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Year 3 - primary care + medicine > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is eczema?

A

Chronic atopic condition which causes inflammation of the skin. This causes dry, red, itchy patches of skin, commonly over the flexor surfaces.

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2
Q

How does eczema commonly present?

A

Patches of dry, red, itchy, sore skin over the flexor surfaces (e.g. I sided of elbows). There is often periods of remission with flare ups

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3
Q

What can trigger eczema flare ups?

A 
Stress
Atopy - pollen
Certain clothing - synthetic 
Certain foods
Fragrances - particularly in soaps
Hormones
Heat and sweating
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4
Q

How can eczema be managed?

A 
Avoid scratching and scrubbing skin.
Avoid triggers if possible - e.g. certain cleaning products.
Use emollients - act as a skin barrier - e.g. E45, Diprobase. Can be creams or ointments
Steroid creams (only for a short period of time in a flare up) - e.g. hydrocortisone or betamethasone (betnovate)
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5
Q

What is the stepladder of steroid creams for eczema?

A

Hydrocortisone
Betnovate (betamethasone)
Eumovate (clobetasone butyrate)
Dermovate (clobetasol proprionate)

http://gmmmg.nhs.uk/docs/guidance/GM-Steroid-Ladder.pdf

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6
Q

What lifestyle advice can be given to someone with eczema?

A 
Don’t use soap on body.
Moisture regularly
Don’t itch and scratch
Leave time in between applying steroid and emollient to let it sink into the skin.
Try to wear cotton / silk clothing
Avoid triggers
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7
Q

How does infected eczema present?

A 
Yellow crusting
Redness and inflammation 
Blistered skin
Increased itchiness
Pain / burning sensation
Not helped by steroid creams

https://www.healthline.com/health/infected-eczema

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8
Q

What organism most commonly causes infected eczema?

A

Staph aureus

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9
Q

What is eczema herpeticum?

A

A viral skin infection caused by the herpes simplex virus or the varicella zoster virus. It usually occurs in a patient with a pre-existing skin condition.

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10
Q

How is infected eczema managed?

A

Steroid - to reduce inflammation

Antibiotics ( topical - such as fusidic acid)

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11
Q

How does eczema herpeticum present?

A

A widespread, painful, vesicular (vesicles containing pus) rash with systemic symptoms such as fever, lethargy, irritability and reduced oral intake. There is also often lymphadenopathy.
Commonly presents in a person with pre-existing eczema.

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12
Q

How is eczema herpeticum managed?

A

Aciclovir - oral but if severe then IV.

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13
Q

What is acne vulgaris?

A

Acne - condition commonly affecting people during puberty that causes red, inflamed and sore spots (differ in the type of lesion’ on the skin.

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14
Q

What is the pathophysiology of acne vulgaris?

A

Chronic inflammation with or without infection in the skin. There is increased production of sebum (commonly stimulated by increased androgens during puberty) in the hair follicles and sebaceous glands. This traps keratin and causes a blockage which leads to swelling and inflammation.

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15
Q

What are macules?

A

Flat, discoloured mark on the skin that is less than 1cm.

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16
Q

What are papules?

A

Small raised area of skin that is less than 1cm

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17
Q

What are pustules?

A

Small raised lumps that contain white/yellow pus (whiteheads)

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18
Q

What are comedomes?

A

Skin coloured papules that are due to blocked pilosebaceous glands.

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19
Q

What are blackheads?

A

Open comedones with black pigmentation in the centre

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20
Q

What are ice pick scars?

A

Small indentations in the skin that remain after acne lesions heal

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21
Q

What are hypertrophic scars?

A

Small lumps in the skin that remain after acne lesions heal

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22
Q

How can acne vulgaris be managed?

A
  • Topical benzoyl peroxide - antiflammatory that helps unblock the skin and toxic to cutibacterium acnes
  • Topical retinoids - slows production of sebum (teratogenic)
  • Topical antibiotics - e.g. clindamycin
  • Oral antibiotics - e.g. lymecycline
  • combined oral contraceptive pill - stabilises female hormone (not progesterone only)
  • Oral retinoids - e.g. isotretinoin - last line option if severe. Highly teratogenic.
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23
Q

What are some side effects of oral isotretinoin (retinoids)?

A

Dry skin and lips
Photosensitivity of the skin
Depression, anxiety, aggression and suicidal ideation
Rarely - Stevens Johnsons syndrome
Not appropriate in pregnancy - must be on appropriate contraceptives

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24
Q

What is psoriasis?

A

A chronic autoimmune condition that causes a dry, flaky, scaly that appear raised, rough and slightly red. It affects the extensor surfaces such as the elbows and knees. This is due to a rapid generation of new skin cells which build up and thicken the skin.

25
Q

What are the types of psoriasis?

A

Plaque psoriasis
Guttate psoriasis
Pustular psoriasis
Erythrodermic psoriasis

26
Q

Describe plaque psoriasis

A

Thickened erythematous plaques with silver scales on extensor surfaces. Plaques are 1-10cm in diameter. This is normally in adults.

27
Q

Describe guttate psoriasis

A

Commonly occurs in children. Lots of small raised papules across the trunks and limbs - these are slightly erythematous and scaly. Over time the papules can turn into plaques. Often resolves in 3-4 months.

28
Q

What commonly triggers guttate psoriasis?

A

Often triggered by a streptococcal throat infection, stress or medications.

