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Dermatology Flashcards

1
Q

What type of condition is eczema?

A

Chronic atopic

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2
Q

What causes eczema?

A

Defects in the normal continuity of the skin barrier, leading to inflammation

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3
Q

At what stage does eczema usually present?

A

In infancy

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4
Q

How does eczema usually present?

A

Dry, red, itchy sore patches of skin over flexor surfaces

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5
Q

What are the main areas of the body where eczema presents?

A

Flexor surfaces- inside of elbows and knees

Face and neck

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6
Q

What is the pathophysiology of eczema?

A

Defects in the skin barrier provide an entrance for irritants, microbes and allergens that create an immune response, resulting in inflammation

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7
Q

What are the two aspects to eczema management?

A

Maintenance and management of flares

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8
Q

What is the key to maintenance of eczema?

A

Create an artificial barrier over the skin to compensate for the defective skin barrier

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9
Q

What is used as maintenance eczema treatment?

A

Emollients

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10
Q

How should emollients be used?

A

As thick and greasy as can be tolerates, used as often as possible. Used particularly after washing and before bed

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11
Q

What should patients with eczema avoid?

A

Activities that break down the skin barrier such as bathing in hot water, scratching or scrubbing their skin
Soaps that remove natural oils

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12
Q

What factors may trigger an eczema flare?

A 
Changes in temperature
Dietary products
Washing powders
Cleaning products
Emotional events
Stress
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13
Q

How can eczema flares be treated?

A

Thicker emollients
Topical steroids
Wet wraps
Treat complications

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14
Q

What may specialist treatment of severe eczema include?

A

Zinc bandages
Tacrolimus
Phototherapy
Systemic immunosuppressnats (corticosteroids, methotrexate)

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15
Q

What are some examples of some thin emollient creams?

A

E45
Dibprobase
Aveeno
Cetraben

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16
Q

What are some examples of thick, greasy emollitents?

A

50:50 ointment
Hydromol
Diprobase
Cetraben

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17
Q

What is the general rule for topical steroid treatment in eczema?

A

Use the weakest steroid for the shortest period required to get the skin under control

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18
Q

What are the side effects of using topical steroids?

A

Can lead to thinning of the skin which can make it more prone to flares, bruising, tearing, stretch marks and telangiectasia.
May be systemic absoprtion

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19
Q

What is the the steroid ladder?

A

Mild: Hydrocortisone
Moderate: Eumovate
Potent: Betnovate
Very potent: Dermovate

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20
Q

What is a common side effect of eczema?

A

Opportunistic bacterial infection of the skin

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21
Q

What is the most common organism that causes bacterial skin infection associated with eczema?

A

Staph. aureus

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22
Q

How is opportunistic skin bacterial infection treated?

A

Oral antibiotics (Flucloxacillin)

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23
Q

What is eczema herpeticum?

A

Viral skin infection in patients with eczema

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24
Q

What organisms cause eczema herpeticum?

A

Herpes simplex virus (HSV)

Varicella zoster virus (VZV)

