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Medicine > Derm > Flashcards

Derm Flashcards

1
Q
A

Malignant Melanoma

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2
Q

Features of Malignant Melanoma?

A

Asymmetry

Border: irregular

Colour: non-uniform

Diameter > 6mm

Evolving / Elevation

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3
Q

Risk factors for Malignant Melanoma?

A

Sunlight: esp. intense exposure in early years.

Fair skinned (Low Fitzpatrick Skin Type)

↑ no. of common moles

+ve FH

↑ age

Immunosuppression

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4
Q

Types of Malignant melanoma?

A

Superficial Spreading: 80%

  • Irregular borders, colour variation
  • Commonest in Caucasians
  • Grow slowly, metastasise late = better prognosis

Lentigo Maligna Melanoma

  • Often elderly pts.
  • Face or scalp

Acral Lentiginous

  • Asians/blacks
  • Palms, soles, subungual (w Hutchinson’s sign)

Nodular Melanoma

  • All sites
  • Younger age, new lesion
  • Invade deeply and metastasis early = poor prog

Amelanotic

  • Atypical appearance → delayed Dx
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5
Q

Irregular borders, colour variation

Commonest in Caucasians

Grow slowly, metastasise late = better prognosis

which type of malignant melanoma?

A

Superficial Spreading

most common

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6
Q

Often elderly pts.

Face or scalp

Which type of malignant melanoma?

A

Lentigo Maligna Melanoma

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7
Q

Asians/blacks

Palms, soles, subungual (w Hutchinson’s sign)

Which type of malignant melanoma?

A

Acral Lentiginous

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8
Q

Staging and Prognosis of Malignant Melanoma?

A

Breslow Depth

Thickness of tumour to deepest point of dermal invasion

<1mm = 95-100% 5yrs

>4mm = 50% 5ys

Clark’s Staging

Stratifies depth by 5 anatomical levels

Stage 1: Epidermis

Stage 5: sc fat

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9
Q

mx og malignant melanoma?

A

Excision + 2O margin excision depending on Bres depth

± lymphadenectomy

± adjuvant chemo (may use isolated limb perfusion)

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10
Q

melanoma

poor prognostic indicators?

A

Male sex (more tumours on trunk > females)

↑ mitoses

Satellite lesions (lymphatic spread)

Ulceration

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11
Q
A

Actinic keratosis

Irregular, crusty warty lesions.

Pre-malignant (~1%/yr)

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12
Q

Mx of Actinic Keratoses?

A
  • pre malignant

Cautery

Cryo

5-FU

Imiquimod

Photodynamic phototherapy

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13
Q

What is Bowens disease?

A

Red/brown scaly plaques

SCC in situ

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14
Q

Evolution of actinic keratoses?

A

Actinic keratoses -> bowens -> SCC

LN spread is rare

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15
Q

features of squamous cell carcinoma?

A

Ulcerated lesion w hard, raised everted edges

Sun exposed areas

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16
Q

Causes of SCC?

A

Sun exposure: scalp, face, ears, lower leg

May arise in chronic ulcers: Marjolin’s Ulcer

Xeroderma pigmentosa

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17
Q

mx of SCC?

A

Excision + radiotherapy to affected nodes

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18
Q

most common skin cancer?

A

Basal cell carcinoma

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19
Q

features of Basal cell carcinoma?

A

Commonest cancer

Pearly nodule w rolled telangiectactic edge

May ulcerate

Typically on face in sun-exposed area

Above line from tragus → angle of mouth

Locally invasive

v rarely metastasize

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20
Q

mx of Basal cell carcinoma?

A

Excision:

Mohs: complete circumferential margin assessment using frozen section histology

Cryo/radio may be used.

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21
Q
A

Psoriasis

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22
Q

pathology of Psoriasis?

A

T4 hypersensitivity reaction

Epidermal proliferation

T-cell driven inflammatory infiltration

Histo: Acanthosis: thickening of the epidermis

Parakeratosis: nuclei in stratum corneum

Munro’s microabscesses: neutrophils

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23
Q

Histology shows

Acanthosis: thickening of the epidermis

Parakeratosis: nuclei in stratum corneum

Munro’s microabscesses: neutrophils

A

Psoriasis

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24
Q

Triggers for psoriasis?

A

Stress

Infections: esp. streps

Skin trauma: Kobner phenomenon

Drugs: β-B, Li, anti-malarials, EtOH

Smoking

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25
Q

Signs of Psoriasis?

A

Plaques

Symmetrical well-defined red plaques w silvery scale

Extensors: elbows, knees

Flexures (no scales): axillae, groins, submammary

Scalp, behind ears, navel, sacrum

Nail Changes (in 50%)

Pitting

Onycholysis

Subungual hyperkeratosis

10-40% Develop Seronegative Arthritis

Mono-/oligo-arthritis: DIPs commonly involved

Rheumatoid-like

Asymmetrical polyarthritis

Psoriatic spondylitis

Arthritis mutilans

May → dactylitis

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26
Q

features of psoriatic plaques?

A

usually on extensors and flexures

Symmetrical well defined salmon pink plaques w silvery scale

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27
Q

what nail changes are assoc w psoriasis?

