Derm Flashcards
Rosacea signs
typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms
Rosacea treatment
Sun cream
If erythema - topical brimonidine
Mild-mod pustules - topical ivermectin
Severe pustules - ivermectin and doxycycline
Laser therapy for prominent telangectiasia
Most common BCC description
sun-exposed sites, especially the head and neck account for the majority of lesions
initially a pearly, flesh-coloured papule with telangiectasia
may later ulcerate leaving a central ‘crater’
BCC management
surgical removal
curettage
cryotherapy
topical cream: imiquimod, fluorouracil
radiotherapy
Pityriasis vesicolor organism
Malassezia furfur
Pityriasis versicolor features
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus
Pityriasis versicolol predisposing factors
occurs in healthy individuals
immunosuppression
malnutrition
Cushing’s
Pityriasis versicolor management
Ketoconazole shampoo
Stevens Johnson’s description
Stevens-Johnson syndrome is a severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction.
Stevens-Johnson’s causes
penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
Stevens-Johnson’s features
the rash is typically maculopapular with target lesions being characteristic
may develop into vesicles or bullae
Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently
mucosal involvement
systemic symptoms: fever, arthralgia
What is Nikolsky sign
the top layers of the skin slip away from the lower layers when rubbed
Where do you get Nikolsky sign
Staph infection
Stevens-Johnson’s
What is systemic mastocytosis
Systemic mastocytosis results from a neoplastic proliferation of mast cells
Features of systemic mastocytosis
urticaria pigmentosa - produces a wheal on rubbing (Darier’s sign)
flushing
abdominal pain
monocytosis on the blood film
Diagnostics for systemic mastocytosis
raised serum tryptase levels
urinary histamine
Risk factors for skin SCC
excessive exposure to sunlight / psoralen UVA therapy
actinic keratoses and Bowen’s disease
immunosuppression e.g. following renal transplant, HIV
smoking
long-standing leg ulcers (Marjolin’s ulcer)
genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
Features of skin scc
typically on sun-exposed sites such as the head and neck or dorsum of the hands and arms
rapidly expanding painless, ulcerate nodules
may have a cauliflower-like appearance
there may be areas of bleeding
Good prognostic factors for skin scc
Well differentiated tumours
<20mm diameter
<2mm deep
No associated diseases
Which melanoma is most aggressive
Nodular
Which malignant melanoma is most common
Superficial spreading
Superficial spreading melanoma affects
Arms, legs, back and chest, young people
Nodular melanoma affects
Sun exposed skin, middle-aged people
Lentigo maligna malignant melanoma affects
Chronically sun-exposed skin, older people
Appearance of Nodular malignant melanoma
Red or black lump or lump which bleeds or oozes
Flexural psoriasis signs
well defined, shiny, erythematous patches in the flexural areas
Flexural psoriasis treatment
Topical steroid
Face psoriasis management
Topical steroid - maximum 2 week
Features of scabies
widespread pruritus
linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
in infants, the face and scalp may also be affected
secondary features are seen due to scratching: excoriation, infection
Inheritance pattern of hereditary haemorrhagic telangiectasia
Autosomal dominant with age related entrance
Diagnostic criteria of hereditary haemorrhagic telangiectasia
Epistaxis
Telangiectases
Visceral lesions (AVM’s, GI telangiectasia)
Family history
Lichen Planus features
Itchy, popular wash on palms, soles, arms & genitals
Polygonal in shape with white lines over them
Koebner phenomenon
Oral involvement in 50%
Thinning nails and longitudinal ridging
Lichen Planus management
Potent topical steroids
Benzydamine mouthwash for oral
Causes of lichenoid drug eruptions
Gold
Quinine
Thiazides
5 P’s of lichen Planus
Planus, purple, pruritic, papular, polygonal
Venous ulcers investigation
ABPI in non-healing
Venous ulceration management
Compression bandage
Oral pentoxifylline
Seborrhoeic dermatitis associated conditions
HIV
Parkinson’s
Seborrhoeic dermatitis features
Eczematous lesions on - scalp, periorbit, auricular, nasolabial folds
Otitis external and blepharitis
Seborrhoeic dermatitis scalp management
Ketoconazole shampoo
H&S & T gel otc
Selenium sulphide
Topical corticosteroid
Seborrhoeic dermatitis face and body management
Topical Ketoconazole
Topical steroids
Dermatitis herpetiformis association
Coeliac
Dermatitis herpetiformis causes
IgA deposition in the dermis
Dermatitis herpetiformis features
Itchy vesicular lesions on the extensors
Dermatitis herpetiformis diagnosis
Skin biopsy, direct immunofluorescence shows IgA in granular pattern in dermis
Management of dermatitis herpetiformis
Gluten free diet
Dapsone
Pyoderma gangrenosum causes
Idiopathic
IBD - crohns, UC
Rheum - RA, SLE
Haem - myeloproliferative, lymphoma, myeloid leukaemia
Granulomatosis with polyangitis
Primary biliary chirrosis
Features of pyoderma gangrenosum
Lower limb
Sudden, small pustule or red bump
Then skin breaks down to ulcer, edge is purple and undermined, deep and necrotic
May have fever or myalgia
Management of pyoderma gangrenosum
Oral steroids
Ciclosporin and infliximab
Causes of acanthosis Nigricans
T2DM, gastro cancer, obesity, PCOS, acromegaly, Cushings, hypothyroidism, familial, prader-willi, COCP, nicotinic acid
Features of a keratoacanthoma
Looks like a volcano or crater. Initially a smooth dome-shaped papule. Then rapidly grows to a crater filled with keratin
Drugs that exacerbate psoriasis
Trauma, alcohol, drugs Inc beta blockers, lithium, anti malarials, nsaids, ace inhibitors, infliximab, withdrawal of systemic steroids
Erythema multiforme features
Target lesions, hands and feet first then torso, upper limb more than lower, pruritus occasional but mild
Erythema multiforme causes
HSV. Idiopathic, bacteria (mycoplasma and streps) drugs, penicillin, sulphonamides, carbamazepine, allopurinol, nsaids, cocp, SLE, sarcoidosis, malignancy
Blisters/Bullae exam features
Mucosal involvement - pemphigus
No mucosal involvement - bullous pemphigoid
Rosacea features
Nose,cheeks & forehead
Flushing
Telangiectasia
Later persistent erythema with papules and pustules
Rhinophyma
Blepharitis
Features of acrodermatitis
Red crusted lesions
Acral distribution
Peri orifice
Perianal
Cause of acrodermatitis
Zinc deficiency
Where are keloid scars most likely to form?
