DERMATOLOGY Flashcards by Freya Rhodes

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

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What is the pathophysiology of psoriasis?

Systems
Immune mediated
Chronic relapsing

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What is the most common type of psoriasis?

Chronic plaque psoriasis

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Name two associated symptoms of psoriasis.

Nail changes (50%)
Arthritis (5-8%)

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Which type of psoriasis is a medical emergency?

Erythrodermic psoriasis - over 90% of body covered, systemically unwell.

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What is oncholysis?

Nail psoriasis

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Which drugs are likely to exacerbate psoriasis?

Beta-blockers
Lithium
NSAIDs
ACEIs
Anti-malarials

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What are the topical managements for psoriasis?

Emollients
Topical corticosteroids
Vitamin D analogue - calcipotriol
Calcineurin inhibitors - tacrolimus
Cold tar preparations

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Non topical therapy for psoriasis?

(all prescribed by dermatologist)

Phototherapy
Methotrexate
Ciclosporin
Biologics

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What is the most suitable long-term treatment of psoriasis?

Vitamin D analogues (avoid long-term steroid use)

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What is the first-line treatment of rosacea? What can be used if that is unsuccessful?

Topical metronidazole

Oral doxycycline

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What is another name for BCCs?

Rodent ulcer

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Describe the appearance of BCC.

pearly, flesh-coloured papule with telangiectasia –> ulceration, central crater

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What is the most common type of skin cancer in the western world?

BCC

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What is the most common type of BCC?

Nodular

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What are the risk factors for BCCs?

UV
Elderly
Male
Fair skin
immunosuppression

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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.

1. Superficial spreading - 70% 2. Nodular 3. Lentigo meligna 4. 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