A

pitting

onycholysis

subungal hyperkeratosis

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28
Q
A

Guttate Psoriasis

Drop-like salmon-pink papules w fine scale

Mainly on trunk

Occurs in children assoc. w strep infection

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29
Q

what infection does guttate psoriasis commonly occur after?

A

strep

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30
Q

Differential of Psoriasis?

A

Eczema

Tinea: asymmetrical

Seborrhoeic dermatitis

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31
Q

What is pustular psoriasis?

A

Sterile pustules (filled w pus)

May be localised to palms and soles

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32
Q
A

Generalised Pustular Psoriasis

Generalised exfoliative dermatitis

Severe systemic upset: fever, ↑WCC, dehydration

May be triggered by rapid steroid withdrawal

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33
Q

Generalised exfoliative dermatitis

Severe systemic upset: fever, ↑WCC, dehydration

May be triggered by rapid steroid withdrawal

what type of skin disorder?

A

Generalised pustular psoriasis

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34
Q

Mx of Psoriasis?

A

Education: Avoid triggers

Soap Substitute: Aqueous cream, Dermol cream

Emollients: Epaderm, Dermol, Diprobase

Topical Therapy: Vit D3 analogue: e.g. calcipotriol

Steroids: e.g. betamethasone

Tar: mainly reserved for in-patient use

Retinoids: e.g. tazarotene

UV Phototherapy: Causes local immunosuppression

Non-Biologicals: Methotrexate, Ciclosporin, Acetretin (oral retinoid / vit A analogue)

Biologicals: ustekinumab (IL12/23), Secukinumab (IL17A), Infliximab (anti-TNFa)

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35
Q

What biologics are available for Psoriasis?

A

Ustekinumab (anti IL12/ IL23)

Secukinumab (anti IL17a)

Infliximab, Etanercept, Adalimumab

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36
Q

What can Secukinumab (anti-IL17A) be used for?

A

Psoriasis

Ank Spondylitis

Psoriatic arthritis

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37
Q

what is Ustekinumab anti-IL12/23 used for?

A

Psoriasis

Psoriatic arthritis

Crohns Disease

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38
Q

UV phototherapy in Psoriasis?

A

Narrow Band UVB

PUVA: Psoralen + UVA

Psoralen is a photsensitising agent and can be topical or oral

PUVA is more effective but ↑ skin Ca risk

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39
Q

Presentation of Eczema?

A

Extremely itchy, Poorly demarcated rash

Acute: oozing papules and vesicles

Subacute: red and scaly

Chronic eczema → lichenification

  • Skin thickening w exaggeration of skin markings
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40
Q

Causes of Atopic Eczema?

A

TH2 driven inflammation w ↑IgE production

FH of atopy common

Specific allergens: House dust mite, Animal dander

Diet: e.g. dairy products

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41
Q

Presentation of atopic eczema?

A

Face: esp. around eyes, cheeks

Flexures: knees, elbows

May become 2O infected

  • Staph → fluclox
  • HSV → aciclovir
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42
Q

Atopic eczema assoc w?

A

Hay fever

Asthma

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43
Q

Ix of eczema?

A

↑ IgE

RAST testing: identify specific Ag

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44
Q

Common causes of irritant contact dermatitis?

A

detergents, soaps, oils, solvents, venous stasis

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45
Q

Common allergens of Allergic Contact Dermatitis?

A

Type IV hypersensitivity reaction

Nickel: jewellery, watches, coins

Chromates: leather

Lanolin: creams, cosmetics

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46
Q

ix of allergic contact dermatitis?

A

Patch testing

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47
Q

Cause of Seborrhoeic Dermatitis?

A

overgrowth of skin yeasts (e.g. malassezia furfur)

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48
Q

features of seborrhoeic dermatitis?

A

Red, scaly, rash

Location: scalp (dandruff), eyebrows, cheeks, nasolabial folds

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49
Q

Mx of seborrhoeic dermatitis?

A

scalp:

OTC preparations containing zinc pyrithione (‘Head & Shoulders’) and tar (‘Neutrogena T/Gel’) are first-line

2nd line: ketoconazole

selenium sulphide and topical corticosteroid may be useful

face and body:

topical antifungals e.g. ketoconazole

topical steroids

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50
Q

Mx of atopic eczema?

A

Education: Avoid triggers: e.g. soap

Soap Substitute: Aqueous cream, Dermol cream

Emollients: Epaderm, Dermol

Topical Therapy: Steroids

  • 1% Hydrocortisone: face, groins
  • Eumovate: can use briefly (<1wk) on face
  • Betnovate
  • Dermovate: very strong, brief use on thick skin like Palms, soles

2nd line Therapies: Topical tacrolimus, Phototherapy, Ciclosporin or azathioprine

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51
Q

Causes of generalised pruritus?

A

CRF

Cholestasis

Haematological: Polycythaemia, Hodgkin’s, Leukaemia, Iron deficiency

Endocrine: DM, Hyper- / hypo-thyroidism, Pregnancy

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52
Q

Very itchy dermatological diseases

differential?

