Derm Flashcards
ABPI > what for compression bandaging?
>0.8
Management of venous ulceration?
Emollients, and compression bandaging if abpi adequate
Pain management in venous ulcers, what not to use?
Do not use nsaid as impairs healing! Paracetamol and codein helpful and leg elevation
What is this?
Lipodermatosclerosis
inflammation of the subcutaneous fat causing fibrosis, and hard, tight skin which may be red or brown.
Champagne bottle legs
What is this?
Risk factors?
Treatment?
Venous eczema
Standing for long periods, past DVT, varicose veins
Emollients ABX if needed steroids for flares and compression stocking if ABPI above 0.8
Diagnosis of eczema, most likely symptoms/history?
The presence of itching
Starts in infancy
History of Atopy
In adults often hands, longstanding disease affects flexures usually
Chronic causes thickened skin
Diagnosis?
Eczema probably adult due to hands
Diagnosis?
Eczema- flexural
Moderately potent steroid cream?
betamethasone valerate 0.025%
Eczema treatment in general?
Stepwise approahc always emollients even when skin is clear
Steroids depending on the severity calcineurin inhibitors on specialsit advice
Trauma to the skin and then development of itchy scaly area?
Psoriasis can occur in 20% of people with psoriasis trauma or insect bites
Drugs causing or exacerbating psoriasis?
lithium, antimalarial drugs such as chloroquine, beta-blockers, nonsteroidal anti-inflammatory drugs
URTI and then droplet scaly lesions appear?
Guttate psoriasis can also be an exacerbation of chronic plaques
Nail symptoms with psoriasis?
Common with psoriatic arhtritis
Pitting
discoloured-oil drop
nail bed hyperproliferation
onycholysis-nail bed away from the nail
Diagnosis? Treatment?
Eczema herpeticum
Aciclovir and referall to hospital especially in young kids
Important things to consider when using accutane?
teratogenic, mood disorders, very dry skin(esp lips)
Measure LFTYs and cholesterol/triglycerides
Try and avoid ETOH
Systemic treatments for psoriasis?
Methoterexate, acetritin ciclosporin
UVB/PUVA light therapy
Then biologics
Risks for BCC?
–Sun
–Age
–Prev BCC
–Type 1 skin
Features of BCC?
- Pearly
- Papular
- Bleeds regularly
- Peripheral telangectasia
What margin size for BCC excision?
4mm also for SCC too
Risks for SCC and what is a precursor?
Age, Sun, Type 1 skin, Previous Ak, Smoking
Actinic keratosis is a precursor
SCC features/presentation?
indurated nodular keratinising or crusted tumour that may ulcerate
often present on head and neck
7 points for checklist of skin cancer?
Major
Change in size
Irregular shape
Irregular colour.
Minor
Largest diameter 7 mm or more
Inflammation
Oozing
Change in sensation
BCC referall urgency?
Usually routine unless a good reason not to be
Primary treatment of actinic keratosis?
cryotheraoy, but can use imiquimod or 5FU
What is this? Complications?
Actinic keratosis, possible transformation in to scc
Diagnosis?
SCC
Diagnosis?
SCC
Solar (actinic) keratosis?
Stages of development?
Where found?
Usually single spot feels like sandpaper initially
then multiple plaques red and scaly
eventually thick and hyperkarotic
Usually found on head, face, ears scalp back of hands
Treatments of keloid scar?
Local steroids and rarely excision
Risk for keloid?
Hx trauma, Fhx of scarring, darker skinned
Spot diagnosis?
Features?
kaposis sarcoma- maligancy AIDS defining
Can affect mucosa, Usually painless unless inflamed
Lesions can ulkcerate- respirastory involment common
Excoriations between fingers? ++Itchy
Treatment?
Scabies
permethrin 5%
or malathion 0.5%
Keep on for 8-12hrs repeat after 7 days pruritis may continue for a while
Diagnosis why?
Nodular BCC, pearly and rolled edges
Where would you use MOHS surgery?
Sensitive areas such as face eyes and ears
A-E of melanoma?
A Asymmetry
B Border irregularity
C Colour variation
D Diameter over 6 mm
E Evolving (enlarging, changing)
Diagnosis?
How common?
Superficial spreading melanoma
most common
What is used to assess severity of melanoma?
Breslow thickness
Initial treatment of melanoma?
Wide local excision- Margins depend on thickness and size of melanoma
Biopsy of kaposi shows?
Spindle cells
What is this? Associations?
Pyoderma ganrenosum assoc with IBD and RA
Pyoderma gangrenosum treatment?
Steroids topicalfor small ulcer and systemic for big
later deep, red, necrotic ulcers with a violaceous border buzz word for?
Pyoderma- may have immunosupression/immune condition
not usually caused by diabetes
What is this what may be an underlying condition?
Erythemaq nodosum
IBD, SLE, sarcoid, strep infection
Venous ulcer features?
Where?
features of venous insufficiency (previous DVT/Veins)
Usually above medial malleoulus, painless, illdefined border
mange with compression bandages and emollient if ABPI >0.8
Multiple target lesions?
Causes?
Erythema multiforme
infection- mycoplasma, EBV, Anti tnf/NSAIDS
1st line for bowens disease treatment?
Cryotherapy or curretage
or 5FU or imiquimod
Risk of what increased in psoriasis?
CVD
