dermatology Flashcards
eczema
inflammatory skin condition which can either be endogenous or exogenous
aka dermatitis
types of endogenous eczema
atopic discoid pompholyx gravitational seborrhoeic
types of exogenous ezcema
irritant
allergic
photodermatitis
atopic eczema
presents in infancy
chronically relapsing
association with atopic triad (+asthma+hayfever)
discoid eczema
scattered, well-defined, coin shaped and coin size plaques of eczema
also called nummular dermatitis
pompholyx eczema
tiny blisters on palms and soles
often adults <40
gravitational eczema
common form of eczema occuring on lower extremitites in patients with chronic venous insufficiency
precursor to more problematic conditions such as venous leg ulceration and lipodermatosclerosis
seborrheic dermatitis
common skin condition affecting only the scalp
causes scaly patches, red skin and stubborn dandruff
also affects oilet areas of the body such as face, nose, eyebrows, ears, eyelids and chest
irritant dermatitis
irritant contact dermatitis is most common type
non allergic skin reaction that occurs when a substance damages your skins outer protective layer
some people react to strong irritants after 1 exposure, others develop signs and symptoms after repeated exposures to even mild irritants
allergic dermatitis
contact dermatitis is red, itchy rash caused by direct contact with substance and allergic reaction to it
non contagious or life threatenng but can be v uncomfortable
soaps, cosmetics, fragrances, jewlery, plants
photodermatitis
drug induced photosensitivity - thiazides, tetracyclines, NSAIDs
phototoxic chemicals - photocontact dermatitis - plants, veg, fruit, fragrances
aggravating factors of atopic dermatitis
dryness
stress
infection
allergy
presentation of atopic dermatitis
infants, childhood and adults
infants - starts on face, nappy area spared, once crawling affects knees, secondary to infection common
childhood - found on flexures, neck involved, infraorbital/demimorgan folds,
adults - increased lichenification, flexures and hands, pitting and ridging of nails
diagnostic criteria of atopic eczema
itchy skin condition onset <2 yrs skin crease involvement dry skin relative with atopy visible flexural dermatitis
management of eczema
look for and reduce aggravating factors
emollients
topical steroids - using steroid ladder
topical immunomodulators
if doesnt work - abx for secondary infection, oral steroids, phototherapy, immunosuppressants
what is psoriasis
condition that causes red and crusty patches of skin covered with silvery scales.
types of psoriasis
chronic plaque guttate flexural erythrodermic pustular - localised or generalised
risk factors for psoriasis
trauma - koebner phenomenon infection metabolic factors drugs psychogenic factors alcohol
presentation of psoriasis
acute intermittent or chronic disease of:
- red scaly plaque
- disease on scalp, elbows and knees
- potential involvement of the whole skin
- nail disease
- joint disease in 5-10%
conditions associated with psoriasis
psoriatic arthritis and spondyloarthropathies
IBD, uveitis, coeliac disease
obesity, hypertension, cvd, t2dm
PASI scoring
psoriasis area and severity index
DLQI
dermatology life quality index
treatment of psoriasis
non specific - emollients, keratolytics, topical steroids, tar preparations, occlusion
specific - vit D and A analogues, dithranol
topical therapy
phototherapy
disease modifying therapy
what is acne?
