Dermatology Flashcards
what is BCC a malignancy of?
basal epidermal keratinocytes
a pearly, flesh coloured papule with rolled edge
Associated telangiectaisa.
Ulcerated
Bleeds from minor trauma
What is the diagnosis?
BCC
- what is SCC a malignancy of?
- What are its premalignant lesions known as?
- What is SCC in situ also known as?
- epidermal keratinocytes
- solar keratosis
- bowen’s disease
Ill defined, dome shaped lesion
rapid growing
ulcerated and bleeds easily
multiple associated actinic solar keratoses on surrounding skin.
What is the diagnosis?
SCC
What is malignant melanoma a malignancy of?
Melanocytes
Mole has grown recently
Borders are now irregular
multiple colours
What is the dx?
Malignant Melanoma
- What is the most common form of Malignant Melanoma?
- What is the most aggressive type of malignant melanoma and why?
- What is used to measure depth of spread of melanoma (i.e. T on TNM staging?
- superficial spreading
- nodular - vertical invasion
- breslow thickness
- Inflammatory lesions of acne vulgaris (3)
2. non-inflammatory lesions of acne vulgaris (2)
- papules, pustules, macules
2. comedomes, pseudocysts
stepwise management of acne vulgaris (4)
- single topical therapy - benzyl peroxide or retinoids
- combination topical therapy - benzyl peroxide/retinoids + clindamycin
- oral antibiotics (tetracyclines or erythromycin if contraindicated)/COCP + topical treatments
- oral isotreinoin
elderly patient
itchy, tense blisters, around flexures
mouth is spared
- what is the diagnosis
- pathophysiology
- management
- bullous pemphygoid
- autoimmune
- refer to derm; oral corticosteroids
- Most common subtype of psoriaisis
2. exacerbating factors (5)
- plaque psoriasis
- trauma
alcohol
drugs - beta blockers, lithium, antimalarials, NSAIDS, ACEi
withdrawal of systemic steroids
steptococcal infection (gluttate psoriasis)
NAME THE SUBTYPE OF PSORIASIS BASED ON THE FOLLOWING CLINICAL FEATURES
- well defined, red, scaly patches affecting extensor surfaces, sacrum and scalp
- shiny, smooth, red, well defined patches localised to skin folds and genitals
- transient psoriatic rash with multiple teardrop lesions
- red, tender, rash followed by the appearance of small pustules, which become bigger. Commonly occurs on palms and soles
- plaque psoriasis
- flexural psoriasis
- gluttate psoriasis
- pustular psoriasis
Management of Psoriasis
a) general conservative measure
b) stepwise topical mangagement
c) first line systemic therapy and what this can be useful for
a) regular emollients to reduce scales and pruritis
b) 1. topical potent corticosteroid + vitamin D analogue OD for up to 4 weeks
2. vitamin D analogue BD for up to 8 weeks
3. potent corticosteroid BD for up to 4 weeks, or coal tar preparation
c) methotrexate - associated joint disease
- What other condition is dermatitis herpetiformis associated with and why?
- how is it managed?
- coeliac disease - IgA deposition in dermis leading to inflammatory response
- management of coeliac disease
Dapsone
Itchy, vesicular skin lesions on extensor surfaces
abdominal pain and bloating, weight loss, steatorrhoea
What is the dx?
Dermatitis Herpeteformis
Child with atopic eczema Rash has come on suddenly painful round, punched out lesions feels unwell
What is the dx?
Eczema herpeticum
Management of Eczema Herpeticum
- swab for viral PCR and bacterial cultures (impetigo is a ddx; can be complicated by secondary bacterial infection)
- consider admission - dermatological emergency
- acyclovir - oral or consider IV
- systemic Abx if complicated by secondary bacterial infection
rapid eruption of multiple target lesions of varying sizes
flat, or slightly raised
painless
preceding viral infection
what is the diagnosis?
