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Year 4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Eczema

A

morphological descriptor for maculopapular erythematous rash ± scale/eroison/blistering, it is used in isolation usually to describe atopic eczema

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2
Q

Atopic dermatitis / atopic eczema

A

chronic relapsing inflammatory skin condition characterised by an itchy red rash that favours the skin creases e.g. fold of the elbow or behind knee

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3
Q

Epidemiology of atopic dermatitis / eczema

A

typically manifests in childhood (often improves in adolescence)

associated with other atopic disease e.g. asthma, allergic rhinitis, food allergies

affects ~10-30% of all children & up to 10% of all adults

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4
Q

Triggers for atopic dermatitis / eczema

A 
irritants (e.g. soaps/detergents)
heat
very dry or very humid climate
emotional stress
dust mites
pollen
infections
dietary factors (in ~50% of children)
genetics
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5
Q

Associated conditions with atopic dermatitis / eczema

A

asthma
allergic rhinitis
food allergies

NB ~70% of cases have family history of atopic disease

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6
Q

Presentation of atopic dermatitis / eczema

A

intense pruritus & dry skin, redness ,swelling
distribution tends to vary with age

Infancy: face/scalp/extensor surfaces of limbs (nappy area generally spared)

Childhood: flexural creases, skin folds, extensor surfaces

adults/adolescents: flexural creases, lichenfied lesions & pruritus

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7
Q

Pompholyx eczema presentation

A

tiny vesicles on the palms and soles
intense pruritus ± burning sensation
once blisters burst skin may become dry and crack

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8
Q

Diagnostic criteria for eczema

A

Must have itchy skin condition + ≥3 of the following:

  • hx of flexural itchiness
  • hx of asthma / eczema
  • dry skin for past year
  • visible flexural eczema
  • onset before 2 y/o
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9
Q

Investigations of atopic dermatitis / eczema

A

generally clinical diagnosis

consider allergy testing
IgE level (↑)
Radioallergosorbent test (RASTs)
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10
Q

Management of atopic dermatitis / eczema

A

Generally:
emollients & moisturisers (apply liberally & frequently, best on moist skin e.g. after shower, use 3-4/day)
soap substitutes

1st line: Topical steroids

2nd line: Topical tacrolimus / pimecrolimus

3rd line: systemic steroids

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11
Q

Finger tip unit

A

1 finger tip unit is ~0.5g

sufficient to treat area 2x size of flat adult hand

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12
Q

Mild topical steroids

A

e.g. hydrocortisone 0.5-2.5%

use in mild eczema and eczema on face

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13
Q

moderate strength topical steroids

A

e.g Eumovate, Modrasone

used in moderate eczema

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14
Q

potent topical steroids

A

e.g. Betnovate, Synalar, clobetasol

in severe eczema

NB super potent steroids include Dermovate

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15
Q

Eczema herpeticum

A

severe skin infection caused by herpes simplex virus (HSV) in a pt suffering from eczema

usually seen in children

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16
Q

Eczema herpeticum presentation

A

extensive disseminated & painful eruptions on head / upper body, erythematous skin with multiple round vesicles which may progress to pushed out lesions

the rash is painful & rapidly progressing

fever, malaise, lymphadenopathy

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17
Q

Eczema herpeticum investigations

A

may be a clincial diagnosis in those with know eczema & an acute eruption of a painful monomorphic clustered vesicle + fever & malaise

viral swabs /scrapings (for PCR of antibody fluorescence)

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18
Q

Eczema herpeticum management

A

Dermatological emergency

antiviral therapy e.g. aciclovir (PO/IV)
consider Abx for secondary bacterial infection

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19
Q

Discoid / Nummular eczema

A

chronic inflammatory skin condition charactersied by scattered well defined coin shaped & coin sized plaques of eczema

relatively common form of eczema, more frequently seen in men around the ages 50-65

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20
Q

Presentation of Discoid / Nummular eczema

A

2-5cm coin shaped / oval well demarcated erythematous plaques, pruritus, scale
primarily affects the extremities especially the legs

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21
Q

Investigations for Discoid / Nummular eczema

A

skin scrapping to exclude tinea (dermatophytosis)

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22
Q

Management of Discoid / Nummular eczema

A

rehydrate skin (shower/bathe in cool water)
emollients/moisturisers
soap substitutes

topical steroids (usually mild steroids sufficient e.g. hydrocortisone cream)

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23
Q

Urticaria (hives)

A

itchy, red, blotchy rash resulting from swelling of the superficial payer of the skin (dermis) due to mast cell degranulation & histamine release

NB angio-oedema occurs if the deeper tissues such as the lower dermis or subcutaneous tissue are involved & become swollen

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24
Q

Types of urticaria

A

Acute:
usually self limiting, causes include allergies, viral infections, skin contact with chemicals/nettles/latex, physical stimuli e.g. firm rubbing

Chronic:
maybe spontaneous, autoimmune or induced (e.g. by exercise, sun exposure etc)

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25
Q

Dermatographism

A

writing on skin with urticaria

i.e. urticaria develops when scratching the skin

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26
Q

Investigations for urticaria

A

clinical diagnosis

if chronic/recurring consider investigating (FBC, ESR/CRP, physical challenge testing, IgE tests, patch testing)

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27
Q

Management of urticaria

A

minimise non specific aggravating factors e.g. stress, alcohol
topical anti-pruritic agents e.g. calamine lotion, topical method
non sedating antihistamines e.g. cetirizine, loratadine

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28
Q

Psoriasis

A

chronic inflammatory skin condition characterised by erythematous, circumscribed scaly papules & plaques

affects ~2% of population, majority of cases present before age 35

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29
Q

Subtypes of psoriasis

A

plaque psoriasis:
90% of cases, usually well demarcated red scaly plaques on extensor surfaces/sacrum/scalp

flexural psoriasis:
skin is smooth, mainly affecting flexural surfaces & skin folds

guttate psoriasis:
widespread tear drop shaped psoriatic lesions triggered by streptococcal throat infection

pustular psoriasis:
commonly on palms & soles, associated with HLA-B27, confluent, white pustules

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30
Q

Guttate psoriasis

A

transient psoriatic rash usually triggered by streptococcal infection, presents as multiple widespread tear drop shaped lesions

more commonly seen in children

responds well to light therapy

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31
Q

Most common type of psoriasis

A

plaque psoriasis = ~90% of all cases

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32
Q

Risk factors for psoriasis

A 
Family history (~30% of pts)
infection (e.g. streptococcal)
stress
drugs (lithium, ACE-Is, beta-blockers, penicillins)
smoking
alcohol
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33
Q

Presentation of psoriasis

A

well demarcated erythematous plaques/papules with silvery-white scale (usually on scalp, extensor surfaces, back)
mild pruritus
pin point bleeding if scales scrapped of (Auspitz sign)

Nail involvement (~50% of pts)
nail pitting, small round depression of nails, onycholysis, brittle nails, discolouration of nail bed

