common skin conditions Flashcards
covers itch, psoriasis, acne, rosacea, lichen planus
what is hyperkeratosis
increased thickness of keratin
what is parakeratosis
persistence of nuclei in the keratin layer
what is acanthosis
increased thickness of epithelium
what is papillmatosis
irregular epithelial thickening
what is spongosis
oedema between squames, will increase prominence of intercellular prickles
what is puritus
a unpleasant, poorly localised, non-adapting, sensation that provokes the desire to scratch
where is the itch sensation processed
parts of the forebrain and hypothalamus
what are the 4 types of itch, give examples
pruritoceptive = something triggers itch e.g. eczema, dry skin, psorasis
neuropathic = damage to nerves e.g. MS
neurogenic = no evidence of damage to the CNS but it has been affected e.g. opiates
psychogenic = pyschological cause with no CNS damage e.g. delusion
what is the treatment for itch
determine and treat underlying cause antihistamine emollients antidepressants phototherapy opiate antagonists
what is the most common type of psoriasis
chronic plaque psoriasis aka psoriasis vulgaris
describe psoriasis
symmetrical
Commonly affects the extensors, scalp, sacrum, hands, feet, trunk and nails
Sharply demarcated, scaly, erythematous plaques which are reversible
what are auspitz signs, what condition are they associated with
removal of surface scale reveals tiny bleeding points
what is the kobner phenomenon
psoriasis develops in areas of skin trauma e.g. scratch marks or scars
describe nails found in psoriasis
pitting
dystrophy
sublungal hyperkeratosis
onycholysis
what is the buzzword description for psoriasis
Sharply demarcated, scaly, erythematous plaques which are reversible
what is psoriasis associated with
arthritis crohns cancer depression uvetitis obesity/hypertension/dibetes/lipid abnormalities
what is the management of psoriasis
emollients = 1st line steroid ointments =2nd line vitamin D analogues coal tar dithranol can combine with phototherapy last line = systemic treatments
give examples of vitamin D analogues
Calciptriol
calcitrol
what is Guttate psoriasis
small lesions over the upper trunk and proximal extremities classically trigged by a bacterial infection usually a URT infection
aka eruptive
what is palmoplantar pustular psoriasis
chronic condition affecting the soles and palms, can occur without psoriasis
what is eruthrodemic psoriasis
this is a rare aggressive, inflammatory form of psoriasis. Symptoms include a peeling rash across the entire surface of their body. The rash can itch or burn intensely and it spreads quickly.
aka widespread pustular
what is acne vulgaris
chronic inflammatory disease of the pilosebaceous unit
what is the cause of acne (3)
increased androgens at puberty = increased sebum
keratin plugging of pilosebaceous units = blockage
infection with anaerobic bacteria “corynebacteium acnes” = infection
describe the appearance of acne
relates to sites with the most sebaceous glands comedones: open = blackheads, closed = whiteheads pustules, papules, and cysts erythema secondary features include: scars texture change hypertrophic changes
what are the gradings of acne
mild, moderate and severe
describe mild acne
scattered papules, pustules and comedones
describe moderate acne
numerous papules, pustules and mild atrophic scarring
describe severe acne
cysts, nodules, and significant scarring
what i the treatment of acne
most will spontaneously resolve with time benzoyl peroxide vitamin A derivatives antibiotics (topical or oral) isotrentinoin (oral)
what is rosacea
prominent facial flushing exacerbated by sudden change
what commonly affects rosacea
spicy foods
alcohol
change in temperature
describe rosacea
located on chin, cheeks, and forehead papules, pustules but no Comedones erythema = visible blood vessels thickening of skin (rhinophyma) = enlarged, unshapely nose conjunctivitis/gritty eyes
what is the management of rosacea
reduce aggravating factors metronidazole ivermectin = reduces mite numbers tetracycline (long term) isotretinon at low dose if severe
treatment of telangiectasia
vascular laser
treatment of rhinophyma
surgery.laser shaving
what is lichen planus
type of lichenoid eruption which is characterised by damage and infiltration between the epidermis and dermis
Itchy, non-infectious rash
describe the appearance of lichen planus
Violaceous (pink/purple), flat-topped shiny papules
Wickham’s striae = fine, lace-like pattern on surface of papules and buccal mucosa
what is the treatment of lichen planus
generally lasts 12-18 months before disappearing on its own
topical or oral steroids
what is vasculitis
group of disorders in which there are inflamed blood vessels
what are the symptoms of vasculitis
wide range:
pain
sudden onset
purpuric rash/pustules
necrotic
what is a chronic leg ulcer
open lesion between the knee and the ankle joint that remains unhealed for at least 4 weeks
what are the causes of leg ulcers
venous (60-80%) arterial (22%) mixed venous and arterial (10-20%) rheumatoid arthritis (9%) diabetes (5%)
describe a venous leg ulcer
lower leg
shallow edged
shallow base
may have other venous pathologies (e.g. varicose veins)
describe a arterial leg ulcer
punched out appearance
deep
very painful
may have other arterial pathologies (e.g. pale, hairless, shiny, cool to the touch)
what are the symptoms of leg ulcers
pain leakage smell Lipodermatosclerosis/ hyperpigmentation infection
what are the investigations of leg ulcers
ABPI bloods patch testing duplex scan swab
what would a ABPI tell you
if the ulcer was arterial
what is the normal range for ABPI
1
what range suggests vascular disease in ABPI
<0.8
what range suggest calcification in ABPI
> 1.5
when would you do a patch test for a leg ulcer
if there is associated eczema or an allergy/irritant is suspected
when would you take a swab of an leg ulcer
if infection is suspected
what is the treatment of leg ulcers
non-adherent dressing de-sloughing compression application compression stockings leg elevation pain relief
what must you consider if normal treatments aren’t working with leg ulcers
malignancy
what treatment should be considered for psoriasis of the scalp
greasy ointments
tar shampoo
steroid shampoo
vit D analogues
what treatment should be considered for psoriasis of the axilla
calcineurin inhibitor
what is the buzzword for lichen planus
Irregular sawtooth acanthosis
where does lichen plans typically affect
Typically effect volar wrists/forearms, shins and ankles
what is the histology of lichen planus
Hypergranulosis = thicken granular layer
orthohyperkeratosis = hyperkeratosis with no nuclei
Band-like upper dermal infiltrate of lymphocytes
