Derm Flashcards
Basal Cell Carcinoma
Initially a skin coloured pearly papule on sun exposed areas.
Later may ulcerate and have telangectasia.
Need to refer routinely.
Squamous cell carcinoma
Scaly crust lumps.
RF - excessive sunlight, actinic keratosis, bowens disease, immunosuppression (renal transplant), smoking, ulcers and genetic conditions.
Need excision.
Actinic
Psoriasis
Chronic skin condition in which there is red scaly patches seen. There are subtypes:
Chronic Plaque - most common and found on extensor surfaces.
Flexural - happens on flexures but the skin remains smooth.
Guttate - triggered by a strep infection. Red teardrop lesions
Pustular - seen on palms and soles
There is also classical nail changes seen - pitting, onycholysis, subungual hyperkeratosis and loss of nail
This condition is made worse by steroid withdrawal, alcohol, NSAIDs, beta blockers, ACE and lithium. Also by trauma
Eczema
Itchy red rash found on flexors. In young children may appear on the extensors. In infants face and trunk affected.
treat with topical emoilents and then if no better topical steroids.
Pompholyx is linked with temperature (humidity) and is found on palms and feet.
Herpeticum - needs adission. Infection with herpes virus 1 or 2. Rapidly progressing painful rash. IV aciclovir.
Shingles
Reactivation of VZV in the dorsal root ganglion. Normally occurs when patient becomes immunosuppressed.
Prodromal - bruning pain over region and some get fever and headache.
rash - initially macular and red but then turns to vesicles. Dermatomal.
Clinical Diagnosis
Management - infectious until crusted over. Analgesia and steroids if IC. Antiviral mainstay within 72 hours. Only bnefit of this is to stop ost-herpetic neuralgia.
Venous Ulcers
Normally seen over the MM
Compression bandaging is how to manage. Pentoxifylline can also speed up process .
Acanthosis Nigricans
Symmetrical brown plaues.
Causes:
T2DM, GI cancer, PCOS, acromegaly, cushings, prader willi and cocp
Insulin resistance leads to hyperinsulinemia. This causes keratinocytes stimulation and fibroblast proliferation.
Acne Vulgaris
Obstruction of the pilosebaceous follicle with keratin plugs. They then get colonised by propionibacterium acnes leading to inflammation.
Comedomes = closed = whitehead.
Papules and pustules
Ice pick scars and hypertrophic scars
Acne fulimans - systemic upset + acne. Need admission and steroids
Treatment:
1. Single topical therapy - retinoid or benzoyl peroxide
2. Topical combination
3. Oral AB + topical treatment - tetracycline (unless pregnant / BF / under 12 - erythromycin)
Note COCP is alternative to oral AB in women
4. Oral isoretinoin - specialist needs to start
No role in diet
Alopecia
Localised well demarcated patches of hair loss. Presumed to be auto immune in nature.
50% it comes back in one year and 80-90% eventually. To treat can use steroids
Athletes foot
Tinea Pedis. USually caused by Tricophyton fungi.
Scaling, flaking and itching between toes.
Topical Imidazole or terbinafine used first line
Bullous Pemphigoid
Autoimmune condition causing sub epidermal blistering. Get AB against BP180 and 230.
Itchy blisters and no mucosal involment.
Derm referral and oral steroids.
Subtypes of burns
Superficial Epidermal - First degree - red and Painful
PArtial thickness - superficixal dermal - 2nd degree - pale pink and blistered
Partial thickness - deep derma - 2nd degree - white and reduced sensation
Full thickness - third degree - white / brown in colour and no pain
Subtypes of burns
Superficial Epidermal - First degree - red and Painful
PArtial thickness - superficixal dermal - 2nd degree - pale pink and blistered
Partial thickness - deep derma - 2nd degree - white and reduced sensation
Full thickness - third degree - white / brown in colour and no pain
Management of Burns
First Aid - ABC, heat burns = irrigate cold water and layer with cling film. In chemical burns irrigate with water.
Rule of 9s - Neck and head = 9%. Anterior leg = 9%. ANterior chest = 9% etc
All deep dermal and full thickness need referral. Also superficial dermal if more then 3% TBSA adults or 2% kids. Also if these effect hands, face, feet or flexure or genitlas. Circumferentila burns should also be referred.
Superifical epiderma - symtpoms relief and emolients
Superficial dermal - leave blisters in tact and avoid creams
Fluids - needed in those over 15% TBSA. Parkland formula - % x weight x 4 - half of which in first 8 hours.
Circumferential may need escharotomy.
Cherry Haemangioma
Benign skin lesions which contain abnormal proliferation of capillaries.
1-3mm papular red lesions non blanching.
No treatment
Dermatitis
Irritant - non allergic due to weak acids or alkalis. Crusting redness
Allergic - acute weeping eczema. Need topical steroid. More rare
Dermatitis Herpetiformis - autoimmune blistering skin disorder linked with coeliac disease. IgA deposition. Seen on extensors.