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25
What is the most common causative organism of eczema herpeticum?
HSV-1
26
In which patients does eczema herpeticum usually occur?
Those with a pre-existing skin condition (e.g. eczema or dermatitis) where the virus can easily enter the skin
27
How does eczema herpeticum present?
Widespread, painful, vesicular rash with systemic symptoms
28
What systemic symptoms may be found with eczema herpeticum?
``` Fever Lethargy Irritability Reduced oral intake Lymphadenopathy ```
29
What is the rash like in eczema herpeticum?
Widespread, erythematous, painful and sometimes itchy | Has vesicles that contain pus which may burst to leave small ulcers
30
How is a eczema herpeticum diagnosis confirmed?
Viral swabs of the vesicles
31
How is eczema herpeticum treated?
Aciclovir (oral or IV in severe cases)
32
What are the complications of eczema herpeticum?
Can be life threatening if not treated adequately | Bacterial superinfection can occur
33
What is psoriasis?
Chronic autoimmune condition that causes recurrent psoriatic skin lesions
34
What proportion of patients with psoriasis have a first degree relative with the condition?
1/3
35
What is the patches like in psoriasis?
Dry, flaky, scaly lesions that appear in raised rough plaques
36
Where is psoriasis commonly found on the body?
Extensor surfaces (elbows, knees and scalp)
37
What happens to the areas of psoriasis after a while?
There is abnormal buildup and thickening of the skin due to the rapid regeneration of new skin cells
38
What are the different types of psoriasis?
Plawue Guttate Pustular Erythrodermic
39
What is plaque psoriasis?
Thickened erythematous plaques with silver scales found on extensor surfaces.
40
What is the most common type of psoriasis?
Plaque psoriasis
41
What is guttate psoriasis?
Small raised papules across trunk and limbs which may eventually turn into plaques
42
In which patients is guttate psoriasis most common?
Children
43
What may trigger guttate psoriasis?
Strep throat Stress Medication
44
What is pustular psoriasis?
Rare severe form of psoriasis where pustules form under areas of erythematous skin.
45
What is erythrofermic psoriasis?
Rare severe form with extensive erythematous inflamed areas covering most of the surface of the skin. The skin comes away in large patches
46
What are the specific signs suggestive of psoriasis?
Auspitz sign Koebner phenomenon Residual pigmentation
47
What is auspitz sign?
Small points of bleeding when plaques are scraped off
48
What is Koebner phenomenon?
Development of psoriatic lesions to areas of skin where trauma has occured
49
What are the different treatment options for psoriasis?
Topical steroids/ vitamin D analogues/ dithranol/ calcineurin inhibitors Phototherapy
50
What conditions is psoriasis associated with?
Nail psoriasis Psoriatic arthritis Psychosocial implications
51
What is nail psoriasis?
Nail changes that occur with in patients with psoriases including pitting, thickening, discolouration, ridging and onycholysis
52
In what percentage of patients with psoriasis does psoriatic arthritis occur?
10-20%
53
What is the full name for acne?
Acne vulgaris
54
What is acne caused by?
Chronic inflammation in pockets within the skin (pilosebaceous unit)
55
What are pilosebaceous units?
Tiny units in the skin that contain hair follicles and sebaceous glands
56
What do sebaceous glands produce?
Natural skin oils and sebum
57
What is sebum?
A waxy substance produced by the sebaceous glands that coats, moisturises and protects the skin
58
What 3 things is acne the result of?
Increased production of sebum Trapping of keratin Blockage of the pilosebaceous unit
59
What increases the production of sebum?
Androgenic hormones
60
What are comedones?
Pores/ hair follicles that have become blocked
61
What bacteria plays a role in acne?
Propionibacterium acnes
62
What is Propionibacterium acnes?
A bacteria that colonises the skin
63
What are macules?
Flat marks on the skin
64
What are papules?
Small lumps on the skin
65
What are pustules?
Small lumps containing yellow pus
66
What are comedomes?
Skin coloured papules representing blocked pilosebaceous units
67
What are blackheads?
Open comedones with black pigmentation in the cntre
68
What are ice pick scars?
Small indentions in the skin that remain after acne lesions heal
69
What are hypertrophic scars?
Small lumps in the skin that remain after acne lesions heal
70
What are rolling scars?
Irregular wave-like irregularities of the skin that remain after acne lesions heal
71
What are the treatment aims with acne?
Reduce the symptoms Reduce the risk of scarring Minimise psychosocial impact
72
What is the stepwise treatment of acne?
1. Topical benozyl peroxide 2. Topical retinoids 3. Topical antibiotics 4. Oral antibiotics 5. OCP
73
