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phase 2a mine > derm top tier > Flashcards

derm top tier Flashcards

1
Q

acne treatment

A

Advice

  • Avoid over washing
  • Don’t pick
  • Healthy diet

Mild

  • Benzoyl peroxide
  • – Increases skin turnover
  • – Clears pores and reduces bacteria count
  • – Dry
  • Retinoid (tretinoin)
  • – Topical
  • – Inhibit formation and reduce microcomedomes
  • Antibiotics
  • – Topical

Moderate

  • Antibiotics
  • – Doxycline
  • – Minocycline
  • Combined oral contraceptive
  • – Hormones suppress sebum production

Severe

  • Retinoid (isotretinoin)
  • –Decreases sebum production
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2
Q

acne investigations

A

Clinical
Skin swabs - microscopy and culture
Hormonal tests

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3
Q

acne complications

A

scarring

psychological / social

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4
Q

what is a comedom

A

in hair follicle but hair not there, instead dead skin and bacteria

open = black head
closed = whitehead (skin)
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5
Q

acne symptoms

- different severities

A

Mild

  • Blackheads = open comedones
  • Whiteheads = closed comedones
  • No scarring

moderate

  • Papules - small red bumps
  • Pustules - white/yellow spots
  • No scarring

Moderately severe

  • Inflammatory papules
  • Some scarring

Severe

  • Nodules - large red bumps
  • Severe scarring
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6
Q

acne pathophysiology

A
  • Chronic
  • Hypercornification = corneodesmosomes block entrance to hair follicles, resulting in narrowing of the hair follicle
  • Causes increased sebum production → greasy skin
  • Sebum becomes trapped in narrow hair follicles. Stagnates at bottom of pit - it is anaerobic here, allowing propionibacterium acnes bacteria to multiply in stagnant sebum
  • This results in irritation and inflammation (neutrophils attracted), so pus is formed and further inflammation
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7
Q

what emotion may worsen/ trigger/ cause acne

inc pathophysiology

A

Psychological stress → increased cortisol → increased sebum

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8
Q

is acne vulgaris a particularly severe form of acne?

A

no. vulgaris means common. this is the medical term for acne

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9
Q

complications of eczema

A

Broken skin may become infected (secondarily)

  • Staph aureus
  • –Crusted
  • –Weeping
  • Herpes simplex
  • –Multiple small blisters

Depression, anxiety

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10
Q

treatments for more severe/ non responsive eczema

A
  • Oral immune -modulators (cyclosporine, azathioprine)
  • Oral steroids (prednisolone)
  • Antibiotics (flucloxacillin)
  • Phototherapy - UV A
  • Antihistamines (chlorphenamine) –No clinical effect, but they sedate patient for better rest
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11
Q

first and second line pharmacological treatment for eczema

A

First line =Topical corticosteroids (hydrocortisone, clobetasol)

  • Different levels for different severities
  • Inhibit proinflammatory cytokines

Second line = topical calcineurin inhibitors (pimecrolimus, tacrolimus)

  • Less effective but less side effects - may be good for especially sensitive areas
  • calcineurin induces transcription factors for interleukins which activate T helper cells and cytokine production. so this medicine inhibits this so reduces inflammation
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12
Q

non pharmacological management of eczema

A

Hydration
- Inc emollients – artificially restore skin barrier, traps moisture

bandages

Minimising exposure to allergens
- Bath soap substitutes

Minimizing itching

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13
Q

eczema investigations

A 
Clinical 
Bloods -- High serum IgE
Must have itchy skin in past 6 months
Patch testing- identifies suspected allergens
Skin prick test
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14
Q

where is eczema often (on the body)

A 
Elbows
Knees
Ankles
Wrist
Neck
Cheeks in infants - before spreading to rest of body
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15
Q

describe eczema appearance

A 
Red
Itchy
Scaly
hyper/hypopigmented 
Dry 
Weeping/ exudation/ vesicles - if very acute
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16
Q

what conditions is eczema sometimes associated with

A

atopic triad =
Asthma
Allergic rhinitis
atopic dermatitis

Depression
Anxiety

17
Q

dermatitis vs eczema

A

same thing

18
Q

eczema pathophysiology

A
  • Inflammatory skin disease with vesicles (when acute), redness, oedema, oozing, scaling and usually pruritus (itch)
  • Skin breakdown due to stratum corneum thinning - so increased risk of inflammation
  • Filaggrin is a skin barrier protein. It is damaged allowing allergens to invade more easily and hence inflammation more likely
19
Q

eczema exacerbated by…

A 
Chemicals
Detergents
Woolen clothes
Infection 
Sweat 
Scratching / rubbing
cats/ dogs
Cigarette smoke
Stress
Weather changes
20
Q

is eczema more common in children or adults

A

children

but common in both

21
Q

types of eczema

causes/ risk factors

A

Endogenous - atopic

  • Hypersensitivity
  • Asthma , food allergy

Exogenous

  • Precipitated by chemicals, sweat and abrasives over a period of time
  • Sensitization of T lymphocytes
  • Itching and dermatitis upon re-exposure to antigen

family history also a risk factor/ cause – faulty gene that codes for filaggrin (skin barrier protein)

22
Q

psoriasis managment
advice
1st, 2nd, 3 rd line

A

Advice

  • Avoid irritants
  • Emollients

First line= topical therapy

  • Vitamin D analogues (calcitriol)
  • Corticosteroids
  • Retinoids (vit A agonist) (tazarotene)

Second line

  • Photherapy with UV A (induces damage in keratinocytes)
  • DMARD (methotrexate) (+ folic acid supplements)

