Derm Flashcards
is lichen planus more likely to present with pruritis or pain?
pain
causes of pruritis ani
fissure incont poor hygiene tight pants threadworm fistula dermatoses lichen sclerosis anxiety contact dermatitis or unknown cause
Mx of pruritis ani
hygiene avoid scrating avoid foods that loosen stool soothing ointment mild topical corticosteroids if inflamm oral antihist for night
pre-malignant crumbly yellow-white scaly crusts on sun exposed skin from dysplastic intra-epidermal proliferation of atypical keratinocytes. What is the diagnosis, and give 2 differentials
actinic [solar] keratoses
Bowen’s
psoriasis
BCC
serorrhoeic keratosis
Ix and Mx in actinic keratoses
biopsy if in doubt of diagnosis
none, emollient, diclofenac gel, fluorouracil [inflamm rn>heal] imiquimod [inflamm] cryotherapy photodynamic therapy surg excision + curettage
a well defined slowly enlarging red scaly plaque with a flat edge [asymptomatic]. Histology shows full thickness dysplasia/carcinoma in situ. Diagnosis?
bowen’s disease
Mx of bowen’s disease
fluorouracil [inflamm rn>heal] imiquimod [inflamm] cryo photodynamic curettage, excision
causes of bowens disease
UV exposure radiation imm.supp. arsenic HPV [in genital area]
most common skin cancer
BCC
describe the 2 types of BCC
nodular: pearly nodule, rolled telangiectasia edge, face
superficial: red scaly plaque, trunk/shoulders
Mx BCC
excision cryo curettage radiotherapy photdynamic imiquimod/fluorouracil [superficial low risk]
Mx of primary SCC
local complete excision
most common cancers causing cutaneous mets
breast stomach and colon lung GU [uterus/ovary/kidney/bladder] non-hodgkins, leukaemia
describe pagets diseas eof the nipple
itchy red scaly crusted nipple, from direct extension of intraductal adenocarcinoma
how do you differentiate pagets diseas eof the nipple from eczema?
eczema is bilateral, non-deforming, waxes and wanes
risk factors for melanoma
UV exposure sunburn fair complexion >50 melanocytic/ dysplastic naevi FH previous melanoma ^age
ring like (annulatr lesions ) indicate what?
fungal infection
target-like pattern of lesions = ?
erythema multiforme
> 5 cafe au lait spots, consider what disease?
neurofibromatosis
what can cause melasma
preg
COCP
systemic diseses that can cause hyperpigmentation
addisons
haemochrom
Ix.s in itch
FBC haematinics LFT U+E ESR glucose TSH
skin signs in DM
flexural candidiasis necrobiosis lipoidica acanthosis nigricans granuloma anulare folliculitis
skin signs in coeliac
dermatitis herpetiformis
dermatitis herpetiformis immediate Mx
dapsone
skin signs in IBD
erythema nodosum
pyoderma gangrenosum
skin signs in lupus
facial butterfly rash
photosensitivity
diffuse alopecia
lupus erythematosus [chilblain, discoid, psoriasis-like plaques, vasculitis, oral ulcers, palmar erythema, periungal erythema, raynauds]
erythema multiforme is a hypersensitivity rn usualy triggered by what organism
herpes simplex
Mx of erythema multiforme
topical steroid for discomfort
aciclovir for HSV
resolves spontaneously
causes of acanthoiss nigricans
obesity
DM
lymphoma
gastric CA
risk factors for psoriasis + triggers
FH
triggers:
stress, infetions, skin trauma, drugs [lithium, NSAIDs, BB], alcoohol, obesity, smoking, climate
systemic upset found with generalised severe psoraisis
^WCC
fever
dehydration
nail chnages in psoroaiss
pitting
onycholysis
thickening
subungual hyperketatosis
differentials for psoriasiss
eczema
tinea [few lesions]
mycosis fungoides [asymmetric]
seborhoeic dermatitis
Mx of psoriasis
topical emollient + steroids [betnovate] topical vit D Prep [Calcipotriol] (DOVOBET = vit D + steroid) COAL tar dithranol retinoid [acitretin] phototherapy (methotrex, ciclosporin) (infliximab etc)
scalp psoriasis Mx
steroid/vit D/coal tar shampoo
tell parents of eczema patient to report any severe weeping rash e.g. around the mouth. Why?