Sternum
Features of pompholyx
Small blisters on palms and soles
Pruritus
Dry and cracked skin when blisters burst
Management of pompholyx
Cool compress
Emollient
Topical steroids
3 D’s of Pellagra
Dermatitis, diarrhoea and dementia (and depression)
Describe livedo reticularis
Purplish, non-blanching reticulated rash
Causes of livedo reticularis
Idiopathic
Polyarteritis nodosa
SLE
Cryoglobulinaemia
Antiphospholipid syndrome
Ehlers-Danlos
Homocystinuria
What condition gives pretibial myxoedema
Graves
Features of pretibial myxoedema
Shiny orange peel skin
Symmetrical
What is melasma?
Benign skin condition in pregnancy. Discolouration of skin. Large, flat, symmetrical.
Treatment for atopic eruption of pregnancy
Nil
Features of atopic eruption of pregnancy
Eczematous, itchy red rash
Features of polymorphic eruption of pregnancy
Last trimester
Abdominal striae
Pruritic
Treatment of polymorphic eruption of pregnancy
Emollient
Mild potency topical steroid
Oral steroid
Features of pemphigoid gestationis
Pruritic blistering lesions
2/3 trimesters
Peri umbilical region to trunk and back and buttocks
Treatment of pemphigoid gestationis
Oral steroids
Causes of hypertrichosis
Minoxidil, ciclosporin & diazoxide
Congenital
Porphyria cutanea tarda
Anorexia nervosa
Malignancy associated with acanthosis nigricans
Gastric
Malignancy associated with acquired ichthyosis
Lymphoma
Malignancy associated with acquired hypertrichosis lanuginosa
GI and Lung
Malignancy associated with dermatomyositis
Ovarian and lung
Malignancy associated with erythema gyratum repens
Lung
Malignancy associated with erythroderma
Lymphoma
Malignancy associated with migratory thrombophlebitis
Pancreatic
Malignancy associated with necrolytic migratory erythema
Glucagonoma
Malignancy associated with pyoderma gangrenosum
Myeloproliferative disorders
Malignancy associated with seeets syndrome
Haemotological
Malignancy associated with tylosis
Oesophageal
What is necrobiosis lipoidica
Shiny painless areas of yellow/red/brown skin. On shin. Telangiectasia. Associated with diabetes.
Conditions associated with diabetes
Necrobiosis lipoidica
Candidasis & staphs
Neuro ulcers
Vitiligo
Lipoatrophy
Granuloma annulare
Adverse effects with isotretinoin
Teratogenicity
Low mood
Dry eyes and skin and lip
Raised triglycerides
Hair thinning
Nose bleeds
What is yellow nail syndrome
Slowing of nail growth, leads to thick and discoloured nails
Yellow nail syndrome associations
Congenital lymphoedema
Pleural effusions
Bronchiectasis
Chronic sinus infections
Fungal nail causative organisms
Dermatophytes - mainly trichophyton
Yeasts - candida
Risk factors for fungal nail infections
Increasing age
Diabetes
Psoriasis
Repeated nail trauma
Management of fungal nail
Nil if patient ok
Limited involvement then amorolfine nail lacquer
Oral terbinafine 6-12 weeks for dermatophyte
Oral itraconazole if candida
What’s the Koebner phenomenon
Skin lesions that appear at the site of injury
Where do you see Koebners phenomenon
Psoriasis
Vitiligo
Warts
Lichen planus
Lichen sclerosus
Molluscum
What is erythrasma
Superficial skin infection
Groin
Corynebacterium
Well defined, pink or brown patches with fine scaling
Woods lamp for porphyrins
What are the mild topical steroids
Hydrocortisone 0.5-2.5
What are the moderate topical steroids
Betamethasone valerate (betnovate) 0.025%
Clobetasone butyrate 0.05% (eumovate)
What are the potent topical steroids
Fluticasone propionate 0.05% (cutivate)
Betamethasone valerate (0.1%) (betnovate)
What is the very potent topical steroid
Dermovate
Clobetasol propionate 0.05%
Psoriasis management
First line - topical steroid and topical vit D
2nd - vit D BD
3rd - steroid BD or coal tar
Psoriasis secondary care management
Phototherapy - UVB or PUVA (SCC side effect)
Oral methotrexate
Ciclosporin
Systemic retinoids
Infliximab, etanercept
Scalp psoriasis management
Potent topical steroid for four weeks
