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YEAR 3 & 5 CORE CONDITIONS > Dermatology 1 (inflammatory) > Flashcards

Dermatology 1 (inflammatory) Flashcards

1
Q

What are the functions of the skin?

A
  • Physical barrier
  • Thermoregulation
  • Fluid balance
  • Vitamin D synthesis
  • Sensation
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2
Q

What is the outer layer of the skin called and what cells are in it?

A

Epidermis

Keratinocytes (90%) and melanocytes

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3
Q

What are the layers of the epidermis?

A
  1. Stratum corneum
  2. Stratum lucidum
  3. Stratum granulosum
  4. Stratum spinosum
  5. Stratum basale
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4
Q

Define macule and papule

A 
Macule = small, flat lesion <5mm
Papule = small, raised lesion <5mm
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5
Q

Define nodule and patch

A 
Nodule = discrete raised lesion >1cm
Patch = diffuse flat lesion >1cm
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6
Q

Define vesicle, bulla and pustule

A 
Vesicle = small fluid filled lesion <5mm 
Bulla = large fluid filled lesion
Pustule = pus filled blister <5mm
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7
Q

What is telangiectasia?

A

Dilated blood vessels visible on the skin

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8
Q

Difference between erosion and ulcer

A 
Erosion = superficial
Ulcer = deep
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9
Q

When describing a skin lesion, what is the structure you follow?

A
  1. Site
  2. Size
  3. Shape, symmetry and border
  4. Colour + pigmentation
  5. Surface features
  6. Surrounding skin
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10
Q

What is the distribution of eczema?

A

Flexor surfaces

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11
Q

What is the diagnostic criteria for atopic eczema?

A

Itchy skin condition plus 3 of the following:

  • History of itchiness in skin creases
  • History of atopic disease
  • General dry skin
  • Visible flexural eczema
  • Onset in first 2 years of life
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12
Q

What are the first line treatments for eczema?

A

Emollients (500g per week in adults) - creams, lotions, ointments, soap substitutes
Topical steroids - hydrocortisone (mildest) to dermovate (most potent)

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13
Q

How much does 1 finger tip unit cover?

A

2 palms of area

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14
Q

What are some complications of eczema?

A

Lichenification in adults
Staphylococcal infection
Eczema herpeticum = rapidly worsening, painful, clustered blisters and punched out erosions

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15
Q

How would you treat an infection of eczema?

A

Flucloxacillin for 14 days (erythromycin if penicillin allergic)

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16
Q

What genetic mutation is associated with atopic eczema?

A

Filaggrin

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17
Q

Where and how does discoid eczema present?

A

Symmetrical oval erythematous patches/plaques on extremities
Extremely itchy especially at night

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18
Q

What age is discoid eczema more common in?

A

Over 60 years old

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19
Q

What type of hypersensitivity reaction is allergic contact dermatitis?

A

Type IV hypersensitivity - occurs after sensitisation and re-exposure to allergen

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20
Q

How can you distinguish between irritant and allergic contact dermatitis?

A

Irritant = fast onset of burning, stinging, soreness in exposed area and resolves quickly after removal of irritant

Allergic = delayed onset of redness, itch, scaling in exposed area and other areas. Takes longer to resolve.

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21
Q

Which type of contact dermatitis is more commonly associated with atopic eczema?

A

Irritant contact dermatitis

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22
Q

What are the main risk factors for seborrhoeic dermatitis?

A

Immunocompromised
Stress and fatigue
Parkinson’s

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23
Q

What causes seborrhoeic dermatitis?

A

Inflammatory reaction to yeast (Malassezia spp) due to reduced resistance to the yeast

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24
Q

How does seborrhoeic dermatitis present?

A

Erythematous scaling rash over nasolabial folds, bridge of nose, eyebrows, ears and scalp (dandruff)

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25
Q

What medication can you give for seborrhoeic dermatitis?

A

Ketoconazole = topical antifungal

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26
Q

What can you use to remove crusts on the skin?

A

Salicylic acid and olive oil

27
Q

How is acne rosacea different to seborrhoeic dermatitis?

A

It is not scaly
It spares the nasolabial folds
It has papules and pustules

28
Q

What bacteria can cause infection in acne vulgaris?

A

Propionibacterium Acnes

29
Q

What is acne vulgaris a disorder of?

A

Pilosebaceous follicles

30
Q

What can acne vulgaris be associated with?

A

Excess androgens e.g:

  • Polycystic ovarian syndrome
  • Cushing’s
  • Steroid abuse
31
Q

How do you treat mild and severe acne vulgaris?

A

Mild - benzoyl peroxide

Severe - retinoids

32
Q

What are the side effects of retinoids?

A

Teratogenic - don’t give in pregnancy
Photosensitivity
Dry skin

33
Q

What antibiotics are useful in acne vulgaris

A

Doxycycline/tetracycline

34
Q

What is acne rosacea?