issues with sebaceous glands
- androgens stimulate sebaceous glands and cause more sebum to nbe secreted = comedone plug in hair follicle, this traps p.acnes and causes spot to form (abscess like)
late onset acne location
chin/jaw
presentation of acne
seborrhoea (greasy)
comedomes (bumpy)
papules, pustules, nodules (keratin and pus) and cysts (enclosed sac of fluids and cell products)
mild, mod or severe
grading acne
lees acne grading system
acne management
OTC
topical - benzoyl peroxide, retinoids, antibiotics
systemic - antiandrogens,(ocp) , abx, retinoids
what is rosacea
common skin condition causing blushing or flushing and visible blood vessels in your facw
causes of rosacea
sum damage
inflammatory
presentation of rosacea
middle aged
sun exposed sites - face and chest
erythema - papules, pustules, telangiectasia, flushing
rhinophyma
progressive skin condition affecting the nose in rosacea - big bumpy red nose
blepharitis
inflammation on the edges of the eyelids as they become irritated and itchy and appear greasy and crusted with scales clinging to lashes
- happens in rosacea
signs of rosacea
rhinophyma
blepharitis
lymphoedema
treatment of rosacea
lifestyle - avoid triggers and irritants
topical - azelaic acid, metronidazole gel
systemic - lymecycline, doxycycline, low dose isotretinoin
laser treatment
herpes simplex skin infection
common infection
causes of cold sores and herpetic whitlow
affects most people during their lives
herpes simplex type 1
oral and facial infections
herpes simplex type 2
genital and rectal infections, often sexually transmitted
how is herpes simplex spread?
direct or indirect contact
remains dormant in dorsal root nerves where it can be reactivated
virus can be transferred to new skin sites by the patient during an attack
risk factors for herpes simplex
infants and young children
less developed countries, nearly all under 5yo have it
which type of herpes simplex is more symptomatic?
type 2
presentation of herpes simplex 1
gingivostomatitis in children 1-5
fever, dribbling and bad breath, gums red and swollen, white vesicles, yellow uclers on tongue, throat, palate and inside cheeks, lymphadenopathy
presentation of type 2 herpes simplex
genital herpes after onset of sexual activity
painful vesicles, ulcers, redness, swelling for 2-3 weeks
in males - glans, foreskin and shaft, anal herpes with MSM
females - vulva and vagina , painful to urinate, cervical infection may lead to severe ulcers
complications of herpes simplex
eye infection throat infection eczema herpeticum erythema multiforme disseminated/widespread infection
treatment of herpes simplex
uncomplicated eruptions are self-limiting
antiviral drugs used for severe infection or
immunocompromised patient
if recurrent prophylactic antivirals
forms of Varicella Zoster virus
chicken pox
shingles
chicken pox vs shingles
chicken pox = highly contagious and occurs mostly in children <10. once had it, unlikely to get again
shingles = reactivation of VZV - localised painful rash
contagion of VZV
airborne or contact with fluid from open sores
- if not had chicken pox before can contract chicken pox from those with chicken pox or shingles
who gets chicken pox?
children <10
immunocompromised
who gets shingles
elderly
poor immunity
triggers - nerve pressure, radiotherapy at level of nerve root, spinal surgery, infectin
presentation of chicken pox
+adult presentation
itchy red papules»_space;vesicles
stomach, back , face and can spread to other body parts
blisters can also be in mouth
systemic feagtures - fever, headache, D+V
adults:
- prodromal symptoms 48hrs before rash (fever, malaise, headahce, loss of appetite, abdo pain)
- more severe, can be life threatening
complications of chicken pox in children
Secondary bacterial infection caused by scratching
Dehydration from D&V
Viral pneumonia
complications of chicken pox in immunocompromised and adult patient
Disseminated varicella infection (high morbidity)
CNS complications (Reye’s, Guillain-Barre, encephalitis)
Thrombocytopenia & purpura
complciations of chicken pox in pregnancy
viral pneumonia, premature labour
presentation of shingles
- severe pain in one sensory nerve distribution
- fever, headache, lymphadenopathy in affected area
- after 1-3 days, blistering rash appears in same area of skin - red papules»blistering or pustules that crust over. most commonly chest, neck, forehead and lymbar/sacrak regions
complications of shingles
muscle weakness - facial nerve palsy
infection of organs
pregnancy - can harm foetus
post-herpetic neuralgia
management of chicken pox
clea rup naturally in 1-3 wks, may leave scars. supportive treatment: trim fingernails, warm bath and moisturiser, paracet for fever, oral antihistamines to help itch
immunocompromised = IV aciclovir
shingles management
uncomplicated cases - recovery 2-3 weeks, 3-4 in older
antiviral treatment to reduce pain and symptom duration -aciclovir
management of acute - rest and pain relief, protect rash (vaseline), oral abx for secodnary infection
what are viral warts?
