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Dermatology Flashcards

1
Q

What are some key questions to ask in a dermatological history

A

Initial appearance and evolution of the lesion

Symptoms - itch/pain/bleed

Aggravating and relieving factors

Previous and current treatments

Recent contacts, stressful events, illness and travel

History of sunburn and tanning machines

Skin type

History of atopy

FH of skin disease

Occupation - skin contacts at work and improvement of symptoms when away from work

Treatments tried/other medication

QOL impact

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2
Q

Describe an examination of a skin lesion

A

Inspect - general observation, note if richly pigmented skin, site and number of lesions, if multiple the pattern of distribution and configuration

Individual lesion  - SCAM
Size, shape 
Colour 
Associated secondary change
Morphology, margin (border)

ABCDE - the presence of these features increase the likelihood of melanoma

Palpate - surface, consistency, mobility, tenderness, temperature

Systematic check - nails, scalp, hair and mucous membranes

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3
Q

Define comedone

A

Plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris

Open - blackhead
Closed - whitehead

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4
Q

Define Koebner phenomenon

A

A linear eruption arising at a site of trauma

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5
Q

What are the flexural areas

A

Body folds

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6
Q

What are the extensor areas

A

Knees, elbows and shins

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7
Q

Define dermatome

A

An area of skin supplied by a single spinal nerve

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8
Q

Define confluent

A

Merging together

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9
Q

Define target

A

Concentric rings

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10
Q

Describe annular

A

Circle or ring

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11
Q

Define discoid

A

A coin shaped or round lesion

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12
Q

Define purpura

A

Red or purple colour - does not blanche on pressure - petechiae (small pinpoint macules) or ecchymoses (larger bruise like patches)

