A

Anti-folate systemic immunosuppressant

106
Q

Mycophenolate mofetil

A

Systemic immunosuppressant (inhibits enzyme needed for T and B cell proliferation)

107
Q

LPC

A

Liquor carbonis detergens (coal tar)

108
Q

Acitretin

A

Oral retinoid for treatment of psoriasis

109
Q

Azelaic acid

A

Dicarboxylic acid, used to treat mild to moderate acne

110
Q
A
111
Q

Calcipotriol

A

Synthetic derivative of calcitriol, used for chronic plaque psoriasis

MD2 Dermatology (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions