Dermatology Flashcards
1
Q
Functions of the skin
A
- Barrier to infection
- Thermoregulation
- Protection against trauma
- Protection against UV (melanin from tyrosine)
- Vit D synthesis
- Regulate H2O loss
2
Q
What is the epidermis
A
Outermost layer of the 3 layers of the skin
3
Q
What are langerhans cells of the skin
A
- present in the epidermis and dermis
- antigen presenting cells- travel to lymph nodes
4
Q
what are merkel cells
A
- mechanoreceptor and tactile sensation
- make contact with specilised nerve ending
- found in basal layer of epidermis
- merkel tumour is fatal
5
Q
what are the deepest layers of the skin
A
dermis , then hypodermis deeper (ie SC)
6
Q
What are the layers of the skin
A
Epidermis
Basement membrane
Dermis
Hypodermis
7
Q
Where is Type 1 collagen found
A
Skin tendons vasculature organs bone
8
Q
Where is Type 2 collagen found
A
Cartilage
9
Q
Where is Type 3 collagen found
A
Reticular layer of the dermis- commonly found alongside type 1
10
Q
What are eccrine glands
A
sweat glands
help regulate body temp
11
Q
What are Apocrine glands
A
- accompany hair follicles
aporine secretion
12
Q
what are sebaceous glands
A
degradation of cells causes secretions which lubricate and waterproof hairs
13
Q
what are meissener’s corpuscles
A
found in papillary dermis, detect light touch
14
Q
what are pacinian corpuscles
A
foudn in wt bearing areas in deep dermis and SC
deep pressure and vibration detection
15
Q
What are cavernous haemangiomas/strawberry marks
A
- Benign
- present in first few days of life
- raised
- resolves around ~1 year, +- scarring
16
Q
Management of cavernous haemangiomas
A
- generally resolved around 18m of age
- may leave scarring
- if near mouth, nose, eye (impairing eating, nasal breathing, vision), betablockers can stop their growth
17
Q
What is a complication of a massive cavernus hemangioma
A
Kasabach-merrit syndrome:
- decreased platelet count- thrombocytopenia
- DIC
18
Q
What is a port wine stain
A
nevus flammeus
- benign
- present at birth
- flat
- stays for life
19
Q
When may a port wine stain not be benign
A
when over the eye
do CT
-sturge- weber syndrome– abnormal vasculautre in the brain ft eye abnormalities eg glaucoma
20
Q
What is a nevus
A
mole
- small dark spot
- san damage can cause them to become malignant
- more in Tunernes syndrome
21
Q
What is a mongolian blue spot
A
- looks like bruising
- often around bakc or buttocks
- innolculus
- stay ofr life
- more prevalent in dark-skinned populations
- may be mistaken for NAI
22
Q
What are cafe au lait
A
- brown, flat patches
- on most people
- if >5 of them and wid ein diamtere- may be sign of neurofibromatosis
23
Q
What is erythema toxicum neonatum
A
- angry looking, red spots surrounded by red area
- normal
- if child is unwell (off feet, not settling)– make sure of diagnosis and rule out staph infection
24
Q
What is the mechnism of an abscess
A
bacterial infection on minor wound, hair follicle, blocked oil/sweat gland
most commonly S.areus
sometimes parasites in developing countries
25
Management of an abscess
- inscision and drainage
| - abx
26
what would you treat an abscess of the belly button with
co-amox
is in confined area so may be caused by an anaerobe or an aerobe
27
What are the types of cysts
- sebaceous- rare, sebum filled
- pilar- around hair follicles, often on scalp, run in families, middle aged adults
- epidermoid- face, neck, chest, shoulder, genitals. young.middle aged adults. PMHX- acne
28
tx of skin cyst
- do not burst
- warm compress
- excision
- Abx- fluclox
29
What are boils
- deep folliculitis
- staph areus
- looks like big, spots, filled with exudate
30
What are carbuncles
- colleciton/cluster of boils
- red, filled with purulent exudate
- Staph areus, Strep pyogens
- contagious
- most common on back and neck
- may be itchy and painful
- +- systemic sx- feever, chills
31
presentation of contact dermatitis
- infammation
- blistering
- dry
- thickened- red/dark brown
- cracked
- sore, stinging, itchy
- normlly on hands/face
32
management of contact dermatitis
- avoid irritant or allergen
- emollient
- topical steroid- hydrocortisone, beclamethason
- oral steroids
* *- phototherapy
- immunosupression
* *- alitretinoin- retinoid
-- if occupational- need to report it to OH department
33
Causes of itchy skin
- xerosis (dry)
- exposure to heat, sun, wind
- eczema, psoriasis, ichthyosis vulgaris
- bacterial
- fungal
- parasites
Non derm causes:
* *- polycythemia
- liver cirrhosis/cholestasis
- CKD
* *- thyroid disease
* *- leukaemia, hodgkins
* *- pregnancy/menopause
- neuropathic
- psychosomatic
34
who is xerosis more common in
elderly
| redcued sebum production, loss of collagen and elastin
35
Management of xerosis in elderly
- inspect regulalry for damage
- emollients regularly
- OTC products containing menthol- creates cold burn sensation that can relieve itching-- eg tiger balm , capsacin
36
What types of ichthyosis vulgaris are there
Genetic (auto dom/xlinked)
- rate at which skin regenerates is affected-
- either shedding is too slow or skin cells reproduce too fast
Acquired
- Kidney disease
- hypothyroidism
* *- sarcoidosis
* *- Hodgkin's
* *- HIV
37
A baby has persistently dry, very thickened rough skin. Her mother states her skin looks 'fish-scaly'. It has gotten worse in the winter. Her father had a similar issue. What is your main diagnosis
Ichthyosis vulgaris
38
What are some causes of pruritis ani
- idiopathic
- psychological
- anorectal dysfunction
- secondary skin conditions- eczema, psoriasis
- infections- S.aureus, **scabies
- anal pathology- fissures, haemorrhoids
- colorectal cancer
* *- drugs- corticosteroids, colchicine
* *- food- spicy, nuts, alcohol
39
Ix for itchy anus
- DRE
| - swab
40
management of pruritis ani
- coping techniques
- diet
- meds- laxatives, abx
- soothing topical preparations containing bismuth subligate, ZnO
- midly potent corticosteroids if inflamed
- sedating antihistamines if nocturnal
41
Causes of pruritis vulvae
- dermatological conditions- eczema psoriasis
- infections, infestations
- neoplasia- lichen sclerosis/VIN/carcinoma
- hormones- atrophic vaginitis
- GI disease and urinary incontinence
42
management of pruritis vulvae
- shower rather than bathe
- clean vulval area once a day with soap substitute (not soap)
- dab dry
- avoid feminine hygiene products
- avoid tight fitting clothes/synthetics
- avoid fabric conditioner and biological wash powder
- avoid spermicide- lubricated condoms
- management underlying cause
- sx- emollient plus mildly anxiolytic antihistammine
- consider 2 w trial of hydrocortisone 1%
- antifungal/antibacterial if co-existing infection
- 2ww if unexplained lump or ulcer
43
What is urticaria
Type 1 hypersensitivity
swelling involving superficial dermis, raising the epidermis
itchy wheals
prostaglandins, leukotrienes, chemotactic factors, mostly-- histamine (skin mast cells)
44
What is angioedema
- Type one hypersensitivity
- deeper swelling than urticaria involving dermis and SC tissue
- tongue, lips
45
What is anaphylaxis, sx
- type 1 hypersensitivity (igE , histamine from mast cells and basophils)
- bronchospasm, facial and laryngeal oedema, wheeze, SOB, hypotension, tachycardia, light-headedness, collapse
46
Management of urticaria
- Avoid trigger
- Antihistammines- cetirizine, fexofenadine, loratadine
- oral pred if severe
47
Tx of angioedema
- corticosteroids (pred)
48
tx of anaphylaxis
IM Adrenaline (1mg/mL, 1:1000)
- <5yrs 150mcg/0.15mL
- 6-11yrs 300mcg/0.3mL
- 12-17yrs 300 or 500mcg depending on size of child and whether they are prepubertal
- >18yrs 500mcg/0.5mL
repeat every 5 mins if needed for all ages
High flow O2
IM/IV Chlorphenamine maleate
IV hydrocortisone
49
A patient complains he has been suffering from the flu in the past few weeks and is worried about his rash. He states red patches that were painful came up on his shins and have now turned into bruises. PMHx- sarcoidosis, TB. What is this rash called, what causes it
Erythema Nodosum
Causes- TB!!, sarcoidosis, IBD, chlamydia, group A beta haemolytic strep
most commonly found on shins
tender nodules--> bruises
50
Management of erythema nodosum
painkillers
| self limiting
51
A man presents with a red rash consisting of small red spots a few cm in size. They looks like targets/bulls-eye, with a dark red centre with a crusty ring around it. They started suddenly on his hands and feet then spread to his limbs and chest. PMHX- HSV. What is the diagnosis- causes?
Erythema Multiforme
can be
- idiopathic
- triggered by medications (penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapineor)
- infections (HSV)
52
How can you differentiate between steven johnsons syndrome, toxic epidermial necrolysis and erythema mulitforme
Erythema multiforme- no mucosal involvement/limited to one mucosal surface
SJS- at least 2 mucosal sites involved
Toxic epidermal necrolysis- involves mucosal surfaces
53
what is steven johnsons syndrome
mucocutaneous necrosis with at least 2 mucosal surfaces involved
54
sx of steven johnsons syndrome
- prodromal illness- sore throat , runny nose, sore eyes, pyrexia
Rash
- abrupt onset
- painful lesions starting on trunk
- spreads rapidly
- sheet like skin loss
- epidermal/mucosal loss
55
sx of erythema multiforme
target like/bulls eye spots
red spots with dakr centre
start on hands/feet- spread up limbs and trunk
sudden onset
56
tx of erythema multiforme
- self resolving in couple of weeks
- does not progress to SJS or toxic epidermial necrolysis
- pain killers
- tx cause eg hsv-1- oral aciclovir
- itch- antihistamines, topical corticosteroids
recurrent
- dapsone
- hydrochloroquine
- azathioprine
57
Causes of steven johnson syndrome
drugs
| infections
58
Management of steven johnson syndrome
```
- stop causative agent
analgesia, fluids
debridement of necrotic skin
dressings and emollients
ophthalmological review (iris, conjunctival scarring, conjunctivitis, corneal blisters)
```
59
What is Toxic Epidermal Necrosis
Acute
- skin and mucosal necrosis (over 30%)
- with systemic toxicity
60
causes of toxic epidermal necrosis
usually drug induced
- abx- -sulphonamide, penicillins
- allopurinol
- carbamazepine, phenytoin
- NSAIDs
61
presentation of toxic epidermal necrosis
prodromal illness
abrupt onset rash
- painful lesions starting on trunk and rapidly spreading
- sheet like skin loss
- epidermal/mucosal loss
- Nikolsky's sign- epidermal separates with mild lateral pressure- ie skin tears
62
Management of toxic epidermal necrosis
- stop causative agent
- full supportive care- analgesia, fluids
* *- debridement of necrotic skin
- dressings
- emollients
* *- ophthalmological review
63
What is bullous pemphigoid
elderly
Autoimmune
attacks antigens between epidermis and dermis, causing sub-dermal split in the skin
64
Presentation of bullous pehmphgoid
tense, fluid filled blisters on an erythematous base
- large blisters
- itchy
- may be preceded by a non specific itchy rash
- trunk and limbs
65
Management of bullous pemphigoid
- wound dressings
- topical steroids
- oral steroids, tetracycline, nicotinamide
- azathioprine/methotrexate- immunosups
66
What is pemphigus vulagris
midle-aged/older
autoantibodies against antigens within epidermis
intra-epidermal split
blistering and erosion of skin and mucosal membranes
67
presentation of pemphigus vulgaris
- flaccid, easily ruptured blisters
- form erosions and crusts
- painful
- usually affects mucosal areas
68
Management of phemphigus vulgaria
- dressings
- oral care
- hgih dose steroids
- immunosups- metho, azathioprine, cyclophosphamide
69
Two main subdivisions of skin cancer
- melanocytic (melanoma)
| - non melanocytic (keratinocyte carcinomas, cancers of the epidermis, eg BCC, SCC,
70
What are melanocytic naevi
- moles, skin tags
| - raised or flat
71
how to check if mole is malignant
- ABCDE
```
Asymetry
Boarder- irregular
Colour - multi
Diamtere >6mm
Evolving
```
72
What si seborrheic keratosis, appearance
benign warty spot
- not pre-cancerous
- can be assoc with BCC
- common sign of skin aging
appearance
- stuck on
- well demarcated brown plaque
- only 1st layer of epidermis
73
Management of seborroeic keratosis
- leave it
| - if irritating- cryotherapy, curettage
74
What is actinic keratosis
- precancerous- 20% chance of turning into SCC
appearance
- red or white flat plaques
- mostly seen on scalps
- feel rough, dry
75
Causes/RFs of actinic keratosis
- UV- sunbeds, sunbathing
- P53 mutation
* *- HPV
* *- immunosupression
76
Ix for actinic keratosis
look out for IDRBEU (BCC)
- induration/inflam
- Diamtere >1cm
- rapidly growing
- bleeding
- erythema
- ulceration
biopsy/excision
77
What is Bowen's disease, appearance
- non invasive SCC
- precancerous
irregular, well defined red,scaly lesion
slow growing
sun-distributed, often on shins
78
Management of Bowen's disease
- topical 5-flurouracil (cytotoxic)
- cryotherapy, excision
- pt education- UV protection
- FU- 3m
79
What is a malignant melanoma
- highly malignant
melanocyte tumour
1/4 progress from moles
80
RFs for malignant melanoma/SCC
- UV exposure
- prev skin ca
- >5 melanocytic naevi
- immunosupression
- genetic skin conditions
81
presentation of malig melanoma
```
asymmetrical
irregular border
multi-pigmented lesion
diameter >6mm