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13
Q

Describe hypo-pigmentation

A

Areas of paler skin

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14
Q

Describe de-pigmentation

A

White skin due to absence of melanin

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15
Q

Describe hyper-pigmentation

A

Darker skin which may be due to various causes

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16
Q

Define macule

A

A flat area of altered colour

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17
Q

Define patch

A

Larger flat area of altered colour or texture

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18
Q

Define papule

A

Solid raised lesion <0.5cm in diameter

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19
Q

Define nodule

A

Solid raised lesion >0.5 cm in diameter with deeper component

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20
Q

Define plaque

A

Palpable scaling raised lesion >0.5cm in diameter

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21
Q

Define vesicle

A

Raised, clear fluid filled lesion <0.5cm in diameter

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22
Q

Define bulla

A

Raised, clear, fluid filled lesion >0.5cm in diameter

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23
Q

Define pustule

A

Pus containing lesion <0.5cm in diameter

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24
Q

Define abscess

A

Localised accumulation of pus in the dermis or subcutaneous tissue

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25
Define wheal
Transient raised lesion due to dermal oedema
26
Define boil/furuncle
Staphylococcal infection around or within a hair follicle
27
Define carbuncle
Staphylococcal infection of adjacent hair follicles
28
Define excoriation
Loss of the epidermis following trauma
29
Define Lichenification
Well defined roughening of the skin with attenuation of skin markings
30
Define scales
Flakes of corneum
31
Define crust
Rough surface consisting of dried serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis
32
Define scar
New fibrous tissue which occurs post-wound healing and may be atrophic (thinning), hypertrophic (hyperproliferation within wound boundary) or keloidal (hyperproliferation beyond the wound boundry)
33
Define ulcer
Loss of the epidermis and dermis
34
Define fissure
Epidermal crack often due to dryness
35
Define striae
Linear areas which progress from purple to pink to white and with the histopathological appearance of a scar
36
Define alopecia
Loss of hair
37
Define hirsutism
Androgen dependent hair growth in a female
38
Define hypertrichosis
Non-androgen dependent pattern of excessive hair growth
39
Define clubbing
Loss of the angle between the posterior nail fold and nail plate
40
Define koilonychia
Spoon shaped depression of the nail plate
41
Define onycholysis
Separation of the distal end of the nail plate from the nail bed - trauma, psoriasis, fungal nail infection and hyperthyroidism
42
Define pitting
Punctate depressions of the nail plate
43
List the functions of the skin
Protective barrier against environmental insults and infection Temperature regulation Sensation Vit D synthesis Immunosurveillence Appearance or cosmesis
44
Describe the structure of skin
Epidermis Dermis Subcutaneous tissue Skin appendages - hair, nails, sebaceous glands and sweat glands
45
Describe the layers of the epidermis
4 layers representing a different stage of maturation of the keratinocytes - Basal cell layer/stratum basale - actively dividing cells (deepest layer) - Stratum spinosum - differentiating cells - Stratum granulosum - cells lose their nuclei and contain granules of keratohyaline - secrete lipid into intercellular spaces - Stratum corneum/horny later - layer of keratin, most superficial layer
46
What is the dermis composed of
Collagen Elastin Glycosaminoglycans - synthesised by fibroblasts - provide skin with elasticity and strength Nerves, immune cells, skin appendages as well as lymphatic and blood vessels
47
What are the 3 main types of hair
Lanugo - fine long hair in fetus Vellus hair - fine short hair on body surfaces Terminal hair - eyebrows, eyelashes, scalp and pubic area
48
List the 3 growth phases of hair
Anagen Catagen Telogen
49
What are sebaceous glands and give their function
Produce sebum via hair follicles to lubricate and waterproof the skin
50
What sweat glands are inflamed/infected in hidradenitis suppurativa
Appocrine
51
Which sweat glands are overactive in hyperhidrosis
Eccrine
52
Describe the 4 phases of wound healing
Haemostasis - Vasoconstriction and platelet aggregation - Clot formation Inflammation - Vasodilation - Migration of neutrophils and macrophages - Phagocytosis of cellular debris and invading bacteria Proliferation - Granulation tissue formation and angiogenesis - re-epithelisation Remodelling - collagen fibre re-organisation - scar maturation
53
Describe urticaria and its treatment
Local increase in permeability of capillaries and small venules caused by local mediator release of histamine from mast cells presenting with itchy wheals from swelling of the superficial dermis Treat with antihistamines
54
Describe angioedema and its treatment
Deeper swelling of the dermis and subcutaneous tissues Swelling of the tongue and lips Corticosteroids for severe acute urticaria and angioedema
55
Describe anaphylaxis and its treatment
Bronchospasm, facial and laryngeal oedema, hypotension Lie patient flat, Establish airway, high flow Oxygen Adrenaline IM 500 mcg 1:1000 - repeat after 5 mins - anterolateral aspect of middle third of the thigh Chlorphenamine 10mg IM/IV IV fluids 500ml over 15 mins Hydrocortisone 200mg IV
56
What blood test can be done to determine if a reaction was due to anaphylaxis
Serum tryptase
57
What is erythema nodosum
A hypersensitivity response to a variety of stimuli
58
What causes erythema nodosum
``` Group A beta haemolytic streptococcus Primary TB Pregnancy Malignancy Sarcoidosis IBD Chlamydia Leprosy ```
59
Describe the presentation of erythema nodosum
Discrete tender nodules which may become confluent Lesions continue to appear for 1-2 weeks and leave bruise like discolouration as they resolve Lesions do not ulcerate and resolve without atrophy or scarring The shins are the most common sight
60
Describe erythema multiforme
Often unkown cause Acute self limiting condition with herpes simplex virus being a precipitating factor Other infections and drugs (penicillin, NSAIDs, allopurinol, COCP) are also causes Mucosal involvement is absent or limited to one mucosal surface
61
Describe stevens-johnson syndrome
Mucocutaenous necrosis with at least two mucosal sites involved Skin involvement may be limited or extensive Drugs (penicillin, phenytoin) or infection are main associations Epithelial necrosis with few inflammatory cells is seen on histopathology May have prodromal illness
62
Describe the management of erythema multiforme, stevens-johnson syndrome and toxic epidermal necrolysis
Full supportive care to maintain haemodynamic equilibrium | Early recognition and call for help
63
What are deaths from SJS and TEN due to
Sepsis Electrolyte imbalance Multisystem organ failure
64
Which bacteria commonly causes acute meningococcaemia
Gram negative diplococcus Neisseria meningitides
65
Describe the presentation of acute meningococcaemia
Features of meningitis - headache, fever, neck stiffness Features of septicaemia - hypotension, fever, myalgia Typical rash - non blanching purpuric rash on the trunk and extremities which may be preceded by a blanching maculopapular rash and can rapidly progress to ecchymoses, haemorrhagic bullae and tissue necrosis
66
Which prophylactic antibiotics doe you give to close contacts (within 14 days of exposure) of acute meningococcaemia
Rifampicin
67
Describe erythroderma
Exfoliative dermatitis >90% skin surface Skin appears inflamed, oedematous and scaly Systemically unwell with lymphadenopathy and malaise Richly pigmented skin may look darker with hint of erythema, palpating the skin reveals increased temperature
68
List some causes of erythroderma
Previous skin disease - eczema and psoriasis Lymphoma Drugs - sulphonamides, gold, sulphonlyureas, penicillin, allopurinol, captopril Idiopathic
69
Describe the management of erythroderma
Treat the underlying cause Emollients and wet wraps to maintain skin moisture Topical steroids to relieve inflammation
70
List some complications of erythroderma
``` Secondary infection Fluid loss Electrolyte imbalance Hypothermia High output cardiac failure ```
71
Describe eczema herpeticum
Widespread eruption Complication of atopic eczema Extensive crusted papules, blisters and erosions Systemically unwell with fever and malaise
72
What causes eczema herpeticum
Herpes simplex virus
73
Describe the management of eczema herpeticum
Antivirals (Aciclovir) | Antibiotics for bacterial secondary infection
74
List some complications of eczema herpeticum
Herpes hepatitis Encephalitis DIC Death
75
Describe necrotising fasciitis
A rapidly spreading infection of the deep fascia with secondary tissue necrosis Severe pain, erythematous, blistering and necrotic skin, systemically unwell with fever and tachycardia, presence of crepitus, X-ray may show soft tissue gas
76
What causes necrotising fasciitis
Group A haemolytic streptococcus | Mixture of anaerobic or aerobic bacteria
77
List some risk factors for necrotising fasciitis
Abdominal surgery | Co-morbidities - DM (SGLT2 inhibitors) or malignancy
78
Describe the management of necrotising fasciitis
Urgent referral for extensive surgical debridement | IV antibiotics
79
Describe erysipelas and cellulitis
Spreading bacterial infection of the skin Cellulitis - deep SC tissue Erysipelas - acute superficial form of cellulitis and involves the dermis and upper subcutaneous tissue
80
What are the causes and risk factors for erysipelas and cellulitis
Streptococcus pyogenes and staphylococcus aureus Immunosuppression, wounds, leg ulcers, toe web intertrigo and minor skin injury
81
Describe the presentation of erysipelas and cellulitis
Erysipelas - well defined, raised, red border Local signs of inflammation - swelling (tumour), erythema (rubor), warmth (calor), pain (dolor) - may be associated with lymphangitis Systemically unwell with fever, malaise and rigors
82
How is cellulitis and erysipelas treated
Antibiotics - flucloxacillin or benzylpenicillin Supportive care - rest, leg elevation, sterile dressing and analgesia
83
What are some complications of cellulitis and erysipelas
Local necrosis Abscess Septicaemia
84
Describe staphylococcal scalded skin syndrome
