DERMATOLOGY Flashcards
What factors may exacerbate psoriasis?
trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
Strep infection
What is the pathophysiology of psoriasis?
Systems
Immune mediated
Chronic relapsing
What is the most common type of psoriasis?
Chronic plaque psoriasis
Name two associated symptoms of psoriasis.
Nail changes (50%) Arthritis (5-8%)
Which type of psoriasis is a medical emergency?
Erythrodermic psoriasis - over 90% of body covered, systemically unwell.
What is oncholysis?
Nail psoriasis
Which drugs are likely to exacerbate psoriasis?
Beta-blockers Lithium NSAIDs ACEIs Anti-malarials
What are the topical managements for psoriasis?
- Emollients
- Topical corticosteroids
- Vitamin D analogue - calcipotriol
- Calcineurin inhibitors - tacrolimus
- Cold tar preparations
Non topical therapy for psoriasis?
(all prescribed by dermatologist)
Phototherapy
Methotrexate
Ciclosporin
Biologics
What is the most suitable long-term treatment of psoriasis?
Vitamin D analogues (avoid long-term steroid use)
What is the first-line treatment of rosacea? What can be used if that is unsuccessful?
Topical metronidazole
Oral doxycycline
What is another name for BCCs?
Rodent ulcer
Describe the appearance of BCC.
pearly, flesh-coloured papule with telangiectasia –> ulceration, central crater
What is the most common type of skin cancer in the western world?
BCC
What is the most common type of BCC?
Nodular
What are the risk factors for BCCs?
UV Elderly Male Fair skin immunosuppression
What is the gold standard management for BCC?
MOHS micrographically controlled excision
under microscope, layer by layer
What margin should be given in excision of BCCs?
3-10mm margin of normal tissue
What is the management of BCC if inoperable?
Radiotherapy
What kind of referral should be made for suspected BCC?
Routine –> dermatology
Describe the appearance of SCCs?
Scaly
crust
What are the risk factors for SCCs?
Actinic keratosis UV light (most associated with PUVA therapy)
What is actinic keratosis?
Pre-malignant lesion found in sun damaged skin
Removed by cryotherapy or shave curettage
What is Bowen’s disease?
type of precancerous dermatosis that is a precursor to squamous cell carcinoma
Often occurs on sun-exposed areas e.g. head/lower limbs
What is the management of Bowen’s disease?
Topical 5-fluorouracil - BD, 4 weeks
Topical steroids (to control inflammation from t-fluorouracil)
Cryotherapy
Excision
When should Mohs micrographic surgery be used?
high-risk patients and in cosmetically important sites.
What margins should be used in the excision of SCCs?
Lesion <20mm = 4mm margin
Lesion >20mm = 6mm margin
Name some poor prognostic factors for melanoma
Poorly differentiated
>20mm
>4mm deep
Immunosuppression
What is the pathophysiology of melanoma?
Uncontrolled growth of melanocytes
What are the risk factors for melanoma?
Sun damage
Moles
Fair skin
age
What approach should you use to differentiate between a mole and a melanoma?
ABCDE
Asymmetry Border Colour Diameter Evolving
OR Glasgow 7 point checklist
Name 4 types of melanoma.
- Superficial spreading - 70%
- Nodular
- Lentigo meligna
- Acral lentiginous - rare
Which prognostic factor is most important?
The invasion depth of a tumour (Breslow depth)
Which type of melanoma is the most aggressive?
Nodular
What are the main diagnostic features of melanoma?
Mole:
- Change in size
- Change in shape
- Change in colour
What are the secondary diagnostic features of melanoma?
• Diameter >= 7mm
• Inflammation
• Oozing or bleeding
Altered sensation
What is the management of melanoma?
2WW
Wide local excision
+/- Rx
Name two scoring systems that are used in the management of melanoma.
Clarks
Breslow thickness - how deep invasion (most important in prognosis)
Which neurological condition is associated with Seborrhoeic dermatitis?
Parkinson’s
What is the first-line management of Seborrhoeic dermatitis?
topical fluconazole
What is the treatment for rosacea?
mild/moderate: topical metronidazole
severe/resistant: oral tetracycline