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Finals > Derm > Flashcards

Derm Flashcards

1
Q

causes of acanthosis nigricans

A
  • T2DM
  • gastrointestinal cancer
  • obesity
  • PCOS
  • acromegaly
  • Cushing’s disease
  • hypothyroidism
  • familial
  • Prader-Willi syndrome
  • drugs
  • COCP
  • nicotinic acid
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2
Q

name for whiteheads and blackheads

A

W- closed comedones
B- closed comedones

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3
Q

categories of acne

A
  • Mild: open/closed comedones +/-sparse inflammatory lesions
  • Moderate: widespread non-inflammatory lesions and numerous papules and pustules
  • severe: extensive inflammatory lesions, which may include nodules, pitting, and scarring
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4
Q

Mx of mild acne

A

Mild: 12 weeks topical combination therapy:

  • topical adapalene with topical benzoyl peroxide
  • topical tretinoin with topical clindamycin
  • topical benzoyl peroxide with topical clindamycin
  • topical benzoyl peroxide may be used as monotherapy if these options are contraindicated or the person wishes to avoid using a topical retinoid or an antibiotic
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5
Q

Mx of moderate to severe acne

A

12-week course of one of the following options:

  • topical adapalene with topical benzoyl peroxide
  • topical tretinoin with topical clindamycin
  • topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
  • a topical azelaic acid + either oral lymecycline or oral doxycycline

can use COCP instead of abx in females

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6
Q

when to refer acne to a dermatologist

A
  • acne conglobate acne
  • nodulocystic acne
  • mild acne hasn’t responded to 2 trials of meds
  • oral abx has not cleared it
  • scarring or pigment changes
  • psychological distress
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7
Q

Condition associated with coeliac disease

A

dermatitis herpetiformis

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8
Q

What is dermatitis herpetiformis

A

autoimmune blistering skin disorder due to IgA deposition
itchy, vesicular skin lesions on the extensor surfaces
Mx gluten free anad dapsone

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9
Q

what are salmon patches

A
  • Vascular birthmark in half of newborn babies (stork marks/bites)
  • pink and blotchy on forehead, neck, eyelids
  • fade over a few months, though marks on the neck may persist
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10
Q

Psoriasis and subtypes

A
  • red, scaly patches
  • plaque psoriasis: MC! well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
  • flexural psoriasis: skin is smooth
  • guttate psoriasis: transient psoriatic rash triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
  • pustular psoriasis: on palms and soles
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11
Q

what exacerbates psoriasis

A
  • trauma
  • alcohol
  • drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
  • withdrawal of systemic steroids
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12
Q

Mx of psoriasis

A
  • emollients
  • a potent corticosteroid applied once daily plus vitamin D analogue applied once daily for 4 weeks
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13
Q

Mx of guttate psoriasis

A
  • most resolve in 2-3 months
  • can use psoriasis topical agents
  • UVB phototherapy if necessary
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14
Q

what is pityriasis rosea

A
  • acute, self-limiting rash which tends to affect young adults
  • recent viral infection
  • herald patch then erythematous, oval, scaly patches in a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer.
  • Has an ‘xmas tree’ appearance
  • Mx self-limiting 6-12 weeks
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15
Q

tinea capitis

A
  • fungal infection
  • flaky skin, itch, and hair loss
  • kerion= raised, pustular, boggy masses which appear as numerous bright yellow areas with the skin surface surrounded by regions of hair loss and flakiness
  • Mx- antifungal
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16
Q

seborrhoeic dermatitis

A
  • fungus called Malassezia furfur
  • eczematous lesions on the sebum-rich areas: scalp, periorbital, auricular and nasolabial folds
  • otitis externa and blepharitis may develop
  • associated with HIV and parkinson’s
  • ketoconazole cream or 2% shampoo
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17
Q

Rosacea features and mx

A
  • affects nose, cheeks and forehead
  • flushing (first), telangiectasia, persistent erythema with papules and pustules, rhinophyma
  • ocular involvement: blepharitis
  • sunlight, exercise, alcohol may exacerbate symptoms
  • Mx= suncream. Mild= topical brimonidine gel. Moderate= topical ivermectin. Severe= mod + oral doxycycline
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18
Q

complication of acne rosacea

A

rhinophyma (mx is to remove)

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19
Q

Toxic epidermal necrolysis (TEN)

