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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
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2
Q

What is the epidermis

A

Outermost layer of the 3 layers of the skin

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3
Q

What are langerhans cells of the skin

A
  • present in the epidermis and dermis

- antigen presenting cells- travel to lymph nodes

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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
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5
Q

what are the deepest layers of the skin

A

dermis , then hypodermis deeper (ie SC)

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6
Q

What are the layers of the skin

A

Epidermis
Basement membrane
Dermis
Hypodermis

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7
Q

Where is Type 1 collagen found

A 
Skin
tendons
vasculature
organs
bone
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8
Q

Where is Type 2 collagen found

A

Cartilage

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9
Q

Where is Type 3 collagen found

A

Reticular layer of the dermis- commonly found alongside type 1

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10
Q

What are eccrine glands

A

sweat glands

help regulate body temp

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11
Q

What are Apocrine glands

A
  • accompany hair follicles

aporine secretion

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12
Q

what are sebaceous glands

A

degradation of cells causes secretions which lubricate and waterproof hairs

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13
Q

what are meissener’s corpuscles

A

found in papillary dermis, detect light touch

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14
Q

what are pacinian corpuscles

A

foudn in wt bearing areas in deep dermis and SC

deep pressure and vibration detection

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15
Q

What are cavernous haemangiomas/strawberry marks

A
  • Benign
  • present in first few days of life
  • raised
  • resolves around ~1 year, +- scarring
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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
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17
Q

What is a complication of a massive cavernus hemangioma

A

Kasabach-merrit syndrome:

  • decreased platelet count- thrombocytopenia
  • DIC
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18
Q

What is a port wine stain

A

nevus flammeus

  • benign
  • present at birth
  • flat
  • stays for life
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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

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20
Q

What is a nevus

A

mole

  • small dark spot
  • san damage can cause them to become malignant
  • more in Tunernes syndrome
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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
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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
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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
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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

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25
Q

Management of an abscess

A
  • inscision and drainage

- abx

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26
Q

what would you treat an abscess of the belly button with

A

co-amox

is in confined area so may be caused by an anaerobe or an aerobe

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27
Q

What are the types of cysts

A
  • 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
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28
Q

tx of skin cyst

A
  • do not burst
  • warm compress
  • excision
  • Abx- fluclox
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29
Q

What are boils

A
  • deep folliculitis
  • staph areus
  • looks like big, spots, filled with exudate
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30
Q

What are carbuncles

A
  • 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
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31
Q

presentation of contact dermatitis

A
  • infammation
  • blistering
  • dry
  • thickened- red/dark brown
  • cracked
  • sore, stinging, itchy
  • normlly on hands/face
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32
Q

management of contact dermatitis

A
  • avoid irritant or allergen
  • emollient
  • topical steroid- hydrocortisone, beclamethason
  • oral steroids
  • *- phototherapy
  • immunosupression
  • *- alitretinoin- retinoid

– if occupational- need to report it to OH department

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33
Q

Causes of itchy skin

A
  • 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
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34
Q

who is xerosis more common in

A

elderly

redcued sebum production, loss of collagen and elastin

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35
Q

Management of xerosis in elderly

A
  • inspect regulalry for damage
  • emollients regularly
  • OTC products containing menthol- creates cold burn sensation that can relieve itching– eg tiger balm , capsacin
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36
Q

What types of ichthyosis vulgaris are there

A

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
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37
Q

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

A

Ichthyosis vulgaris

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38
Q

What are some causes of pruritis ani

A
  • 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
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39
Q

Ix for itchy anus

A
  • DRE

- swab

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40
Q

management of pruritis ani

A
  • coping techniques
  • diet
  • meds- laxatives, abx
  • soothing topical preparations containing bismuth subligate, ZnO
  • midly potent corticosteroids if inflamed
  • sedating antihistamines if nocturnal
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41
Q

Causes of pruritis vulvae

A
  • dermatological conditions- eczema psoriasis
  • infections, infestations
  • neoplasia- lichen sclerosis/VIN/carcinoma
  • hormones- atrophic vaginitis
  • GI disease and urinary incontinence
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42
Q

management of pruritis vulvae

A
  • 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
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43
Q

What is urticaria

A

Type 1 hypersensitivity

swelling involving superficial dermis, raising the epidermis

itchy wheals

prostaglandins, leukotrienes, chemotactic factors, mostly– histamine (skin mast cells)

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44
Q

What is angioedema

A
  • Type one hypersensitivity
  • deeper swelling than urticaria involving dermis and SC tissue
  • tongue, lips
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45
Q

What is anaphylaxis, sx

A
  • type 1 hypersensitivity (igE , histamine from mast cells and basophils)
  • bronchospasm, facial and laryngeal oedema, wheeze, SOB, hypotension, tachycardia, light-headedness, collapse
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46
Q

Management of urticaria

A
  • Avoid trigger
  • Antihistammines- cetirizine, fexofenadine, loratadine
  • oral pred if severe
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47
Q

Tx of angioedema

A
  • corticosteroids (pred)
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48
Q

tx of anaphylaxis

A

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

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49
Q

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

A

Erythema Nodosum

Causes- TB!!, sarcoidosis, IBD, chlamydia, group A beta haemolytic strep

most commonly found on shins

tender nodules–> bruises

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50
Q

Management of erythema nodosum

A

painkillers

self limiting

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51
Q

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?

A

Erythema Multiforme

can be

  • idiopathic
  • triggered by medications (penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapineor)
  • infections (HSV)
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52
Q

How can you differentiate between steven johnsons syndrome, toxic epidermial necrolysis and erythema mulitforme

A

Erythema multiforme- no mucosal involvement/limited to one mucosal surface

SJS- at least 2 mucosal sites involved

Toxic epidermal necrolysis- involves mucosal surfaces

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53
Q

what is steven johnsons syndrome

A

mucocutaneous necrosis with at least 2 mucosal surfaces involved

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54
Q

sx of steven johnsons syndrome

A
  • 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
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55
Q

sx of erythema multiforme

A

target like/bulls eye spots
red spots with dakr centre

start on hands/feet- spread up limbs and trunk

sudden onset

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56
Q

tx of erythema multiforme

A
  • 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
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57
Q

Causes of steven johnson syndrome

A

drugs

infections

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58
Q

Management of steven johnson syndrome

A 
- stop causative agent
analgesia, fluids
debridement of necrotic skin
dressings and emollients
ophthalmological review (iris, conjunctival scarring, conjunctivitis, corneal blisters)
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59
Q

What is Toxic Epidermal Necrosis

A

Acute

  • skin and mucosal necrosis (over 30%)
  • with systemic toxicity
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60
Q

causes of toxic epidermal necrosis

A

usually drug induced

  • abx- -sulphonamide, penicillins
  • allopurinol
  • carbamazepine, phenytoin
  • NSAIDs
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61
Q

presentation of toxic epidermal necrosis

A

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

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62
Q

Management of toxic epidermal necrosis

A
  • stop causative agent
  • full supportive care- analgesia, fluids
  • *- debridement of necrotic skin
  • dressings
  • emollients
  • *- ophthalmological review
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63
Q

What is bullous pemphigoid

A

elderly
Autoimmune

attacks antigens between epidermis and dermis, causing sub-dermal split in the skin

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64
Q

Presentation of bullous pehmphgoid

A

tense, fluid filled blisters on an erythematous base

  • large blisters
  • itchy
  • may be preceded by a non specific itchy rash
  • trunk and limbs
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65
Q

Management of bullous pemphigoid

A
  • wound dressings
  • topical steroids
  • oral steroids, tetracycline, nicotinamide
  • azathioprine/methotrexate- immunosups
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66
Q

What is pemphigus vulagris

A

midle-aged/older

autoantibodies against antigens within epidermis
intra-epidermal split

blistering and erosion of skin and mucosal membranes

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67
Q

presentation of pemphigus vulgaris

A
  • flaccid, easily ruptured blisters
  • form erosions and crusts
  • painful
  • usually affects mucosal areas
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68
Q

Management of phemphigus vulgaria

A
  • dressings
  • oral care
  • hgih dose steroids
  • immunosups- metho, azathioprine, cyclophosphamide
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69
Q

Two main subdivisions of skin cancer

A
  • melanocytic (melanoma)

- non melanocytic (keratinocyte carcinomas, cancers of the epidermis, eg BCC, SCC,

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70
Q

What are melanocytic naevi

A
  • moles, skin tags

- raised or flat

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71
Q

how to check if mole is malignant

A
  • ABCDE
Asymetry
Boarder- irregular
Colour - multi
Diamtere >6mm
Evolving
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72
Q

What si seborrheic keratosis, appearance

A

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
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73
Q

Management of seborroeic keratosis

A
  • leave it

- if irritating- cryotherapy, curettage

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74
Q

What is actinic keratosis

A
  • precancerous- 20% chance of turning into SCC

appearance

  • red or white flat plaques
  • mostly seen on scalps
  • feel rough, dry
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75
Q

Causes/RFs of actinic keratosis

A
  • UV- sunbeds, sunbathing
  • P53 mutation
  • *- HPV
  • *- immunosupression
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76
Q

Ix for actinic keratosis

A

look out for IDRBEU (BCC)

  • induration/inflam
  • Diamtere >1cm
  • rapidly growing
  • bleeding
  • erythema
  • ulceration

biopsy/excision

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77
Q

What is Bowen’s disease, appearance

A
  • non invasive SCC
  • precancerous

irregular, well defined red,scaly lesion
slow growing
sun-distributed, often on shins

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78
Q

Management of Bowen’s disease

A
  • topical 5-flurouracil (cytotoxic)
  • cryotherapy, excision
  • pt education- UV protection
  • FU- 3m
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79
Q

What is a malignant melanoma

A
  • highly malignant
    melanocyte tumour
    1/4 progress from moles
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80
Q

RFs for malignant melanoma/SCC

A
  • UV exposure
  • prev skin ca
  • > 5 melanocytic naevi
  • immunosupression
  • genetic skin conditions
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81
Q

presentation of malig melanoma

A 
asymmetrical
irregular border
multi-pigmented lesion
diameter >6mm
evolving
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82
Q

ix for malignant melanoma

A
  • dermatoscpoy- ABCDE
  • excision biopsy
    METS
    **- lactate dehydrogenase (mets liver)
  • XR
    -CT
  • MRIs, PET
  • USS
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83
Q

Management of malig melanoma

A
  • surgical excision with 0.5cm safety margin
  • CT
  • Immunotherapy
  • if large, nearby lymph node biopsy
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84
Q

Site of mets malig melanoma

A
  • brain
    liver
    bones
    abdo
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85
Q

Cell type of SCC

A

epidermal keratinocytes

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86
Q

presentation of SCC

A
  • 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

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87
Q

Management of scc

A
  • Surgical excision
  • Cryotherapy, curettage, or cautery
  • RT
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88
Q

what cell type is bcc

A
  • epidermal keratinocytes
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89
Q

presentation of bcc

A 
- shiny pearly nodule
with umbilical centre
- rolling edges
- telangiectasias
- face/head/neck
- slow growing
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90
Q

ix for bcc

A

dermatoscopy

biopsy

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91
Q

tx of bcc

A
  • Surgical excision
  • Cryotherapy, curettage, or cautery
  • RT
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92
Q

What is paget’s disease of the nipple

A
  • skin condition indicative of malignanct- HER-2

- Eczemoid changes- itching, flaking, flattened nipple, ulceration

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93
Q

ix for Pagets disease of the nipple

A

punch biopsy

mammogram

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94
Q

tx for pagets disease of the nipple

A
  • excision
  • CT
  • RT
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95
Q

What is Kaposi sarcoma, RF

A

endothelial cell cancer, caused by HPV 8 virus

RF- AIDS, immunosupression

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96
Q

ix kaposis

A

biopsy of the skin
endoscopy , colonoscopy, FIT if suspected in digestive tract
CXR, bronchosocpy

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97
Q

tx of kaposis

A

tx cause- eg HAART retrovirus for HIV
CT or RT
excise big lesions

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98
Q

What is neurofibromatosis

A 
genetic condition
causes tumour (usually benign) to grow along the nerves
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99
Q

Sx of kaposis

A

painless red/purple papules/nodules anywhere on skin or mucous membranes

with N+V, SOB, chest pain, haemoptysis, abdo pain, diarrhoea if affecting internals

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100
Q

What genes are affected in neurofibromatosis

A

NF1 chromosome 17/NF2 chromosome 22

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101
Q

Presentation of neurofibromatosis

A
  • 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
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102
Q

What is the difference between neurofibromatosis 1 and 2

A

NF1- schwannomas on nerves throughout nervous system- impaired hearing, vision, dizziness, balance, discoordination, headaches

NF2- less common, neurofibromas on peripheral nerves. Pain, neurological sx

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103
Q

tx of acne vulgaris

A

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

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104
Q

what advice do you need to give after giving isotreinoin

A

teratogenic- need to use 2x contraception

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105
Q

How to evaluate unconscious , burnt pt

A
  • ABCDE
  • look- mechanism, depth, % coverage
  • monitor NV status of extremities to detect compartment syndrome
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106
Q

Mechanism of burns and how deep they tend to affect

A

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
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107
Q

What are the degree of burns

A 
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

  1. full thickness (3rd degree)
    - epidermis, full dermis and SC
    O/e- dry.waxy/white/leathery/brown
    no blisters, blanching, cap refill or sensation
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108
Q

burns- what is the rule of 9 for calculating % coverage

A 
each arm- 9%
head 9%
entire chest 9%
entire abdo 9%
Entire back 18%
each leg 18%
groin 1%
palm 1%
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109
Q

What is a more precise way of calculating % burns

A

Lund and Browder diagram

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110
Q

Immediate general management of burns

A
  • 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
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111
Q

Immediate management of chemical burns

A
  • 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
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112
Q

Immediate management of electrical burn

A
  • rush to ED (not much 1st aid)

- topical abx- 1% silver sulfadiazine cream, 0.5% silver nitrate solution and mafendine acetate 10% cream

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113
Q

Immediate management of scald

A
  • 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
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114
Q

Immediate management of sunburn

A
  • 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+
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115
Q

Non-immediate management of burns in general

A
  • debridement
  • moisturisation
  • broad spec abx
  • escharotomy
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116
Q

what is an escharotomy

A
  • 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
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117
Q

Where do u cut in an escharotomy

A
  • 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
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118
Q

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

A

burn wound cellulitis

strep pyogens

penicillin

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119
Q

What is the difference between cellulitis and erysipelas

A

cellulitis- involves deep SC tissue

erysipelas- acute, suerficial form of cellulitis, involves dermis and upper SC tissue

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120
Q

What are 2 main bacterial causes of cellulitis

A
  • strep pyogens

staph areus

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121
Q

sx of cellulitis

A

most commonly in lower limb

  • inflammation- swelling, eythema, warmth, pain
  • lymphangitis
  • systemically unwell

erysipelas- more well defined, raised borders

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122
Q

tx of cellulitis

A 
abx- fluclox, benzylpenicillin
rest
leg/limb elevation
sterile dressings
analgesia
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123
Q

complications of cellulitis

A

abscess
septicaemia
local necrosis

124
Q

stages of wound healing

A

1- vascular response/haemostasis
- vasoconstriction and platelet aggregation
clot formation

    • inflammatory response
      - vasodilation, neutrophil infiltration, macrophages
      - pahgocytosis

3- proliferation

  • granulation tissue (made by fibroblasts)
  • angiogenesis
  • re=epitheliazation
    • Maturation/remodelling
      - collagen fibre reorganisation
      - scar maturation
125
Q

5 features of inflammation

A 
Rubor
Calor (heat)
Dolor (pain)
Tumour
loss of function
126
Q

Intention of wound healing

A

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
Q

What are the 5 main types of dressing

A 
Alginate
Foams
Hydrocolloid
Hydrogel
Collagen
128
Q

What are alginate dressings, when are they used

A
  • 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
Q

What are foam dressings

A
  • absorbent
  • allow water vapour to enter
  • non adhesive/adhesive options
130
Q

What are hydrocolloid dressing, when are they used

A

Absorbs water and forms a gel
Long lasting

good for...
burns
exudative/weeping wounds
wet necrotic wounds
pressure ulcers
venous ulcers
131
Q

What are Hydrogeldressing, when are they used

A
  • 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
Q

What are collagen dressing, when are they used

A
  • 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
Q

Eczema exacerbating factors

A 
Allergens- chemicals, food, dust, fur
Sweating
Heat
Stress
Over-washing
- Lack of sunlight
134
Q

What are the different types of eczema (7)

A
  • Atopic
  • Contact
  • Dyshidrotic
  • *- Neurodermatitis
  • Nummular/Discoid
  • Stasis/varicose/gravitational
  • *- Sebborheic
135
Q

What is atopic eczema, presentation

A
  • inherited factors
  • inflammatory
  • famhx dermatitis/atopy
  • personal hx of atopy (hayfever, asthma)
  • generalised dryness, itchiness, rash
  • widespread
136
Q

What is contact dermatitis, presentation

A
  • 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
Q

what is discoid/nummular eczema, presentation

A
  • 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
Q

What is Seborrhoeic dermatitis, presentation

A
  • 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
Q

What is dyshidrotic/pomopholyx eczema?

A
  • 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
Q

What is neurodermatitis/lichen simplex chronicus

A
  • 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
Q

What is stasis eczema

A
  • 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
Q

What are some complications of dermatitis/eczema

A
  • infection (S.aureus, herpes simplex)
  • thickening
  • psychosocial
143
Q

What is eczema herpeticum/kaposi varicelliform eruption

A

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
Q

Presentation of eczema herpeticum

A
  • 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
Q

Complications of eczema herpeticum

A
  • secondary infection- staph, strep– impetigo, cellulitis
  • scarring
  • herpes hepatitis
  • encephalitis/meningitis
  • keratoconjunctivitis
146
Q

diagnosis of eczema herpeticum

A
  • viral culture
  • *- fluorescent antibody scan
  • PCR
  • Tzank smear
  • bacterial swabs for secondary infections
147
Q

tx eczema herpeticum

A
  • refer immediately
  • oral aciclovir
  • calamine, doxepin for itch
148
Q

tx of seborrhoeic dermatitis

A
  • shampoos with active agents against yeast (ketoconazole, coal tar)
  • mild topical corticosteroids
149
Q

tx of eczema

A
  • 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
Q

Examples of emollients

A 
--Least greasy--
E45 lotion
Aproderm Cream
Diprobase ointment
50:50 ointment, paraffin, hydromol ointment
--Most greasy--
151
Q

What is erythroderma, causes

A
  • intense, widespread reddening of the skin (at least 90%)

casues

  • eczema, psoriasis
  • lymphoma
  • drugs- sulphonamides, sulphonylureas, penicillin, allopruinol
  • idiopathic
152
Q

presentation of erythroderma

A
  • inflammed, oedematous, erythromatous skin
  • scaly
  • systemically unwell
  • lymphadneopathy
  • malaise
  • skin peeling
153
Q

tx erythroderma

A
  • tx cause
  • emollients
  • wraps- moisture
  • topical steroids
154
Q

mortality of erythroderma

A

20-40%

155
Q

complications of erythroderma

A
  • *- 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
Q

What is tinea, presentation

A
  • RINGworm
  • FUNGAL infection
  • ring shaped, scaly rash with clearing centre
157
Q

tx of tinea

A
  • ketoconazole or selenium sulfide shampoo
  • topical antifungal- imidazoles (clotrimazole, ketoconazole)
  • terbinafine cream
158
Q

what is tinea corporis

A
  • tinea of trunk and limbs
    itchy, circular/annular lesions
    clearly defined
159
Q