Seen in infancy and early childhood Production of epidermolytic toxin from phage group 2, benxylpenicillin resistant staphylococci Develops within hrs to days and may be worse over axillae, groin , face and neck ``` Scalded like skin appearance followed by large flaccid bullae Perioral crusting Intraepidermal blistering Lesions are painful Eruption may be more localised Recovery within 5-7days ```
85
Describe the management of staphylococcal scalded skin syndrome
Antibiotics - erythromycin or cephalosporin | Analgesia
86
What are the 3 main groups of superficial fungal infections of the skin
Dermatophytes (tinea/ringworm) Yeast (candidiasis, malassezia) Moulds (aspergillus)
87
Describe tinea corporis
Tinea infection of the trunk and limbs | Itchy, circular or annular lesions with clearly defined, raised, scaly edge
88
Describe tinea cruris
Tinea infection of the groin and natal cleft | Very itchy
89
Describe tinea pedis
Athletes foot | Moist scaling and fissuring in the toe webs, spreading to the sole and dorsal aspect of the foot
90
Describe tinea manuum
Infection of the hand | Scaling and dryness in the palmar creases
91
Describe tinea capitis
Infection of the scalp - patches of broken hair, scaling and inflammation
92
Describe tinea unguium
Infection of the nail Yellow discoloration Thickened Crumbly nail
93
Describe tinea incognito
Inappropriate treatment of tinea infection with topical or systemic corticosteroids - ill defined and less scaly lesion
94
Describe candidiasis skin infection
White plaques on mucosal areas, erythema with satellite lesion in flexures
95
Describe pityriasis/tinea versicolor
Infection with malassezia furfur Scaly pale brown patches on upper trunk that fail to tan on sun exposure Usually asymptomatic
96
Describe the management of superficial fungal skin infections
Establish correct diagnosis by skin scrapings, hair or nail clippings (dermatophytes) and skin swabs (yeast) Treat underling immunosuppression, remove moist environments Topic antifungal agents (terbinafine cream) Oral antifungal agents (itraconazole) for severe, widespread or nail infections
97
Why should topical steroids be avoided in superficial fungal infections
Lead to tinea incognito
98
Describe basal cell carcinoma
Slow growing, locally invasive malignant tumour of the epidermal keratinocytes normally in older individuals - only rarely metastasises Most common Nodular (most common) - small, skin coloured papule or nodule with surface telangiectasia and a pearly rolled edge, the lesion may have a necrotic or ulcerated centre
99
List some risk factors for basal cell carcinoma
``` UV expisure History of frequent or severe sunburn in childhood Skin type 1 - always burns, never tans Increasing age Male Immunosuppression Previous skin cancer FH ```
100
Describe the management of basal cell carcinomas
Surgical excision - examination of tumour and margins Mohs micrographic surgery - excision of lesion and tissue borders are progressively excised until specimens are microscopically free of tumour - high risk recurrent tumours Radiotherapy - when surgery is not appropriate Cyrotherapy, currettage and cautery, topical photodynamic therapy, topical treatment (imiquimod cream)
101
List the complications of BCC
Local tissue invasion and destruction
102
Describe the prognosis of BCC
Depends on size, site, type, growth pattern/histology, failure of previous treatment/recurrence and immunosuppression
103
Describe squamous cell carcinoma
Locally invasive malignant tumour of the epidermal keratinocytes or its appendages which has the potential to metastasise Keratotic (scaly, crusty), ill defined nodule which may ulcerate
104
List some risk factors of SCC
``` Excessive UV exposure Pre-malignant skin conditions Chronic inflammation Immunosuppression Genetic predisposition ```
105
Describe the management of SCC
Surgical excision - treatment of choice Mohs micrographic surgery - ill defined large, recurrent tumours Radiotherapy - large, non-resectable tumours
106
Describe malignant melanoma
Invasive malignant tumour of the epidermal melanocytes which have the potential to metastasise
107
List some risk factors of malignant melanoma
``` Excessive UV exposure Skin type 1 History of >100 moles/atypical nevus syndrome moles FH in 1st degree relative Previous melanoma ```
108
Describe the ABCDE symptoms rule for malignant melanoma
``` Asymmetrical shape Border irregularity Colour irregularity Diameter >6mm Evolution of the lesion - change in size and shape Symptoms - itching or bleeidng ```
109
Describe superficial spreading melanoma
Most common type - 70% More common on the lower limbs in young/middle aged adults Related to intermittent high UV exposure
110
Describe nodular melanoma
Common on the trunk in young and middle aged adults, related to intermittent high intentity UV exposure
111
Describe lentigo maligna melanoma
Common on the face, in elderly population, related to long term cumulative UV exposure
112
Describe acral lentiginous melanoma
Common on palms, soles and nail beds in elderly population | No clear relation to UV exposure
113
Describe the management of malignant melanoma
Surgery Radiotherapy Chemotherapy
114
How is malignant melanoma staged
Breslow's thickness Lymph node involvement Metastasis Stage 1-4
115
What is thought to be the primary gene defect in eczema
Loss of protein filaggrin function - defect in skin barrier function