very common
non cancerous growths
causes of viral warts
HPV
contagion of viral warts
skin to skin contact or auto inoculation (if scratched, virus can spread to another area)
incubation period of viral warts
up to 12 months
risk factors of viral warts
school aged
eczema - defective skin barrier
immunosuppressed individuals
presentation of viral warts
hard surface with black dot in middle of each scale
common - plantar, plane, filiform, mucosal
treatment of viral warts
topical treatment - salicyclic acid - removes dead surface cells, works in 12 weeks
cryotherapy - freezing, sucess after 3-4 months
electrosurgery - curettage and cautery for large/persistent warts
what is molluscum contagiosum
common childhood skin infection
cause of molluscum contagiosum
poxvirus
spread by skin to skin contact, indirect, auto inoculation and sexual transmission
risk factors of molluscum contagiosum
children < 10 warmer climates wet conditions overcrowded environments atopic eczema (deficient skin barrier) immunocompromised
presentation of molluscum contagiosum
clusters of small round papules
white brown or pink
often shiny with umbilicated pit
contain white, cheesy material
arise in warm/moist places - flexures
frequently induce dermatitis
complications of molluscum contagiosum
secondayr bacterial infection = impetigo
secondary eczema
conjuntivitis if eyelid becomes infected
large and numerous mollusca in immuno compromised individuals
treatment of molluscum contagiosum
reduce spread - wash hands, avoid scratching etc
physical treatment - picking out white core, cryotherapy, laser ablation,
medical treatment- antiseptic (hydrogen peroxide), wart paint (salicylic acid)
what is impetigo
highly contagious skin infection mainly affecting infants and young children
what causes impetigo
bacteria - staphylococci organism
risk factors of impetigo
2-5 yo close contact warm, humid weather broken skin other health conditions - eczema, diabetes, immunocompromised
Presentation of impetigo
reddish sores on face, espcially around nose and mouth and on hands and feet
after a week the sores burst and develop honey coloured crusts
complications of impetigo
cellulitis, kidney problems, scarring
prevention of impetigo
gently wash affected area with mild soap and running water
wash infected persons clothes, sheets etc
gloves to apply antibiotic ointment
cut nails
regular handwashing and good hygiene
keep child at home until uncontagious
treatment of impetigo
mupirocin antibiotic ointment or cream applied directly to sores 2-3 times a day, 5-10 days
what is erysepilas
superficial form of cellulitis
potentially serious bacterial infection affecting the skin
who gets erysepilas
infants and older people
cause of erysepilas
group A beta-haemolytic streptococci
staph A, MRSA, strep pnuemoniae, klebsiella pnuemoniae, yersinina enterolitica, haemophilus influenzae
risk factors of erysepilas
Prev episodes
Breaks in skin barrier – insect bites, ulcers, chronic skin conditions – psoriasis, athletes foot and eczema
Current or piror injury (trauma, surgical wounds, radiotherapy)
Umbilical cord and vaccination site injury in newborns
Nasopharyngeal infection
Venous disease and lymphodema
Immune deficiency or compromise
Nephrotic syndrome
pregnancy
pesentation of erysepilas
abrupt onset and accompanied by fever, chills and shivering
skin of lower limbs
butterfly distribution of face
sharped raised border, bright red firm, swollen, finely dimpled, blistered, necrotic, purpura
umbilicus or diaper region in infants
complications of erysepilas
Abscess
Gangrene
Thrombophlebitis
Chronic leg swelling
Infections distant to site of erysupelas – infective endocaridtis, septic arthritis, bursitits, tendonitiis
Post streptococca; glomerulonephritis
Cavernous sinus thrombosis
Streptococcal TSS
investigations for erysepilas
FBC - raised WCC, c reactive protein, positive blood culture indentifying organism
MRI and CT in deep infection
skin biopsy
treatment of erysepilas
general - cold packs, analgesics, elevation of limb, compression stockings, saline dressings
antibiotics - oral or IV penicillin
long term preventative penicillin for recurrent attacks
what are dermatophytes
cause fungal infection affecting the skin, hair and nails
aka dermatophytosis or tinea
________ are most common cause of superficial fungal infections
tinea infections
tinea corpis
ringworm - arms, trunk and legs
tinea capitis
scalp ringworm - scalp and hair shafts
tinea facei
facial skin
tinea cruris
jock itch - groin and inner thighs
tinea pedis
athletes foot
tinea manuum
feet and hands
tinea barbae
facial hair follicles
tinea unguium
nail infections
cause of tinea infections
dermatophytes - filamentous fungi requiring keratin for frowth
risk factors of tinea infections`
Decreased immune repsonse
Older individuals
Children
Diabetes
Poor circulation
Topical corticosteroid use
presentation of tinea infections
round red itchy rash with inflamed scaly border
can be either inflammatory (pus filled lumps + permanent hair loss) or non inflammatory
investigations of tinea infections
microscopy, fungal cultures, woods light examination (UV light to detect fluorescence caused by certain dermatophytes)
treatment of tinea infections
antifungals - clotrimazole
oral antifungals in scalp as topical cannot penetrate
nail infection treated with chemical or surgical removal of affected nail
what is candida
yeast infection
causes of candida
c. albicans = most common
c. parapsilosis, c. tropicalis
risk factors for candida
weakened or less competition in immune system
candida overgrowth
diabetes, HIV, steroids, radiotherapy, chemotherapy
presentation of candida
pseudomembranous = weakened immune system
erythematous
thrush
candida of mouth and oesophagus
vulvovaginitis
caused by yeast infection - vaginal itching, discharge and dysuria
treatment of oral thrush
oral nystatin suspension
treatment of vulvovaginitis
topical antifungals
if resistant, azole antifungals
treatment of severe thrush infections
remove device, amphotericin, azole antifungals echinocandins
what is pityriasis versicolour
common fungal infection of skin localised to outermost layer of epidermis
cause of pitryriasis versicolour
mycelial growth of funghi of the genus malassezia
risk factors for pitryriasis versicolour
hot and humid climate
summer
teenagers and young adults - sebaceous glands more active
genetics
presentation of pitryriasis versicolour
affects the trunk, neck and/or arms
patches of coppery brown, paler than surrounding skin or pink
pale patches more common on darker skin (pituyriasis veriscolour alba)
patches can start scaly and brown then reoslve through a non scaly an white stage
investigations for pityriasis versicolour
wood lamp (black light) examination = yellow/green fkiyresence observed inaffected areas
microscopy of skin scraping - spaghetti and meatballs
fungal culture
skin biopsy
treatment of pityriasis versicolour
topical antifungal angents
oral antifungals if severe or topical agents failed
reapplication of topical treatment once rash has cleared to prevent recurrence
scabies what is it
parasitic mite causing itchy skin condition = contagious
cause of scabies
parasitic mite
contagious - spread through close physical contact, sharing clothes, bedding etc
presentation of scabies
itchy, often severe and usually worse at night
thin irregular burrow tracts made of tiny blisers or bumps on skin - appear in skin folds
infants and young = scalp, palms, soles
complications of scabies
secondary bacterial infection - impetigo
crusted scabies in high risk groups - chronically immunosuppressed, ill and old peep
investigations for scabies
microscopy to determine presence of mites or their eggs
treatment of scabies
prevention - clean all clothes and linin, starve mites by leaving materials in sealed plastic bag for couples weeks
permethrin cream - kill mites ivermectin - oral med for altered immune system crotamiton cream lotion to sooth antihistamines
what are cutaneous drug erruptions
acute or subacute adverse cutaneous reactions to a drug or medication
SCAR
severe cutaneous adverse reaction
most common cutaneous dry erruptions
morbilliform or exanthematous drug erruption
urticaria and/or angioedema
risk factors of cutaneous drug erruptions
genetics
female
underlying viral infections
prev allergic reaction to another drugs
cause of cutaneous drug erruptions
true allergy - immediate (IgE), delayed (IgG)
predictable reactions explicable by pharmacology
drug intolerances
psuedoallergy - urticarial reaction
presentation of cutaneous drug erruptions
fever
malaise
other organ involvement
complications of cutaneous drug erruptions
deprivation of sueful meds
death in SCAR
permanent scarring lafing to blindness and deformity in scar
investigations for cutaneous drug erruptions
determine prev exposure to meds
meds stopped then reintroduced to see if symptoms recur
blood tests - FBC, LFTs, U+Es
skin intradermal/prick tests
patch tests
treatment of cutaneous drug erruptions
topical corticosteroids
emmolients
drug induced urticaria reposnds to antihistaminea
what is erythroderma?
inflammatory ski disease affecting the entire surface of the skin
acute or chronic
often precedes or is associated with exfoliation = exfoliative dermatitis
causes of erythroderma
adverse drug erruption dermatitis psoriasis pityriasis rubra pilaris (PRP) immunobullous disease cutaneous t cell lymphama underlying systemic malignancy graft vs host disease HIV infection
presentation of erythroderma
generalised erythema oedema serous exudate (ecezema) scaling (eczema, psoriasis) itchy (eczema, bullous disease)
hair loss, keratoderma of palms and soles, ectropion, hyper or hypopigmentation, localised or generalised lymphadenopathy
complications of erythroderma
secondary infection loss of temp control high output heart failure fluid and electrolyte imbalance hypoalbuminaemia
investigations of erythroderma
skin swabs for bacterial culture
haematology and biochemistry
skin bipsy
treatment of erythroderma
determine underlying cause
discontinue all unecessary meds
apply amolients and mild topical steroids
wet dressings, fluids and body temo, oral and IV abx, sedcative antihistamines
what is SJS?
steven johnson syndrome
rare and serious disorder of skin and mucous membranes
reaction to meds starting with flu like symptoms followed by painful rash that spreads like blisters
cause of SJS
normally triggered by medication, infection or both
drugs that can cause SJS
anti-gout meds - allopurinol
anticonvulsants and antipsychotics
antibacterial sulfonamides
nevirapine
pain releivers - acetaminophen, ibuprogen, naproxen sodium
risk factors of SJS
HIV, immunos uppressed
cancer
history of SJS + family history
genetic factors
presentation of SJS
fever sore mouth and thorat, fatigue, burning eyes
unexplained widespread skin pain, red or purplish rash that spreads
blister on skin and mucous membranes of the nose, eyes and genitals
shedding of skin within days after blisters form
complications of SJS
dehydration sepsis eye problems lung involvement - acute resp failure permanent skin damage
investigations of SJS
review of medical history and physical exam
skin biopsy
culture
imaging - CXR for pneumonia
blood tests
treatment of SJS
hospitalisation
supportive care - fluids, nutrition, wound care, eye care
medications - pain meds, anti inflammatory, antibiotics, topical or oral/IV if severe
IV immunoglobulin
what is toxic epidermal necrolysis (ten)
rare life threatening skin reaction caused by medication usually
severe form of SJS - when >30% skin and moist linings of body have extensive damage
cause of TENS
skin reaction to medication
symptoms 1-4 weeks after starting new drug
risk factors of TENS
HIV infection weakened immune system cancer history of SJS/TEN family history of SJS/TEN genetic factors
presentation of TENS
widespread skin pain
spreading rash covering >30% of the body
blisters and large areas of peeling skin
sores, swelling and crusting on mucous membranes, inc mouth eyes and vagina
complications of TENS
sepsis lung involvement - acute resp fialure visual impairment permanent skin damage vaginal sores emotional distress
treatment of TENS
supportive care - fluid replacement and nutrition, wound care, breathing help, pain control, eye care
medications - cyclosporine, etanercept, IVIG
what is melanom
most serious type of skin cancer
occurs in melanocytes (produce skin colour)
causes of melanoma
UV exposure increase risk
environment genetic factora
presentation of melanoma
change in existing mole
development of new pigmented or unusual looking growth on skin
unusual mole signs
A-E
asymmetrical irregular borders changes in colou diameter >6mm evolving - itchness/blededing etc
hidden melanoma
under nail acral-lentiginous melanoma
melanoma in mouth, GI tract, urinary tract or vagina
melanoma in the eye
investigations of melanoma
physical exam
biopsy
management of melanoma
small = surgery
surgery to remove lymph nodes
immunotherapy
targeted therapy
radiation therapy
chemotherapy
basal cell carcinoma what is it
skin basal cell develops mutation in DNA
skin cell that produces new skin cells
risk factors for basal cell carcinoma
UV exposure radiation therapy fair skin increasing age family history of skin cancer immune suppressing drugs exposue to aresnic inherited syndromes that cause skin cancer
presentation of basal cell carcinoma