evolving
```
82
ix for malignant melanoma
- dermatoscpoy- ABCDE
- excision biopsy
METS
**- lactate dehydrogenase (mets liver)
- XR
-CT
- MRIs, PET
- USS
83
Management of malig melanoma
- surgical excision with 0.5cm safety margin
- CT
- Immunotherapy
- if large, nearby lymph node biopsy
84
Site of mets malig melanoma
- brain
liver
bones
abdo
85
Cell type of SCC
epidermal keratinocytes
86
presentation of SCC
- grow over weeks or months
- pink or hyperpigmented /brown lesion
- hyperkaratotic
- may be ulcerated, nodular, warty
- crusting
- will not heal
ear, lips, genitals, mucosal sites
sore/tender
87
Management of scc
- Surgical excision
- Cryotherapy, curettage, or cautery
- RT
88
what cell type is bcc
- epidermal keratinocytes
89
presentation of bcc
```
- shiny pearly nodule
with umbilical centre
- rolling edges
- telangiectasias
- face/head/neck
- slow growing
```
90
ix for bcc
dermatoscopy
| biopsy
91
tx of bcc
- Surgical excision
- Cryotherapy, curettage, or cautery
- RT
92
What is paget's disease of the nipple
- skin condition indicative of malignanct- HER-2
| - Eczemoid changes- itching, flaking, flattened nipple, ulceration
93
ix for Pagets disease of the nipple
punch biopsy
| mammogram
94
tx for pagets disease of the nipple
- excision
- CT
- RT
95
What is Kaposi sarcoma, RF
endothelial cell cancer, caused by HPV 8 virus
RF- AIDS, immunosupression
96
ix kaposis
biopsy of the skin
endoscopy , colonoscopy, FIT if suspected in digestive tract
CXR, bronchosocpy
97
tx of kaposis
tx cause- eg HAART retrovirus for HIV
CT or RT
excise big lesions
98
What is neurofibromatosis
```
genetic condition
causes tumour (usually benign) to grow along the nerves
```
99
Sx of kaposis
painless red/purple papules/nodules anywhere on skin or mucous membranes
with N+V, SOB, chest pain, haemoptysis, abdo pain, diarrhoea if affecting internals
100
What genes are affected in neurofibromatosis
NF1 chromosome 17/NF2 chromosome 22
101
Presentation of neurofibromatosis
- cafe au lait spots- pale, coffee coloured flat patches
- soft tumours under the skin
- cluster of freckles in unusal places- armpits, groin, under breast
- problems with bnoes, eyes, nervous system
102
What is the difference between neurofibromatosis 1 and 2
NF1- schwannomas on nerves throughout nervous system- impaired hearing, vision, dizziness, balance, discoordination, headaches
NF2- less common, neurofibromas on peripheral nerves. Pain, neurological sx
103
tx of acne vulgaris
topical
- benzoyl peroxide
- topical abx - eg clindamicin
- retinoid- comedolytic and antinflam
```
oral
1. - tetracyclines- doxy, lymecycline, oxytetracycline,
2. erythro, trimetho
Antiandrogens (for females)
- spironolactone
- COCP, POP
- Cyproterone
- metformin
```
Isotretinoin (systemic retinoid)-sebaceous gland function, keratinization)- accutain/roaccutane/rizuderm
laser therapy for scarring
104
what advice do you need to give after giving isotreinoin
teratogenic- need to use 2x contraception
105
How to evaluate unconscious , burnt pt
- ABCDE
- look- mechanism, depth, % coverage
- monitor NV status of extremities to detect compartment syndrome
106
Mechanism of burns and how deep they tend to affect
scalds- hot liquids
- superficial, superficial dermal
Flash burns
- high voltage, but current did not enter the body
- superficial
sunburn
- UVA- dermis, SC fat
- UVB- potent, erythema, epidermis
- epidermis, if severe may reach dermis and blister
Contact Burns
- touching hot object directly
- deep dermal, full thickness
Electrical
- small, deep burns at entry and exit points
Muscles tetany- arrhythmias, resps, spinal cord injury, transient paralysis, pareasthesia,
Chemical
- acids, alkalis
- deep dermal, full thickness
- formation of eschar (thick dead skin) more common
107
What are the degree of burns
```
1. superficial epidermal later
o/e- red, no blistering
cap refill fast
painful
heals within a week
```
2a. Superficial dermal/partial thickness
- epidermis and upper dermis
o/e- red/pale pink, blistering
cap refil- slow, blanches
v painful
heals within 2 weeks
2b. Deep dermal/partial thickness
- epidermis and full dermis
o/e- red, blotchy +- blistering
no blanching, absent/sluggish cap refill
sensation absent or present
3. full thickness (3rd degree)
- epidermis, full dermis and SC
O/e- dry.waxy/white/leathery/brown
no blisters, blanching, cap refill or sensation
108
burns- what is the rule of 9 for calculating % coverage
```
each arm- 9%
head 9%
entire chest 9%
entire abdo 9%
Entire back 18%
each leg 18%
groin 1%
palm 1%
```
109
What is a more precise way of calculating % burns
Lund and Browder diagram
110
Immediate general management of burns
- stop burning process
- do not remove anything stuck to the skin
- 20-30min under cold water
- layer with clingfilm- dont wrap!