What is tinea cruris

A
  • very itchy
  • warm, moist areas of the body
  • similar to tinea corporis in appearance
160
Q

What is tinea pedis, tx

A
  • athletes foot!!!
  • moistscaling and fissuring in the toe webs
  • spreads to soles and dorsal aspect of the foot
  • OTC topical creams containing tolnaftate
161
Q

what is tinea manuum, presentation

A
  • tinea of the hand

- scaling, dryness in palmar creases

162
Q

What is tinea unguium, presentation and tx

A 
tinea of the nail
Onychomycosis
- yellow discolouration
- thickened
- crumbly

oral triazole, topical tioconazole

163
Q

what is tinea capitis

A

tinea on scalp

- patches of broken hair, scaling, inflammation

164
Q

what is tinea versicolour/pityriasis

A
  • 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
Q

Sx of candida skin infections

A

White plaques if on mucosa

- erythema/hyperpigmentation in darker skin tones with satellite lesions in flexures

166
Q

how to distinguish nappy rash from candida

A
  • nappy rash- sparing of screases

- thrush- in creases

167
Q

sx of oral thrush

A
  • 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
Q

tx thrush

A
  • oral–> mystatin, fluclonazole, triazole
  • skin–
    topical imidazole (clotrimazole, ketoconazole)
    topical terbinafine
    topical nystatin
  • Genital
    Imidazoles- topical/pessary (clotrimazole)
    Oral- fluclonazole
169
Q

What is malassezia

A
  • a yeast

- found to cause dandruff, seborrhoeic dermatitis, tinea versicolour, folliculitis

170
Q

tx of seboorhoeic dermatitis

A

steroid and antifungal

171
Q

tx of malassezia caused tinea versicolour, dandruff, folliculitis

A

shampoos containing selenium disulfide, ketoconazole

172
Q

Cutaneous aspergillus infection- sx

A
  • single or multiple red/violet hardened plaques/papules
  • may be tender
  • evolve into blood/pus blisters
  • centre become necrotic- blackens and scabs
173
Q

tx of skin aspergillus infection

A

voriconazole

liposomal amphotericin B

174
Q

What type of organism is aspergillosis

A

mould

175
Q

What is impetigo

A

Acute superficial bacterial infection
staph aureus (bullous)
group A beta haemolytic strep/strep pyogens (non-bullous, ulcerated)

176
Q

types of impetigo

A

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
Q

sx of impetigo

A

blisters, pustules
honey coloured crust
face, hands, trunk, perineum
single or multiple lesions

lymphadenopathy, fever, malaise

178
Q

ix of ?impetigo

A

bcterial swab- microscpoy, culutre, sensitvity

179
Q

tx of impetigo

A
  • 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
Q

advice of pt with impetigo

A
  • 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
Q

tx of dog/cat bites

A
  • co-amox for 5 days

- metronidazole plus doxy if allergic for 5d

182
Q

what infections can cat bites cause

A
  • viral -rabies
  • cat scratch disease- Bartonella henselae
  • pasteurella multocida
183
Q

sx of at scratch disease

A
  • swelling, blister at site of bite.scratch
  • lymphadenopathy
  • fever
  • headache
  • myalgia
  • arthralgia
  • fatigue
  • poor appetite
184
Q

sx of pasteurella multocida

A
  • swelling, pain, redness at wound site within 2 days
185
Q

what diseases can you catch from cat/dog faeces

A
  • salmonella
  • hookworms, roundworms
  • Protazoal infections (cryptosporidiosis, giardiasis, toxoplasmosis)
186
Q

sx of toxoplasmosis

A
  • myalgia
  • fever
  • headache
  • confusion, seizures, vomiting
187
Q

indications for prophylactic abx after cat/dog bite

A
  • wound requiring surgical repair
  • sensitive area eg hands, face, genitals
  • close to bone/joint
  • immunocomprimised
  • deep/significant wound
188
Q

What are the guidleines concerning tetanus jab following a laceration

A
  • booster needed within 10 years if clean, simple cut

- booster needed within 5 years if complex/dirty cut

189
Q

tx of lice/pediculosis capitis

A
  • 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
Q

Mechanism of necrotising fascitis- causes

A

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
Q

Types of nec fascitis

A

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
  1. 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
Q

sx of nec facsitis

A 
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
Q

ix for ?nec fascitis

A

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
Q

tx nec fascitis

A
  • 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
Q

complications of nec fascitis

A
  • metastatic abscesses- lung, liver, brain, spleen, skin, pericardium
  • death
  • renal failure
  • multiorgan failure
  • disfigurement
  • septiciaemia
196
Q