NB ↑ severity with alcohol consumption, ↓ severity with sunlight

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34
Q

conditions associated with psoriasis

A

psoriatic arthritis
IBD
metabolic syndrome

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35
Q

Investigations for psoriasis

A

generally clinical diagnosis

ESR/CRP (↑ if arthropathy)
consider skin biopsy if diagnosis in doubt

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36
Q

Management of psoriasis

A

1st line: OD potent topical steroid + OD topical Vit D analogue e.g. calcipotriol

2nd line: Vit D analogue BD

3rd line: potent corticosteroid BD / coal tar preparation

Secondary care:
narrow band UV B light theory

Systemic therapy:
methotrexate = 1st line

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37
Q

Exacerbating & relieving factors for psoriasis

A

↑ severity with alcohol consumption

↓ severity with sunlight

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38
Q

Erythema nodosum

A

common cuteness hypersensitivity reaction leading to inflammation of the subcutaneous fat

most commonly affects women in early adulthood

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39
Q

Aetiology of erythema nodosum

A

NB most common cause = underlying streptococcal infection

Causes include:
sarcoidosis*
IBD
Behcet syndrome 
COCP
pregnancy 
TB
infection (e.g. streptococcal)
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40
Q

Presentation of erythema nodosum

A

painful subcutaneous nodules, firm, erythematous, fluctuant & blueish in colour usually on bilateral shins
self resolves in ~6 weeks

fever, arthralgia, aches

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41
Q

Investigations for erythema nodosum

A

to exclude serious underlying cause

anti-streptococcal (ASO) titre
FBC
ESR (↑↑)
CXR (for TB/Sarcoidosis)
Ca2+ / ACE (↑ in sarcoidosis)
intradermal skin test (for TB)
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42
Q

Management of erythema nodosum

A

generally self limiting condition so only symptomatic relief i.e. hot/cold compresses, NSAIDs, potassium iodide
treat underlying disease

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43
Q

Erythema multiforme

A

rare acute hypersensitivity reaction leading to mucocutaneous inflammation which is usually self limiting but often relapsing

most pts are <40y/o

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44
Q

Aetiology of erythema multiforme

A

NB most common cause is Herpes simplex virus (HSV) infection

Infections:
HSV
mycoplasma pneumoniae

Medications:
phenytoin, beta-lactam Abe e.g. penicillin, NSAIDs, allopurinol, carbamazepine

Others:
sarcoidosis, SLE

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45
Q

Presentation of erythema multiforme

A

generally acute onset of rash characterised by target / iris lesions
3 zones, inner (dark red/brown), middle (pale) outer (erythematous ring)
starts on back of hands / feet then spreads to torso

may have mucous involvement e.g. mouth lesions

NB rash may be preceded by 3-14 by infection e.g. cold sores

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46
Q

management of erythema multiforme

A

treat underlying cause e.g. infection or stop offending drug

consider antiretrovirals if recurrent disease due to HSV

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47
Q

Characteristic lesion of erythema multiform

A

Target lesions

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48
Q

Pruritus

A

an unpleasant itching sensation leading to intense scratching, may be localised or general

NB localised usually dermatological cause, generalised pursuits usually systemic/psychogenic cause

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49
Q

Management of pruritus

A

moisturisers
calamine lotion
topical steroids/calcineurin inhibitors e.g. tacrolimus
antihistmamines

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50
Q

Erythoderma

A

term used to describe when >95% if the skin is involved in a rash of any kind

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51
Q

Causes of erythroderma

A

eczema
psoriasis
drugs
lymphomas/leukaemia

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52
Q

Eryhtrodermic psoriasis

A

most common cause of erythroderma in adults, either due to progressively worsening plaque psoriasis or unstable psoriasis triggered by infection/drugs

NB dermatological emergency

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53
Q

Eryhtrodermic psoriasis presentation

A

whole skin is erythematous & hot
dermatological features of psoriasis are often lost, scale is usually finer & flakier
usually painful & pruritic
pt systemically unwell

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54
Q

Management of Eryhtrodermic psoriasis

A

emergency admission to hospital
emollients & cool wet dressing
methotrexate or cyclosporin & infliximab

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55
Q

Steven-Johnson syndrome (SJS) & Toxic epidermal necrolysis (TEN)

A

spectrum of rare immune mediated skin reactions resulting in blistering of the skin & epidermal detachment

SJS & TEN are the same entity but depend on the extend of skin involved
<10% = SJS
10-30% = overlap between SJS & TEN
>30% = TEN

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56
Q

Aetiology of Steven-Johnson syndrome (SJS) & Toxic epidermal necrolysis (TEN)

A 
drug induced (75%)
allopurinol, phenytoin, sulfalazine, pencillin, carbamazepine, other anticonvulsants

infections / other causes (25%)
viral (HSV, EBV), bacterial (group A haemolytic strep), Hep B vaccination

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57
Q

Presentation of Steven-Johnson syndrome (SJS) & Toxic epidermal necrolysis (TEN)

A

ill defined red burning / painful macular/papular rash develops that forms into bull which then coalesce
mucous membrane involvement (90% of pts)

Nikolsky sign +ve

NB mucous membrane involvement differentiates this from SSSS

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58
Q

Management of Steven-Johnson syndrome (SJS) & Toxic epidermal necrolysis (TEN)

A

stop offending drug

supportive therapy:
IV fluids, Abx if septic, electrolyte replacement
ITU/burns unit admission

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59
Q

Necrotising fasciitis

A

life-threatening sub-cutaneous soft tissue infection that may extend to the deep fascia, usually progresses rapidly

NB Fournier gangrene is necrotising fasciitis of the external genitalia / perineum

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60
Q

Types of necrotising fasciitis

A 
Type I (most common)
polymicrobial, usually in pts with chronic disease e.g. diabetes

Type II:
caused by strep pyogenes

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61
Q

Risk factors for necrotising fasciitis

A

skin injury e.g. insect bites/trauma/surgical wounds
diabetes*
IVDU
immunocompromise

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62
Q

Presentation of necrotising fasciitis

A

pt systemically ill with disproportionately severe pain & only minor skin changes in early phase

pain swelling & erythema of affected site (often presents as rapidly worsening cellulitis)

later skin necrosis, gas gangrene

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63
Q

Management of necrotising fasciitis

A

Surgery (should no be delayed if necrotising fasciitis is suspected)
urgent surgical debridement, repeated daily until infection controlled

high dose broad spectrum Abx

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64
Q

Bullous pemphigoid vs Pemphigus vulgaris

A

Pemphigus = S for superficial blisters, usually younger people, +ve Nikolsky sign

Pemphigoid = D for deep blisters, usually old people, -ve Nikolsky sign

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65
Q

Bullous pemphigoid

A

chronic acquired autoimmune blistering disease (subepidermal) characterised by autoantibodies against hemidesmosomal antigens (BP180 & BP230)

most common type of blistering dermatosis

usually seen in pt aged >80 yrs (i.e. a disease of the elderly)

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66
Q

Presentation of Bullous pemphigoid

A

initially pruritus (weeks-months before blisters)

large tense sub epidermal (deep) blisters on normal/erythematous skin, usually on flexor surfaces of arms/legs, axillae, groin, abdomen
heal without scars