may be eczema herpeticum - primary herpes infection which may be fatal
Mx of eczema
emollient, soap substitutes topical steroids Abx for infection tacrolimus/methotrex/azathiop/ciclo in severe antihistamines for itch [hydroxyzine]
what does seborrhoeic dermatitis look like?
which areas does it affect?
what causes it?
how is it treated?
red, scaly
scalp [dandruff], eyebrows, nasolabial folds, cheeks, flexures
over gorwth of skin yeasts [malassezia]
daktacort [steroid + antifungal]
Mx of acute flare of contact dermatitis
topical steroid
local SEs of topical steroid use
skin thinning striae telangiectasia worsening of infection contact dermatitis
what ix can help you diagnose tinea/ ringworm?
skin scraping/ scalp brushings/ nail clippings for microscopy + culture
Tx of ring worm
antifungal e.g. fluconazole
Mx of skin, mouth and vaginal candida infection
SKIN: clotrimazole cream
MOUTH: miconazole
VAG: clotrimazole cream +/- pessary
peak age for impetigo + commonly responsible organism
how is it treated?
2-5 yrs
staph aureus
topical fusidic acid, oral fluclox if severe
what causes erysipelas?
how does it present?
how is it treated?
strep pyogenes
sharply defined superficial infection on face. Fever, ^WCC
Abx
signs and Sx of cellulitis
pain swelling erythema warmth systemic upset lymphadenopathy
Mx of cellulitis
Abx - e.g. benzylpenicillin IV + fluclox PO
if penicillin allergic, erythromycin
what pathogen causes warts?
HPV
treatment of warts
self-limiting if painful/persistent/unsightly: topical salicylic acid cryotherapy duct tape occlusion
Mx of genital warts
sigificant treatmnt failure/ relapse
podophyllin/ imiquimod
cryo
complications of herpes zoster/ shingles
post-herpetic neuralgia
meningitis
encephalitis
what are the 5 pillars of acne?
- basal keratinocyte proliferation in pilosebaceous follicles [androgen + corticotrophin-releasing hormone driven]
- ^sebum productiion
- propionibacterium acnes colonization
- inflamm
- comedones blocking secretions -> papules, nodules, cysts, scars
acne Mx
topical benzoyl peroxide
topical retinoid [isotretinoin]
topical Abx [clindamycin]
azelaic acid
PO Abx [doxy/tetracycline]
COCP/dianette [antiandrogen]
isotretinoin [topical retinoid] SEs
teratogenic
skin + mucosal dryness
depression
common drug culprits for urticaria
penicillins cephalosporins [cefurox/ceftriax] opiates NSAIDs ACEi thiazides phenytoin
Mx of urticaria
antihist +/- hydrocort/adrenaline if anaphylaxis
vague URT Sx 2-3 weeks after starting a new medication. Then rash: painful erythematous macules > target lesions, mucosal ulceration (conjunctivae, oral, labia, urethra). Diagnosis + culprits?
stevens-johnson syndrome
sulfonamides
anti-epileptics
penicillins
NSAIDs
How do you manage toxic epidermal necrolysis + stevens-johnson syndrome
supportive in ICU
IVIg
analgesia
protect skin
flu like Sx.
widespread painful dusky erthema, the necrosis of large sheets of epidermis, severe mucosal involvement.
Following new medication.
Diagnosis
toxic epidermal necrolysis
drug causes of toxic epidermal necrolysis
sulfonamides anti-epileptics penicillins NSAIDs cephalosporins [cefurox/ceftriax] allopurinol
Mx of lichen planus
topical steroids +/-antifungal
pt presents with purple itchy flat-topped papules on inner wrists and legs with white lacy markings. She also has lacy white areas on the inside of her cheeks. Diagnosis?
lichen planus
what is the difference in prognosis for scarring and non-scarring alopecia
scarring implies non reversible
smooth, well-defined round patches of hair loss on scalp. Exclamation mark hairs. diagnoiss?
alopecia areata
mx of alopecia areata
80% spont regrowth in 3 months
topical steroid
psych support
Minoxidil [in androgen-dpeendent]
bullous pemphigoid is the chief autoimmune blistering disorder in the elderly. what cayses it?