116
List some eczema exacerbating factors
``` Infection Allergens - food, chemicals, dust, pet fur Sweating Heat Occupation Severe stress ```
117
Describe the acute presentation of eczema
Itchy papules and vesicles often weepy
118
Describe the chronic presentation of eczema
Dry scaly itchy patches can be erythematous in paler skin or grey/brown in richly pigmented skin Chronic scratching leads to Lichenification Hypo/hyperpigmentation Nails may show pitting and ridging
119
Where is eczema located
Flexor aspects in children and adults (extensors in infants)
120
How may eczema present in richly pigmented skin
Brown, grey, purple bumps
121
Describe the management of eczema
Avoid exacerbating factors Frequent emollients and banadages and bath oil/soap substitutes Topical therapies - topical steroids for acitve areas and topical immunomodulators (tacrolimus and pimecrolimus) for maintenance therapy as steroid sparing agents Oral therapy - antihistamines for symptomatic relief, antibiotics (flucloxacillin) for secondary bacterial infection and antivirals (Aciclovir) for secondary herpes infection Phototherapy and immunosuppressants for severe non-responsive cases and biologic therapy
122
List some complications of eczema
Secondary bacterial infection - crusted weepy lesion Secondary viral infection - molluscum contagiosum (pearly papules with central umbilication), viral warts and eczema herpeticum
123
Describe acne vulgaris
Inflammatory disease of the pilosebaceous follicle Hormonal, increased sebum production, abnormal follicular keratinization, bacterial colonization and inflammation Non-inflammatory lesions (mild acne) - open and closed comedones Inflammatory lesions (moderate and severe acne) - papules, pustules, nodules and cysts In richly pigmented skin - inflammatory lesions not so apparent instead with hyperpigmented lesions or nodules detected by palpation
124
Describe the management of acne
Treatment for 6 weeks to see effect Topical therapy - benzoyl peroxidase and topical antibiotics and topical retinoids Oral therapy - oral antibiotics and anti-androgens in females Oral retinoids for severe acne
125
Describe psoriasis
Chronic inflammatory skin disorder due to hyperproliferation of keratinocytes and inflammatory cell infilration
126
List some types of psoriasis
Chronic plaque psoriasis - most common Guttate (raindrop lesions) Flexural (body folds) Pustular (palmar-plantar) Erythrodermic (total body redness)
127
List some precipitating factors of psoriasis
Trauma - koebner phenomenon Infection Drugs (beta blockers, lithium) and alcohol Stress
128
Describe the presentation of psoriasis
Well demarcated erythematous scaly plaques Richly pigmented skin - psoriasis can be brown, grey or purple patches/plaques Lesions can be burning, itchy and painful Common on extensor surfaces and over scalp Auspitz sign - scratch and gentle removal of the scales causes capillary bleeding 50% have associated nail changes 5-8% have associated psoriatic arthropathy - symmetrical polyarthritis, asymmetrical oligomonoarthritis, lone distal interphalangeal disease, psoriatic spondylosis, arthritis mutilans (flexion deformity of the dip joints)
129
Describe the management of psoriasis
Avoid precipitating factors Use emollients to reduce scales Topical therapies - vitamin D analogues (calcipotriol, calcitriol), topical corticosteroids, coal tar preparations, dithranol, topical retinoids, keratinolytics and scalp preparations Phototherapy for extensive disease - UVB and photochemotherapy psoralen UVA Oral therapy - methotrexate, retinoids, ciclosporin, mycophenolate mofetil, fumaric acid esters, biological agents
130
List some complications of psoriasis
Erythroderma, psychological and social effects
131
What is a complication of PUVA therapy
SCC
132
In psoriasis, how long should you wait before starting a second course of the same treatment (steroids)
4 weeks
133
What does the fragility of blisters depend on
The level of the split in the skin
134
What blisters rupture easily
Intraepidermal - Split within the epidermis
135
Which blisters do not rupture easily
Sub-epidermal - Split between the epidermis and dermis
136
Describe pompholyx
Vesicular eczema of the hands and feet
137
Describe bullous pemphigoid
Blistering skin disorder which affects the elderly Autoantibodies against antigens between the epidermis and dermis causing a sub-epithelial split in the skin Tense, fluid filled blisters on an erythematous base, lesions are itchy and may be preceded by a non specific itchy rash Usually affects the trunk and limbs
138
Describe the management of bullous pemphigoid
Wound dressings where required, monitor for signs of infection Topical therapies for localised disease - topical steroids Oral therapies for widespread disease - oral steroids, combination or oral tetracycline and nicotinamide, immunosuppressive agents (azathioprine, mycophenolate, mofetil, methotrexate)
139
Describe pemphigus vulgaris
Blistering skin disorder which usually affects middle aged Autoantibodies against antigens in the epidermis (desmosomes) causing intra-epidermal split in the skin Flaccid, easily ruptured blisters forming erosions and crusts Lesions are often painful Usually affects the mucosal areas - precede skin involvement
140
Describe the management of pemphigus vulgaris
