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Management from lecs > Dermatitis > Flashcards

Dermatitis Flashcards

1
Q

Psoriasis is a x -mediated disease

A

T-cell mediated disease

Pathogenesis:

  • Hyperproliferative disorder
  • • Alteration of keratinocyte with shortening of the cell cycle
  • • Increased production of epidermal cells.
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2
Q

What is this

A

Koebners phenomenom - is the appearance of skin lesions on lines of trauma and is a cause of psoriasis

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3
Q

Most common type of psoriasis

A

Psoriasis vulgaris

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4
Q

What condition is this

A

Psoriasis Vulgaris

Characteristics:

  • Favours extensors, scalp, intertriginous areas, lower back
  • Usually bilateral and symmetrical
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5
Q

What condition is this?

A

Psoriasis

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6
Q

What condition is this and what infection does it usually follow

A

Guttate Psoriasis

Streptococcal infection

Characteristics:

  • Acute
  • Responds to uv light
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7
Q

What is this

A

Pustular psoriasis

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8
Q

Treatment of pustular psoriasis

A

Usually quite difficult to treat

  1. Steroids
  2. PUVA
  3. Acitretin (retinoid)
  4. Calcipotriol (acts like vitamin D - is antiproliferative, reducing the abnormal proliferation of keratinocytes that occurs in psoriasis, and it induces cell differentiation, normalising epidermal growth)
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9
Q

What is this

A

Psoriatic arthropathy

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10
Q

First line treatment for Psoriasis

A

Emollients - reduces scales

2nd line: Topical e.g. Vit d analogues like calcipotriol or topical corticosteroids

3rd line: if severe give immunosuppresants e.g. methotrexate/ciclosporin

Or

Retinoids e.g. acretentin

OR

UVB phototherapy

Or anti-tnfs e.g. infliximab

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11
Q

Eczema/Dermititis characteristics

A

pruritic (itchy), redness, papulation (raised area of skin)

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12
Q

Atopic dermatitis is an x mediated inflammatory response

A

IgE

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13
Q
A

Atopic dermatitis

**often starts with face then spreads to trunk and limbs

*usually on flexure surfaces

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14
Q

What are the complications of atopic dermatitis

A

Infection – eg:
• Bacterial – usually Staphylococcal
• Eczema herpeticum

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15
Q

Seasonal allergies and/or asthma ora combination are common in patients with

A

Atopic dermatitis

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16
Q

Treatment of Atopic dermatitis

A
  1. Advice to stay away from triggers

+ Emollients (reduce dryness: mainstay of treatment: used 3-8 times per day)

  1. Can add steroids if flare-up e.g hydrocortisone
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17
Q

Pathophysiology of atopic dermatitis

A

Chronic relapsing inflammatory itchy skin condition

  • as a result of impaired skin barrier - leads to excess water loss through the skin
  • usualyl flexural i.e. politeal and antecubital fossa - exception in kids
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18
Q
A

Psoriasis

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19
Q

Paste bandaging can help with x in atopic dermatitis

A

Symptom control (particularly children)

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20
Q

Contact dermititis is majority:

1) immunological (allergic)
2) toxic (irritant)

Please give examples

A

Irritant (80%) e.g. irritating substances e.g. detergents, acids, oils and sometimes water (strip skin off natural oils)

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21
Q

Allergic dermatitis is a type x hypersensitivity reaction

A

4 delayed

  • Needs prior sensitisation to the chemical examples include nickel, rubber , metals, cosmetics, nail varnish or dyes
  • Recurs with each subsequent exposure to antigen
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22
Q
A

Contact dermatitis (specifically irritant dermatitis)

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23
Q
A

Contact dermatitis

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24
Q

How to test for allergic contact dermatitis

A

Patch testing

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25
Q

Treatment of contact dermatitis

A

Advise to avoid allergens/irritants (8-12 weeks before improvement seen)

  1. Liberal emollient and soaps to maintain skin hydration + improve barrier repair
  2. Consider Topical steroids to control symptoms
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26
Q

what is pompholyx eczema

A

Tiny blisters restricted to palms and soles
• Intensely itchy

Treatment:

  1. with emollients and topical steroids
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27
Q
A

Seborrheic dermatitis

Characteristics:

  • greasy/yellow sacle +/- erythema
  • Typically in men around scalp, nasal-facial creases and beard
28
Q

Treatment of seborrheic dermatitis affecting scupl and beard

A

Ketoconazole 2% shampoo - 2 x/7 for 4 weeks then once every 1-2 weeks for maintenance)

29
Q
A

Varicose eczema

30
Q
A

Discoid eczema - coin shaped lesions often on legs

31
Q
A

Lichen (small bumps) planus (flat)

Characteristics:

  1. Itchy and papular eruption with occasional blistering
  2. • Affects skin, mucous membranes, nails and scalp
  3. • More common in women
  4. Oral LP> cutaneous LP
32
Q