What is the last line option for acne and why are the last line?
Oral retinoids- highly teratogenic
74
Which COCP is the most effective for acne?
Dianette due to anti-androgen effects
75
What kind of medication is oral isotretinoin?
Retinoid
76
How do retinoids work?
Reduce production of sebum, reduce inflammation and bacterial growth
77
Why must careful consideration be taken when prescribing isotretinoin?
It is strongly teratogenic
78
What are the common side effects of isotretinoin?
Dry skin and lips Photosensitivity Depression/ anxiety
79
What is erythema nodosum?
Inflammation of the subcutaneous fat in the shins causing red lumps to appear
80
What is panniculitis?
Inflammation of fat
81
What is erythema nodosum caused by?
Hypersensitivity reaction
82
What are the potential causes of erythema nodosum?
``` Strep throat Gastroenteritis Mycoplasma pnaumoniae TB Pregnancy COCP NSAIDs Chronic disease ```
83
What chronic diseases may cause erythema nodosum?
IBD Sarcoidosis Lymphoma Leukaemia
84
How does erythema nodosum present?
Red, inflamed, subcutaenous nodules across both shins which may be painful.
85
What investigations should be done when erythema nodosum is suspected?
``` Inflammatory markers Throat swab for strep CXR Stool microscopy & culture Faecal calprotectin ```
86
What is the management of erythema nodosum?
Investigate and treat underlying cause Manage conservatively with rest & analgesia Steroids in some causes
87
How long does erythema nodosum usually take to fully resolve?
Within 6 weeks
88
What is an exanthem?
Eruptive widespread rash
89
How many viral exanthemas are there?
6
90
What are the 6 red rashes?
``` Measles Scarlet fever Rubella Duke's disease Parvovirus B19 Roseola infantum ```
91
What is first disease?
Measles
92
What is second disease?
Scarlet fever
93
What is third disease?
Rubella
94
What is fourth disease?
Duke's disease
95
What is fifth disease?
Parvovirus B19
96
What is sixth disease?
Roseola infantum
97
What causes measles?
Measles virus
98
Is measles contageous?
Highly
99
How is measles spread ?
Respiratory droplets
100
How soon after exposure to measles symptoms develop?
10-12 days later
101
What are the initial measles symptoms?
Fever Coryzal symptoms Conjunctivitis
102
What symptom confirms a diagnosis of measles?
Koplik spots
103
What are koplik spots?
Greyish white spots on the buccal mucosa
104
What is the buccal mucosa?
Lining of the cheeks and back of lips
105
How soon after the onset of symptoms fo koplik spots develop?
2 days later
106
Where does the measles rash usually start?
On the face/ behind the ears
107
How soon after the fever does the measles rash usually begin to develop?
3-5 days later
108
What type of rash is the measles rash?
Erythematous, macular rash with flat lesions
109
How long does measles usually last?
Self resolves after 7-10 days
110
How long should children with measles be isolated?
Until 4 days after their symptoms resolve
111
Who should be informed about all cases of measles?
Public health
112
What proportion of patients with measles develop a complication?
30%
113
What are the common complications of measles?
``` Pneumonia Diarrhoea Dehydration Encephalitis Meningitis Hearing loss Vision loss Death ```
114
What is the most common causative organism of scarlet fever?
Group A strep
115
What usually causes scarlet fever to develop?
Tonsillitis
116
What causes scarlet fever (pathophysiology)?
Exotoxin produced by strep pyogenes
117
What kind of rash develops with scarlet fever?
Red-pink, blotchy, macular rash with rough sandpaper skin
118
Where does the rash start in scarlet fever?
On trunk and spreads outwards
119
What other features may be present in scarlet fever?
``` Red, flushed cheeks Fever Lethargy Flushed face Sore throat Strawberry tongue Lymphadenopathy ```
120
How is scarlet fever treated?
Antibiotics for underlying streptococcal infection
121
What antibioitic is used for scarlet fever and for how long?
Penicillin V for 10 days
122
Who should be informed about all cases of scarlet fever?
Public health
123
What other conditions associated with group A strep infection may patients with scarlet fever also have?
Post-strep glomerulonephritis | Acute rheumatic fever
124
What is rubella caused by?
Rubella virus
125
How is rubella spread?
By respiratory droplets
126
How soon after exposure do symptoms of rubella start?
After 2 weeks
127
How does rubella present?
Mild erythematous macular rash
128
Where does the rubella rash start?
On the face
129
How long does the rubella rash usually last?
3 days
130
What symptoms may also occur with rubella?
Mild fever Joint pain Sore throat Lymphadenopathy
131
How is rubella managed?
Supportive | Self limiting
132
Who needs to notified about all cases of rubella?
Public health
133
How long should children with rubella stay off school?
At least 5 days
