Dermatology Flashcards
What is pomphoylx?
Type of eczema affecting hands and feet
What exacerbates pomphoylx?
Humidity and high temperatures
Features of pompholyx
Small blisters on palms and soles
Pruritic
Management of pompholyx
Cool compress, emollients, topical steroids
What exacerbates psoriasis (4)?
Trauma,
Alcohol,
Drugs (beta blockers, lithium, antimalarials, NSAIDs and ACEi)
Withdrawal of systemic steroids
What is seborrhoeic dermatitis?
Chronic dermatitis caused by a fungal infection
Features of seborrhoeic dermatitis
Eczematous lesions on sebum rich areas
Otitis externa and blepharitis
Associations of seborrhoeic dermatitis
HIV
Parkinson’s
Management of seborrhoeic dermatitis (scalp)
OTC zinc pyrithione
Ketoconazole
Topical steroids
Management of seborrhoeic dermatitis (face and body)
Topical antifungals
Topical steroids
SCC: RF (6)
Excessive UV exposure Actinic keratoses and Bowen's Immunosuppression Smoking Chronic ulcers
SCC: Management (<20mm)
Surgical excision with 4mm margin
SCC: Management (>20mm)
Surgical excision with 6mm margin
SCC: management (high risk)
Mohs micrographic surgery
What is bullous pemphigoid?
Autoimmune condition causing sub-epidermal blistering of skin
Antibodies in bullous pemphigoid
Hemidesmosomal proteins
Bullous pemphogoid: features
Itchy tense blisters around flexures
Heal without scarring
No mucosal involvement
Bullous pemphogoid: biopsy
IgG and C3 at dermoepidermal junction
Bullous pemphogoid: Management
Oral corticosteroids
Defect in uroprophyyrinogen decarboxylase causes what?
porphyria cutanea tarda
Features of porphyria cutanea tarda
Photosensitive rash with blistering and skin fragility
Hypertrichosis
Hyperpigementation
porphyria cutanea tarda: investigations
Urine: uroporphyrinogen and pink fluorescence under Wood’s lamp
porphyria cutanea tarda: management
Chloroquine
Venesection
What is hereditary haemorrhagic telangiectasia?
AD condition with multiple telangiectasia over skin and mucous membranes
Diagnostic criteria for hereditary haemorrhagic telangiectasia
- epistaxis
- telangiectases
- visceral lesions (GI, pulmonary, hepatic, cerebral, spinal AVM)
- FH
Pyoderma gangrenosum: features
Lower limbs
Small red papule initially
Later deep, red, necrotic ulcers with violaceous border
Pyoderma gangrenosum: causes
LIMPS Lymphomas Idiopathic, IBD Myeloproliferative disorders, Monocloncal gammopathy PBC SLE, RA
Pyoderma gangrenosum: management
PO steroids
What is erythema nodosum?
Tender, erythematous nodular lesions over shins
Causes of erythema nodosum
NODOSUM NO cause Drugs (penicillins, sulphonamides, COCP) OCP UC, Crohn's Behcets Micro (strep, TB)
Pretibial Myxodema
Symmetrical, erythematous lesions seen in Grave’s
Shiny, orange peel skin
Necrobiosis lipoidica diabeticorum
Shiny painless yellow/red skin typically in diabetics
SCC: features
Pearly, flesh coloured papule with telangeictasia
SCC: management
Removal, curettage, cryotherapy, topical creams, radiotherapy
What is systemic mastocytosis?