NB mucous involvement is rare

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67
Q

Investigations for Bullous pemphigoid

A

skin biopsy + direct immunofluorescence (sub epidermal blisters, dermal inflammatory cell infiltrates rich in eosinophils, IgG & C3 deposition)

antibody tests (BP180 & BP230)

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68
Q

Management of Bullous pemphigoid

A

1st line: potent topical steroids e.g. clobetasol (if localised disease) otherwise systemic steroids + osteoporosis cover

2nd line: immunotherapy e.g. azathioprine

NB topical steroids usually better tolerated by the pt than systemic steroids

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69
Q

Pemphigus vulgaris

A

autoimmune blistering condition that involved the epidermal surfaces of skin / mucosa or both, associated with antibodies to demoglein 3 (DSG3) an epithelial cell adhesion molecule

rare conditions, usually seen in those aged 30-70

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70
Q

Presentation of pemphigus vulgaris

A

spontaneous onset painful, flaccid intraepidermal (superficial) blisters that easily rupture, so erode & crust over
blisters usually first present on oral mucosa

pruritus usually absent 
Nikolsky sign (spread of blisters/loss of top layer of skin from moderate lateral pressure on healthy skin

NB often blisters pop before pt presents so generally presents as eroded skin

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71
Q

Nikolsky sign

A

occurrence of blisters or loss of top layer of skin when slight lateral pressure is applied to healthy skin(by rubbing)

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72
Q

Investigations of pemphigus vulgaris

A

skin biopsy with direct immunofluorescence (DIF):
intraepidermal vesicles, acantholysis, IgG deposition in intracellular spaces of epidermis, IgG in reticular pattern around epidermal cells

antibody tests (DSG3)

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73
Q

Management of pemphigus vulgaris

A

topical steroids e.g. beclometasone if mild/oral disease

1st line:systemic steroids

2nd line: electrophoresis

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74
Q

Dermatitis herpetiformis

A

autoimmune blistering skin disease associated with coeliacs disease & may be considered the cutaneous manifestation of coeliacs, due to IgA deposition in dermis

very rare, usually seen in younger people (age 20-40)

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75
Q

Presentation of dermatitis herpetiformis

A

tense grouped sub epidermal vesicles / papule and/or bullae with herpetiform appearance
lesions grow in centrifugal pattern with vesicles predominating the peripheries
intense pruritus

NO mucosal involvement

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76
Q

Investigations for dermatitis herpetiformis

A

skin biopsy & DIF (sub epidermal vesicles, deposition of granular IgA)

coeliac disease screen (anti-TTG / anti-endomysial antibodies)

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77
Q

Management of dermatitis herpetiformis

A

gluten free diet
Dapsone
topical steroids for pruritus

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78
Q

Cellulitis

A

acute spreading infection of the skin with visually distinct borders that principally involves the dermis & subcutaneous tissue

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79
Q

Erysipelas

A

a distinct form of superficial cellulitis with notable lymphatic involvement

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80
Q

Causative organism of cellulitis

A

strep pyogenes

staph aureus

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81
Q

Risk factors for cellulitis

A 
insect bites
elderly
alcohol misuse
IVDU
obesity/overweight
pregnancy 
diabetes
immunocompromised
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82
Q

Presentation of cellulitis

A

erythema, oedema, warmth, tenderness over affected area
usually affects lower limbs (usually unilateral)
Rash = poorly defined with induction (NB erysipelas is well demarcated raised lesions)

lymphadenopathy, fever, chills, nausea, headache etc

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83
Q

criteria guiding cellulitis treatment

A

ERON criteria

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84
Q

Management of cellulitis

A

analgesia (paracetamol, ibuprofen)

Abx:
1st line: flucloxacillin (erythromycin/clarithromycin if penicillin allergy)

2nd line (if severe): co-amoxiclav, ceftriaxone

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85
Q

Impetigo

A

a superficial predominately paediatric skin infection caused by staph aureus, either as a primary infection or secondary to other skin conditions e.g. eczema

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86
Q

Causative organism of impetigo

A 
Staph aureus (80%)
strep pyogenes
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87
Q

Presentation of non-bullous impetigo

A

70% of cases
papules which turn into small vesicles with surrounding erythema, ooze secretions that dry to from honey-coloured crusts
often seen around mouth & nose or on limbs
rapidly spreads
local lympahdenopathy

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88
Q

Presentation of bullous impetigo

A

30% of cases
vesicles that grow in large flaccid bullae that tend to be thin roofed & spontaneously rupture
no regional lymphadenopathy
more likely to have systemic upset & pain than non bullous impetigo

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89
Q

Investigations for impetigo

A

generally clinical diagnosis

consider swab for culture especially if MRSA is suspected

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90
Q

Management of impetigo

A

Localised non bullous impetigo:
hydrogen peroxide 1 % cream or topical Abx (e.g. fusidic acid)

extensive disease:
oral Abx e.g. flucloxacillin (erythromycin if penicillin allergy)

School exclusion:
until all lesion are dry/scabbed over or after 48h of Abx

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91
Q

School exclusion for impetigo

A

stay off school/work until all lesion are dry/scabbed over or after 48h of Abx

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92
Q

Dermatophyte infection / tinea

A

fungal infections of the skin/hair/nails caused by dermatophytes - a group of fungi that invade & grow in dead keratinocytes

tend to grow outward on skin producing a ring like pattern hence the name ring worm, often itchy & erythematous

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93
Q

Tinea pedis (athletes foot)

A

most common tinea infection

particularly in between webs of toes where skin may be marcated & erythematous
itchy, peeling skin between toes

common in adolescence

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94
Q

Tinea corporis (ringworm)

A

dermatophyte infection anywhere on body excluding feet/scalp/nails/groin

well defined annular erythematous lesions with pustules & papules
lesions have annular scaly plaques with raised edges

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95
Q

Tinea capitis

A

dermatophyte infection of the head & scalp mainly seen in children

round pruritic scalp plaques with broke hair shafts or alopecia in affected area
cause of scarring alopecia
post auricular lymphadenopathy

NB if untreated a kerion may form = deep, boggy plaque with pustule formation

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96
Q

Tinea unugvium (onychomycosis)

A

fungal nail infection usually affecting toe nails

discoloured white/grey/yellow nails, very brittle nails
separation of nail from nailed common
nail dystrophy & thickening

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97
Q

Tinea cruris (jock itch)

A

Ringworm affecting genital area

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98
Q

Risk factors for tinea infection

A 
diabetes 
immunocompromise
exposure to infected individuals/animals 
public bathing/swimming pools
chronic steroid use
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99
Q

Investigations for Tinea

A

KOH (potassium hrydoxide) microscopy:
hyphae (branching red-shaped filament sou infirm with with septa) + spores

UV light (Wood's light)
specifically for tinea = blue-green fluorescence of causative microsporum species
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100
Q