- no wet dressings or creams
- elevate, NSAID, opiate
111
Immediate management of chemical burns
- 1 hour irrigation ASAP
- elemental metals- soaked with mineral oil instead of above
- topical abx- 1% silver sulfadiazine cream, 0.5% silver nitrate solution and mafendine acetate 10% cream
112
Immediate management of electrical burn
- rush to ED (not much 1st aid)
| - topical abx- 1% silver sulfadiazine cream, 0.5% silver nitrate solution and mafendine acetate 10% cream
113
Immediate management of scald
- run affected areas under running cold water for at least 20min
- avoid icy water as causes vasocontriction
- lightly wrap with towel dipped in cold water
114
Immediate management of sunburn
- avoid sun
- protective clothing
- sunscreen SPF 50%
- oral food supplement polupodium
- 2 aspirin, then 2 every 4 hours, topical steroid B for 2-3 days
- cool baths
- Aloe vera
- keep hydrated
- if severe- electrlyte correction
- abx if signs of infection
```
SMART prevention
- shade 11am-3pm
aim to cover up
remember to take extra care with children
then use sun protection SPF 30+
```
115
Non-immediate management of burns in general
- debridement
- moisturisation
- broad spec abx
- escharotomy
116
what is an escharotomy
- for full thickness, circumferential burns
- skin dies, tought and leathery
- this contrcits the swelling internal tissues-- compartment syndrome
- plus poor breathing if arounf torso
- procedure to relive pressure, done in ED
117
Where do u cut in an escharotomy
- along ulnar surface of upper limbs
- midline of neck
- horizontally on upper chest
- lateral sides of chest
- horizontal across abdo
- medial and lateral surfaces of lower limb and feet
118
A pt who suffered a chemical burn 3 days ago develops a progressive reddening of the intact skin around the burn- what is you main differential, causative agent and tx
burn wound cellulitis
strep pyogens
penicillin
119
What is the difference between cellulitis and erysipelas
cellulitis- involves deep SC tissue
erysipelas- acute, suerficial form of cellulitis, involves dermis and upper SC tissue
120
What are 2 main bacterial causes of cellulitis
- strep pyogens
| staph areus
121
sx of cellulitis
most commonly in lower limb
- inflammation- swelling, eythema, warmth, pain
- lymphangitis
- systemically unwell
erysipelas- more well defined, raised borders
122
tx of cellulitis
```
abx- fluclox, benzylpenicillin
rest
leg/limb elevation
sterile dressings
analgesia
```
123
complications of cellulitis
abscess
septicaemia
local necrosis
124
stages of wound healing
1- vascular response/haemostasis
- vasoconstriction and platelet aggregation
clot formation
2. - inflammatory response
- vasodilation, neutrophil infiltration, macrophages
- pahgocytosis
3- proliferation
- granulation tissue (made by fibroblasts)
- angiogenesis
- re=epitheliazation
4. - Maturation/remodelling
- collagen fibre reorganisation
- scar maturation
125
5 features of inflammation
```
Rubor
Calor (heat)
Dolor (pain)
Tumour
loss of function
```
126
Intention of wound healing
Primary
- little/no tissue loss
- edges directly against eachother
- linear scarring
Secondary
- wounds not opposed
- wound allowed to granulate
- epitheliazation occurs from edge of hair follicle remnant in wound base
Tertiary intention
- wound left open intentionally and observed- surgically closed later
127
What are the 5 main types of dressing
```
Alginate
Foams
Hydrocolloid
Hydrogel
Collagen
```
128
What are alginate dressings, when are they used
- absorbent
- wounds that are highly exudative
- contain sodium and seaweed
- create a healing gel
```
good for...
burns
venous ulcers
packing wounds
higher grade pressure sores
```
change every 2 days
129
What are foam dressings
- absorbent
- allow water vapour to enter
- non adhesive/adhesive options
130
What are hydrocolloid dressing, when are they used
Absorbs water and forms a gel
Long lasting
```
good for...
burns
exudative/weeping wounds
wet necrotic wounds
pressure ulcers
venous ulcers
```
131
What are Hydrogeldressing, when are they used
- for dry wounds- leaking little to no fluid
- painful wounds- having colling gel that has analgesic properties and speeds healing
good for...
- dry necrotic wounds
- pressure ulcers
- donor sites
- second degree burns
- infected wounds
132
What are collagen dressing, when are they used
- for chronic/stalled wounds
- act as scaffolding for new cells to grow
- help bring wound edges together
good for...
- pressure sores
- transplant sites
- surgical wounds
- burns
- injuries with large SA
133
Eczema exacerbating factors
```
Allergens- chemicals, food, dust, fur
Sweating
Heat
Stress
Over-washing
- Lack of sunlight
```
134
What are the different types of eczema (7)
- Atopic
- Contact
- Dyshidrotic
* *- Neurodermatitis
- Nummular/Discoid
- Stasis/varicose/gravitational
* *- Sebborheic
135
What is atopic eczema, presentation
- inherited factors
- inflammatory
- famhx dermatitis/atopy
- personal hx of atopy (hayfever, asthma)
- generalised dryness, itchiness, rash
- widespread
136
What is contact dermatitis, presentation
- provoked by irritants
- often only on hands
- type 4 hypersensitivity (T-cells)
- dry, irritated skin
- localised to site of contact
- burning pain is more common than itch
137
what is discoid/nummular eczema, presentation
- cause unknown
- some cases assoc with staph aureus
- dry/erythematous-- very well defined dry, red patche(s)
- exudative type: oozy papules, blisters and plaques within the lesion
- Dry type- plaques are dry and itchy, skin between patches is irritable
138
What is Seborrhoeic dermatitis, presentation
- due to irritation from toxic substances produced by malassezia yeast that lives on scalp, face and sometimes other places
- eczematous lesions with flakes on the periorbital, auricular and nasolabial folds. -- assume dry areas in these areas are seborrhoeic > eczema
Infant
- cradle cap (diffuse, greasy scaling)
- groin folds (nappy)
- armpit
Adult
- minimal itch
- T zone dryness, scalp, chest, back, underarms, groin
- winter flares
- combination of oily and dry skin
- blepharitis
- salmon, thin, scaly, ill-defined plaques in facial folds/scalp
- petal shaped flaky patches in hairline/ant chest
- rash in armpits, under breast, groin folds, genital creases
- superficial folliculitis on cheeks/upper trunk
139
What is dyshidrotic/pomopholyx eczema?