What is periorbital/preseptal cellulitis

A
  • infection of the eyelids and periorbital skin
  • no involvement of the orbit
  • can follow minor injury to the eye /sinusitis
197
Q

causative microorganisms of periorbital/preseptal cellulitis

A

Haemophilus influenzae
Staph
Strep

198
Q

sx or periorbital/preseptal cellulitis

A
  • redness
  • oedema around eye

you need to check eye movements- if reduced, is orbital cellulitis and is much more serious

199
Q

complications of periorbital/preseptal cellulitis

A
  • sinusitis
  • meningitis
  • *- pneumonia
  • *- otitis media
    • conjuncivitis
  • *- epiglottitis
200
Q

tx of periorbital/presptal cellulitis

A
  • oral coamox/clinda with metro
  • IV ceftriaxone
  • ophthalmic and ENT assessment
201
Q

tx if ?orbital cellulitis

A

IV coamox/clinda with metro

CT head

202
Q

Red flags of orbital cellulitis

A

admit immediately if:

  • CN involvement
  • systemically unwell
  • not responding to above tx
  • when drainage of lid abscess is required
203
Q

What is a pilonidal cyst

A
  • cyst forms on the natal cleft due to an ingrown hair

- becomes an abscess and sinus if infected recurrently

204
Q

who do pilonidal cysts occur in

A
  • mainly in hairy men
205
Q

sx of pilonidal cyst

A
  • painful swelling at top of natal cleft

- may discharge

206
Q

indications of referral to colorectal with pilonodal cysts

A
  • recurrent infections
  • cyst discharging w/o signs of infection
    (may have become sinus, risk of becoming a fistula with rectum
207
Q

indication pilonidal cyst has become a fistula

A

foul smelling discharge

208
Q

tx of pilonidal cyst and complications

A
  • fluclox for acute infection
  • surgery to close fistula
  • advise men to wax as this will prevent ingrown hairs
209
Q

What classification system is used for pressure ulcers

A

European pressure ulcer advisory panel classification system

- grade1-4

210
Q

What is a grade 1 pressure ulcer

A

non-blanchable erythema of intact skin

- darker skin- discolouration, warmth, oedea, induration, hardness

211
Q

What is a grade 2 pressure ulcer

A
  • 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
Q

What is a grade 3 pressure ulcer

A
  • full thickness skin loss
  • damage to/necrosis of SC tissue
  • may extend down to but not through fascia
213
Q

What is a grade 4 pressure ulcer

A
  • tissue necrosis or damage to muscle/bone/supporting structures
  • +- full thickness skin loss
214
Q

What is psoriasis

A
  • hyperproliferation of keratinocytes

inflammatory cells infiltration

215
Q

What are the different types of psoriasis (7)

A
  • Chronic Plaque Psoriasis
  • Guttate psoriasis
  • *- Inverse psoriasis
  • *- Pustular psoriasis
  • Erythrodermic psoriasis
  • Nail Psoriasis- pitting and oncholysis
  • Psoriatic arthritis
216
Q

sx of chronic plaque psoriasis

A
  • white/red/hyperpigmented patches
  • extensor surfaces of elbows, knees, scalp, lower back
  • pruritis, burning, pain
  • Auspitz sign (pinpoint bleeding when plaque is removed)
217
Q

Auspitz sign- what is it?

A

careful scratch and removal of scales cause bleeding

218
Q

what is the most common type of psoriasis

A

Chronic Plaque

219
Q

sx of guttate psoriasis

A
  • Small, pink/red spots
  • Trunk, upper arms, thighs, scalp
  • Assoc w strep throat
220
Q

sx of inverse psoriasis

A
  • 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
Q

sx of pustular psoriasis

A

pustules surrounded by red skin

  • hands, feet, may cover most of body
  • fever, nausea, high BPM, muscles weakness
222
Q

sx of erythrodermic psoriasis

A
  • v serious
  • affects most of body
  • fiery skin that appears burned
  • severe pruritis
  • peeling
  • fast bpm
  • changes in body temp
223
Q

sx of nail psoriasis

A
  • often w psoriasis arthritis
  • pitting
  • tender nails, painful,
  • onycholysis- separation from the nail bed
  • yellow/brown discolouration
  • chalk like material under nail
224
Q

sx of psoriatic arthritis

A
  • most also have nail changes
  • painful, stiff joints
  • worse in morning/after rest
  • warm, swollen joint
  • sausage digits
  • boutonniere deformity of the toe
225
Q

What is arthritis mutilans

A
  • shortening of the fingers
  • sausage
  • looks paw like
    excess skin creates folds at the joints
226
Q