Dermatofibroma
Abnormal growth of dendritic histiocyte cells are trauma.
Firm papule and skin dimples on pinching lesions
Erysipelas
Localised skin infection caused by Strep Pyogens. Superficial limited cellulilits treated with flucloxacillin
Erythema ab igne
Over exposure to infra red radiation. Reticulated red patched with hyperpigemntation and telangiectasia. Sitting next to fire. CAn lead to SCC
Erythema Multiforme
Hypersensitivity reaction - triggered by infections
Target lesions seen on back of hands spreading to torso.
Herpes simplex most common but also pencillin, allopurinol, COCP, sarcoid and SLE
It is classed as major if there is mucosal involvement.
Erythrasma
No symptoms. Flat slighly scaley pink or brown rash.
Overgrowth of corynebacterium.
Topical miconzaole or antibacterial. If extensive can use oral erythromycin
Erythroderma
More than 95% of skin is involved in a rash
can be eczema, psoriasis, drugs, lymphomas or no cause
Fungal Nail infections
dermatophytes cause 90% of the cases. Trichophtan rubrum is the most common.
Thickened rough and opaque in nature
Take clippings and scrappings.
No treatment if no symptoms. But if patient wants:
dermatophyte - oral terbinafine
Candida - topical antifungals but kf severe oral itraconazole
Hereditary Haemorrhagic telangiectasia
Autosomal Dominant - Need to have two of the following 4:
Epistaxis, telangiectasias, visceral lesions or FH.
Hiradenitis Suppurativa
Chronic Panful inflammatory skin disorder. Inflmmatory nodules form. There is occlusion of the folliculopilosebaceous units. Obstructs the apocrine glands and orevent keratinocytes from shedding.
Smoking, obesity, PCOS and DM are all risk factors.
Axilla is the most common site. Cause rope like scarring.
Managed with smoking cessation, weight loss, steroids or fluxcloax for acute disease. More chronically topical clindamycin or oral lymeycycline can be given.
Hirsutism
Hirsutism - Androgen dependent hair growth in women.
PCOS
cushings
Adrenal Hyperplasia
Obesity
Tumours of adrenal
Steroids and phenytoin
COCP or eflornithene if on face is used
Hypertrichosis
Androgen independent hair growth.
Anorexia and drugs such as ciclosporin and minoxidil are the common causes.
Hyperhidrosis
Excessive production of sweat.
Al Cl used to manage. Botox can also be used or worse comes to worse surgery of the sympathectomy.
Keloid Scar
Tumour like lesions that arise from the Connective tissue. Extends beyond the limit of original wound
More in dark skin and on the sternum .
Steroids used to treat if early. If not can excise
Keratocanthoma
Benign epithelial tumour.
Said to look like a volcano. Initally is smooth dome and then turns into crater.
Often goes away on own in 3 months. Lesions should be removed - hard to differentiate from SCC
Lichen Planus
Itchy papular rash on palms soles genitals or flexors.
Polygonal, planar, pruritic, papules, plaques and purple.
potent topical steroids are used to treat
Lichen Sclerosus
Usually affects the genitalia in elderley females. Leads to white plaque formation.
Can do biopsy if atypical features present
Topcial steroids and emolients sued with follow up for vulval cancer
Malignant Melanoma
superficial spreading - most common. Growing mole
Nodular - 2nd most common. Red or black oozing lump / bleed
Lentigo maligna - less common. More chronic. Same as SS
Acral lentiginous - rare and subungual hyperpigementation (Hutchinsons sign)
Breslow depth is key to prognosis.
Molluscum contagiosum
Caused by the virus in the name. Transmitted via close personal contact or indirectly via towels
Pinkish / pearly papules with central umbilication.
Self limiting and will go away in 1.5 years. No schoolexclusion. If really need treatment can use cryotherapy
Need to refer people with HIV. eyelid or ocular lesions or anogenital lesions
Pellagra
Niacin deficiency
Diarrhoea, dermatitis and demenita.
Can occur secondary to isonaizide therapy.
Pemphigus Vulgaris
Autoimmune in nature and there are antibodies against desmoglein 3.
Mucosal ulceration is often first symptom. Skin blistering follows.
Steroids
Periorifacial Dermatitis
Steroids can cause
Clustered red papules, vesicles and pustules.
STeroids worsen so treat with topical or oral AB
Pityriasis rosea
Acute self limiting rash caused by HHV 7.
May have recent viral prodrome. Heradl patch seen followed by oval scales fir tree distribution.
Usually disappears on own 6-12 weeks
Pityriasis veriscolor
Malassexia furfur infection.
Hypopigemented lesions or can be pink or brown. More noticable after sun tan.
Mild itch.