change in skin - growth or sore that won’t heal
- shiny skin colour bump,
- brown, black or blue lesion
- flat, scaly ptach with a raised edge
- white, waxy, scar like lesion
complications of basal cell carcinoma
risk of recurrance
increased risk of other types of skin cancer
cancer spreads beyond the skin
management of basal cell carcinoma
surgery - surgical excision or mohs surgery
curettage and electordessciation
radiation therapy
frezzing
topical treatments
photodynamic therapy
mohs surgery
removes cancer layer by layer
reccommended if high risk of recurrence or if larger or extends deeper in the skin or if located on the face
squamous cell carcinoma
cancer f sqaumous cells
not usually life threatening but it can be aggressive and if untreated can metastasise causing serious complications
squamous cell carcinoma causes
prolonged UV exopsre
history of skin cancer
weakened immune system
rare genetic disorder
presentation of squamous cell caricnomas
firm red nodule
flat sore with a scaly crust
new sore or raised area on an old scar or ulcer
rough sclay patchy on lip that may evolve to open sore
red sore or rough patch inside mouth
red raised patchy or wartlike sore on o in anus or genitals
complications of squamous cell carcinoma
spread to lymph nodes or other organs
risk of agressive SCC increased when particularly deep involves mucous membranes such as lips, weakened immune system
management of SCC
minor surgery cutteage and electrodessciecation laser therapy freezing photodynamic therapy
management of SCC metastasis
chemotherapy
targeted drug therapy
immunotherapy
seborrheic keratoses lipoma epidermoids cysts dermatofibromas cambell de morgan spots fibroepithelial polyps
benign skin tumours
seborrheic keratoses
aka senile warts
middle aged and elderly
aetiology unknown
presentation of seborrhoeic keratoses
often multiple
asymptomatic
sign of skin aging
warty, greasy papules or nodules with well defined borders , colour varies, stuck on appearance
management of seborrheic keratoses
no treatment
may be removed if catch on clothing or for cosmetic reasons
sudden erruption of multiple seborrheic keratoses
sign of underlying malignancy
lipoma
very common
middle aged ppl
aetiology not understood
adipose tissue proliferation
presentation of lipoma
slitary more in women
multiple more in men
asymptomatic
slow growing, soft, smooth, mobile, subcutaneous nodules, 2-10cm
management of lipomas
usually no treatment required
may be surgically removed if impacting nearby muscles
complication of lipomas? rare
liposarcoma
what are epidermoid cysts
follicular infundibular cysts/epidermal cysts/keratin cysts
caused by epidermal cell proliferation
presentation of epidermoid cysts
solitary or multiple
more in men
commonly on face, neck and trunk
asymptomatic
coloured/yellow, firm round nodules with central punctum
offensive smelling keratinous contenta
management of epidermoid cysts
usually no treatment required, antibiotics if infection occurs
dermatofibroids
aka histiocytomas
caused by fibroblast proliferation
presentation of dermatofibroids
common on lower legs, often after insect bite, eruptions of dermatofibroma may occur in immuno suppressed people
F>M
asymptomatic but often itchy and painful
firm fibrous dermal nodules or papules, skin dimples upon compression
management of dermatofibromas
usually no treatment required
campbell de morgan spots
aka cherry angiomas
aetiology unknown
endothelial cell proliferation and subsequent blood vessel overgrowth
presentation of campbell de morgan spots
number of spots increases with age
common on midtrunk
red/purple/balck papules or macules
fibroepithelial polyps
skin tags
common
develop with age
aetiology not fully understood
management of campbell de morgan spots
usually no treatment required - but may be removed for cosmetic reasons
presentation of fibroepithelial polyps
commonly found in skin folds e.g. armpits
usually skin coloured, vary in size
management of fibroepithelial polyps
may be removed for cosmetic reasons
acanthosis nigracans - what is it
hyperpigmentation and hyperkeratosis of the skin folds and mucosa
who gets acanthosis nigracans
obesity
endocrine conditons
drug induced
underlying GI malignancy
necrobiosis lipoidica - what is it?