Management of Tinea

A

1st line: Topical antifungals e.g. fluconazole / terbinafine / itraconazole

2nd line: systemic antifungals (as above) used for tinea Capitis & extensive disease

NB for tinea capitis use oral griseofulvin or terbinafine + Topical ketoconazole shampoo

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101
Q

Tinea vesicolor / Pityriasis vesicolor

A

common superficial fungal infection of the stratum corneal (outer layer of epidermis) commonly caused by malassezia furfural or other malassezia species

usually seen in teenagers & young adults usually in hot & humid climates

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102
Q

Risk factors for Tinea vesicolor / Pityriasis vesicolor

A 
warm & humid climates
excessive sweating (hyperhidrosis)
occlusive clothing 
malnutrition
immunosuppression
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103
Q

Presentation of Tinea vesicolor / Pityriasis vesicolor

A

usually affects trunk/chest
round well demarcated macule that reveal fine subtle scale with gentle scrapping

patches of altered pigmentation (hypo or hyper pigmented)

NB lesions do not tan so are often more apparent after sunbathing e.g. on holiday

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104
Q

Management of Tinea vesicolor / Pityriasis vesicolor

A

1st line: ketoconazole shampoo
2nd line: other topical anitfungals e.g. clotrimazole or miconazole used as shampoos / creams
3rd line: oral itraconazole (if resistant to topical treatment)

NB hypo/hyper pigmented patches may take several months to disappear after treatment

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105
Q

Acne rosacea / Rosacea

A

chronic inflammatory skin condition with unclear aetiology characterised by recurrent episodes of facial flushing with persistent erythema, telangiectasia, papules & pustules

106
Q

Epidemiology of Rosacea

A

primary seen in white population

more common in women

triggers associated with ↑ body temp

107
Q

Triggers for rosacea

A 
alcohol consumption
hot weather
consuming spicy food
stress
nicotine
caffeine 
sun exposure
steroids
108
Q

Presentation of rosacea

A

often long history of intermittent flushing

persistent erythema on face with telangiectasia, usually on forehead, nose & cheeks ± papules / pustules

Rhinophyma: enlarged bulbous nose usually seen in men

NB if any comedones present = not rosacea

109
Q

Rhinophyma

A

associated with acne rosacea

enlarged bulbous nose (looks like brain) almost exclusively seen in men

110
Q

Management of acne rosacea

A

avoidance of triggers
daily application of high factor sunscreen

Mild to moderate:
1st line: topical metronidazole
2nd line: azelic acid gel

moderate to severe:
oral Oxytetracycline (Abx)

Symptomatic:
laser therapy for telangiectasia
surgery for rhinophyma

111
Q

Acne vulgaris

A

common skin condition that affects the pilosebaceous unit, will affect most individuals at some point in their lives
related to ↑ sebum production in response to ↑ androgen levels during puberty

more common in boys especially in teenagers years

112
Q

Presentation of acne vulgaris

A

usually in areas with sebaceous glands (face, shoulders, upper chest, back)

non inflammatory comedonal acne:
closed comedones (white heads)
open comedones (black heads)

inflammatory lesions when follicles burst = erythema, papules, pustules, pain

ultimately scars develop ( ice pick or hypertrophic scars)

113
Q

Nodulocystic acne

A

affects chest/face/back
usually seen in males

characterised by multiple inflamed & uniflammed nodules with scarring

topical treatment is usually not effective

114
Q

Drug induced acne

A

usually monomorphic e.g. pustules characteristically seen in steroid use

115
Q

Management of acne vulgaris

A

Topical preparations: e.g. topical retinoids, benozylperoxide, topical Abx
1st line: single therapy
2nd line: combination therapy

Systemic treatment:
Abx e.g. tetracyclines. oxytetracycline, doxycycline + topical agent e.g. topical retinoids, benozylperoxide
give single Abx for max 3 months

COCP in women

Specialist therapy:
isoretinoin (teratogenic so females but be on effective contraception & have negative pregnancy test)

116
Q

Specific treatment for acne vulgaris in women

A

COCP

117
Q

Pityriasis rosea

A

acute self limiting inflammatory condition usually affecting young adults (10-35yrs), more commonly women

118
Q

Presentation of pityriasis rosea

A

prodrome of fever, mailasie, joint pain

herald patch:
2-5 cm diameter oval/round patch with central salmon coloured area, fine white scale on outside

secondary rash appears after herald patch, erythematous, oval scaly patches appear along Langers lines (Christmas tree / fir tree)

119
Q

Management of pityriasis roscea

A

self limiting

disappears in 6-12 weeks

120
Q

Seborrhoeic dermatitis / eczema

A

chronic inflammatory skin condition that affects areas with high sebaceous activity e.g. scalp / face / chest

peaks in infancy & puberty

121
Q

Presentation of Seborrhoeic dermatitis

A

infants:
affects scalp (cradle cap), nappy area, face, limb flexures
erythematous plaques with patchy coarse yellow scale & greasy yellow crusts

adults:
erythematous greasy areas with fine scaling often on nasolabial folds, bridge of nose, behind ear
dandruff on scalp
may develop blepharitis or otitis externa

122
Q

Management of Seborrhoeic dermatitis

A

infants:
baby shampoo & baby oil
if severe mild topical steroids e.g. hydrocortisone

adults:
scalp = 1st line: zinc pyrithione shampoo
2nd line: ketoconazole shampoo

face/body = topical antifungals e.g. ketoconazole & topical steroids

123
Q

Seborrhoeic keratosis

A

common benign skin tumour mostly found on torso, due to being growth of immature keratinocytes usually seen in older people (90% of >60y/o have at least 1)

124
Q

Seborrhoeic keratosis presentation

A

multiple darkly pigmented papules/plaques, have a stuck on appearance, greasy, wav like, sharply demarcated soft
may have keratitis plugs on surface

most commonly seen on trunk & face

125
Q

Management of Seborrhoeic keratosis

A

reassurance usually no treatment required

may consider dermoscopsy & biopsy to rule out cancer

may remove for cosmetic purposes

126
Q

Pyogenic granuloma

A

common benign vascular lesion of the skin & mucosa which are characterised by rapid growth & tendency to bleed easily

unknown aetiology

more common in women

127
Q

presentation of pyogenic granuloma

A

most commonly found on head/neck, upper trunk & hands

solitary red/purple/yellow papule or nodules arising from normal skin, usually soft & round, very friable (bleeds easily), has polypoid appearance i.e. develops stalk

usually erupts & growth over a few weeks

NB very common in pregnancy (may be seen on oral mucosa)

128
Q

Investigations for pyogenic granuloma

A

biopsy ( for histological confirmation)

dermoscopy

129
Q

Management of pyogenic granuloma

A

pregnancy related lesions generally self resolve post partum

removal of lesions e.g. cryotherapy, curettage, excision

130
Q

Dermatofibroma

A

fibroblast proliferation resulting in a small fibrous, benign growth, more frequent in women

presents as single nodule that develops on an extremity, freely moving, firm to hard nodule with smooth skin surface

clinical diagnosis (pinch test)

managed with reassurance or removal for cosmetic reasons

131
Q

Solar lentigo (liver spots)