Topical antifungal ie ketoconazole shampoo. If no response then oral itraconazole
Porphyria Cutanea Tarda
Most common hepatic porphyria
Photosensitive rash wih blisterin + hypertrichosis _+ hyperpigmentation
Elevated urinary uroporphyrinogen.
Chlorquine and venesection used
Port whine stain
Unilateral vascular birth marks. Deep red / purple in colour. They do not go away on own. Laser therapy used
Pyoderma Gangrenosum
Rare non infectious inflammatory skin disorder. It is a neutrophillic dermatoses.
Can be idiopathic, IBD, RA, Blood cancers, PBC or Granulomatosis with polyangitis.
Normally lower limb at site of minor injury. Small pustule or red bump initially. The ulcerates and becomes painful.
Oral steroids.
Pyogenic Granuloma
Cause is not known but linked to trauma, pregnancy and women.
Mostly on the head / neck, hands although oral mucosa is common in pregnancy.
Initially there is a red / brown spot but grows and raises and can bleed.
In pregnancy often go on own after birth. If it persists then cane use excision or cryotherapy.
Rosacea
Normally affects the nose and cheeks.
Flushing and telangiectasia initially which transforms to redness with papules and pustules. Made worse by sunlight.
Topical Metro / ivermectin is for mild with oxytetracycline oral for severe.
If there is prominent telangiectasia then think of laser therapy. Brimiodine gel if limited telangiectasia but flushing
Salmon Patch
Pink and blotchy birth marks. Usually fade over few months.
Scabies
The mite sarcoptes scabei causes burrowing into skin and laying of eggs. Cause a T4HS reaction.
Intense itching, burrows in fingers and inbetween them.
Manage with Permthrin first line and malthion second line.
Treat all household and physical contacts at same time.
Seborrhoeic dermatitis
Normally malessiza fufur causes. Chronic inflammation.
Get eczema like regions around eyes, ears and nasolabial folds.
Linked with HIV and Parkinsons.
Face and bOdy - topical ketoconazole.
Scalp - Head and shoulders/ Ketoconazole second line
Seborrhoeic keratoses
Bening epidermal skin lesions.
Brown in colour and have stuck on appearance.
Reassure and can excise or freeze off
Skin and pregnancy
Atopic eruption - Most common. Eczema like rash. No treatment
Polymorphic eruption - Late T1. Itchy. Abdominal striae. Emolinets and steroids. Spares the peri-umbilical region
Pemphigoid gestationis - puruitic and blistering. Often starts peri umbilicus and spreads T2 or T3. Oral steroids
Spider Naevi
Central red papule with surrounding cappilaries. Blanch when pressed. Fill from centre.
Liver disease, pregnancy and COCP can cause
Steven Johnson syndrome
severe systemic reaction affecting the skin and mucosa.
Maculopapular rash with target lesions. There is mucosal involvement and get fever and joint pain.
Causes - Sulphonamides, anti epileptics, penicillin, allopurinol, NSAIDs and COCP.
Need admissio
Strawberry Naevus
Normally not present at birth but become present in first month. Raised red.
Resolve eventually.
Propranolol if need treatment.
Tinea
Tine capitis - scalp - oral antifungals - tebrinfaine if trichophytan or griseofulvin for microsporium. Both need topical ketoconazole.
Tine corpis - Tricophytan rubrum and verrucosum. Well defined annular red lesion Oral fluconazole. Ringworm
Toxic epidermal Necrolysis
Skin looks scalded. Systemically unwell and have Nikolskys sign - separation of the epidermis on mild lateral pressure.
Phenytoin, sulphonamides, allopurinol, penicillins, NSAIDs and carbemazpine.
IV immunoglobulin and supprotive care
Uriticaria
Superfifical swelling of the skin.
Pale pink raised skin. Itcchy
Non sedating antihistamines. Pred if resistant
Zinc Deficiency
The presentation:
Acrodermatitis - red crusted lesions either around mouth or anus
Hypogonadism
Alopecia
Short
Hepatosplenomegaly
Congition issues
Head and neck cancer referral
Includes oral cavity cancers, pharyngeal cancer and laryngeal cancers
Features can be:
Neck lump
Hoarseness
Persistent sore throat
Persistent Mouth Ulcer
2WW Referrals:
Laryngeal - 45+ with unexplained hoarseness or unexplained lump
Oral Cancer - Unexplained ulceration lasting more than 3 weeks or lump
Thyroid - thyroid lump
Please note urgent referral to dentist can also be done if there is a lump in lip or in mouth or erythroplakia/ erythroleukoplakis
Management of Psoriasis
Plaque:
Management - Use Steroid and Vit D analogue. Then if not better at 8 weeks x2 Vit D and then if no better again x 2 on steroid or add coal tar. In hospital UVB and methotrexate may be used.
Scalp:
Potent steroids
Face / Flexural - mild or mod potency steroids for max 2 weeks