Third line = biologics

  • TNF alpha inhibitors
  • Monoclonal antibodies
23
Q

Erythrodermic and pustular psoriasis presentation

A

Most severe
Widespread inflammation
Extremely itchy fire red scales that may fall off
Malaise, pyrexia, circulatory disturbances

24
Q

palmoplantar psoriasis presentation

A

Red, tender, thickening of palms and soles

25
Q

guttate psoriasis presentation

and age

A

Generalised, concentrating on trunk and upper arms/legs
Explosive eruption of very small circular/ oval (raindrop-like) plaques
Following streptococcal sore throat

children and young adults

26
Q

flexural psoriasis presentation

and age

A

Well demarcated red, glazed plaques.
No scaling
Confined to flexures - groin, natal cleft, submammary (underboob)

later in life

27
Q

chronic plaque psoriasis presentation

A

Most common
Well demarcated disc shaped, salmon pink silvery plaques
Thickened
Scalp common, hair margin, elbows, knees, limbs or at skin trauma sites

28
Q

general psoriasis symtpoms

where
skin
nail

A

Where?

  • Lower back
  • Scalp
  • Elbows
  • Knees

Skin

  • Thickening
  • Itchy
  • Painful
  • Red
  • Scaly

Nail changes

  • Pitting (dents)
  • Onycholysis (separation of nail from bed)
  • Yellow-brown discolouration
  • Thickening
29
Q

psoriasis pathophysiology

A

Chronic
T lymphocyte driven hyperproliferation of keratinocytes → thickened plaques (opposite of eczema which has skin breakdown)
Inflammatory cell infiltration

30
Q

psoriasis risk factors

A 
Polygenic- family history
Group a strep infection
Drugs eg lithium
UV light
High alcohol consumption
Stress
31
Q

psoriasis epidemiology

gender
age
– inc age for guttate and flexural psoriasis

A

m=f

rare in children
Peak in early adulthood. Second less big peak 50-60y
Guttate psoriasis - children and young adults
Flexural psoriasis - later in life

32
Q

risk factors for

Squamous cell carcinoma (SCC)
Basal cell carcinoma (SCC)
Malignant melanoma (MM)

A

Squamous cell carcinoma (SCC)

  • UV exposure
  • Chronic inflammation eg wound scars, immunosuppression

Basal cell carcinoma (BCC)

  • UV exposure
  • Skin type 1 (burns doesn’t tan)
  • Ageing
Malignant melanoma (MM) 
- UV exposure 
- Alcohol drinking
- Affluence 
- Red hair
- High density freckles
- Skin type 1 (burns doesn't tan)
- -Atypical moles
- Sun sensitivity
 Pale skin  
- Family history
- Immunosuppression
33
Q

squamous cell carcinoma (scc)

  • presents when
  • presents how
  • tumour of?
  • features inc how aggressive
  • commonness
A
  • Present later in life
  • Locally invasive, malignant tumour of squamous keratinocytes (outermost bit of epidermis)
  • More aggressive than BCC as has higher metastatic potential - particularly to lymph nodes (but still rare to metastasise)
  • 2nd most common (to BCC)
  • On sun exposed sites
  • Ill defined nodules
  • May ulcerate
  • Grow rapidly
34
Q

basal cell carcinoma (bcc)

  • presents when
  • presents where
  • presents how
  • tumour of?
  • features inc how aggressive
  • commonness
A
  • Tumour of basal keratinocytes (deepest bit of epidermis)
  • Most common malignant skin cancer
  • Non pigmented mostly. If pigmented, can resemble melanoma
  • Majority in elderly
  • Majority head and neck
  • May ulcerate (=rodent lesion)
  • Border of ulcerated lesion is raised with pearly appearance
  • Shiny nodule
  • Non pigmented mainly
  • Bleeds following minor trauma and does not heal
  • less aggressive and metastatic than SCC– slow growing, slowly causing local tissue destruction
35
Q

malignant melanoma (mm)

  • tumour of?
  • presents when
  • presents where
  • presents how
  • prognosis inc bad prognosis signs
  • features inc how aggressive
  • commonness
  • types (4)
A
  • Most malignant
    — Tumour of melanocytes
    in basal layer of epidermis
    —Produce melanin
    —Absorbs UV (protective)
  • rarest out of MM, SCC, BCC
  • younger patients
  • Often fatal
  • Bad prognosis signs
    — Thick lesions
    — Over 60 y
    — Male
    — Ulceration of lesion
    — On trunk
  • Men - back/chest
    Women - lower legs
  • Most lesions have dark colour, almost black in parts

Types

  • Superficial spreading (SSMM- large, flat (laterally growth not vertical))
  • Nodular (most aggressive)
  • Lentigo maligna (face, slow growing)
  • Acral (palms/soles)
36
Q

skin cancer investigations

A 
A- asymmetrical shape
B- border irregularity
C- colour irregularity
D- diameter >6mm
E- elevation, 
Major = Change / evolution is key
-- Size, shape, colour (usually darkening)
Minor = 
-- Inflammation
-- Crusting
-- Bleeding
-- Sensory change- inc itching

Feel lymph nodes

37
Q

skin cancer management

A

Surgical excision - wide borders (minimal 5mm) and histology

Radiotherapy (esp if non resectable/ not fit for surgery)

Superficial ones (esp BCC)

  • –Cryotherapy
  • –Photodynamic therapy

Metastatic (esp MM)

  • –Remove regional lymph nodes
  • –Radiotherapy
  • –Immunotherapy
  • –Chemotherapy
  • –Isolated limb perfusion - limb circulation temporarily disconnected from body. External pump includes chemo that circulates to only particular limb

phase 2a mine (38 decks)

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