A

flat brown macules/patches found on back of hands or cheeks that are induced by sun exposure (UV light) usually seen in older fair skinned people

no treatment necesary

132
Q

Moles / Nevi / melanocytes naevi

A

a benign collection of pigment producing cells (melanocytes) in there epidermis/dermis or both

may be present at birth or shortly thereafter or acquired throughout childhood

most important differential is melanoma

133
Q

Common acquired melanocytes naevi

A

Types:

  • Junctional melanocytes naevi (circular macules, flat, darkly pigmented)
  • Compound naevi (domed pigmented nodules, usually smooth + uniform colour)
  • Intradermal naevi (raised mole with same pigmented as surrounding skin)

all associated with fair skin
all have potential for malignant transformation

134
Q

Congenital melanocytes naevi

A

mongolian spot

congenital, usually >1cm diameter, blue-grey hyper pigmented
disappear in childhood

135
Q

Spitz naevus

A

develops over few months in children
pink/red, may grow rapidly
usually excised

136
Q

dysplastic/atypical naevi

A

ugly duckling sing (naves not in keeping with other moles on same pt)
treated with excision

137
Q

Strawberry naevus / infantile haemangioma

A

benign vascular skin tumour that usually develops rapidly in first months of life, usually occur on head/neck

often solitary erythematous, raised, painless multilobulated tumours

usually self resolve but if symptomatic e.g. periorbital causing visual problems or in oral cavity = propanolol

138
Q

Cherry haemangioma / Campbell de Morgan spots

A

usually seen in middle aged adults, usually found on trunk

presents as bright red cherry red dome shaped papules/macules, often multiple lesions, non blanching

no treatment required

139
Q

Keloid scars

A

skin lesion caused by high fibroblast proliferation & collagen production as excessive tissue response to minor injury, more common in dark skinned individuals

presents as brownish-red scar tissue of varying consistency with claw like appearance growing beyond boundaries of original lesion, most common on sternum

may require excision or intralesional steroids

140
Q

Lipoma

A

common benign tumour of subcutaneous soft tissue

presents as slow growing, round, rubbery non tender nodule

no management needed unless painful / cosmetic removal wanted

141
Q

Sebaceous gland hyperplasia

A

enlarged sebaceous glands surrounded by yellowish lobules

no treatment required

142
Q

sebaceous adenoma

A

benign overgrow of sebaceous gland presenting as yellowish papule

143
Q

Epidermoid cyst

A

cells lining cyst come from epidermal cells that line top of the hair follicle, seen on face/neck/upper back

presents as slow growing firm, mobile, painless mass

no treatment if asymptomatic

144
Q

Pilar cyst

A

derived from cells at bottom of hair follicle, often seen in middle aged women on scalp

presents as slow growing firm, mobile, painless mass

145
Q

Common location of keloid scars

A

Sternum > shoulder > neck > face > extensor surfaces of limb > trunk

146
Q

Lichen planus

A

chronic pruritic inflammatory skin condition of unknown origin commonly seen in middle age

associated with Hep C*, Hep B, primary biliary cirrhosis

147
Q

Presentation of lichen planus

A

usually cute onset on flexor surfaces of arms, palms, soles, genitalia, scalp

pruritic, planar, purple well demarcated papuples/plaques, polygonal shape with white line pattern on surface (wickham’s striae usually on oral mucosa)

Koebeners phenomenon = new lesions at site of trauma

NB if on scalp may cause scarring alopecia (lichen planapilaris)

148
Q

7 Ps of Lichen planus

A

Planus = pruritic, polygonal, planar purple papules & plaque

149
Q

Investigations for lichen planus

A

usually clinical diagnosis

skin biopsy (saw tooth pattern of epidermal hyperplasia, hyperkeratosis, hypergranulosis)

150
Q

Management of lichen planus

A

1st line: potent topical steroids e.g. betnovate/dermovate
2nd line: systemic steroids

NB benzydamine mouthwash for oral lichen planus

151
Q

drug induced lichen planus

A

may be caused by quinine, thiazides, ACE-Is

stop offending drugs

only distinguished histological

152
Q

Lichen sclerosus

A

chronic inflammatory dermatosis primarily affecting the anogenital region in women & the glans penis / foreskin in men

more common in post menopausal women

153
Q

Presentation of lichen sclerosus

A

white thickened patches (porcelain white papules & plaques), may progress to crinkled white patches

women may present with vaginal discharge

active lesions may have areas of ecchymosis, hyperkeratosis, bullae

pruritus is severe especially in women (may disrupt sleep)

154
Q

Investigations for lichen sclerosus

A

usually clinical diagnosis

biopsy if uncertain/no response to treatment/suspected SCC

155
Q

Management of lichen sclerosus

A

topical steroids & emollients e.g. clobetasol

NB need to follow up as ↑ risk of vulval cancer

156
Q

Scabies

A

parasitic skin manifestation caused by the sarcoptes scabiei mite, spreads by prolonged skin-to-skin contact

highly contagious

157
Q

Risk factors of scabies

A 
overcrowding
poverty
poor nutritional status 
poor hygiene
institutions e.g. care homes, prisons
158
Q

Presentation of scabies

A

symptoms develop 3-4 weeks post infection

wide spread pruritus, worse at night (if multiple household members affected = indicative)

linear burrows (thread like whitish-grey lines on skin) on side of fingers, interdigital webs, flexor aspects of wrists

excortications, papules, vesicles

159
Q

Investigations for scabies

A

largely clinical diagnosis

ectoparasitic presentation (from skin biopsy) = presence of mites/eggs/faecal material

160
Q

Management of scabies

A

1st line: premetherin 5%
2nd line: malathion 0.5%

happy head to toe & repeat after 7 days
treat all household members & close contacts
tumble dry/wash/launder all clothing & bedding on day 1 of treatment

NB: symptoms develop 3-4 weeks post infection (contacts may be asymptomatic during this period so empirical treatment is vital)

161
Q

crusted (norwegian) scabies

A

seen in immunosuppressed pts e.g. HIV, infection with thousands of mites

hyperkeratotic crusted lesions on hands/feet/nails/scalp/ears

treatment = ivermectin

162
Q

Candidiasis

A

candida spp is a species of yeast like fungi, usually part of normal body flora but may become an invasive pathogen

candida albicans = most common species

severe disease is associated with immunosuppression

163
Q

Oral candidiasis

A

oral thrush (curd like white patches in mouth) may be followed by marked erythema & soreness, especially on tongue

usually treated with topical/oral miconazole

164
Q

candidial skin infections

A

soreness & itching, red moist skin area with ragged peeling edge ± pustules / papules at margin, yellow-white curd like scale

treated with topical imidazole cream e.g. miconazole / ketoconazole

165
Q

Viral warts

A

hyperkeratosis & hyperplasia of epidermis usually caused by human papillomavirus (types 1,2,3,4,10,27,57)

very common, up to 30% of children & young adults affected, peak in teenage years