- cause unknown, more common in those with other forms of eczema, fam hx
- small, intensely itchy blisters on palms of hands/feet/digits
- burning
- as blisters heal, skin cracks, reddens and peals
- single flare ups or coming and going
- stress and nickel often triggers it
140
What is neurodermatitis/lichen simplex chronicus
- extremley itchy thick, leathery patches of skin
- scaly, red/brown/grey in colour
- usually confined to 2 patches, rather than widespread like atopic dermatitis
- rarely subsides without tx
- continued scratching irriates nerve endings, intensifying itchy sensation
141
What is stasis eczema
- stasis/varicose/venous
- assoc with venous insufficiency
- itchy, red, blistered and crusted plaques
- orange-brown macular pigmentation due to haemosiderin deposition
- atrophie blanche (white irregular scaring/what looks like dry skin)
- champagne bottle shape to lower leg- due to lipodermatosclerosis of ankles
142
What are some complications of dermatitis/eczema
- infection (S.aureus, herpes simplex)
- thickening
- psychosocial
143
What is eczema herpeticum/kaposi varicelliform eruption
Complication of eczema
- HSV 1 or 2
- occurs due to skin barrier breakdown generally due to eczema, but may also occur following thermal burns, pemphigus vulgaris, ichthyosis
144
Presentation of eczema herpeticum
- blisters- all similar in appearnace to eachother
- fluid filled with yellow or thick purulent fluid
- sometimes blood stained (red, purple, black)
- New blisters have central dimple (umbilication)
- older blisters crust and form sores
- lesions heal 2-6weeks
- may have scarring
145
Complications of eczema herpeticum
- secondary infection- staph, strep-- impetigo, cellulitis
- scarring
- herpes hepatitis
- encephalitis/meningitis
- keratoconjunctivitis
146
diagnosis of eczema herpeticum
- viral culture
* *- fluorescent antibody scan
- PCR
- Tzank smear
- bacterial swabs for secondary infections
147
tx eczema herpeticum
- refer immediately
- oral aciclovir
- calamine, doxepin for itch
148
tx of seborrhoeic dermatitis
- shampoos with active agents against yeast (ketoconazole, coal tar)
- mild topical corticosteroids
149
tx of eczema
- avoid irritants
- frequent liberal use of emollients (see emollient ladder)
- for flares: topical hydrocortisone (1-2.5%), eumovate, betamethasone 0.025%, dermovate
- can apply steroids prophylactically if flares are frequent (2 consecutive days a week)
- oral antihistammines
- calamine, doxepine for itch
- topical immunomods
- phototherapy
- immunosups- pred, azathioprine
150
Examples of emollients
```
--Least greasy--
E45 lotion
Aproderm Cream
Diprobase ointment
50:50 ointment, paraffin, hydromol ointment
--Most greasy--
```
151
What is erythroderma, causes
- intense, widespread reddening of the skin (at least 90%)
casues
- eczema, psoriasis
- lymphoma
- drugs- sulphonamides, sulphonylureas, penicillin, allopruinol
- idiopathic
152
presentation of erythroderma
- inflammed, oedematous, erythromatous skin
- scaly
- systemically unwell
- lymphadneopathy
- malaise
- skin peeling
153
tx erythroderma
- tx cause
- emollients
- wraps- moisture
- topical steroids
154
mortality of erythroderma
20-40%
155
complications of erythroderma
* *- secondary infection
- fluid loss, electrolyte imbalance, hypothermia
* *- high CO failure
* *- capillary leak syndrome- oedema, hypotension, hypercoagulable blood, low blood levels of albumin (an important blood protein
156
What is tinea, presentation
- RINGworm
- FUNGAL infection
- ring shaped, scaly rash with clearing centre
157
tx of tinea
- ketoconazole or selenium sulfide shampoo
- topical antifungal- imidazoles (clotrimazole, ketoconazole)
- terbinafine cream
158
what is tinea corporis
- tinea of trunk and limbs
itchy, circular/annular lesions
clearly defined
159
What is tinea cruris
- very itchy
- warm, moist areas of the body
- similar to tinea corporis in appearance
160
What is tinea pedis, tx
- athletes foot!!!
- moistscaling and fissuring in the toe webs
- spreads to soles and dorsal aspect of the foot
- OTC topical creams containing tolnaftate
161
what is tinea manuum, presentation
- tinea of the hand
| - scaling, dryness in palmar creases
162
What is tinea unguium, presentation and tx
```
tinea of the nail
Onychomycosis
- yellow discolouration
- thickened
- crumbly
```
oral triazole, topical tioconazole
163
what is tinea capitis
tinea on scalp
| - patches of broken hair, scaling, inflammation
164
what is tinea versicolour/pityriasis
- skin eruption on the trunk and proximal extremities
- fine scaling
- pale, dark tan or pink in colour
- darken when overheating
- clear boarders
- flat, painless
165
Sx of candida skin infections
White plaques if on mucosa
| - erythema/hyperpigmentation in darker skin tones with satellite lesions in flexures
166
how to distinguish nappy rash from candida
- nappy rash- sparing of screases
| - thrush- in creases
167
sx of oral thrush
- white tongue, erythematous/white mucosa
- when wiped, white comes off and leaves red spots that bleed
- unpleasant/reduced tast
- crack in corner of mouth
- sore tongue/gums
168
tx thrush
- oral--> mystatin, fluclonazole, triazole
- skin--
topical imidazole (clotrimazole, ketoconazole)
topical terbinafine
topical nystatin
- Genital
Imidazoles- topical/pessary (clotrimazole)
Oral- fluclonazole
169
What is malassezia
- a yeast
| - found to cause dandruff, seborrhoeic dermatitis, tinea versicolour, folliculitis
170
tx of seboorhoeic dermatitis
steroid and antifungal
171
tx of malassezia caused tinea versicolour, dandruff, folliculitis
shampoos containing selenium disulfide, ketoconazole
172
Cutaneous aspergillus infection- sx
- single or multiple red/violet hardened plaques/papules
- may be tender
- evolve into blood/pus blisters
- centre become necrotic- blackens and scabs
173
tx of skin aspergillus infection
voriconazole
| liposomal amphotericin B
174
What type of organism is aspergillosis
mould
175
What is impetigo
Acute superficial bacterial infection
staph aureus (bullous)
group A beta haemolytic strep/strep pyogens (non-bullous, ulcerated)
176
types of impetigo
Ulcerated impetigo/ecthyma
- crusted sores
- necrotic punched out ulcer
- scarring
nonbullous/crusted-
- infection of trauma site
- pink macule evolves into vesicle or pustule, then into yellow crusted erosions
- self limiting in 4w
- no scarring
- S.aureus/Group A beta-haemolytic strep (pyogenes)
bullous-
- staph toxins
- small vesicles evolved into flaccid transparent bullae
- no scarring
- S. aureus
177
sx of impetigo
blisters, pustules
honey coloured crust
face, hands, trunk, perineum
single or multiple lesions
lymphadenopathy, fever, malaise
178
ix of ?impetigo
bcterial swab- microscpoy, culutre, sensitvity
179
tx of impetigo
- moist soaks removes crusting
TOP- non bullous, well:
- hydrogen peroxide cream
- fusidic acid
PO- bullous/non bullous unwell or widespread
oral abx- fluclox, erythro
180
advice of pt with impetigo
- avoid close contact w others
- no school until crusts have dried out, for 24hours after starting oral abx
- use separate towels
- change and launder clothes and linen daily
preventing recurrence
- antiseptic cream to nostrils (carrier site)- Naseptin
- wash daily with antibacterial soap, soak in bleach baths
- cut nails and keep hands clean
181
tx of dog/cat bites
- co-amox for 5 days
| - metronidazole plus doxy if allergic for 5d
182
what infections can cat bites cause
- viral -rabies
- cat scratch disease- Bartonella henselae
- pasteurella multocida
183
sx of at scratch disease
- swelling, blister at site of bite.scratch
- lymphadenopathy
- fever
- headache
- myalgia
- arthralgia
- fatigue
- poor appetite
184
sx of pasteurella multocida
- swelling, pain, redness at wound site within 2 days
185
what diseases can you catch from cat/dog faeces
- salmonella
- hookworms, roundworms
- Protazoal infections (cryptosporidiosis, giardiasis, toxoplasmosis)
186
sx of toxoplasmosis
- myalgia
- fever
- headache
- confusion, seizures, vomiting
187
indications for prophylactic abx after cat/dog bite
- wound requiring surgical repair
- sensitive area eg hands, face, genitals
- close to bone/joint
- immunocomprimised
- deep/significant wound
188
What are the guidleines concerning tetanus jab following a laceration
- booster needed within 10 years if clean, simple cut
| - booster needed within 5 years if complex/dirty cut
189
tx of lice/pediculosis capitis
- liberal application of any conditioner and leave it on every day for 5d
- cut hair
- ointments with insecticide- at least 2 applications 7 days apart (dimethicone, malathion)
- removal of lice with lice comb
- inform school
190
Mechanism of necrotising fascitis- causes
bacterial infection- Strep!
toxins and enzymes cause thrombosis in BVs
tissue death
- infection of skin opening
- dental infection, mandibular #
- SGLT2 inhibitors
- IM use of adrenaline
191
Types of nec fascitis
1- polymicriobial
- S aureus, haemophilus, e.coli
- older people/diabetics
2- haemolytic strep gangrene
- group A (S pyogens)
- staph commonly also present, incl. MRSA
- All age groups
3. Gas gangrene
- Clostridium perfringens
- can be caused by group A streptococcus, Staphylococcus aureus, and Vibrio vulnificus.