A

Eczema

Urticaria

Scabies

Dermatitis herpetiformis

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53
Q

What is Eczema Herpeticum

A

first episode of infection with Herpes simplex HSV1

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54
Q

Risk factors for candida infection

A

immunosuppression, Abx, steroid inhalers

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55
Q

features of candidiasis?

A

Pink + white patches

Moist

Satellite lesions

Mouth, vagina, skin folds, toe web

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56
Q

Mx of candidiasis?

A

Mouth: nystatin

Vagina: clotrimazole cream and pessary

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57
Q
A

Pityriasis vesicolor

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58
Q

What organism causes Pityriasis Versicolor?

A

malassezia furfur

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59
Q

presentation of pityriasis versicolor?

A

Common in hot and humid environments

Circular hypo-/hyper-pigmented patches

Fine white scale

Itchy

Back of neck and trunk

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60
Q

Ix of pityriasis versicolor?

A

“Spaghetti and meatballs” appearance w KOH stain

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61
Q

Mx of pityriasis versicolor?

A

Selenium sulphate or ketoconazole shampoos

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62
Q
A

Impetigo

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63
Q

features of Impetigo?

A

Age: peak @ 2-5yrs

Honey-coloured crusts on erythematous base

Common on face

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64
Q

What organism is responsible for Impetigo?

A

Staph aureus

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65
Q

Mx of Impetigo?

A

Mild: topical Abx (fusidic acid, mupirocin)

More severe: fluclox PO

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66
Q
A

Pityriasis rosea

  • herald patch
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67
Q

features of pityriasis Rosea?

A

HHV-6/-7

Herald patch precedes rash, mainly on the trunk

fir tree appearance of rash

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68
Q

features of Shingles/ herpes zoster?

A

Recurrent VZV infection

Dermatomal distribution of cropping vesicles and crust

Thoracic: 50%,

Ophthalmic: 20% -> Cornea affected in 50% → keratitis, iritis

May → post-herpetic neuralgia

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69
Q

Mx of Shingles?

A

Aciclovir or famciclovir PO if severe

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70
Q

Features of herpes simplex?

A

Gingivostomatitis or recurrent genital or oral ulcers

Triggered by infection (e.g. CAP), sunlight and immunosuppression

May complicate eczema: eczema herpeticum

Grouped painful vesicles on an erythematous base

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71
Q

Mx of herpes simplex

A

aciclovir or famciclovir indicated if immunosuppressed or recurrent genital herpes

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72
Q

pink papules w umbilicated central punctum

resolve spontaneously in most

Pox virus

A

Molluscum contagiosum

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73
Q

what organism is responsible for molluscum contagiosum?

A

pox virus

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74
Q

Mx of genital warts (HPV)?

A

Expectant

Destructive:

Topical salicylic acid

Cryotherapy

Podophyllin

Imiquimod

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75
Q

What is Erysipelas?

A

Sharply defined superficial infection by S. pyogenes

Often affects the face

High fever + ↑ WCC

more superficial, raised and demarcated compared to cellulitis

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76
Q

features of cellulitis?

A

Acute infection of skin and soft tissues

Deeper and less well defined than erysipelas

Pain, swelling, erythema and warmth

Systemic upset

± lymphadenopathy

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77
Q

Causes of cellulitis?

A

Group A Strep + Staph Aureus

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78
Q

Mx of cellulitis?

A

Empiric: fluclox IV

Confirmed Strep: Benpen or Pen V

Pen allergic: clindamycin

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79
Q

pathophysiology of acne vulgaris?

A

↑ sebum production: androgens and CRH

P. acnes is a skin commensal that flourishes in the anaerobic environment of the blocked follicle → inflammation

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80
Q

features of acne vulgaris?

A

Inflammation of pilosebaceus follicles

Comedones (white- or black-heads), papules, pustules nodules, cysts

Face, neck, upper chest and back

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81
Q

Mx of mild acne vulgaris?

A

Pt. education

Remember that topical therapy is difficult to apply to the back.

topical therapy: Benzoyl peroxide

Erythromycin, Clindamycin

Tretinoin / Isotretinoin

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82
Q

Mx of moderate acne vulgaris?

A

Pt. education

Remember that topical therapy is difficult to apply to the back.

Topical benzoyl peroxide + oral Abx (doxy or erythro)

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83
Q

Mx of severe acne vulgaris?

A

Isotretinoin (vitamin A analogue)

  • 60-70% have no further recurrence
  • SE: teratogenic, hepatitis, ↑lipids, depression, dry skin, myalgia
  • Monitor: LFTs, lipids, FBC

May try Co-cyprindiol (cyproterone acetate and ethinylestradiol) in women

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84
Q

What should u monitor in pt on isotretinoin?

A

LFTs, lipids, FBC

SE: teratogenic, hepatitis, ↑lipids, depression, dry skin, myalgia

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85
Q

features of acne rosacea?

A

Chronic relapsing remitting disorder affecting the face

Chronic flushing ppted. by alcohol or spicy foods.

Fixed erythema: chin, nose, cheeks, forehead

Telangiectasia, papules, pustules (no comedones)

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86
Q

Acne rosacea assoc w?