IgG autoantibodies to basement membrane
elderly lady presents with tense blisters 1-3cm in size. A biopsy shows +ve immunofluorescence, [IgG and complement along the basement membrane]. Dx?
bullous pemphigoid
bullous pemphigoid mx
topical steroids + pred PO [+PPI+bisphos]
difference between pemphigus + bullous pemphigoid
pemphigus younger [<40], oral mucosa affected, flaccid blisters [tense in BP]
Mx of pemphigus
pred
ritux + IV Ig in resistant
precipitants for urticaria
infection/parasites[helminth]
chemicals - insect bites, latex, drugs, food
systemic disease
risk factors for venous leg ulcers
varicose veins DVT venous insufficiency poor calf muscle fn. AV fistulae obesity leg fracture minimal trauma over medial malleolus
what is the name of the skin changes seen in venous leg ulcers/ venous HTN?
lipodermatosclerosis
[or haemosiderin deposition]
give 5 causes of ulcers
neuropathy
trauma
vascular: venous/arterial/mixed
rarer: vasculitis [e.g. SLE] malignancy pyoderma gangrenosum [IBD] sickle cell infection [leishmaniasis] drugs [nicorandil for angina]
Mx of venous leg ulcers [including initial Ix]
DOPPLER to rule out arterial graded compression bandaging, dressings PO abx if infection analgesia [pentoxifylline]
prevention of venous leg ulcers
skin care, compression stockings, calf exercises, leg elevation, good nutrition
risk factors for pressure ulcers
extremes of age reduced mob reduced sensation vasc disease chronic/terminal illness incont spinal injury
complicaiton of pressure ulcer
osteomyelitis
Tx of pressure ulcer
pressure relieving mattress frequent repositioning/turning nutrition ABx for infection modern dressings debridement -ve pressure
prevention of pressure ulcers
regular skin inspection
minimise moisture
positioning/turning
pillows to separate knees + ankles
skin causes of pruritus in the elderly
eczema
scabies
pemphigoid
dry skin
medial/systemic causes of pruritus in the elderly
anaemia polycythaemia lymphoma solid neoplasms hepatic/renal failure hypo/hyperthyroidism DM [candida]
causes of pruritus vulvae
systemic e.g. liver/renal/anaemia etc lichen planus, psoriasis candida allergy [washing powder] infestation [scabies] vulval dystrophy [lichen sclerosis, carcinoma]
exacerbating:
obesity
incont
difference between wet and dry gangrene
wet is with infection
features of acute seroconversion in HIV + when does this occur?
1-3 weeks after exposure acute EBV-type illness maculopapular eruption on trunk lymphadenopathy malaise headache fever oral/genital ulcers/candidiasis
examples of pathogens that dont usually cause disease, but HIV +ve patients are at incerased risk on infection from
herpes: oral/genital ulcers, varicella [+post-herpetic neuralgia], KS EBV [oral hairy leukoplakia] warts molluscum contagiosum candida tinea syphilis cryptoccus demodicosis scabies
Mx of HIV associated KS
optimize HAART radiotherapy chemo cryo laser photodynamic therapy excision interferon alpha
Mx of candidiasis in HIV
topical nystatin
systemic imidazoles
Mx of skin cryptococcosis in HIV
fluconazole
scabies Mx , including practical measures
treat all close contacts
permethrin lotion
oral ivermectin in severe
crotamiton [anti-pruritic]
long bath, soap skin all over, scrub under fingernails.
wash all bedding, towels, clothing in hot wash
HIV skin neoplasias
kaposi sarcoma BCC SCC melanoma skin lymphomas merkel cell cancer
what is immune reconstitution inflamm syndrome in HIV?
with antiretrovirals, immunity begins to recover, but then responds to previously acquired opportunistic infection with a powerful inflamm response. Worsening of Sx, often involves skin.
pt presents with itching
+ itchy red penile and scrotal papules. Diagnosis?
scabies [ itchy red penile and scrotal papules are virtually diagnostic]
Mx of headlice
malathion or dimeticone lotion
combing
Mx for crab lice
malathion or permethrin
hanging legs over the side of the bed to relieve pain indicates what type of ulcer + why?
use gravity to aid blood flow to ischaemic tissue
Mx of arterial ulcers
optimise vascular risk factors e.g. QUIT SMOKING!
regular inspection
surg: revacularisation, amputation
ABCDEF CRITERIA for suspicious pigmented lesion
asymmetry border irregularity colour variation diameter >6mm evolution funny looking [diff from rest]
briefly describe the 4 types of melanoma.
which is the mos common
superficial spreading [most common]
nodular [agressive]
acral lentiginous [palm and soles]
lentigo maligna
melanoma Mx
excision
interferon alpha for mets
palliative chemo
NOT radio