- crackling sounds
- IVDU injecting black tar heroin SC
Other
- fungal
- marine
- genital
192
sx of nec facsitis
```
onset of 1 hour of minor injury
pain- severe, worsens
flu-like sx, diarrhoea, malaise
intense thirst
commonly in the perineal/groin area!
```
then after 2-4 days:
- affected area swells
- purplish rash
- blistering with dark fluid
- area dies and blackens
- oedema
- severe pain, until periheral nerves are destroyed
- dishwater coloured exudate
- no blood
day 5
- severe hypotension
- severe pyrexia
- toxic shock
- reduced GCS
193
ix for ?nec fascitis
clinical and hx
- finger test- 2cm incsiion and push finger in, positive- through SC w/o resistance, necrotic tissue/dishwater fluid oozes out
- high WCC, hyponatraemia, CRP, raised CK, hyperuricaemia
- blood culture
- deep tissue biopsy
- fungal culture if immunocomprimised
- XR, CT, MRI- ID fluid collection
194
tx nec fascitis
- admit ICU
- O2, fluids
1. debridement- most important initial step in management
- high dose IV penicillin, clinda, metronidazole, cephalosporins
* *- midodrine to increase BP (vassopressor)
* *- IV immunoglobulins
- skin grafting
- vacuum assisted wound healing
195
complications of nec fascitis
- metastatic abscesses- lung, liver, brain, spleen, skin, pericardium
- death
- renal failure
- multiorgan failure
- disfigurement
- septiciaemia
196
What is periorbital/preseptal cellulitis
- infection of the eyelids and periorbital skin
- no involvement of the orbit
- can follow minor injury to the eye /sinusitis
197
causative microorganisms of periorbital/preseptal cellulitis
Haemophilus influenzae
Staph
Strep
198
sx or periorbital/preseptal cellulitis
- redness
- oedema around eye
you need to check eye movements- if reduced, is orbital cellulitis and is much more serious
199
complications of periorbital/preseptal cellulitis
- sinusitis
- meningitis
* *- pneumonia
* *- otitis media
* - conjuncivitis
* *- epiglottitis
200
tx of periorbital/presptal cellulitis
- oral coamox/clinda with metro
- IV ceftriaxone
- ophthalmic and ENT assessment
201
tx if ?orbital cellulitis
IV coamox/clinda with metro
| CT head
202
Red flags of orbital cellulitis
admit immediately if:
- CN involvement
- systemically unwell
- not responding to above tx
- when drainage of lid abscess is required
203
What is a pilonidal cyst
- cyst forms on the natal cleft due to an ingrown hair
| - becomes an abscess and sinus if infected recurrently
204
who do pilonidal cysts occur in
- mainly in hairy men
205
sx of pilonidal cyst
- painful swelling at top of natal cleft
| - may discharge
206
indications of referral to colorectal with pilonodal cysts
- recurrent infections
- cyst discharging w/o signs of infection
(may have become sinus, risk of becoming a fistula with rectum
207
indication pilonidal cyst has become a fistula
foul smelling discharge
208
tx of pilonidal cyst and complications
- fluclox for acute infection
- surgery to close fistula
- advise men to wax as this will prevent ingrown hairs
209
What classification system is used for pressure ulcers
European pressure ulcer advisory panel classification system
| - grade1-4
210
What is a grade 1 pressure ulcer
non-blanchable erythema of intact skin
| - darker skin- discolouration, warmth, oedea, induration, hardness
211
What is a grade 2 pressure ulcer
- partial thickness skin loss involving epidermis, dermis or both
- SC fat may be visible
includes:
- open wound with red/pink wound bed- +-slough
- intact open/ruptured serum filled blister
212
What is a grade 3 pressure ulcer
- full thickness skin loss
- damage to/necrosis of SC tissue
- may extend down to but not through fascia
213
What is a grade 4 pressure ulcer
- tissue necrosis or damage to muscle/bone/supporting structures
- +- full thickness skin loss
214
What is psoriasis
- hyperproliferation of keratinocytes
| inflammatory cells infiltration
215
What are the different types of psoriasis (7)
- Chronic Plaque Psoriasis
- Guttate psoriasis
* *- Inverse psoriasis
* *- Pustular psoriasis
- Erythrodermic psoriasis
- Nail Psoriasis- pitting and oncholysis
- Psoriatic arthritis
216
sx of chronic plaque psoriasis
- white/red/hyperpigmented patches
- extensor surfaces of elbows, knees, scalp, lower back
- pruritis, burning, pain
- Auspitz sign (pinpoint bleeding when plaque is removed)
217
Auspitz sign- what is it?