Management of psoriasis

A 
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
Q

complications of psoriasis

A

erythroderma
pruitis ani/vulvae
skin infections
psychological and social effects

defomities

  • arthritis mutilans
  • boutonniere (although more commonly seen in RA)
228
Q

what is erysipelas/cellulitis commonly caused by

A

group a strep (pyogens)

also cause scarlet fever- so sometimes coincide

229
Q

what organsism causes scarlet fever

A

group A beta haemolytic strep (pyogens)

230
Q

sx of scarlet fever

A
  • 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
Q

tx of scarlet fever

A

Strep pyogens

  • phenoxymethylpen for 10d
  • azithromycin if allergy
232
Q

What is staph scalded skin syndrome

A
  • infancy and childhood
  • ## benzylepenicillin resistant (coagulase positive) staph trigger epidermolytic toxin reaction
233
Q

Presentation of staph scalded skin

A
  • 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
Q

Management of staph scalded skin syndrome

A
  • systemic penicillinase resistant penicillin eg methicillin or
  • fusidic acid or
  • erythromycin or
  • cephalosporin
  • analgesia
235
Q

Describe a typical arterial ulcer

A
  • small
  • sharply defined
  • deep
  • necrotic base
236
Q

describe a typical venous ulcer

A
  • large
  • shallow
  • irregular boarder
  • exudative and granulating base
237
Q

what features other then the ulcer may you see in venous deficiency

A
  • peipheral oedema
  • haemosiderin and melanin deposition (brown)
  • lipodermatosclerosis- hardening, redness of the skin (SC swelling)
  • atrophine blanche (white scarring due to dilated capillaries)
238
Q

describe a typical neuropathic ulcer

A

variable in size and depth
granulating base
may be surrounded by or over a hyperkeratotic lesion eg callus

239
Q

describe a vasculitic ulcer

A

deep
punched out
reddish/blue tinge around edge
may be accompanied by a purpuric rash

240
Q

what is pyoderma gangrenosum

A
  • autoinflammatory

- assoc with UC, IBS, RA, myeloid dysplasia, gammopathy

241
Q

sx of pyoderma gangrenosum

A
  • 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
Q

tx of pyoderma grandrenosum

A

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
Q

molluscum contagiosum, organism

A
  • parvovirus
244
Q

molluscum contagiosum presentation

A
  • localised clusters of epidermal papules, pearly papules with umbilication
245
Q

who does molluscum contagiosum affect

A
  • children, infants, HIV+
246
Q

transmission of molluscum contagiosum

A

skin to skin contact
towels
autoinolculation
sexual transmission

247
Q

Management of molluscum contagiosum

A
  • 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
Q

complications of moiluscum contagiosum

A 
secondary bact infection from scracthing (impetigo)
conjunctivitis if eyelid affected
eczema
widespread molluscum 
pitted scarring
249
Q

what causes viral warts

A

HPV

250
Q

classification of viral warts

A

Cutaneous

mucosal- anogenital, sex

251
Q

what are cutaneous warts, transmission

A
  • skin to skin contact/autoinoculation

- proliferation of keratinocytes and hperkeratosis

252
Q

Types of cutaneous wart

A
  • common wart
  • plantar/verruca plantaris
  • plane/flat warts
  • filliform
253
Q

appearance of common wart, cause

A

cauliflower like papules with rough surface

HPV-2

254
Q

appearance of verruca plantaris, cause

A

tender, inwardly growing, yellow, hyperkratotic callus-like

HPV-1

255
Q

appearance of plane wart, cause, common location

A

multiple, flat topped
skin coloured papules

HPV3, 10
face.hands, shins (often spread via shaving)

256
Q

Appearance of filliform wart

A

cluster of fine fronds emerging from narrow pedicle
usually on face
digitate (finger like)

257
Q

Management of cutaneous warts

A
  • refer if on face

non facial:

  • topical keratlytic salicylic acid
  • cyrotherapy

Hands and feet- formaldehyde, silver nitrate

258
Q

What are chicken pox cuased by

A

Human alphaherpesvirus 3 (HHV-3)

also called varicella zoster virus

259
Q

transmission of chicken pox

A

direct skin to skin contact with open sores

260
Q

sx of chicken pox

A
  • icthy red papules with vesicles in centre
  • high fever
  • headache
  • cold like sx
  • vomiting
  • diarrhoea
  • clear up in 1-3w, may leave scars
261
Q

Complications of chicken pox (in non pregnant people)

A
  • secondary bact inf (abscess, cellulitis, nec fasc, gangrene
  • dehydration
  • exacerbation of asthma
  • viral pneumonia
  • encaphalitis
  • GBS
  • Reye’s
262
Q

complication of chicken pox in non immune pregnant woman

A
  • 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
Q

tx of chicken pox

A
    • trim nails
  • warm bath
  • emollients
  • paracetemol
  • calamine lotion
  • oral antihistammines
  • oral acyclovir if >12 years old
  • immunocomp- IV aciclovir
  • vaccination prevention is recommended
264
Q