Treatment of lichen planus

A

Not always needed - usually resolves in 1-2 years

  • Topical steroids (1st line for oral LP) or can give Tacrolimus ointment (anti-inflammatory)
  • Systemic – Steroids – Retinoids (diff cases) – PUVA (severe and more widespread)
33
Q

This patient presented with this asymptomatic rash. It started a week earlier with this lesion (herald patch)
• Name the lesion and the subsequent rash

A

Pityriasis Rosea

  • Lesions follow lines of the dermatomes – ‘Christmas tree distribution
  • usually symmetrical (on trunnk or plantar skin surfaces
34
Q
A

Comedonal acne

35
Q

Treatment for Acne

A
  • Mild to moderate: Topical therapies e.g. benzoyl peroxide or azelic acid + topical abx e.g. clindamycin
  • Mod-severe: consider adding oral antibiotics e.g. doxycycline for a max of 3 months
  • Review after 8 weeks then every 3-4 months

**Maintenance is usually with topical retinoids (1st line)**

36
Q

What is this and its conmmon cause

A

Viral wart

Human papilloma Virus (HPV)

37
Q

Common treatment for verrucas/warts

A

salicylic acid, and/or cryotherapy

38
Q

Differentiating rosacea from Acne vulgaris

A

Rosacea has other symptoms such as visible dilated blood vessels. bumps may appear inflammed/ blood shot eyes

39
Q

Acne vulgaris clinical features

A
  • comedones e.g. blackheads/ white heads
  • Inflammatory lesions e.g. papules/postules <5mm in diameter
  • Soborrhoe
40
Q
A

Strep skin infection - streptoco impetigo

41
Q

Scarlet fever presentation

A
  • Strawberry tongue
  • fever
  • Nause/vomiting
  • widespread pink/red rash on abdomen, sides of chest and skin folds
42
Q
A
  1. chicken pox
  2. shingles

**blistering rash cause by herpes simplex Virus

43
Q

Treatment of scarlet fever

A

antibiotics:

  • Pencillin/azithromycin if allergiv for a full 10 days
44
Q

Treatment of chicken pox

A
  1. advise adequate fluid intake , first 2 days is most infectious so avoid contact with pregnant women & until crusting over
  2. simple analgesia
  3. consider aciclivor if pt presents within 24 hrs
45
Q
A

Molluscum contagiosum

46
Q

infection of dermis and subcutaneous tissue associated with pain/signs of inflammation and either strep or staphy infection

A

Cellulitis

47
Q

Treatment of cellulitis/erysipelas

A

antibiotics e.g. flucloxallin/benzyl penicillin - if allergic then erythromycin

48
Q
A

SLE due to malar flush and vasiculitis

*others include:Raynauds phenomenom (chaging of skin colour in cold) and photsensitivity

49
Q

What blood test would u do to confirm SLE

A

Anti-nuclear antibodies

50
Q
A

Toxic epidermal necrolysis

51
Q
A

Stevenson-johnson syndrome

52
Q
A

Actinic keratosis

* caused by damage due to prolonged sun exposure

* 10% chance of progressing to cancer

53
Q

Treatment of actinic keratosis

A
  1. Liquid nitrogen cryotherapy
  2. Topical therapies e.g 5-FU (Efudex) or Imiquimod (Aldara) to be used 3-5 times a week for 6-8 weeks
  3. Curettage for hypertrophic lesions
54
Q
A

Dyspastic nevi

**precursors/markers of melanoma

** diagnosed histologically and excised

55
Q

Risk factors for developing skin cancer

A

Fair skin (Fitzpatrick’s types I-III) – Blue eyes – Red hair
• Family history – Genetic syndromes
• Chronic sun exposure/ tanning bed
• Old age
• Chemical exposure (arsenic)

56
Q

Most common skin cancer

A

Basal cell carcinoma (80%) - 4 x more frequent than SCC

** rarely metastasizes

57
Q
A

Nodular BCC

  • Chronic lesion
  • easy bleeding
  • pearly white shaped dome
  • surface talengiectasias
    *
58
Q
A

pigmented BCC

59
Q
A

Superficial BCC

60
Q
A

morpheaform BCC - resembles scar

61
Q

Treatment of BCC

A
  • small + low risk lesions: topical therapy e.g. imiquimod
  • Radiotherapy if surgical excision appropriate
  • Electrosurgery
  • For high risk + recurrent = mohs surgery(progressive lesion excision of tissue borders until specimens are free from tumor)
62
Q
A

Keratoacanthoma

63
Q
A

invasive SCC

64
Q
A

Bowens disease

65
Q

Treatment of SCC

A

-Efudex or aldara
– Liquid nitrogen cryotherapy
– Radiation therapy
– Electrosurgery
– Surgical excision • Mohs Surgery

66
Q

Features of malignant melanoma

A
  1. assymetry
  2. poor borders
  3. multicoloured
  4. Large diameter
  5. Evolving size
67
Q

Prognostic features of melanoma is done via the

A

Looking at the breslow thickness

Management from lecs (7 decks)

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