A

Rhinophyma: swelling and soft tissue overgrowth of the nose in males

Blepharitis: scaling and irritation at the eyelashes

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87
Q

Mx of acne rosacea?

A

Avoid sun exposure + daily applications of sun screen

topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)

more severe disease is treated with systemic antibiotics e.g. Oxytetracycline

camouflage creams may help conceal redness

laser therapy - for patients with prominent telangiectasia

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88
Q
A

Lichen Planus

Flexors: wrists, forearms, ankles, legs

Display Kobner phenomenon

Purple, Pruritic, Polygonal, Planar, Papules

Lacy white marks: Wickham’s Striae

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89
Q

Other than skin, where else can you find Lichen Planus?

A

Scalp: scarring alopecia

Nails: longitudinal ridges

Mouth: lacy white plaques on inner cheeks

Genitals

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90
Q

Wickhams striae?

A

Lichen Planus

  • lacy white marks
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91
Q

features of Lichen Planus

A

Flexors: wrists, forearms, ankles, legs

Display Kobner phenomenon

Purple, Pruritic, Polygonal, Planar, Papules

Lacy white marks: Wickham’s Striae

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92
Q

Mx of Lichen Planus?

A

Mild: topical steroids

Severe: systemic steroids

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93
Q
A

Bullous Pemphigoid

tense bullae on erythematous base

autoimmune blistering disease due to auto abs against hemidesmosomes

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94
Q

pathophysiology of bullous pemphigoid?

A

Autoimmune blistering disease due to auto-abs against hemidesmosomes

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95
Q

features of bullous pemphigoid?

A

Mainly affects the elderly

Tense bullae on erythematous base

Can be itchy

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96
Q

Ix of bullous pemphigoid?

A

Biopsy shows linear IgG along the BM and subepidermal bullae

97
Q

mx of bullous pemphigoid

A

Refer to dermatologist for biopsy and confirmation of diagnosis

Oral corticosteroids are mainstay of tx

Topical corticosteroids, immunosuppressants and antibiotics are also used

98
Q

features of pemphigus vulgaris?

A

Younger pts.

Large flaccid bullae which rupture easily

Nikolsky’s sign +ve

Mucosa is often affected

99
Q

pathophysiology of pemphigus vulgaris?

A

Autoimmune blistering disease due to auto-abs against desmosomes.

May be ppted by drugs: NSAIDs, ACEi, L-dopa

100
Q

Ix of pemphigus vulgaris?

A

Intraepidermal bullae (superficial)

101
Q

Mx of pemphigus vulgaris?

A

Prednisolone

Rituximab

IVIg

102
Q

What drugs may precipitate Pemphigus vulgaris?

A

NSAIDs

ACEi

l-dopa

103
Q

Mx of head lice?

A

Malathion

combing - fine tooth to get rid of lice

104
Q

features of head lice?

A

itch

papular rash @ nape of neck

105
Q

Mx of scabies?

A

Permethrin cream: applied from neck down for 24hrs

2nd line: Malathion

3rd line: oral ivermectin

Treat all members of the household

106
Q

Burrows: short, serpiginous grey line, block dot

Hypersensitivity rash: eczematous, vesicles

Extremely itchy → escoriation

Particularly affects the finger web spaces (esp. 1st)

Also: axillae, groin, umbilicus

A

Scabies

107
Q

features of scabies?

A

highly contagious: spread by direct contact

Burrows: short, serpiginous grey line, block dot

Hypersensitivity rash: eczematous, vesicles

Extremely itchy → escoriation

Particularly affects the finger web spaces (esp. 1st)

Also: axillae, groin, umbilicus

108
Q

commonest type of skin problem from drugs?

A

maculopapular rash

  • Generalized erythematous macules and papules

± fever and ↑ eosinophils

Develops w/i two weeks of onset of drug

e.g. penicillins, cephalopsporins, AEDs

109
Q

Causes of Erythema Multiforme?

A

Idiopathic

Infections: HSV, mycoplasma

Drugs: Sulphonamides, NSAIDs, allopurinol, penicillin, phenytoin

110
Q

Symmetrical target lesions on palms, soles and limbs

A

Erythema Multiforme

Occurs 1-2wks after insult

Infections are commoner cause of EM

111
Q

What is Stevens-Johnson syndrome?

A

More severe variant of EM,

Blistering mucosa: conjunctiva, oral, genital

skin detachment <10% of body surface

112
Q

What is toxic epidermal necrolysis?

A

Extreme form of SJS (skin involvement >30%)

Nearly always a drug reaction

Severe mucosal ulceration

Widespread erythema followed by epidermal necrosis w loss of large sheets of epidermis → dehydration

+ve Nikolsky’s sign: epidermis separates with mild lateral pressure

↑↑↑ risk in HIV+

113
Q

Mx of Toxic Epidermal Necrolysis?

A

Supportive

Dexamethasone

IVIg

114
Q

what condition increases risk of toxic epidermal necrolysis?

A

HIV +ve

115
Q
A

Livedo Reticularis

Persistent mottled red/blue lesions that don’t blanch

Commonly found on the legs

Triggered by cold

116
Q

Causes of livedo reticularis?