rare granulomatous skin disorder
1+ tender yellow/brown patches on the lower legs
centre of patch skiny, atrophic and telangiectasia
can ulcerate
who gets necrobiosis lipoidica
diabetes
treatment of necrobiosis lipodica
no always needed
topical steorids
PUVA
immuno suppressants
what is granuloma annulare
common
delayed hypersensitivity reaction to dermis with unknown cause
smooth, discoloured, thickened, nummular/annular plaque lesions
can occur anywhere on the body or be widespread
who gets granuloma annulare
if extensive -
autoimmune thyroiditis
DM
hyperlipidaemia
lymphoma or HIV
management of granuloma annulare
most often no treatment and resolve spontaneously in 18 months
steroids, calcineurin inhibitors, immunosuppressants, phototherapy if widespread
what is erythema nodosum
hypersensitivity resonse often to recent infection
lesions are tender nodules for 1-2 weeks which appear like bruises then resolve. do not ulcerate or scar
commonly on shins, size of cherry to grapefruit
causes of erythema nodosum
group A strep primary TB pregnancy malignancy inflammatory bowel disease chlamydia leprosy OCP sarcoidosis
treatment of erythema nodosum
treat underlying infection
bed rest, supportive bandages + antinflammatory medicine
pyoderma gangrenosum - what is it?
rare painful ulcerating condition following minor trauma
most common on legs
uclers have violaceous undermined border
autoinflammatory disease
who gets pyoderma gangrenosum
IBD
RA
myeloid blood disorders (leukaemia)
treatment of pyoderma gangrenosum
avoid surgical debridement when ulcers active as may increase its size
abx not useful unless secondary infection
steroids, ciclosporin, biologics
metronidazole, useful if pts complain of odour
what does vasculitis show?
skin changes give clue to size of vessels affected and therefore diagnosis
skins of rheumatic disease
Cutaneous atrophy. Palmar erythema. Onycholysis. Periungual erythema. Yellow nail syndrome. splinter haemorrhage. Hyperpigmentation. Erythromelalgia.
what is vitiligo
condition which causes loss of skin colour in patches
cause of vitligo
cells that produce melanin die or stop functioning
autoimmune conditon, family hsitory and often trigger events (stress, severe sunburn, skin trauma etc)
vitiligo many parts of body affected
generalised vitiligo
segmental vitligo
only one side of body
focalised vitiligo
one or only a few areas of body affected
acrofacial vitiligo
face and hands affected
presentation of vitiligo
patchy loss of ski n colour appearing on hands, face and areas around body openings and genitals
premature whitening or greying of hair on scalp, eyelashes, eyebrows or beard
loss of colour in mucous membranes
complications of vitiligo
increased risk of social or psychological disease, sunburn, eye problems, hearing loss
investigations for vitiligo
medical history and examine skin
may need biopsy and blood tests (FBC, ANA)
management of vitiligo
depends on extent of disease and age
medications - antiinflammatory drugs (steroid cream), immunosuppresants (calcineurin inhibitors)
therapies - UV light therapy, psoralen and lgith therapy, depigmentation
surgery - skin grafting, blister grafting, cellular suspension transplant
alopecia areata - what is it?