134
What are the rare complications of rubella?
Thrombocytopenia Encephalitis Congenital rubella syndrome in pregnancy
135
What is congenital rubella syndrome?
Triad of deafness, blindness and congenital heart disease
136
What is Parvovirus B19 also known as?
Slapped cheek syndrome or erythema infectiosum
137
How does parvovirus B19 start?
Mild fever, coryza and non-specific viral symptoms
138
How long after symptoms begin do you get a rash with slapped cheek syndrome?
2-5 days
139
What is the rash like in Parvovirus B19?
Diffuse red rash on both cheeks
140
What kind of rash appears a few days after the slapped cheek rash?
Reticular erythematous rash affecting trunk and limbs. May be raised and itchy
141
Which patients are at risk of complications with parvovirus B19?
Immunocompromised Pregnant women Patients with haematological conditions
142
What are the complications of slapped cheek syndrome?
Aplastic anaemia Encephalitis/ meningitis Pregnancy complications
143
What is roseola infantum also known as?
Human herpesvirus 6
144
What is the typical pattern of illness with roseola?
Presents 1-2 weeks after infection with sudden, high fever that lasts 3-5 days. May also be coryzal symptoms. Rash appears for 1-2 days after fever.
145
What is the rash like in roseola infantum?
Mild erythematous macular rash across arms, legs, trunk and face
146
What is the main complication of roseola infantum?
Febrile convulsions
147
What is erythema multiforme?
Erythematous rash caused by hypersensitivity reaction
148
What are the most common causes of erythema multiforme?
Viral infections | Medications
149
How does erythema multiforme present?
Widespread, itchy, erythematous rash with characteristic target lesions May be associated with other symptoms (e.g. stomatitis)
150
What are target lesions?
Red rings with larger red ring around (like bulls-eye target)
151
How is erythema multiforme diagnosis made?
Clinically based on rash
152
How is erythema multiforme managed?
Identify underlying cause | Usually resolves spontaneously
153
What is urticaria also known as?
Hives
154
What do hives look like?
Small, itchy lumps on skin
155
What other symptoms may be associated with urticaria?
Angioedema and flushing of skin
156
What are the typical causes of acute urticaria?
``` Allergies Contact with chemicals, latex or stinging lessons Medications Viral infections Insect bites Rubbing of skin ```
157
What is the pathophysiology of urticaria?
Release of histamine by mast cells
158
What causes acute urticaria?
Allergic reaction
159
What causes chronic urticaria?
Autoimmune reaction
160
What are the 3 subtypes of chronic urticaria?
Chronic idiopathic Chronic inducible Autoimmune
161
What is chronic idiopathic urticaria?
Recurrent episodes of chronic urticaria without clear underlying cause
162
What is chronic inducible urticaria?
Episodes of chronic urticaria that can be induced by certain triggers
163
What may trigger chronic inducible urticaria?
``` Sunlight Temperature change Exercise Strong emotions Hot or cold weather Pressure ```
164
What is autoimmune urticaria?
Chronic urticaria associated with an underlying autoimmune condition
165
How is urticaria managed
Antihistamines
166
What is the antihistamine of choice for urticaria?
Fexofenadine
167
What is chickenpox caused by?
VZV (Varicella zoster virus)
168
What is the characteristic chickenpox rash?
Widespread, erythematous, raised, vesicular lesions
169
What does a vesicular rash mean?
Fluid filled
170
Where does the chickenpox rash usually start and spread to?
Starts on trunk or face and spreads outwards to whole body.
171
What other symptoms may occur with chickenpox?
Fever Itch General fatigue/ malaise
172
How is chickenpox spread?
Direct contact with lesions or through infected droplets
173
How soon after exposure to chicken pox do patients become infected?
10 days to 3 weeks
174
What are the complications of chicken pox?
``` Bacterial superinfection Dehydration Conjunctival lesions Pneumonia Encephalitis Shingles ```
175
What can be given to unvaccinated pregnant women after exposure to chickenpox?
VZV immunoglobulins
176
What can chickenpox infection before 28 weeks gestation cause?
Congenital varicella syndrome: developmental problems in the fetus
177
What can chickenpox in the mother around time of delivery lead to?
LIfe threatening neonatal infection
178
How is chickenpox managed in otherwise healthy children?
Self-limiting
179
What medication can be used in immunocompromised patients with chickenpox?
Aciclovir
180
What causes hand foot and mouth disease?
Coxsackle A virus
181
How does hand foot and mouth disease usually start?
With URTI
182
What develops after 1-2 days in hand foot and mouth disease?
Small mouth ulcers | Blistering red spots across body

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