A

idiopathic

vasculitis: RA, SLE, PAN

Obstruction: anti-phos, cryoglobulinaemia

Sneddon’s syndrome: Livedo reticularis + CVAs

117
Q

skin manifestation of Rheumatic fever?

A

erythema marginatum

118
Q

Skin manifestations of Lyme Disease?

A

Erythema chronicum migrans

119
Q

skin manifestations of crohns disease?

A

Perianal ulcers and fistulae

Erythema nodosum
Pyoderma gangrenosum

120
Q

Skin manifestations of dermatomyositis?

A

Heliotrope rash on eyelids

Shawl sign (macular rash)

Gottron’s Papules
Mechanic’s hands
Nailfold erythema, telangiectasia

121
Q

Skin manifestations of DM?

A

Ulcers
Candida
Kyrle disease
Acanthosis nigricans
Necrobiosis lipoidica (shins) Granuloma annulare (hands, feet)

122
Q

Skin manifestations of sarcoidosis?

A

Erythema nodosum

Erythema multiforme

Lupus pernio

Hypopigmented areas

Red/violet plaques

123
Q

Skin manifestations of Coeliac?

A

Dermatitis herpetiformis (elbows)

124
Q

skin manifestations of Graves?

A

Pre-tibial myxoedema (lat mal)

125
Q

skin manifestations of Rheumatoid arthritis?

A

Rheumatoid nodules

Vasculitis (palpable purpura)

126
Q

Skin manifestations of systemic sclerosis?

A

Calcinosis
Raynaud’s
Sclerodactyly

Telangiectasia
Generalised skin thickening

127
Q

skin manifestations of SLE?

A

facial butterfly rash

128
Q

Skin manifestations of liver disease?

A

Palmar erythema

Spider naevi

Gynaecomastia

↓ 2O sexual hair

Jaundice

Bruising

Excoriations

129
Q

Skin manifestations w chronic kidney failure?

A

Assoc w Cause

  • DM, vasculitis, sclero, RA, SLE

Assoc w ESRD

  • Pruritus, xerosis, pigment change, Bullous disease

Assoc. w Transplant
- Cushingoid, gingival hyperplasia,

Infections, BCC, SCC, melanoma Kaposi’s

130
Q

Skin manifestations of neoplasia?

A

Dermatomyositis

Thrombophlebitis migrans

Acquired ichthyosis

131
Q

thickened, velvety, relatively darker areas of skin on the neck, armpit and in skin folds

A

Acanthosis nigricans

associated with obesity or endocrinopathies e.g DM, cushings, PCOS

132
Q

autoimmune condition causing localised, well demarcated patches of hair loss.

A

Alopecia areata

133
Q

mx of Alopecia areata?

A

autoimmune condition causing localised, well demarcated patches of hair loss.

Hair will regrow in 50% of patients by 1 year, and in 80-90% eventually.

Careful explanation is therefore sufficient in many patients.

134
Q

What is Koebner phenomenon?

A

new skin lesions appearing at the site of trauma

e.g. in psoriasis, lichen planus

135
Q

mx of lichen planus?

A

topical steroids are the mainstay of treatment

benzydamine mouthwash or spray is recommended for oral lichen planus

extensive lichen planus may require oral steroids or immunosuppression

136
Q

What is the single most important prognostic marker in malignant melanoma?

A

invasion depth of the tumour (Breslow depth)

137
Q

what drug may cause pellagra?

A

isoniazid

138
Q

diagnostic criteria in HHT?

A

4 main diagnostic criteria.

2 = possible diagnosis of HHT.

3 or more = definite diagnosis of HHT:

epistaxis : spontaneous, recurrent nosebleeds

telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)

visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM

family history: a first-degree relative with HHT

139
Q

mx of pityriasis rosea?

A

no mx required

self-limiting skin condition

usually disappears after 4-12 weeks

140
Q

mx of lichen sclerosus?

A

topical steroids and emollients

141
Q

margins of excision of a melanoma are dependent on?

A

breslow thickness

lesions 0-1mm thick: 1cm margin

1-2 mm: 1-2 cm

2-4 mm: 2-3 cm

>4mm: 3 cm

142
Q

mx of actinic keratoses?

A

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

143
Q

Which of the following bacteria found on skin is known to contribute to the development of acne?

A

Propionibacterium acnes

-> tetracyclines, macrolides or trimethoprim must be used in managing acne.

144
Q

Never tans, always burns (often red hair, freckles, and blue eyes)

skin type?

A

Fitzpatrick type 1

145
Q

Black skin (e.g. Afro-Caribbean), never tans, never burns

what skin type?

A

Fitzpatrick skin type 6 VI

146
Q

Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian)

what skin type?

A

Fitzpatrick type V

147
Q

Usually tans, always burns

what skin type?

A

fitzpatrick skin type 2

148
Q

Always tans, sometimes burns (usually dark hair and brown eyes)

what skin type?

A

Skin type III

149
Q

Always tans, rarely burns (olive skin)

what skin type?