patchy hair loss
who gets alopecia areata?
those with family history or other autoimmune disorders such as diabetes, lupus or thyroid disease
cause of alopecia areata
autoimmune disease (attacks their own hair follicles)
genetics + wirus/substance which may trigger
presentation of alopecia areata
hair falls out, often in clumps the size and shape of a coin
extent of hairloss varies
unpredictabel disease - can grow back
investigations for alopecia areata
blood tests
pull test - determine stage of shedding process
scalp biopsy
light microscopy
management of alopecia areata
corticosteoirds - injection into scalp, topically or oral
orgaine - topical drug for pattern baldness
what is lupus?
autoimmune disease
develops when those with an inherited predisposition come into contact with something in the environment that causes it
who gets lupus
women more
15-45 yo
african americans, hispanics, asian americans
presentation of lupus
fatigue, fever,
joint pain, stiffness and swelling
butterfly rash on face, skin lesions appear or worsen with sun exp`osure
fingers and toes that turn white or blue when exposed to cold or stress
sob, chest pain
dry eyes,
headache, confusion, memory loss
investigations of lupus
bloods - FBC, ESR, U+Es, LFTs and ANA
Urinalysis
CXR, ECHO
biopsy kindyes
management of lupus
NSAIDS for pain, swelling and fever associated
antimalarial drugs - decrease risk of flare ups
corticosteorids - reduce inflamm
immunosuppressants
biologics - reduce lupus symptoms
dermatomyositis
uncommon inflammatory disease marked by muscle weakness and distinctive skin rash
who gets dermatomyositis
adults and children
5-15 yo, 40-60 yo
F>M
cause of dermatomyositis
unknown
more common w certain conditions - raynauds, connective tissue disorders, cardiovaSCULAR DISEASE, lung disease, lung disease, cancer
presentation of dermatomyositis
skin changes - violet or dusky red rash, face and eyelids and knuckles, elbows, knees, chest and back. can be itchy and painful
muscle weakness - progressive on muscles closest to trunk - hips, shoulders, upper arms and neck, bilateral
complications - difficulty swallowing (wt loss, malnutrition), aspiration pneumonai, breathing probs, calcium deposits in muscles, skin and connective tissue
investigations for dermatomyositis
bloods: troponins and ANA
CXR - lung dmaage
electromyography
MRI - inflammation in muscle
skin or muscle biopsy
management of dermatomyositis
improve skin and muscle strength and function:
- corticosteroids - control symptoms
- corticosteroid sparing agents
- rituximab - treat RA
- antimalarial meds for rash
- sunscreens to manage rash
therapy - phsycial therapy, speech therpay, dietetic assessment (teach how to prep easy to eat foods)
surgery - remove caclium depostis and prevent recurrent skin infections
what is vasculitis
inflammation of blood vessels
thicken and reduces width of passage
blood flow restricted
organ and tissue damage
cause of vasculitis
possible triggers of immune reaction = infection (hep B and C), blood cancers, autoimmune disease, reactions to certain drugs
presentation of vasculitis
fever, headache, fatigue, weight loss, general aches and pains
Digestive system – pain after eating and blood in stool if perorations or ulcers
Ears – dizziness, ringing in ears and abrupt hearing loss
Eyes – red and itchy, giant cell arteritis (double vision and temporary or permanent blindness)
Hands or feet – numbness or weakness in hand or foot. Palms of hands and soles of feet might swell or harden
Lungs – SOB or haemoptysis if lungs affected
Skin – red spots from bleeding under skin, lumps or open sores on skin
complications of vasculitis
organ damage
blood clots and aneurysms
vision loss or blindness -GCA
infections
investigations of vasculitis
CRP, FBC, ANCA
imaging, angiography
biopsy
management of vasculitis
corticosteroids and surgery