166
Q

Presentation of viral warts

A 
common wart (verruca vulgaris):
papules/nodules with keratotic papillomatous surface, skin coloured/whitish, rough, usually on hands/fingers/knees/elbows
flat warts (verruca plana):
slightly elevated flat topped warts often on face/back of hands/legs
plantar warts (verruca plana):
on soles of feet, firm, flat flesh colours hyperkeratotic lesions
167
Q

Management of viral warts

A

may resolve spontaneously without therapy

1st line: topical salicylic acid (treat daily for ≥12 weeks)
2nd line: cryotherapy

168
Q

herpes simplex virus (HSV) infection

A

infection with the major strains of HSV (type 1 or type 2), which manifests as oral/genital/occular ulcers

very common, worldwide seroprevalence ~90%

169
Q

Labial/oral herpes (cold sores)

A

cold sores - recurring erythematous vesicles that progress to painful ulceration
usually found on oral mucosa & lip border

may be preceded by burning/tingling/pain

170
Q

Genital herpes

A

redness, swelling, tingling, pain pruritus
painful lymphadenopathy
single/disseminated painful red bumps / white vesicles that later ulcerate

171
Q

Investigations for herpes

A

often clinical diagnosis (especially cold sores)

nucleic acid amplification tests (NAAT) = test of choice for genital herpes

consider serology if recurrent genital ulcers

172
Q

Management of herpes

A

cold sores:
usually self limiting
symptomatic management with choline salicylate gel

genital ulcers:
GUM clinic referral, oral aciclovir (within 5 days of onset)
if recurrent (>6 attacks/year) = oral aciclovir as long term suppressive therapy

173
Q

Herpes Zoster infection

A

shingles (herpes zoster) is a dermatomal rash with painful blistering caused by reactivation of varicella zoster virus (VZV)

NB initial VZV infection usually in childhood as chickenpox after which the virus remains in the dorsal root ganglia

174
Q

Risk factors for herpes zoster

A 
↑ age
immunocompromise
HIV
malnutrition 
chronic corticosteroid use
malignancy
175
Q

Presentation of herpes zoster (shingles)

A

dermatomal distribution usually affecting 1-3 dermatomes unilaterally, i.e. does not cross midline
most commonly T1-L2

prodrome of burning, itching, paraesthesia in one dermatome lasting 2-3 days

rash = erythematous macular rash over affected dermatome that quickly becomes vesicular

NB any rash crossing midline = not shingles

176
Q

Management of herpes zoster (shingles)

A

avoidance of immunosuppressed & pregnant people (infections until all lesions crusted over)
analgesia (paracetamol / ibuprofen)
oral antivirals e.g. aciclovir (within 72h of onset)

177
Q

Complications of herpes zoster (shingles)

A

Zoster opticus

post hepatic neuralgia (usually resolved in 6 months, chronic neuropathic pain treated with amitriptyline or pregabalin/gabapentin

178
Q

Ramsay-Hunt syndrome (Zoster oticus)

A

VZv reactivation in geniculate ganglion CN VII

presents with facial paralysis, loss of taste, pain, vestibulocochlear dysfunction (vertigo/tinnitus), rash, auricular pain, facial nerve palsy

treated with oral corticosteroids & aciclovir

179
Q

Alopecia

A

hair loss form any hair bearing area but most often of the scalp

180
Q

Types of alopeica

A

Scarring alopecia:
also know a cicatricial alopecia
hair loss accompanies by scarring & irreversible destruction of hair follicles
i.e. irreversible hair loss

Non-scarring alopecia:
also known as noncicatricial alopecia
loss of hair without the presence of scarring & the preservation of hair follicles
i.e. potential for hair regrowth

181
Q

Androgenic alopecia

A

progressive non scarring alopecia affecting area of scalp with most androgen sensitive hair follicles resulting in characteristic pattern of balding, most common type of alopecia

↑ incidence with age
age of onset may be as early as puberty in males, and usually postmenopausal in women

↑ androgen insensitivity of hair follicles is genetically predisposed to

182
Q

Male pattern baldness

A

bitemporal M pattern of hairless (receding hair line) & loss of crown hair
affectes 1/2 men >50y/o
negative hair pull test (i.e. not pulling out multiple hairs)

treatment = mostly nothing, minoxidil, finasteride or hair transplant

183
Q

Female pattern baldness

A

more diffuse hairloss particularly at top of scalp (vertex), more diffuse shining of hair on entire scalp
usually in post menopausal women

treatment = reassurance, minoxidil, spironolacton or finasteride

184
Q

Telogen effluvium

A

when physiological/hormonal stress triggers many hairs to move into telogen phase (sheding), as new hairs appear in anagen phase the telogen hairs are pushed out ~4-12 weeks post insult

may be caused by physiological stress, childbirth, crash dieting, anorexia, chronic illness etc

presents as ↓ hair density >50%, does not progress to baldness

hair pull test = >50% of the hairs in telogen phase

managed by reassurance & treating underlying condition

185
Q

Anagen effluvium

A

hair production arrested in anagen phase e.g. secondary to chemo therapy, immunotherapy or radiotherapy casing rapid hair loss

hair grows back within months of stopping offending treatment

186
Q

Alopecia areata

A

autoimmune disease that’s causes inflammation of hair follicles leading to non-scarring alopecia of scalp & body hair, usually seen ages 15-29

presents as well defined patches of non scarring alopecia, with small, broken, ‘exclamation mark”’ hairs around outside
usually abrupt onset with circular patterns of hair loss
NB may have nail involvement e.g. pitting/onycholysis)

management is generally reassurance (~90% of pts eventually have regrowth)
may consider topical corticosteroids if severe

187
Q

Trichotillomania

A

hair pulling disorder, usually a behavioural disorder linked to OCD, often starting in adolescence

presents as asymmetrical hair loss with unusual shape, broke hairs across bald patch & minimal inflammation

psychotherapy & CBT = management

188
Q

Scarring alopecia

A

discoid lupus erythematous:
itch, scale & hair loss, usually in women aged 30-50

lichen planopilaris (lichen planus affecting scalp):
perifollicular redness & minimal scale, pruritus + hair loss often seen in postmenopausal women

acquired scarring alopecia:
e.g. from burns, chemical burns or viral disease

folliculitis decalvans:
inflammation of hair follicle characterised by redness, swelling & pustules around hair follicles, triggered by staph aureus

tinea capitis:
often seen in children, round pruritic scaly plaques with broken hair shaft & alopecia

189
Q

Hirsutism

A

androgen dependant hair growth in women, i.e. excessive growth of thick hair to an androgen dependant pattern in women where hair growth is normally minimal

190
Q

Causes of hirsutism

A 
PCOS (most common)
idiopathic (often familial)
Cushings 
congenital adrenal hyperplasia
androgen therapy
obesity 
adrenal tumour
drugs e.g. phenytoin, corticosteroids, danazol, valproate
191
Q

Presentation of hirsutism

A

excessive terminal hair growth in masculine pattern i.e. moustache / beard /chest / areola / line alba / buttocks

signs if hyperandrogenism (acne, alopecia, truncal obesity, clitoromegaly, deepening of voice)