A

Chronic, relapsing erythema/flushing, telangiectasia, papules and pustules affecting the face

35
Q

What ocular symptoms are associated with acne rosacea?

A

Blepharitis
Conjunctivitis
Stinging of eyes

36
Q

What do men especially get with acne rosacea?

A

Rhinophyma = large nose

37
Q

What kinds of things can trigger acne rosacea?

A 
Temperature changes
Alcohol
Caffeine
Spicy foods
Stress
Amiodarone
38
Q

What is the management for mild and severe acne rosacea?

A 
Mild = topical metronidazole or azelaic acid
Severe = oral tetracycline/erythromycin
39
Q

What causes urticaria?

A

Food/drugs/insect bites/infections cause increased permeability of capillaries (histamine-mediated) which leads to itchy white weals with erythematous flare

40
Q

What is the treatment for urticaria?

A

Antihistamines e.g. loratidine

41
Q

What can be a complication of urticaria and how do you manage it?

A

Angio-oedema (non-pitting facial erythematous oedema) which can lead to airway obstruction and anaphylaxis

Treat with adrenaline, oxygen, hydrocortisone, chlorphenamine (antihistamine)

42
Q

What is the pathophysiology behind psoriasis?

A

Inflammatory autoimmune T-cell mediated

43
Q

How does chronic plaque psoriasis present?

A

Extensor surfaces, scalp and lower back

Itchy circular symmetrical erythematous plaques with fissuring

44
Q

What is Auspitz’ sign?

A

Bleeding on scraping of a psoriatic lesion

45
Q

What is Kobner’s reaction? What conditions demonstrate this reaction?

A

Lesions arising following trauma to skin in otherwise health skin

  • Psoriasis
  • Lichen planus
  • Vitiligo
46
Q

What nail changes are seen in psoriasis?

A

Pitting - superficial depressions in nailbed
Onycholysis - separation of nail plate from nailbed
Subungual hyperkeratosis - thickening of nailbed
Oil drop discolouration

47
Q

What triggers a relapse of psoriasis?

A 
· Skin trauma (Koebner phenomenon)
· Infection - strep, HIV
· Drugs - BALI
- Beta-blockers
- Anti-malarials
- Lithium
- Indomethacin/NSAIDs
· Withdrawal of steroids
· Stress
· Alcohol and smoking
· Cold/dry weather
48
Q

What antigens is psoriatic arthritis associated with?

A

HLA-B27 (also ankylosing spondylitis, IBD, reactive arthritis)
HLA-DR4 (also RA and type 1 diabetes)

49
Q

What topical treatments are used for psoriasis?

A

Emollients
Topical vitamin D - reduces keratinocyte proliferaiton
Potent topical steroids (betnovate)

50
Q

What DMARDs can be given for psoriasis?

A

First-line - Methotrexate
Second-line - Ciclosporin (1st line if rapid disease control needing or are considering conception)
Third-line - Acitretin

51
Q

What areas are most commonly affected by lichen planus?

A

Flexors
Genitalia
Mucous membranes

52
Q

What is the pathophysiology of lichen planus?

A

T-cell mediated autoimmune condition where the inflammatory cells attack a protein within the skin and mucosa

53
Q

How does lichen planus present?

A

Itchy eruptions of papules and polygonal plaques that look like white lace
Wickham’s striae = white on buccal mucosa

54
Q

What disease is lichen planus associated with?

A

Hepatitis C

55
Q

What is a potential complication of oral lesions in lichen planus?

A

2% malignant potential to squamous cell carcinoma

56
Q

What conditions is lichen sclerosis associated with?

A

Thyroid diseases

Diabetes

57
Q

What is the treatment for lichen planus?

A

Potent topical steroids e.g. dermovate

58
Q

What is the management of eczema herpeticum?

A

Oral acyclovir
Oral flucloxacillin (to cover secondary bacterial infection)
Stop topical steroids

59
Q

What are the 5 different types of psoriasis?

A
  1. Chronic plaque psoriasis
  2. Flexural (inverse) psoriasis
  3. Guttate psoriasis
  4. Pustular psoriasis
  5. Generalised/erythrodermic psoriasis
60
Q

How does guttate psoriasis present and what usually causes it?

A

Multiple small, tear-drop shaped, erythematous plaques occurring on the trunk

Post-Strep infection in young adults

61
Q

How does pustular psoriasis present?

A

Multiple petechiae and pustules on palms and soles

62
Q

What phototherapy is used to treat psoriasis?

A
  1. Narrowband UVB phototherapy

2. Psoralen + UVA (PUVA)

63
Q

What are the side effects of ciclosporin?

A

5 H’s

  • Hypertrophy of gums
  • Hypertrichosis
  • Hypertension
  • Hyperkalaemia
  • Hyperglycaemia (diabetes)

Requires monitoring of U&Es, BP and fasting glucose

YEAR 3 & 5 CORE CONDITIONS (30 decks)

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