A

Skin type IV

150
Q

spider naevi associations?

A

liver disease

pregnancy

combined oral contraceptive pill

151
Q

when do ppl with burns require IV fluids?

A

IV fluids should be given in second or third degree burns that cover 15% body surface area or more.

In children, IV fluids are recommended when burns cover 10% body surface area.

152
Q

Mx of hyperhidrosis?

A

1st line: Topical aluminium chloride

(main SE= skin irritation)

Iontophoresis

Botulinum toxin

Surgery: e.g. endoscopic transthoracic sympathectomy

(risk of compensatory sweating)

153
Q

features of lipoma?

A

benign tumour of adipocytes

smooth, mobile, painless

154
Q

features suggesting sarcomatous change in a lipoma?

A

Size >5cm

Increasing size

pain

deep anatomical location

155
Q

Mx of lipoma?

A

reassurance, no need for review

can be removed surgically if they are causing symptoms e.g pain, affecting nearby structures like nerves

If features of sarcomatous change (ie size> 5cm) -> US required to rule out liposarcoma

156
Q

difference between bullous pemphigoid and pemphigus vulgaris in terms of site?

A

mouth usually spared in bullous pemphigoid

157
Q

Mx of severe burns?

A

A->E, senior help

Conservative:

IV fluids required for burns >15% total body surface area (>10% in children)

-> calculate using Parkland formula

Analgesia

Urinary Catheter

May need transfer to burns unit

Surgical:

Escharotomy to divide burnt tissue if respiration impaired/ compartment syndrome and oedema of limb

Excision and skin grafting

158
Q

Predisposing factors for pityriasis versicolor?

A

occurs in healthy individuals

immunosuppression

malnutrition

Cushing’s

159
Q

What drugs are known to induce toxic epidermal necrolysis?

A

phenytoin

sulphonamides (e.g. sulfasalazine)

allopurinol

penicillins

carbamazepine

NSAIDs

160
Q

what is the most common malignancy assoc w acanthosis nigricans?

A

GI adenocarcinoma

161
Q

what medications are assoc w acanthosis nigricans?

A

OCP

nicotinic acid

162
Q

Shingles vaccine

who is offered?

A

offered to all patients aged 70-79 years*

is live-attenuated and given sub-cutaneously

As it is a live-attenuated vaccine the main contraindications are immunosuppression.

163
Q

main benefit of giving pts w shingles oral aciclovir?

A

reduction in the incidence of post-herpetic neuralgia.

164
Q

What is erythroderma?

A

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

165
Q

Causes of erythroderma?

A

eczema

psoriasis

drugs e.g. gold

lymphomas, leukaemias

idiopathic

166
Q

Mx of erythroderma?

A

monitor for complications like dehydration, infection and high-output heart failure.

tx primary cause

IV fluids

Topical steroids

Antihistamine to help itch

167
Q

Mx of vitiligo

A

sun block for affected areas of skin

camouflage make-up

topical corticosteroids may reverse the changes if applied early

there may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients

168
Q

what viruses may lead to erythema multiforme?

A

HSV

169
Q

What bacteria may lead to erythema multiforme?

A

Streptococcus, mycoplasma

170
Q

what infection may precipitate guttate psoriasis?

A

streptococcal infection

171
Q

excision margins in SCC?

A

if lesion <20mm in diameter -> 4 mm margin

>20mm -> 6 mm

172
Q

tx of eczema herpeticum?

A

admitted to hosp

IV aciclovir

173
Q

In what pt population is crusted scabies more prevalent in?

A

immunosuppressed, especially HIV

174
Q

Tx of crusted scabies?

A

Ivermectin

isolation is essential

175
Q

Ix of choice for contact dermatitis?

A

Skin patch testing

Around 30-40 allergens are placed on the back. Irritants may also be tested for. The patches are removed 48 hours later with the results being read by a dermatologist after a further 48 hours

176
Q

Ix of choice to determine food allergies, inhaled allergens etc if skin prick not suitable?

ie. extensive eczema or pt taking antihistamines

A

Radioallergosorbent test (RAST)

Determines the amount of IgE that reacts specifically with suspected or known allergens, for example IgE to egg protein. Results are given in grades from 0 (negative) to 6 (strongly positive)

177
Q

Ix of choice for food allergies/ pollen?

A

Skin prick test

Most commonly used test as easy to perform and inexpensive. Drops of diluted allergen are placed on the skin after which the skin is pierced using a needle. A large number of allergens can be tested in one session. Normally includes a histamine (positive) and sterile water (negative) control. A wheal will typically develop if a patient has an allergy. Can be interpreted after 15 minutes

178
Q

what conditions are assoc w Seborrhoeic dermatitis?

A

HIV

Parkinson’s disease

179
Q
A

Cherry haemangiomas

aka Campbell de Morgan spots

benign skin lesions which contain an abnormal proliferation of capillaries

Features:

erythematous, papular lesions

typically 1-3 mm in size

non-blanching

not found on the mucous membranes

benign -> NO tx required

180
Q
A

Oral Leukoplakia

premalignant condition which presents as white, hard spots on the mucous membranes of the mouth

more common in smokers.