Results from neoplastic proliferation of mast cells
Features of systemic mastocytosis
Urticaria pigementosa (wheal on rubbing)
Flushing
Abdo pain
Monocytosis
systemic mastocytosis diagnosis
raised serum tryptase levels
Urinary histamine
Keloid scars: RF
- dark skin
- young adults
Keloid scars: Mx
- Intra-lesional steroids
- Excision
Causes of hypertrichosis
- Drugs (minoxidil, ciclosporin, diazoxide)
- Congenital
- Porphyria cutaena tarda
- Anorexia nervosa
Vitiligo: associations
T1DM, addison’s, autoimmune thyroid, pernicious anaemia, alopecia areta
Keratoacanthoma: features
Smooth dome shaped papule
Grows to become a crater filled with keratin
Keratoacanthoma: management
Although benign should be urgent excised as hard to exclude SCC
Lichen planus: features
Itchy papular rash on palms, coles, genitalia and flexor surfaces
White lace pattern on buccal mucosa
Causes of lichenoid drug eruptions
gold, quinine, thiazides
Lichen planus: management
Topical steroids
Acanthosis nigricans: features
Symmetrical, brown velvety plaques on neck, axilla and groin
Acanthosis nigricans: causes
T2DM, GI cancer, obesity, PCOS, acromegaly, Cushing’s, hypothyroid, familial, Prader-Willi, COCP, nicotinic acid
Toxic Epidermal Necrolysis: features
Scaled appearance
Systemic upset
Epidermis separates with lateral pressure
Toxic Epidermal Necrolysis: drugs (6)
Phenytoin Sulphonamides Allopurinol Penicillins Carbabamazepine NSAIDs
Actinic Keratoses: features
Small, crusty, scaley lesions
On sun exposed areas
Pityriasis rosea: features
Herald patch on trunk
Erythematous, oval scaly patches
Rosacea: management
- topical metronidazole or topical brimonidine
2. PO antibiotics
Pityriasis versicolor: features
Trunkal
Hypopigmented patches with scale and prutius
Pityriasis versicolor: management
Topical antifingal
Ketoconazole shampoo
Impetigo: MRSA
Topical mupirocin
Guattae psoriasis: features
Strep infection
Tear drop papules on trunk and limbs
Guttase psoriasis: Mx
Self resolves
Topical agents
UVB phototherapy
Cancer associations: acanthosis nigricans
gastric cancer
Cancer associations: acquired ichthyosis
lymphoma
Cancer associations: acquired hypertrichosis lanuginosa
GI and lung cancer
Cancer associations: deramtomyositis
ovarian and lung cancer
Cancer associations: erythema gyratum repens
lung cancer
Cancer associations: erythroderma
lymphoma
Cancer associations: migratory thrombophlebitis
pancreatic cancer
Cancer associations: necrolytic migratory erythema
glucagonoma
Cancer associations: pyoderma gangrenosum
myeloproliferative disorders
Cancer associations: Sweet’s syndrome
haematological malignancies
Cancer associations: tylosis
oesophageal cancer
Most common melanoma
Superficial spreading
Superficial melanoma: typically affects…
arms, legs, back and chest
young people
nodular melanoma: typically affects…
sun exposed skin
middle aged
nodular melanoma: appearance
red or black lump
bleeding or oozing
lentigo melanoma: typically affects…
chronically sun exposed skin
older people
acral lentiginous: typically affects…
nails, palms. soles
Dark skin
acral lentiginous: appearance
subungunal pigmentation
SJS: causes (6)
Penicillin Sulphonamides Lamotrigine, carbamazepine, phenytoin Allopurinol NSAIDS COCP
Psoriasis management
- topical corticosteroid
- vitamin D analogue
- coal tar
- phototherapy
Scabies: Mx
Permethrin 5%
Malthion 0.5%
How long can scabies pruritus last for
6 weeks
Retinoids: SE (8)
Teratogenic Dry skin Low mood Raised triglycerides Hair thinning Nose bleeds Intracranial HTN Photosensitivity
Scarring alopecia: causes (5)
Trauma Radiotherapy Lichen planus Discoid lupus Tinea capitis
Non-scarring alopecia: causes
Male pattern baldness Drugs (cytotoxins, carbimazole, heparin, COCP, clochine) Iron and zinc deficiency Alopecia areta Stress Trichotillomania
Koebner phenomenon is seen in…
Psoriasis Vitiligo Warts Lichen planus Lichen sclerosus Molluscum contagiosum
Erythema ab igne increases risk of
SCC
Dermatitis herpetiformis: description
Itchy vesicular lesions on extensor surfaces
Dermatitis herpetiformis: biopsy
Deposition of IgA in granular pattern in upper dermis
Dermatitis herpetiformis: Mx
Gluten free diet
Dapsone
Erythema multiforme: features
Target lesions
Upper > lower limbs
Erythema nodosum: features
Tender, erythematous nodular lesions
Shins
Diagnosis of nickel dermatitis..
skin patch test
No mucosal blisters
Bullous pemphigoid
Mucosal blisters
Pemiphigus vulgaris
Polymoprhic eruption is blisters has…
no blisters
Acne in pregnancy
Erythromycin is safe
Dermatitis herpetiformis: biopsy
IgA deposition
Monomorphic, punched out erosins
Eczema herpeticum
Pityriasis rosea: cause
HHV7
Pityriasis versicolour: cause
Malassezia
Pemphigus vulagaris: antibodies
Against demoglin 3
Atopic eruption in pregnancy: features
Eczematous itchy rash
No Mx
Polymorphic eruption of pregnancy: features
Pruritic condition in last trimester
Erythasma: features
Asymptomatic flat scaly lesion in groin or axilla
Granuloma annulare: features
Papular lesions, slightly hyperpigmented and centrally depressed
Typically on dorsum of hands and feet
Pretibial Myxodema: features
Shiny orange peel skin
Seen in Grave’s
Necrobiosis lipoidica diabeticorum: features
Shiny, pain less areas of yellow/red skin on shin of diabetics