careful scratch and removal of scales cause bleeding
218
what is the most common type of psoriasis
Chronic Plaque
219
sx of guttate psoriasis
- Small, pink/red spots
- Trunk, upper arms, thighs, scalp
- Assoc w strep throat
220
sx of inverse psoriasis
- bright red, smooth, shiny patches of skin
- no scales
- gets worse with sweating, rubbing
- 'inverse'- areas other types don't present in- armpits, groin, under breasts, skin folds of genitals and buttocks
221
sx of pustular psoriasis
pustules surrounded by red skin
- hands, feet, may cover most of body
- fever, nausea, high BPM, muscles weakness
222
sx of erythrodermic psoriasis
- v serious
- affects most of body
- fiery skin that appears burned
- severe pruritis
- peeling
- fast bpm
- changes in body temp
223
sx of nail psoriasis
- often w psoriasis arthritis
- pitting
- tender nails, painful,
- onycholysis- separation from the nail bed
- yellow/brown discolouration
- chalk like material under nail
224
sx of psoriatic arthritis
- most also have nail changes
- painful, stiff joints
- worse in morning/after rest
- warm, swollen joint
- sausage digits
- boutonniere deformity of the toe
225
What is arthritis mutilans
- shortening of the fingers
- sausage
- looks paw like
excess skin creates folds at the joints
226
Management of psoriasis
```
Emollients
topical:
1. corticosteroids with vit d analogues (eg calcipotriol)/vit D
- coal tar preps
- dithranol
- retinoids
- keratolytics
```
Phototherapy- UVB and photochemotherapy (UVA, psoralen)
Oral
- methotrexate
- retinoids
- ciclosporin
- mycophenolate
- fumaric acid esters
- biological agents- infliximab
227
complications of psoriasis
erythroderma
pruitis ani/vulvae
skin infections
psychological and social effects
defomities
- arthritis mutilans
- boutonniere (although more commonly seen in RA)
228
what is erysipelas/cellulitis commonly caused by
group a strep (pyogens)
also cause scarlet fever- so sometimes coincide
229
what organsism causes scarlet fever
group A beta haemolytic strep (pyogens)
230
sx of scarlet fever
- intense redness and sometimes **blistering- looks scalded
- similar to staph presentation- tx as both
- strep tonsillitis- pus on tonsils
* *- strawberry tongue
* *- red spots
- red rash on face except around mouth
231
tx of scarlet fever
Strep pyogens
- phenoxymethylpen for 10d
- azithromycin if allergy
232
What is staph scalded skin syndrome
- infancy and childhood
- benzylepenicillin resistant (coagulase positive) staph trigger epidermolytic toxin reaction
-
233
Presentation of staph scalded skin
- onset of few hours- days
- intense red skin, worse on face, neck, axillae, groin
- then large, flaccid bullae
- perioral crusting
- intraepidermal bleeding
- lesions very painful
- sometimes more localised
- recovery 5-7 days
234
Management of staph scalded skin syndrome
- systemic penicillinase resistant penicillin eg methicillin or
- fusidic acid or
- erythromycin or
- cephalosporin
- analgesia
235
Describe a typical arterial ulcer
- small
- sharply defined
- deep
- necrotic base
236
describe a typical venous ulcer
- large
- shallow
- irregular boarder
- exudative and granulating base
237
what features other then the ulcer may you see in venous deficiency
- peipheral oedema
- haemosiderin and melanin deposition (brown)
- lipodermatosclerosis- hardening, redness of the skin (SC swelling)
- atrophine blanche (white scarring due to dilated capillaries)
238
describe a typical neuropathic ulcer
variable in size and depth
granulating base
may be surrounded by or over a hyperkeratotic lesion eg callus
239
describe a vasculitic ulcer
deep
punched out
reddish/blue tinge around edge
may be accompanied by a purpuric rash
240
what is pyoderma gangrenosum
- autoinflammatory
| - assoc with UC, IBS, RA, myeloid dysplasia, gammopathy
241
sx of pyoderma gangrenosum
- sudden onset
- very painful
- papule turns into ulcer
- rapid, wide enlargement of ulcer
- very painful
- undertermined necrotic edge with pustules
- necrotic base
- lower legs most commonly
+- systemic sx- fever, myalgia
242
tx of pyoderma grandrenosum
autoinflammatory disorder, assoc with AI conditions
* *- oral doxy
- careful compression bandaging
- oral pred- can use orally or intranassally also
- intralesional steroid injections into ulcer edge
* *- tacrolimus ointment-
* *- ciclosporin topically and orally
* *- biologic agents- infliximab
243
molluscum contagiosum, organism
- parvovirus
244
molluscum contagiosum presentation
- localised clusters of epidermal papules, pearly papules with umbilication
245
who does molluscum contagiosum affect
- children, infants, HIV+
246
transmission of molluscum contagiosum
skin to skin contact
towels
autoinolculation
sexual transmission
247
Management of molluscum contagiosum
- none, reassurance
- resolution wihtin 18m
- avoid squeezing and itching
- avoid sharing towels, clothing, baths
- itching- emollient and hydrocortisone 1%
- infection- topical abx fusidic acid 2%
- tx if eczema flare
- podophyllotoxin can be used in anorectal
248
complications of moiluscum contagiosum
```
secondary bact infection from scracthing (impetigo)
conjunctivitis if eyelid affected
eczema
widespread molluscum
pitted scarring
```
249
what causes viral warts
HPV
250
classification of viral warts
Cutaneous
| mucosal- anogenital, sex
251
what are cutaneous warts, transmission
- skin to skin contact/autoinoculation
| - proliferation of keratinocytes and hperkeratosis
252
Types of cutaneous wart
- common wart
- plantar/verruca plantaris
- plane/flat warts
- filliform
253
appearance of common wart, cause
cauliflower like papules with rough surface
| HPV-2
254
appearance of verruca plantaris, cause
tender, inwardly growing, yellow, hyperkratotic callus-like
HPV-1
255
appearance of plane wart, cause, common location
multiple, flat topped
skin coloured papules
HPV3, 10
face.hands, shins (often spread via shaving)
256
Appearance of filliform wart
cluster of fine fronds emerging from narrow pedicle
usually on face
digitate (finger like)
257
Management of cutaneous warts
- refer if on face
non facial:
- topical keratlytic salicylic acid
- cyrotherapy
Hands and feet- formaldehyde, silver nitrate
258
What are chicken pox cuased by
Human alphaherpesvirus 3 (HHV-3)
| also called varicella zoster virus
259
transmission of chicken pox
direct skin to skin contact with open sores
260
sx of chicken pox
- icthy red papules with vesicles in centre
- high fever
- headache
- cold like sx
- vomiting
- diarrhoea
- clear up in 1-3w, may leave scars
261
Complications of chicken pox (in non pregnant people)
- secondary bact inf (abscess, cellulitis, nec fasc, gangrene
- dehydration
- exacerbation of asthma
- viral pneumonia
- encaphalitis
- GBS
- Reye's
262
complication of chicken pox in non immune pregnant woman
- viral pneumonia
- premature labour, delivery
- maternal death
- 1/4 of fetuses become infected- harmless to most of these
- congential varicella syndrome- spont abortion, chorioretinitis, cataracts, limb atrophy, cerebral atrophy, microcephaly
263
tx of chicken pox
- - trim nails
- warm bath
- emollients
- paracetemol
- calamine lotion
- oral antihistammines
- oral acyclovir if >12 years old
- immunocomp- IV aciclovir
- vaccination prevention is recommended
264
What causes shingles
herpes zoster reminas dormant in dorsal root ganglion, reactivated and travels down sensory nerve to the skin
265
sx of herpes zoster
(Shingles)
- burning pain, preceding rash
- blistering painful rash over one dermatome, doesnt cross midline
- rash becomes pustular and crusty
- lymphadenopathy
- fever, headache
- recovery should occur within 3-4w
266
tx shingles
Antiviral asap to reduce posterherpetic neuropathic pain-- aciclovir 800mg 5x a day for 1w within 1-3 days on onset
- infectious to those who have not had chicken pox before
- rest, pain relief
- petroleum jelly
- oral abx for secondary infection
267
management of posteherpetic neuralgia
- capsacin cream 3-4x per week for 1 w
- then oral carbamazepine
- amitriptyline, gabapentin, pregablin
- TENS
- botulinum toxin
268
complications of shingles
- postherpetic neuralgia
- ophthalmic complications if over V division
- muscle weakness- VII palsy (Bells/ramsay hunt)
- encephalitis
269
prevention of shingles/herpes zoster
vaccination
| - 70-78y/o, optional
270
What is pityriasis rosea, who does it affect
- viral rash
| - mostly in teens and young adults
271
presentation of pityriasis rosea
- herald patch- one single patch of red, dry skin (macular)
- followed by smaller red oval pacthes, mainly on chest/back
- often no other sx
- may be preceded by an URTI
- lasts ~12weeks
272
tx of pityriasis rosea
- use plain water, bath oil or aq cream when showerign/batheing
- apply moisturiser/emollient cream on rash
- expose skin to some sunlight (being careful not to burn)
if persistent/extensive:
- aciclovir 7d
- oral erythro 2w
- topical steroid cream
- phototherapy UVB
273
What is the difference between bullous pemphigoid and pemphigus vulgaris?