A

life-threatening skin disorder that is most commonly seen secondary to a drug reaction

Drugs known to induce TEN
- phenytoin
- sulphonamides
- allopurinol
- penicillins
- carbamazepine
- NSAIDs

Mx- stop drug, supportive, IVIG

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20
Q

Actinic keratosis

A
  • pre malignant due to chronic sun exposure
  • small, crusty, scaly, lesions, well demarcated, pink/red/brown/same colour as skin
  • Mx: 2/3 wks fluorouracil cream, topical imiquimod, cryotherapy, curettage and cautery
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21
Q

Athlete’s foot (tinea pedis)

A
  • scaling, flaking, and itching between the toes
  • topical imidazole, undecenoate, or terbinafine
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22
Q

Fungal nail infection causative organisms

A
  • dermatophytes (90%): mainly Trichophyton rubrum
  • yeasts (5-10%) e.g. Candida
  • non-dermatophyte moulds
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23
Q

Ix for fungal nail infection

A
  • nail clippings +/- scrapings
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24
Q

Mx of mild fungal nail infection

A

Less than 50% nail effected or 2 or < nails effected
- topical treatment with amorolfine 5% nail lacquer; 6 months for fingernails and 9 - 12 months for toenails

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25
Q

Mx of more severe fungal infection

A

dermatophyte
- oral terbinafine 6 weeks - 3 months for fingernail + 3 - 6 months for toes

candida
- oral itraconazole

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26
Q

seborrhoeic keratosis

A
  • benign epidermal skin lesions in elderly
  • stuck on appearance
  • colour from flesh to light-brown to black
  • keratotic plugs may be seen on the surface
  • Mx: reasurre, can remove by curettage, cryo or shave biopsy
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27
Q

Pityriasis versicolor

A
  • Malassezia furfur
  • scale, pruritis, patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
  • ketoconazole shampoo
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28
Q

Lichen planus mx

A

potent topical steroids

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29
Q

erysipelas

A
  • localised skin infection caused by Streptococcus pyogenes
  • Mx flucloxacillin
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30
Q

Scabies

A
  • burrows into the skin, laying its eggs in the stratum corneum
  • pruritis, burrows in fingers
  • Mx: permerthrin for child and household 2 doses one week apart
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31
Q

Four D’s of pellagra (vitamin B3 deficiency)

A

Diarrhoea
Dermatitis
Dementia
Death

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32
Q

Periorificial dermatitis

A
  • women aged 20-45 years old
  • clustered erythematous papules, papulovesicles and papulopustules
    most commonly in the perioral region but also the perinasal and periocular region
  • skin immediately adjacent to the vermilion border of the lip is spared
  • Mx: steroids may worsen sx, treat with topical or oral antibiotics
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33
Q

Sebaceous cysts

A
  • most common scalp, ears, back, face, and upper arm
  • contain a punctum
  • excise to prevent recurrence
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34
Q

dermatofibroma

A
  • solitary firm papule or nodule around 5-10mm in size
  • typically on a limb
  • overlying skin dimples on pinching the lesion
  • precipitated by injury i.e. insect bite
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35
Q

impetigo

A
  • Staphy aureus or Strep pyogenes
  • ‘golden’, crusted skin lesions typically found around the mouth, very contagious
  • Mx: hydrogen peroxide 1% cream
  • exclude from school until lesions are crusted and healed or 48 hours after commencing abx
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36
Q

Vitiligo

A
  • well-demarcated patches of depigmented skin
  • peripheries most affected
  • trauma may precipitate new lesions (Koebner phenomenon)
  • Mx: suncream, camouflage make-up, topical corticosteroids may reverse the changes if applied early, phototherapy
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37
Q

isotretinoin side effects

A
  • dry skin (MC)
  • teratogenic
  • low mood
  • raised triglycerides
  • hair thinning
  • nose bleeds
  • intracranial hypertension
  • photosensitivity
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38
Q

Types of melanoma

A
  • superficial spreading (MC)
  • nodular
  • lentigo maligna
  • acral lentiginous
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39
Q

superficial spreading melanoma features

A
  • 70% cases
  • arms, legs, back, chest, young
  • irregular borders with variation in
    colour, growing
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40
Q

nodular melanoma features

A
  • second commonest
  • sun exposed skin, middle aged
  • Red or black lump or lump which bleeds or oozes
  • can occur on all sites
  • most aggressive, metastasis early
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41
Q

lentigo maligna melanoma features

A
  • less common
  • chronically sun exposed, elderly
  • Caucasians, flat,
    slowly growing black lesion
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42
Q

acral lentiginous features

A
  • rare
  • Nails, palms or soles, People with darker skin pigmentation
  • Subungual pigmentation (Hutchinson’s sign) or on palms or feet
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43
Q

Kaposi Sarcoma

A
  • Tumour of vascular and lymphatic endothelium.
  • Purple cutaneous nodules.
  • Associated with immuno supression.
  • Affects elderly males and is slow growing.
  • Immunosupression form is much more aggressive and tends to affect those with HIV related disease. HHV8
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44
Q

Pyogenic granuloma

A
  • Overgrowth of blood vessels.
  • Red nodules.
  • Usually follow trauma.
  • May mimic amelanotic melanoma.
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45
Q

Hereditary haemorrhagic telangiectasia

A

Need 2-3/4 to diagnose:
1. epistaxis : spontaneous, recurrent
2. telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
3. visceral lesions: for example gastrointestinal telangiectasia (+/-bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
4. FH: a first-degree relative with HHT

46
Q

Basal cell carcinoma features

A
  • sun-exposed sites, especially the head and neck
  • initially a pearly, flesh-coloured papule with telangiectasia
  • may later ulcerate leaving a central ‘crater’
47
Q

Mx of basal cell carcinoma

A
  • routine referral should be made
  • surgical removal
  • curettage
  • cryotherapy
  • topical cream: imiquimod, fluorouracil
  • radiotherapy
48
Q

Bowen’s disease features

A
  • precancerous dermatosis that is a precursor to squamous cell carcinoma
  • red, scaly patches, slow growing, on sun exposed areas
49
Q

Mx of bowen’s disease

A
  • topical 5-fluorouracil BD for 4 weeks
  • meds often results in significant inflammation/erythema. Topical steroids are often given to control this
  • cryotherapy
  • excision
50
Q

pathway of SCC formation

A

actinic keratosis –> bowen’s –> SCC

51
Q

erythema multiforme features

A
  • hypersensitivity reaction
  • target lesions
  • initially seen on the back of the hands / feet before spreading to the torso
  • upper limbs > lower limbs
  • pruritus is occasionally seen and is usually mild
52
Q

erythema multiforme causes

A
  • viruses: HSV (most common), Orf
  • idiopathic
  • bacteria: Mycoplasma, Strep
  • drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
  • connective tissue disease e.g. SLE
  • sarcoidosis
  • malignancy
53
Q

erythema multiforme major

A

more severe form
associated with mucosal involvement

54
Q

Bullous pemphigoid features

A
  • autoimmune condition causing sub-epidermal blistering of the skin
  • itchy, tense blisters typically around flexures
  • blisters usually heal without scarring
  • stereotypically no mucosal involvement (i.e. the mouth is spared)
55
Q

Ix for bullous pemphigoid

A

immunofluorescence shows IgG and C3 bind to hemidesmosomes of BM at the dermoepidermal junction

56
Q

Mx of bullous pempihgoid

A
  • referral to a dermatologist
  • oral corticosteroids 1st line
  • topical corticosteroids, immunosuppressants and antibiotics are also used
57
Q

Pemphigus vulgaris features

A
  • autoimmune disease
  • Ashkenazi Jewish population
  • mucosal ulceration is common
  • flaccid, easily ruptured vesicles and bullae.
  • painful non itchy lesions
  • Nikolsky +ve
58
Q

Ix for pemphigus vulgaris

A

IgG Abs bind to
desmoglein 1 & 3
(adhesion molecules desmosomes)
between keratinocytes
in stratum spinosum →
acantholysis

59
Q

Mx of pemphigus vulgaris

A
  • oral steroids
  • immunosuppressants
60
Q

rash with pain

A

shingles

61
Q

complications is most associated with psoralen + ultraviolet A light (PUVA) therapy?

A

SCC

62
Q

Urticaria features

A
  • local or generalised superficial swelling of the skin
  • due to allergy
  • ‘hives’, ‘wheals’, ‘nettle rash’
  • pruritic
63
Q

Mx of urticaria

A
  • non-sedating antihistamines (e.g. loratadine or cetirizine) up to 6 weeks
  • chlorphenamine may be used at night for troublesome sleep sx
  • prednisolone is used for severe or resistant episodes
64
Q

Eczema herpeticum

A
  • severe primary infection of the skin by herpes simplex virus 1 or 2
  • children with atopic eczema
  • presents as a rapidly progressing painful rash
  • monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm
65
Q

Mx of eczema herpeticum

A
  • refer to secondary care
  • IV aciclovir
66
Q

Cherry haemangioma features

A
  • benign skin lesions which contain an abnormal proliferation of capillaries
  • increasing age RF
  • erythematous, papular lesions
    typically 1-3 mm in size
  • on-blanching
  • not in mucous membranes
  • Mx: nil
67
Q

pyoderma gangrenosum features

A
  • rare, non-infectious, inflammatory disorder
  • very painful skin ulcer
  • lower legs most common site
  • can also have systemic sx
68
Q

causes of pyoderma gangrenosum

A
  • idiopathic 50%
  • IBD
  • RA and SLE
  • haematological e.g. myeloproliferative disorders, lymphoma, myeloid leukaemias
  • granulomatosis with polyangiitis
  • PBC
69
Q

Mx of pyoderma gangrenosum

A

the potential for rapid progression
- oral steroids
- immunosuppressive therapy in difficult cases

70
Q

lichen sclerosis features

A
  • itchy white lesion on elderly vulva
71
Q

Mx of lichen sclerosis

A

topical steroids and emollients

72
Q

what does lichen sclerosis increase risk of

A

vulval cancer

73
Q

Hidradenitis suppurativa features

A
  • chronic, painful, inflammatory skin disorder
  • inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas (axilla MC)
  • F > M , <40y/o
  • ‘rope-like’ scarring
  • sweat related
74
Q

Mx of hiradenitis suppurativa

A
  • good hygiene and loose-fitting clothing
  • Smoking cessation
  • Weight loss in obese
  • Acute flares: steroids (intra-lesional or oral) or flucloxacillin. Surgical incision and drainage may be needed
  • Long-term: topical (clindamycin) or oral (lymecycline or clindamycin and rifampicin) antibiotics.
  • Lumps that persist are excised
75
Q

Tinea corporis (ringworm)

A
  • causes include Trichophyton rubrum and Trichophyton verrucosum (e.g. From contact with cattle)
  • well-defined annular, erythematous lesions with pustules and papules
  • Mx oral fluconazole
76
Q

what burns needed fluid resus

A

> 15% body area

77
Q

side effect of ketoconazole

A

gynaecomastia

78
Q

livedo reticularis features

A

purplish, non-blanching, reticulated rash caused by obstruction of the capillaries –> swollen venules

79
Q

causes of livedo reticularis

A
  • idiopathic (most common)
  • polyarteritis nodosa
  • SLE
  • cryoglobulinaemia
  • antiphospholipid syndrome
  • Ehlers-Danlos Syndrome
  • homocystinuria
80
Q

keratoacanthoma features

A
  • benign epithelial tumour.
  • common with advancing age
  • look like a volcano or crater
  • initially a smooth dome-shaped papule
  • rapidly grows to become a crater centrally-filled with keratin
81
Q

Mx of keratoacanthoma

A
  • Spontaneous regression within 3 months is common, often resulting in a scar.
  • Lesions should be urgently excised as it is difficult clinically to exclude squamous cell carcinoma
82
Q

Keloid scars

A
  • tumour-like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound
  • common in darker skin
83
Q

Mx of keloid scars

A
  • early: intra-lesional steroids e.g. triamcinolone
  • excision is sometimes required but can create further keloid scarring
84
Q

Venous ulceration mx

A
  • compression bandages
  • oral pentoxifylline, a peripheral vasodilator, improves healing rate
85
Q

how to differentiatie toxic epidermal necrolysis from Staphylococcal Scalded Skin syndrome

A

SSSS- neonates and young children
TEN- drug induced

86
Q

uncircumcised man, who has developed a tight white ring around the tip of the foreskin and phimosis

A

lichen sclerosis

87
Q

most effective treatment for prominent telangiectasia in rosacea

A

phototherapy

88
Q

Erythema ab igne

A

caused by infrared radiation and is commonly associated with hot water bottles or open fires

89
Q

single most important prognostic factor of melanom

A

depth
Breslow thickness

90
Q

squamous cell carcinoma RFs

A
  • excessive exposure to sunlight / psoralen UVA therapy
  • actinic keratoses and Bowen’s
  • immunosuppression e.g. following renal transplant, HIV
  • smoking
  • long-standing leg ulcers (Marjolin’s ulcer)
  • genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
91
Q

squamous cell carcinoma features

A
  • sun-exposed sites
  • rapidly expanding painless, ulcerate nodules
  • cauliflower-like appearance
  • there may be areas of bleeding
92
Q

Mx of squamous cell carcinoma

A

Surgical excision
- 4mm margin if lesion <20mm
- >20mm then 6mm margin
- Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.

93
Q

signs of zinc deficiency

A
  • Dermatitis (red crusted lesions) in acral, peri-orificial and perianal distribution
  • alopecia
  • short stature
  • hypogonadism
  • hepatosplenomegaly
  • geophagia (ingesting clay/soil)
  • cognitive impairment
94
Q

niacin deficiency (pellagra)

A
  • vitamin b3 def
  • diarrhoea, dermatitis, and dementia
95
Q

vitamin c deficiency

A
  • scurvy
  • ecchymoses, perifollicular haemorrhages, and corkscrew hairs and purpura.
96
Q

Stevens-Johnson Syndrome causes

A
  • severe systemic reaction affecting the skin and mucosa that is almost always caused by a drug reaction
  • penicillin
  • sulphonamides
  • lamotrigine, carbamazepine, phenytoin
  • allopurinol
  • NSAIDs
  • oral contraceptive pill
97
Q

Features of Stevens-Johnson Syndrome

A
  • rash (<10% BDSA) is 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
98
Q

actinic keratosis vs seborrhoeic keratosis

A

AK: pre-malignant, red rough scaly patches
SK: benign, brown stuck on appearance

99
Q

how to assess depth of burns

A
  1. Superficial epidermal: 1st degree Red and painful, dry, no blisters
  2. Partial thickness (superficial dermal): 2nd degree
    Pale pink, painful, blistered. Slow capillary refill
  3. Partial thickness (deep dermal): 2nd degree
    Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure
  4. Full thickness: 3rd degree
    White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain
100
Q

Causes of pruritis

A
  • liver disease
  • iron deficiency anaemia
  • polycythaemia
  • CKD
  • lymphoma
101
Q

erythroderma features

A

when more than 95% of the skin is involved in a rash of any kind.

102
Q

causes of erythroderma

A
  • eczema
  • psoriasis
  • drugs e.g. gold
  • lymphomas, leukaemias
  • idiopathic
103
Q

conditions that psoriasis increases the risk of

A

cardiovascular disease
lymphoma
non-melanoma skin cancer

104
Q

erythema nodosum features

A
  • inflammation of subcutaneous fat
  • tender, erythematous, nodular lesions
  • over shins, also elsewhere (e.g. forearms, thighs)
  • usually resolves within 6 weeks
    lesions heal without scarring
105
Q

causes of erythema nodosum

A

NODOSUM
No- idiopathic
D- drugs (penicillins, sulphonamides)
O- oral COCP/pregnancy
S- sarcoidosis
U- UC/Crohn’s Behcet’s
M- microbiology infection (streptococci, TB, brucellosis), malignancy

106
Q

port wine stain

A
  • vascular birthmarks that tend to be unilateral
  • deep red or purple
  • do not spontaneously resolve, darken and become raised over time
107
Q

Port wine stain mx

A

cosmetic camouflage or laser therapy (multiple sessions are required)

108
Q

Hyperhidrosis

A

excessive sweat production

109
Q

Mx for hyperhidrosis

A
  • topical aluminium chloride 1st line SE skin irritation
  • iontophoresis: useful for patients with palmar, plantar and axillary hyperhidrosis
  • botulinum toxin: for axillary sx
  • surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating
110
Q

Strawberry naevus

A
  • not present at birth but may develop rapidly in the first month of life
  • erythematous, raised and multilobed tumours
  • increase in size until around 6-9 months before regressing over the next few years
111
Q

mx of cellulitis

A

flucloxacillin
calirthromycin or doxycycline if penicillin allergy
erythromycin if pregnant

Finals (26 decks)

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