Derm 4 (passmed) Flashcards
How do you tell the difference between spider naevi and telangiectasia?
Spider naevi can be differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge
What conditions are associated with spider naevi?
- Around 10-15% of people will have one or more spider naevi and they are more common in childhood
- liver disease
- pregnancy
- combined oral contraceptive pill
What are the treatment options for BCC?
- surgical removal
- curettage
- cryotherapy
- topical cream: imiquimod, fluorouracil
- radiotherapy
What are cherry hemangiomas? What are the features and how do you treat them?
Cherry haemangiomas (Campbell de Morgan spots) are benign skin lesions which contain an abnormal proliferation of capillaries. They are more common with advancing age and affect men and women equally.
Features
- erythematous, papular lesions
- typically 1-3 mm in size
- non-blanching
- not found on the mucous membranes
As they are benign no treatment is usually required.
What’s the condition?
- symmetrical, erythematous, tender, nodules which heal without scarring
- most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)
Erythema nodosum
What’s the condition?
- symmetrical, erythematous lesions seen in Graves’ disease
- shiny, orange peel skin
Pretibial myxoedema
What’s the condition?
- initially small red papule
- later deep, red, necrotic ulcers with a violaceous (purple) border
- idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders
Pyoderma gangrenosum (not pyogenic granuloma)
What’s the condition?
- shiny, painless areas of yellow/red skin typically on the shin of diabetics
- often associated with telangiectasia
Necrobiosis lipodica diabeticorum
What should you screen for in a patient with alopecia areata?
Other autoimmune conditions, such as thyroid disease, diabetes and pernicious anaemia
What is the koebner phenomenon and which conditions is it seen in?
The Koebner phenomenon describes skin lesions which appear at the site of injury. It is seen in:
- psoriasis
- vitiligo
- warts
- lichen planus
- lichen sclerosus
- molluscum contagiosum
What is Bowen’s disease?
SCC in situ
How do you manage Bowen’s disease?
- topical 5-fluorouracil or imiquimod
- cryotherapy
- excision
What is AK and what is its other names?
Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure
What are the features of AK?
- small, crusty or scaly, lesions
- may be pink, red, brown or the same colour as the skin
- typically on sun-exposed areas e.g. temples of head
multiple lesions may be present
How do you manage AK/solar keratoses?
- prevention of further risk: e.g. sun avoidance, sun cream
- fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
- topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
- topical imiquimod: trials have shown good efficacy
cryotherapy - curettage and cautery
What are the signs and symptoms of polycythaemia?
- Pruritus particularly after warm bath
- ‘Ruddy complexion’
- Gout
- Peptic ulcer disease
What are the skin types according to Fitzpatrick classification?
I: Never tans, always burns (often red hair, freckles, and blue eyes)
II: Usually tans, always burns
III: Always tans, sometimes burns (usually dark hair and brown eyes)
IV: Always tans, rarely burns (olive skin)
V: Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian)
VI: Black skin (e.g. Afro-Caribbean), never tans, never burns
How do you treat lichen sclerosis?
The first line treatment is a strong topical steroid thus the answer is topical clobetasol propionate.
In around 4-10% of women with lichen sclerosus, the disease will be resistant to steroids and in this case topical tacrolimus is the next line of treatment however this is only initiated in specialist clinics.
Give examples of topical steroids in order of increasing potency
Humans can BE badly violent before calculatng proceeding death
Hydrocortisone Clobetasone butyrate (eumovate) Betamethasone Valerate (betnovate) Clobetasol Propionate (dermovate)
What causes molluscum contagiosum and how is it transmitted?
- molluscum contagiosum virus (MCV), a member of the Poxviridae family
- transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels.
What are the features of molluscum contagiosum?
- characteristic pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter
- anywhere on the body (except the palms of the hands and the soles of the feet)
- in children, lesions are commonly seen on the trunk and in flexures, but anogenital lesions may also occur
- in adults, sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen. Rarely, lesions can occur on the oral mucosa and on the eyelids.
Should children with molluscum contagiosum be excluded from school?
No, not necessary
When should you treat or refer someone with molluscum contagiosum?
Treatment is not usually recommended. If lesions are troublesome or considered unsightly, use simple trauma or cryotherapy, depending on the parents’ wishes and the child’s age:
- Squeezing (with fingernails) or piercing (orange stick) lesions may be tried, following a bath. Treatment should be limited to a few lesions at one time
- Cryotherapy may be used in older children or adults, if the healthcare professional is experienced in the procedure
Eczema or inflammation can develop around lesions prior to resolution. Treatment may be required if:
→ Itching is problematic; prescribe an emollient and a mild topical corticosteroid (e.g. hydrocortisone 1%)
→ The skin looks infected (e.g. oedema, crusting); prescribe a topical antibiotic (e.g. fusidic acid 2%)
Referral may be necessary in some circumstances:
- For people who are HIV-positive with extensive lesions urgent referral to a HIV specialist
- For people with eyelid-margin or ocular lesions and associated red eye urgent referral to an ophthalmologist
- Adults with anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections
A neonate is brought to your surgery because his mother has noticed some skin lesions on his face. On examination there are multiple tiny white papules on the nose. What is the most likely diagnosis?
Milia
Milia are small, benign, keratin-filled cysts that typically appear around the face. They may appear at any age but are more common in newborns.
Milia are a common and normal finding on examination of the newborn, seen in up to half of babies, typically on the face. They will resolve spontaneously over the course of a few weeks.