192
Q

investigations for hirsutism

A

assessed using Ferriman-gallway scoring system (9 body areas assigned score of 0-4)

testosterone level* 
free androgen index
FSH/LH
24h urine cortisol
prolactin
pregnancy test
TFTs
HbA1c
lipid profile
CT/MRI (if tumour suspected)
193
Q

Actinic keratosis / solar keratosis

A

common premalignant skin lesion that develop as a consequence of chronic sun exposure and may develop into squamous cell carcinoma (SCC) of the skin

usually seen in fair skinned people, uncommon in <45y/o

194
Q

Risk factors for solar / actinic keratosis

A 
pale skin
↑ age
male sex
chronic sun exposure
lifestyle / ↑ time spent outdoors 
being closer to equator
195
Q

Presentation of solar / actinic keratosis

A

small papule/plaque with rough, sand paper like texture, which may grow & become erythematous & scaly

usually on sun exposed parts of body e.g. face, ears, scalp, forearms, back of hands

other features of solar damaged e.e.g telangiectasia, elastosis, pigmented lentigo

196
Q

Investigations for solar / actinic keratosis

A

dermoscopy (strawberry pattern)

skin biopsy (if features with high risk of malignant change)

197
Q

Management of solar / actinic keratosis

A

sun avoidance & use of sunscreen
fluorouracil cream (for single/small lesions)
topical diclofenac
cryotherapy, curettage & cautery

198
Q

Squamous cell carcinoma (SCC) of the skin

A

cutaneous SCC is the proliferation of atypical, transformed keratinocytes in the skin with malignant behaviour

2nd most common skin cancer after BCC

199
Q

Epidemiology of cutaneous SCC

A

2nd most common skin cancer after BCC
more common in caucasian
more common in men
↑ incidence with age

200
Q

Risk factors for cutaneous SCC

A 
chronic exposure to UV radiation
fair skin
blonde hair 
outdoor occupations 
use of tanning beds
immunodeficiency 
actinic keratosis
Bowen's disease (SCC in situ)
HPV
closeness to equator
smoking (for SCC on lip)
201
Q

Bowen’s disease

A

SCC in situ, usually seen as erythematous scaling plaques on sun exposed skin

pathological = full thickness atypic of dermal keratinocytes

202
Q

Presentation of cutaneous SCC

A

presents as indurated nodular keratinise or crusted over tumour that eventually ulcerates
painless non healing ulcer, which may bleed
ulcer is indurated with hard raised edges
slow growth (but faster than BCC)

most common on face/neck/hands

203
Q

Investigations for cutaneous SCC

A

skin biopsy (full thickness keratinocyte atypia) usually excisions skin biopsy done i.e. tumour removal

CT/MRI for metastasis (if advanced)

204
Q

Mangement of cutaneous SCC

A

complete surgical excision + histopatholigcal examination e.g. via cryotherapy or surgical excision

radiotherapy if surgery not possible

205
Q

Metastatic risk of cutaneous SCC

A

locally invasive cancer

generally low metastatic potential but ↑ risk if on earl/lip/scalp or if immunocompromised

206
Q

Basal cell carcinoma (BCC)

A

slow growing, locally invasive malignant epidermal skin tumour, predominantly effects caucasians

most common type of skin cancer

207
Q

Risk factors for Basal cell carcinoma (BCC)

A 
↑ UV exposure 
↑ age
male sex
fair skin
previous BCC
immunosuppression 
basal cell naevus
albinism
208
Q

Presentation of Basal cell carcinoma (BCC)

A

small very slow growing, painless non healing ulcer with central depression & rolled non tender borders (rodent ulcers), i.e. have central crater with pearly, rolled borders
usually in sun exposed areas e.g. head/neck (80% of cases)

209
Q

Investigations for Basal cell carcinoma (BCC)

A 
skin biopsy (palisading nuclei)
CT/MRI (if metastases suspected)
210
Q

Mangement of Basal cell carcinoma (BCC)

A

surgical excision with safety margin
cryotherapy, curretage
radiotherapy (if incomplete excision or large tumours)

211
Q

Melanoma

A

highly malignant tumour arising from melanocytes, more common in females, with 1/3 pts having premalignant lesions e.g. atypical naevi

much less common than BCC & SCC

212
Q

Risk factors for melanoma

A 
Moles (strongest risk factor for cancer)
UV exposure 
light skin
immunosuppression 
genetics (BRAF gene or CDKN2A gene)
Family history 
solar keratosis
213
Q

Superficial spreading melanoma

A

most common type (70% of cases)
on arms/legs/chest/back
flat irregular tumour with variable pigmentation

214
Q

nodular melanoma

A 
2nd most common type of melanoma 
sun exposed areas in middle age 
reddish-brown/black, smooth nodule
verrous surface / ulceration with bleeding
most aggressive form of melanoma
215
Q

lentigo maligna

A

melanoma in-situ

sun exposed area on older people
large & irregular shaped patch
irregular pigmentation

216
Q

Acral lentiginous

A

rare
more common in dark skinned population
irregular shaped brown-black pigmentation + Hutchinson sign (subungal pigmentation)
may be below nail (subungal) which is more aggressive

217
Q

Presentation of melanoma

A

generally a persistently pruritic bleeding skin lesion similar to a mole

exhibits ugly duckling sign (i.e. a mole that is no in keeping with the other moles the pt has)

change in size, colour, shape, irregular border, indistinct margins

218
Q

subungal melanoma

A

tends to be more aggressive
usually hyperpigmentation below nail
may metastasis to lymph nodes, liver, lung, brain, bone

219
Q

Investigations for melanoma

A 
7 point checklist 
ABDCE assessment (asymmetry, border irregular, colour irregular diameter >7mm, evolving)
220
Q

Assessment of pigmented skin lesions

A

7 point checklist (change in size, change in colour, change in shape, diameter >7mm, inflammation, oozing / bleeding, altered sensation)

ABDCE assessment (asymmetry, border irregular, colour irregular diameter >7mm, evolving)

221
Q

7 point check list (Glasgow 7 point score) for melanoma

A
  1. Change in size
  2. change in colour
  3. change in shape
  4. diameter >7mm
  5. inflammation
  6. oozing / bleeding
  7. altered sensation
222
Q

7 point check list (Glasgow 7 point score) for melanoma

A
  1. change in size
  2. change in colour
  3. change in shape
  4. diameter >7mm
  5. inflammation
  6. oozing / bleeding
  7. altered sensation
223
Q

Investigations for melanoma

A

ABCDE assessment / Glasgow 7 point score

complete excisional skin biopsy (abnormal melanocytes proliferation)

staging (USS / CT)

224
Q

Management of melanoma

A

excision with narrow margin followed by a wider margin local excision after Breslow index staging

lymph node resection

adjuvant radiotherapy

225
Q

Breslow index

A

Breslow thickness: is the measurement of the depth of the melanoma from the surface of your skin down through to the deepest point of the tumour.