29
Q

Describe pustular psoriasis

A

Rare severe form - pustules form under erythematous skin. The pus is non- infectious. Patient can be systemically unwell and is often an emergency that requires hospital admission.

30
Q

Describe erythrodermic psoriasis

A

Rare severe form - extensive erythematous inflamed areas covering most surfaces of the skin. The skin comes away in large patches (exfoliation) resulting in raw, exposed areas. Treat as an emergency and requires admission.

31
Q

How can psoriasis be managed?

A

Emollients
Topical steroids with topical vit D (calcipotriol)
Topical dithranol
Topical calcineurin inhibitors (usually only in adults)
Phototherapy (particularly in guttate psoriasis)
In extreme cases there may be systemic treatments (e.g. in psoriatic arthritis- methotexate)
oral tablets - biologics, steroids etc. - done by secondary care

32
Q

What is nail psoriasis?

A

Nail dystrophy resulting in

  • putting
  • thickening
  • discolouration
  • ridging
  • onycholysis (separation of the nail from the nail bed)
33
Q

What conditions are associated with psoriasis?

A

Nail psoriasis
Psoriatic arthritis
Psychosocial implications

34
Q

What six viral diseases cause an exanthem (eruptive widespread rash)?

A 
Measles
Scarlet fever
Rubella
Dukes' disease
Parovirus B19
Roseola infantum
35
Q

What is an exanthem?

A

A eruptive widespread rash

36
Q

How does measles present?

A 
Typically affects children.
Symptoms 10-12 days after exposure
- Fever
- Conjunctivitis
- Koplik spots (spots inside the cheeks)
- rash - widespread erythematous, macular rash with flat lesions
37
Q

What are Koplik spots and what disease do they normally occur in?

A

Small white spots on the buccal mucosa (inside the cheeks) that are often surrounded by redness.
They only occur in measles.

38
Q

Describe the rash that occurs in measles.

A

Widespread erythematous, macular rash with flat lesions. It often starts on the face (particularly behind the ears) before spreading to the rest of the body

39
Q

How is measles managed?

A

Self limiting after 7-10 days of symptoms.
Isolate until symptoms resolve.
Notifiable disease so report to public health

40
Q

What are some complications of measles?

A 
Pneumonia
Diarrhoea
Dehydration
Meningitis
Encephalitis
Hearing loss
Vision loss
Death
41
Q

What is scarlet fever?

A

A condition caused by an exotoxin produced by streptococcus pyogens (commonly from tonsillitis). It is characterised by a widespread rash.

42
Q

How does scarlet fever present?

A

Mainly in children.

  • rash - red/pink, blotchy, macular rash with a rough ‘sandpaper’ like texture.
  • red flushed cheeks
  • fever
  • lethargy
  • sore throat
  • strawberry tongue
  • cervical lymphadenopathy
43
Q

How is scarlet fever managed?

A

Antibiotics - phenoxymethylpenicillin for 10 days

Notifiable disease so report to public health

44
Q

What organism commonly causes scarlet fever?

A

Group A streptococcus

45
Q

What is rubella?

A

A viral infection that is highly contagious and spread via resp droplets. Symptoms start 2 wks after exposure and presents with a erythematous macular rash (milder than in measles).

46
Q

How does rubella present?

A

Mainly in children.

  • Erythematous macular rash - starts on face then spreads to the rest of body. Normally lasts approx 3 days.
  • mild fever
  • joint pain
  • sore throat
  • lymphadenopathy
47
Q

What are the main difference between measles and rubella?

A
  • Measles is much more infections
  • Measles is more severe and life threatening, however rubella needs extra caution in pregnancy.
  • Measles virus specifically affects the respiratory tract.
48
Q

What is the management for rubella?

A

Self limiting.
Notifiable disease.
Children should stay off school while rash present.
Avoid pregnant women.

49
Q

When is rubella particularly dangerous?

A

In pregnancy as can lead to congenital rubella syndrome

50
Q

What is congenital rubella syndrome?

A 
A triad of
- deafness
- blindness
- congenital heart disease
It can also cause other complications
51
Q

What does the MMR vaccine protect against?

A

Measles
Mumps
Rubella

52
Q

How does parvovirus B19 present?

A

Normally in children.
Starts with non specific viral symptoms - fever, lethargy, muscle aches etc.
2-5 days rash develops - diffuse bright red on both cheeks.
A few days later a reticular mildly erythematous rash appears on the trunk and limbs

53
Q

What is parvovirus B19 also known as?

A

Slapped cheek syndrome

Fifth disease

54
Q

How is parvovirus B19 managed?

A

Self limiting

Fluids and analgesia.

55
Q

What are some possible complications of parvovirus b19?

A
  • aplastic anaemia
  • meningitis or encephalitis
  • pregnancy complications
  • rarely hepatitis, myocarditis or nephritis
56
Q

What does a ‘reticular’ rash mean?

A

a rash that is in a net / lace like pattern

56
Q

What is aplastic anaemia?

A

A condition where the body (bone marrow and stem cells) stop producing enough new RBCs

58
Q

What is roseola infantum and how does it present?

A

A viral infection caused by human herpesvirus 6 or 7.
Presents with high fever, mild non itchy rash, sore throat, swollen lymph nodes. it is common in children and resolves itself.

Year 3 - primary care + medicine (20 decks)

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