Cant be ‘rubbed off’

Biopsies usually performed to exclude alternative diagnoses such as SCC and regular follow-up is required to exclude malignant transformation to SCC, which occurs in around 1%

181
Q

What type of infection usually precedes pityriasis rosea?

A

Viral infection

e.g. HHV7

182
Q

most common side effect of isotretinoin?

A

dry skin, eyes and lips/ mouth

183
Q

what is dermatitis herpetiformis caused by?

A

deposition of IgA in the dermis

  • assoc w coeliac disease
184
Q

Keloid scars vs hypertrophic scars

A

Keloid scars extend beyond the dimensions of the original wound

Hypertrophic scars do not

185
Q

Most common sites for keloid scars?

A

Sternum

Shoulder

Neck

186
Q

Mx of keloid scars?

A

early keloids may be treated with intra-lesional steroids e.g. triamcinolone

excision is sometimes required

187
Q
A

Strawberry naevus (aka capillary haemangioma)

usually not present at birth but may develop rapidly in the first month of life. They appear as erythematous, raised and multilobed tumours.

Typically they increase in size until around 6-9 months before regressing over the next few years

Common sites include the face, scalp and back. Rarely they may be present in the upper respiratory tract leading to potential airway obstruction

188
Q

Potential complications of a capillary haemangioma?

A

mechanical e.g. Obstructing visual fields or airway

bleeding

ulceration

thrombocytopaenia

189
Q

Tx of capillary haemangioma?

A

if asymptomatic: no tx required, usually regresses

if tx required e.g. visual field obstruction: propranolol/ topical BB e.g. timolol

190
Q

what is a pyogenic granuloma assoc w?

A

trauma

pregnancy

more common in women and young adults

191
Q

scalp ringworm?

A

tinea capitis

  • cause of scarring alopecia mainly seen in children
192
Q

cause of scarring alopecia mainly seen in children

fungal infection

A

Tinea capitis

diagnosis: scalp scrapings, lesions due to Microsporum canis green fluorescence under Wood’s lamp

193
Q

Mx of tinea capitis?

A

oral antifungals: terbinafine for Trichophyton tonsurans infections and griseofulvin for Microsporum infections.

Topical ketoconazole shampoo should be given for the first 2 weeks to reduce transmission

194
Q

well-defined annular, erythematous lesions with pustules and papules

A

Tinea corporis (ringworm)

causes include Trichophyton rubrum and Trichophyton verrucosum (e.g. From contact with cattle)

may be treated with oral fluconazole

195
Q

Athletes foot organism?

characteristed by itchy peeling skin between toes

A

Tinea pedis

common in adolescence

196
Q

Mx of pressure ulcers?

A

a moist wound environment encourages ulcer healing. Hydrocolloid dressings and hydrogels may help facilitate this. soap discouraged to avoid drying the wound

consider referral to the tissue viability nurse

surgical debridement may be beneficial for selected wounds

197
Q

what organism is responsible in the pathophysiology of acne vulgaris?

A

Propionibacterium acnes

  • anaerobic bacterium
198
Q

initially small red papule

later deep, red, necrotic ulcers with a violaceous border

idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders

A

pyoderma gangrenosum

199
Q

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)

A

Erythema nodosum

200
Q

shiny, painless areas of yellow/red skin typically on the shin of diabetics

often associated with telangiectasia

A

necrobiosis lipoidica diabeticorum

201
Q

most significant complication of PUVA therapy for psoriasis?

A

Squamous cell carcinoma

202
Q

Management of chronic plaque psoriasis?

A

regular emollients may help to reduce scale loss and reduce pruritus

1st line: potent corticosteroid + vitamin D analogue (calcipotriol) OD (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment

2nd line: if no improvement after 8 weeks -> vitamin D analogue twice daily

3rd line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily

short-acting dithranol can also be used

203
Q

Tx of choice for Psoriasis in secondary care?

A

Phototx: narrow band ultraviolet B light (1st line)

Systemic therapy: 1st line oral methotrexate, biologics

204
Q

Mx of tinea pedis? (athletes foot)

A

topical imidazole, undecenoate, or terbinafine first-line

2nd line: oral terbinafine

205
Q

pruritic blistering lesions

often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms

usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy

A

Pemphigoid gestationis

-> oral corticosteroids are usually required

206
Q

Skin manifestations of systemic lupus erythematosus (SLE)?

A

photosensitive ‘butterfly’ rash: usually nasolabial sparing

discoid lupus

alopecia

livedo reticularis: net-like rash

207
Q

two month history of a rapidly growing lesion on his right forearm. The lesion initially appeared as a red papule but in the last two weeks has become a crater filled centrally with yellow/brown material.

A

Keratoacanthoma

  • benign epithelial tumour

said to look like a volcano or crater

initially a smooth dome-shaped papule

rapidly grows to become a crater centrally-filled with keratin

208
Q

Mx of Actinic Keratoses?

A

fluorouracil cream: typically a 2 to 3 week course.

if mild: topical diclofenac

209
Q

1st line mx of psoriatic plaques?