What causes shingles

A

herpes zoster reminas dormant in dorsal root ganglion, reactivated and travels down sensory nerve to the skin

265
Q

sx of herpes zoster

A

(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
Q

tx shingles

A

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
Q

management of posteherpetic neuralgia

A
  • capsacin cream 3-4x per week for 1 w
  • then oral carbamazepine
  • amitriptyline, gabapentin, pregablin
  • TENS
  • botulinum toxin
268
Q

complications of shingles

A
  • postherpetic neuralgia
  • ophthalmic complications if over V division
  • muscle weakness- VII palsy (Bells/ramsay hunt)
  • encephalitis
269
Q

prevention of shingles/herpes zoster

A

vaccination

- 70-78y/o, optional

270
Q

What is pityriasis rosea, who does it affect

A
  • viral rash

- mostly in teens and young adults

271
Q

presentation of pityriasis rosea

A
  • 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
Q

tx of pityriasis rosea

A
  • 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
Q

What is the difference between bullous pemphigoid and pemphigus vulgaris?

A

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
Q

Lichen planus- sx

A
  • 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
Q

what conditiions are associated with UC

A
  • large-joint arthritis
  • sacroilitis
  • pyoderma gangrenosum
  • primary sclerosing cholangitis
276
Q

tx lichen planus

A
  • potent topical corticosteroids.
277
Q

diabetic pt has chronic ulcer with green slough and offensive smell- most likely causative agent?

A

Pseudomonas

  • commonly causes opportunistic infections in patients with any degree of immunosuppression
  • neuropathic ulcers
  • green slough
  • offensive smell
278
Q

what is melasma

A

dark pigmentation of pregnant women/ women taking HRT/contraceptives

279
Q

what is pityriasis alba

A

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
Q

what is erythrasma

A

brown, sclay skin

obese/diabetics

281
Q

what is a Keratoacanthoma, management

A

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
Q

characteristics of acne vulgaris

A
  • Open and closed comedones
  • pustules
  • nodules
283
Q

SE of TOP steroids

A
  • skin depigmentation
  • excessive hair growth
  • skin atrophy
284
Q

what drug class worsens plaque psoriasis

A

beta blockers

285
Q

appearance of morphoeic basal cell carcinoma

A
  • waxy, scar like plaque- poorly defined adges
286
Q

tx of morphoeic BCC

A

mohns micrographic surgery is gold standarf

287
Q

what si the most common type of BCC

A

nodular

  • pearly, flesh coloured papule with telangiectasia,
  • umbilical dot/ulceration in middle
  • rolled edge
  • may ulcerate, causing a crater
  • sun exposed areas
288
Q

what is erythem ab igne

A

heat rash lol

  • reticulated, lacy rash with patches of hyperpigmentation and telangiectasia
  • over exposure to infrared radiation (open fires, hot water bottle)
289
Q

sx dermatitis herpetiformis

A

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
Q

condition dermatitis herpetiformis is assoc with, tx

A

coeliac

  • gluten free diet
  • dapsone
291
Q

what is a pyogenic granuloma, tx

A
  • purple papular lesion at site of trauma
  • bleeds with contact

tx with silver nitrate, phenol, trichloroacetic acid

292
Q

what antifungal inhibits squalene epoxidase and SE is haematoligcal issues (pancytopenia, agranulocytosis, abnormal LFTs)

A

terbinafine

293
Q

what antifungal is use to tx fungal nail infections once this has been confirmed with ix

A

terbinafine PO

294
Q

what is amphotericin B used for

A

systemic fungal issues

295
Q

how is nystatin used

A

very toxic, only used topically eg oral thrush

296
Q

skin manifestations of SLE

A
  • photosensittive butterfly rash on face
  • discoid lupus- coin shaped dry lesions
  • alopecia
  • livedo reitcularis (web/lace like rash)
297
Q

distinguishing between impetigo infected eczema and eczema herpeticum

A

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
Q

sx staphlococcal toxic shock syndrome

A
  • 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
Q

tx toxic shock

A

strep or staph

  • removal of infectious source (eg tmapon)
  • IV fluids
  • IV abx
  • strep- surgeical debridement of source of infection
300
Q

strep toxic shock syndroem

A 
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
Q

what is a solitary, firm papule or nodule which dimples when pinched (positive retraction sign) likely to be?

A
  • dermatofibroma

often occurrs following injury to skin eg shaving cut

302
Q

tx for hirutuisim

A
  • COCP- anti-androgen. eg co-cyprindiol/dianette, Yasmin

- facial- TOP eflornithine (not in preg or breast feeding)

303
Q

scoring system sued for hirtuism severity

A

ferriman gallwey

304
Q

sx rosacea

A
  • 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
Q

tx rosacea

A
  • 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
Q

what is koebner phenomenon

A

formation of new skin lesions at sites of sin injury in psoriatic patients/lichen planus/vitilgo

Finals (15 decks)

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