Erythema multiforme
Causes of Erythema Multiforme:
- infection
- drugs
- systemic diseases
- herpes simplex, streptococcus, mycoplasma
- penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraception
- SLE, sarcoidosis
tender, erythematous, nodular lesions over the shins
self resolving over 6 weeks, with no scarring
What is the dx?
erythema nodosum
Causes of Erythema Nodosum
- infection
- systemic disease
- drugs
- streptococcus, tuberculosis
- Sarcoidosis, IBD, malignancy, lymphoma
- penicillins, sulfonamides, COCP
pregnancy
- tinea infection of the head
- tinea infection of the body
- tinea infection of the groin
- tinea capitis
- tinea corporis
- tinea cruris
ring shaped lesion, with scaly edge, and central hypopigmentation
associated itch
what’s the diagnosis?
dermatophyte infection (tinea)
management of tinea
topical antifungals - terbinafine is first line
keep skin clean and dry thoroughly
- Pathophysiology of Impetigo
- ddx
- management of impetigo
- public health measures
- S. aureus/S. pyrogenes infection
- eczema herpeticum
- topical hudrogen peroxide or topical fusidic acid; oral fluclox/erythromycin if extensive disease
- children should be excluded from school until all lesions are crusted and healed or 48 hours after commencing abx
summer
child with golden crusted lesions around the mouth
what is the dx?
Impetigo
What is keratoacanthoma?
A benign epithelial tumour
smooth, dome shaped papule
central crater filled with keratin
what is the dx?
Keratoacanthoma
hard white spots on oral mucous membranes/tongue
lesions can’t be rubbed off
- what is the dx?
- what are the concerns with this condition? (2)
- leukoplakia
- premalignant condition - can transform to become SCC (regular follow up required)
associated with HIV infection
itchy, papular rash over flexor surfaces, palms and soles
polygonal lesions with white line pattern on surface
- dx?
- management?
- Lichen Planus
2. potent topical steroids
white/hypopigmented crinkled or thickened patches of skin that tend to scar.
elderly female, lesion over genitals
very itchy
- diagnosis
- management
- concern?
- lichen sclerosus
- topical steroids and emollients
- increased risk of vulval cancer
pinkish/pearly white papules with central umbilication <5mm in diameter
clusters of lesions
found on trunk/flexures/anogenital region
- dx?
- cause/pathophysiology?
- management?
- molloscum contagiosum
- viral infection (molloscum contagiosum). spread by close contact
- self limiting
mild topical corticosteroid and emollient if itching is problematic
Ashkenazi Jewish patient
widespread, painful blisters and mucosal ulceration
easily ruptured
- dx?
- aetiopathophysiology?
- management?
- Pemphigus Vulgaris
- autoimmune condition - antidesmoglein 3 antibodies
- steroids and immunosuppressants
19 year old patient
Initial red patch on trunk
now has generalised “fir tree” rash
had a URTI last week
- dx?
- Ddx?
- Pitytiasis Rosea
2. gluttate psoriasis
Hypopigmented and pink patches affecting the trunk
Itchy
Mild scale
Recently returned from Cyprus
- Dx?
- underlying aetiology
- management
- tinea/pitytiasis versicolour
- superficial fungal infection - Malassezia furfur
- topical ketoconazole
eczema type rash on hands and feet
blisters which are very itchy
skin is dry and cracked
worsened during heatwave last week
- dx?
- management?
- pompholyx
2. cool compresses, emollients, topical steroids
really painful ulcer on leg
was initially a small papule, but has rapidly become bigger.
necrotic tissue within lesion
background of Rheumatoid Arthritis
- Dx?
- management
- pyoderma gangrenosum
2. oral steroids
Flushing of the cheeks and nose
some papules and telangiectasia in same distribution of rash
got worse during holiday abroad
dx?
Rosacea
Management of roseaca
topical metronidazole
topical brimonidine if flushing is predominant
systemic abx if more severe disease
daily application of high factor suncream
child who can’t stop itching
excoriations present, predominantly on limbs
linear burrows can be seen on interdigital webs and flexor aspect of wrist
- dx?
- management?
- scabies
2. permethrin 5% to patient and all household contacts
multiple lesions on both covered and uncovered skin
stuck on lesions, highly variable in colour
brother had similar problem
- dx?
- management?
- seborrhoeic keratosis
2. reassurance
Differences between seborrhoeic and actinic keratoses?
- body distribution?
- cancerous potential?
- cause
- seborrhoeic keratoses can be found on covered and uncovered areas of the body, while actinic keratoses are exclusively found on sun exposed areas
- actinic keratoses are pre-malignant for SCC. Seborrhoeic keratoses have no malignant potential
- Actinic keratoses are associated with chronic sun exposure, while seborrhoeic keratoses are associated with genetics/family hx