prognostic & staging index for melanoma

226
Q

Granuloma annulare

A

associated with diabetes & hyperlipidaemia

papular lesions that are often centrally depressed & slightly hyper pigmented, which may coalesce to forms rings / arcs
usually on back of hands/ankles/knees/elbows

no treatment needed

227
Q

Acanthosis nigricans

A

associated with diabetes / insulin resistance, obesity, acromegaly, PCOS, GI cancers

symmetric hypertrophic papillomatous velvety hyper pigmented plaques
found on neck/axillae/groin

228
Q

Necrobiosis lipoidica

A

inflammatory granulomatous skin conditions associated with diabetes & glucose tolerance problems

very painful, rapidly progressing red papules that progress to deep red necrotic ulcers

on extensor surfaces of lower limbs

229
Q

Splinter haemorrhage

A

associated with endocarditis

red/brown linear haemorrhage lying parallel to long axis of nail

230
Q

Janeway lesions

A

associated with infective endocarditis

small non tender erythematous macules on palms & soles

microabscess & haemorrhage caused by septic emboli

231
Q

Osler nodes

A

associated with endocarditis

painful nodules on pads of fingers & toes

due to immune complex deposition

232
Q

Spider naevi / spider angiomas

A

associated with liver disease, pregnancy, COCP

central red papules with surrounding capillaries (blanches on pressing, refill from centre) usually found on upper body

NB telangiectasia fill from edge after blanching

233
Q

Xanthelasma

A

associated with hyperlipidaemia

typically bilateral yellow, flat plaques found around eyes & upper eyelids or on palmar surfaces of hands

234
Q

Staphylococcal scalded skin syndrome (SSSS)

A

potentially serious acute skin condition caused by the exfoliative toxins of staph aureus, toxins are serine proteases that break down the epidermal cell adhesion molecule desmoglein 1

typically seen in neonates & children <5yrs

235
Q

Presentation of staphylococcal scalded skin syndrome (SSSS)

A

usually preceded by mucocutaneous staphylococcal infection e.g. pharyngitis

starts as fever, mails, irritability, skin tenderness
then extremely tender, flaccid bullae (large superficial blisters) which easily rupture with red skin underneath that have scalded appearance
widespread sloughing of epidermal skin

Nikolsky sign positive (gentle shearing force on intact skin causes upper epidermis separate)

NB: no mucous involvement unlike in TEN / SJS

236
Q

Management of staphylococcal scalded skin syndrome (SSSS)

A

Abx (flucloxacillin 1st line)

hospitalisation & isolation of pt
analgesia (paracetamol)
supportive care (fluids, electrolytes, nutrition)
physio (as flexors often affected which may restrict movement)

237
Q

Palmoplantar pustulosis (PPP)

A

crops of sterile pustules on hands & feet associated with thickened scaly skin that easily develops cracks & fissures

managed with plenty of thick emollients, salicylic acid ointment & urea cream

238
Q

Melasma

A

common acquired skin condition presentation as bilateral brownish facial pigmentation, more common in women

managed is year long sun protection

239
Q

Hyperhydrosis

A

excessive sweat production, can be generalised or focal e.g. palms of hands / axillae / soles
may present as bilateral, symmetrical abnormal amounts of sweating, sweating while sleeping, lasting > 6months

management is topical aluminium chloride (1st line), botulinum toxin, surgery

240
Q

Steroid induced skin atrophy

A

thinning of skin due to prolonged steroid exposure usually in its with psoriasis taking steroids for >1year
also presents as easy bruising, telangiectasia, purpurs & striae

treated by stopping steroids

241
Q

Macule

A

flat, distinct, coloured area of skin <1cm in diameter
does no include changes in skin texture/thickness
cannot be felt when running finger over it

e.g. freckles, moles, malignant melanoma

242
Q

Patch

A

a macule > 1cm in diameter i.e. flat, distinct, coloured area of skin >1cm in diameter, no change in skin texture / thickness

e.g. cafe au lait spots in neurofibromatosis

243
Q

Papule

A

a solid raised lesion that has distinct borders, <1cm in diameter
may have a variety of shapes & profiles (domed, flat topped) & may be associated with secondary features such as scales and crusts

e.g. acne vulgaris

244
Q

Nodule

A

a raised solid lesion >1cm in diameter

e.g. warts, sebaceous cysts, lipomas

245
Q

Plaque

A

a solid, raised, flat topped lesion >1cm in diameter

e.g. psoriasis

246
Q

Vesicle

A

raised lesion <1cm in diameter filled with clear fluid

e.g. chickenpox

247
Q

Bullae

A

circumscribed fluid filled lesions >1cm in diameter

e.g. epidermolysis bullosa

248
Q

Wheal

A

area of oedema of the upper epidermis

e.g. during allergic reaction

249
Q

Pustule

A

cricumscribed elevated lesions that contain pus, most commonly infected e.g. in folliculitis but may also be sterile e.g. pustular psoriasis

e.g. acne vulgaris, pustular psoriasis

250
Q

Burrows

A

linear lesions produced by infestation of skin & formation of tunnels

e.g. scabies, cutaneous larva migrant

251
Q

Lichenification

A

thickening of epidermis seen with exaggerated skin lines usually due to chronic rubbing & itching

252
Q

Excortications

A

traumatised / abraded skin caused by acute scratching / itching

253
Q

Scars

A

permanent fibrous changes of skin following damage to the dermis

254
Q

Purpura

A

blood that has leaked from dermal blood vessels so cannot be blanched by pressure

e.g. Henoch-Schonlein purpura, Meningococcal septicaemia

255
Q

Petechiae

A

pin points sports of purport / vasculitis / thrombocytopenia / leukaemia

256
Q

Pyoderma gangrenosum

A

typically on the lower limbs, initially small red papule, later deep, red, necrotic ulcers with a violaceous border
may be accompanied systemic symptoms e.g. fever

associated with IBD, SLE,

oral steroids as first-line treatment

257
Q

Herpes zoster opthalmicus

A

reactivation of the varicella-zoster virus in the area supplied by the ophthalmic division of the trigeminal nerve (V1). It accounts for around 10% of case of shingles

Presents as vesicular rash around eye, may have Hutchinson’s sign (rash on tip/side of nose indicates nasociliary involvement) may involved eye

oral antiviral treatment for 7-10 days (ideally started within 72h of rash onset)

258
Q

Vitiligo

A

autoimmune condition which results in the loss of melanocytes and consequent patchy depigmentation of the skin.

usually presents before age 30

259
Q

Vitiligo associated disease

A 
type 1 diabetes mellitus
Addison's disease
autoimmune thyroid disorders
pernicious anaemia
alopecia areata
260
Q

Vitiligo presentation

A

well-demarcated patches of depigmented skin, more common on peripheries
usually no other symptoms i.e. no pain/pruritus
Koebener phenomenon (i.e. new lesions at site if injury)

261
Q

Vitiligo management

A

sunblock for affected areas of skin
camouflage make-up
topical corticosteroids
topical tacrolimus and phototherapy,

Year 4 (12 decks)

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