A

potent corticosteroid + vitamin D analogue (e.g. calcipotriol)

210
Q

what is Erythema nodosum?

A

inflammation of subcut fat

tender, erythmatous, nodular lesions

usually shins, forearms

211
Q

Immediate first aid of burns caused by heat?

A

A->E

heat: remove person from source

irrigate burn w cool water for 10-30 min

cover burn with cling film, layered, rather than wrapped around a limb

212
Q

immediate first aid of electrical burns?

A

A,B,C

switch off power supply

remove person from source

213
Q

immediate first aid of chemical burns?

A

brush off any powder + irrigate w water

attempts to neutralise chemical not recommended

A, B, C

214
Q

what kind of burn?

skin appears red and painful

A

first degree

aka

superficial epidermal

215
Q

what kind of burn?

skin appears pale pink, painful, blistered

A

partial thickness (superficial dermal) burn

216
Q

what type of burn?

skin Typically white but may have patches of non-blanching erythema. Reduced sensation

A

deep dermal, partial thickness burn

217
Q

what type of burn?

skin is White/brown/black in colour, no blisters, no pain

A

Full thickness burn

218
Q

when to refer a burn to secondary care?

A

all deep dermal and full-thickness burns.

superficial dermal burns of >3% TBSA in adults, or >2% TBSA in children

superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck

any inhalation injury

any electrical or chemical burn injury

suspicion of non-accidental injury

219
Q

mx of superficial dermal burn?

A

first aid: A-E

refer if >3% in adults, >2% in children or involving face, hands, feet, perineum, genitalia or any flexure

Cleanse wound

leave blister intact

non-adherent dressing

avoid topical creams

review in 24h

220
Q

Mx of severe burns?

A

A-E

IV fluids if >10% in children, >15% in adults (Parkland formula)

Urinary catheter inserted

Analgesia

Complex burns -> transfer to burns unit, may require excision and skin grafting

Circumferential burns affecting limb or severe torso burns impeding respiration -> escharotomy

221
Q

When are escharotomies indicated

A

circumferential full thickness burns to torso (impeding respiration) or limbs (compartment syndrome, oedema)

222
Q

Spider naevi vs telangiectasia?

A

Spider naevia fill from centre

telangiectasia from edge

223
Q

hirsutism vs hypertrichosis?

A

hirsutism - androgen dependent hair growth

Hypertrichosis - androgen independent hair growth

224
Q

most common cause of hirsutism in women?

A

PCOS

225
Q

Assessment of hirsutism?

A

Ferriman-Gallwey scoring system

9 body areas are assigned a score of 0 - 4,

score > 15 = moderate or severe hirsutism

226
Q

Mx of hirsutism?

A

weight loss if overweight

cosmetic techniques ie waxing- not avail on NHS

COCP e.g. co-cyprindiol (dianette) or Yasmin (ethinyloestradiol and drospirenone)

facial: topical eflornithine

227
Q

mx of facial hirsutism?

A

topical eflornithine

contraindicated in pregnancy and breast feeding

228
Q

causes of hypertrichosis?

A

drugs: minoxidil, ciclosporin, diazoxide

congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis

porphyria cutanea tarda

anorexia nervosa

229
Q

Abx of choice to treat erythrasma?

A

oral erythromycin

or topical miconazole

Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum

Examination with Wood’s light reveals a coral-red fluorescence.

230
Q

What factors may exacerbate psoriasis?

A

trauma

alcohol

drugs: BB, lithium, antimalarials, NSAIDs, ACEi, infliximab

withdrawal of systemic steroids

231
Q

mx of hyperhidrosis?

A

1st line: topical aluminium chloride (SE: skin irritation)

iontophoresis: palmar, plantar, axillary

botulinum toxin: axillary

Surgery e.g. endoscopic transthoracic sympathectomy

232
Q

Yellow nail syndrome?

A

Improper circulation and drainage of lymph allows fluid to collect in the soft tissue under the skin, which may slowly turn nails yellow.

assoc w lymphoedema

Nail is curved longitudinally and transversely

233
Q

xerosis = ?

A

dry skin

234
Q

ichthyosis?

A

dry, thickened, scaly skin “fish scale”

inherited skin disorder

needs regular moisturizing

235
Q

dermatits artefacta?

A

intentional self inflicted dermatitis

usually odd shapes, straight edges, geometric patterns

straight edges rarely exist in nature -> suggestive of self harm

236
Q

what is lichen simplex?

A

localised area of chronic, lichenified eczema/dermatitis.

  • a response to the skin being repeatedly scratched or rubbed over a long period of time
  • will heal if scratching is stopped
237
Q

Nodular prurigo?

A

very itchy firm lumps

  • on hands, extensor surfaces
  • can be difficult to treat and tends to leave behind scarring
238
Q

Pompholyx?

A

aka dyshidrotic eczema

causes tiny blisters to develop across the fingers, palms of the hands and sometimes the soles of the feet.

most common in adults <40

239
Q

Mycosis fungoides?

A

a rare form of T cell lymphoma that affects the skin

itchy red papules

lesions tend to be of different colours in comparison to eczema/ psoriasis

Medicine (16 decks)

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