bullous pemphigoid
- elderly
- tense fluid filled blisters
- itchy
- no mucosal involvement
- igG
- tx same- oral corticosteroids, tetracycline (doxy), azathioprine, dapsone
pemphigus vulargris
- middle aged
- flaccid blisters
- painful
- mucosal involvement usually
- IgG
- tx same- oral corticosteroids, tetracycline (doxy), azathioprine, dapsone
274
Lichen planus- sx
- itchy
- dark purple, papular lesions (couple of mm wide each)
- on flexor surfaces, palms, soles, genitalia, mucosa!
- white lines on the surface- Wickham's striae
- Oral involvement common- white lesions on buccal mucosa
- nails- thinning of nail, longitudinal ridging
- may be seen appearing around site of trauma- Koebner phenomenon
275
what conditiions are associated with UC
- large-joint arthritis
- sacroilitis
- pyoderma gangrenosum
- primary sclerosing cholangitis
276
tx lichen planus
- potent topical corticosteroids.
277
diabetic pt has chronic ulcer with green slough and offensive smell- most likely causative agent?
Pseudomonas
- commonly causes opportunistic infections in patients with any degree of immunosuppression
- neuropathic ulcers
- green slough
- offensive smell
278
what is melasma
dark pigmentation of pregnant women/ women taking HRT/contraceptives
279
what is pityriasis alba
hypopigemtnation in children/young adults
- pink scaly patches--> leave pale areas
- cause unknown, often coexists with dryo skin, atopic dermatitis
- often presents following sun exposure or excessive washing or malassezia yeasts
280
what is erythrasma
brown, sclay skin
| obese/diabetics
281
what is a Keratoacanthoma, management
benign epithelial tumour
older age, rare in young people
- looks like volcano/crater
- rapidly grow
- friable (crumbles)
-- smooth dome shaped papule --> crater with keratin centrally filling it
- spontaneous regression in 3m is common, may leave scar
- urgent excision is neede tho to exclude Sq cell carcinoma as look a bit like it
282
characteristics of acne vulgaris
- Open and closed comedones
- pustules
- nodules
283
SE of TOP steroids
- skin depigmentation
- excessive hair growth
- skin atrophy
284
what drug class worsens plaque psoriasis
beta blockers
285
appearance of morphoeic basal cell carcinoma
- waxy, scar like plaque- poorly defined adges
286
tx of morphoeic BCC
mohns micrographic surgery is gold standarf
287
what si the most common type of BCC
nodular
- pearly, flesh coloured papule with telangiectasia,
- umbilical dot/ulceration in middle
- rolled edge
- may ulcerate, causing a crater
- sun exposed areas
288
what is erythem ab igne
heat rash lol
- reticulated, lacy rash with patches of hyperpigmentation and telangiectasia
- over exposure to infrared radiation (open fires, hot water bottle)
289
sx dermatitis herpetiformis
NOTE: NOT eczema herpeticus!!!
Dermatitis herpetiformis is coeliac AI skin reaction, just LOOKS like herpetic vesicles
- intense itching
- crops of vescicles on extensor surfaces with dermatic rash
290
condition dermatitis herpetiformis is assoc with, tx
coeliac
- gluten free diet
- dapsone
291
what is a pyogenic granuloma, tx
- purple papular lesion at site of trauma
- bleeds with contact
tx with silver nitrate, phenol, trichloroacetic acid
292
what antifungal inhibits squalene epoxidase and SE is haematoligcal issues (pancytopenia, agranulocytosis, abnormal LFTs)
terbinafine
293
what antifungal is use to tx fungal nail infections once this has been confirmed with ix
terbinafine PO
294
what is amphotericin B used for
systemic fungal issues
295
how is nystatin used
very toxic, only used topically eg oral thrush
296
skin manifestations of SLE
- photosensittive butterfly rash on face
- discoid lupus- coin shaped dry lesions
- alopecia
- livedo reitcularis (web/lace like rash)
297
distinguishing between impetigo infected eczema and eczema herpeticum
Impetigo
- red papule or macule
- becomes vescile
- erodes- golen crusted
- face, mouth
- mild itch, pain
- less likely to have systemic features
Eczema herpeticum
- painful rash
- atopci ezcema most common
- dome shaped vesicles
- punched out erosions- deep, circular, ulcerated
- 1-3mm
- very itchy
- systemic sx, nodes
298
sx staphlococcal toxic shock syndrome
- fever
- hypotension
- desquamating(peeling) rash- typically starting on palms and soles, initially looks like sunburn
- AKI
- Heptaic, GI (diarrhoes or vomt) or CNS involvement
299
tx toxic shock
strep or staph
- removal of infectious source (eg tmapon)
- IV fluids
- IV abx
- strep- surgeical debridement of source of infection
300
strep toxic shock syndroem
```
S. pyogenes/group A strep (+ cocci)
- flu- like sx
- N+V
Quick progression to:
- low BP, tachy
- multi organ failure- kidney, liver, lung, blood
-
```
301
what is a solitary, firm papule or nodule which dimples when pinched (positive retraction sign) likely to be?
- dermatofibroma
| often occurrs following injury to skin eg shaving cut
302
tx for hirutuisim
- COCP- anti-androgen. eg co-cyprindiol/dianette, Yasmin
| - facial- TOP eflornithine (not in preg or breast feeding)
303
scoring system sued for hirtuism severity
ferriman gallwey
304
sx rosacea
- flushing of face with alcohol
- spots on face
- telangiectasia on fce
- later- persitent erythema with papules an dpustules
- blepharitis
- may be worse with sun exposure
- rhinophyma- thickened skin and sebaceous gland enlargement on skin on nose
unknown pathophysiology
305
tx rosacea
- TOP metronidazole if mild
- TOP brimonidine gel
- systemic abx eg oxytetracycline if severe sx
- daily suncream
- laser therpay for telangiectasia
- refer to derm if rhinophyma
306
what is koebner phenomenon
formation of new skin lesions at sites of sin injury in psoriatic patients/lichen planus/vitilgo