Wound dressing where required, monitor for signs of infection, good oral care Oral therapies - high dose steroids, immunosuppressive agents (mycophenolate mofetil, methotrexate, azathioprine, cyclophosphamide)
141
Describe vitiligo
Autoimmune, acquired disorder where the innate immune system causes loss/destruction of melanocytes leading to depigmentation Presents at any age Koebner phenomenon - favours site of injury Face, hands, feet, body folds and genitalia
142
Describe the management of vitiligo
Minimise skin injury Topical treatment - topical steroids and calcineurin inhibitors (topical tacrolimus and pimecrolimus) Phototherapy (UVB) Oral immunosuppression - methotrexate, ciclosporin and mycophenolate mofetil
143
Describe melasma
Acquired chronic skin disorder of increased pigmentation Genetic predisposition plus sun exposure, hormone changes with pregnancy and contraceptive pills Overprouction of melanin by melanocytes Brown macules.larger patches with irregular border Symmetrical distribution Forehead, cutaneous upper lips and cheeks, rarely occur on neck, shoulders and upper arms
144
Describe the management of melasma
Lifelong sun protection Discontinuation of hormone products Cosmetic camouflage Topical treatments - inhibit formation of new melanin - hydroquinone, azelaic acid, vitamin C Laser treatment used with caution as heat from lasers can cause post inflammatory hyperpigmentation
145
Describe a venous ulcer
Medial malleolus Painful when standing up History of venous disease Large, shallow, irregular ulcer with exudative and granulating base Warm skin, normal peripheral pulses, leg oedema, hemosiderin, melanin deposition, lipodermatosclerosis and atrophie blanche
146
How are venous ulcers managed
Compression bandaging after excluding arterial insufficiency
147
Describe an arterial ulcer
``` Painful especially at night or when legs are elevated History of arterial disease Occur on pressure and trauma sites Cold skin Weak/absent pulses Shiny pale skin Loss of hair ```
148
How is arterial ulcer managed
ABPI <0.8 | Doppler studies and angiography - referral to vascular
149
Describe a neuropathic ulcer
``` Often painless, abnormal sensation History of diabetes or neurological disease Occur on pressure sites Variable in size and depth Granulating base May be surrounded by or underneath a callus Warm skin Normal peripheral pulses Peripheral neuropathy ```
150
Describe the management of neuropathic ulcers
X-ray to exclude osteomyelitis Wound debridement Regular repositioning, appropriate footwear and good nutrition
151
Describe scabies
May have history of contact with symptomatic indiviuals Pruititis worse at night Sides of fingers, finger webs, wrists, ankles, feet , nipples and genitals Linear burrows or rubbery nodules Secondary eczema and impetigo
152
How is scabies diagnosed
Skin scrape Extraction of mite View under microscope
153
How is scabies treated
Permethrin or malathion | Antihistamines
154
Describe lichen planus
``` FH (10%) May be drug induced Forearms, wrists and legs Always examine the oral mucosa Violaceous flat topped papules or hyperpigmented papules Symmetrical distribution Nail changes and hair loss Lacy white streaks on the oral mucosa and skin lesions (Wickham's striae) ```
155
How is lichen planus investigated
Skin biopsy
156
Describe the management of lichen planus
Corticosteroids | Antihistamines
157
Describe melanocytic naevi
Asymptomatic Congenital may be large, pigmented, protuberant and hairy Junctional naevi are small, flat and dark Intradermal naevi are usually dome shaped papules or nodules Compound naevi are usually raised, warty, hyperkeratotic and/or hairy
158
Describe seborrheic wart
Occur on the face and trunk Multiple and asymptomatic Middle aged/elderly Warty greasy papules/nodules with a stuck on appearance and well defined edges
159
Describe the management of seborrheic warts
Only if symptomatic Curette and cautery Cryotherapy
160
Describe DIC
History of trauma, malignancy, sepsis, obstetric complications, transfusions or liver failure Spontaneous bleeding from ENT, GI, resp or wound site Petechiae, ecchymoses, haemorrhagic bullae and tissue necrosis, systemically unwell
161
Describe DIC treatment
Treat underlying cause Transfuse for coagulation deficiency Anticoagulants for thrombosis
162
Describe vasculitis
Painful lesions Dependent areas Palpable purpura - often painful Systemically unwell
163
Describe actinic purpura
``` Extensor surfaces of hands and forearms Such skin is easily traumatised Non-palpable purpura Surrounding skin is atrophic and thin Systemically unwell No investigations or treatment needed ```
164
Give some examples of emoliients
Aqueous cream Emulsifying ointment Liquid paraffin and white paraffin 50:50 500g per tub
165
Name a mildly potent topical steroid
Hydrocortisone
166
Name a moderately potent topical steroid
Clobetasone butyrate (Euvomate)
167
Name a potent topical steroid
Betamethasone valerate (Betnovate)
168
Name a very potent topical steroid
Clobetasol propionate (dermovate)
169
List some local side effects of topical steroids
``` Skin atrophy Telangiectasia Striae May mask, exacerbate or cause skin infections Acne Perioral dermatitis Allergic contact dermatitis ```
170
List some systemic side effects of oral steroids
``` Cushings syndrome Immunosuppression HTN DM Osteoporosis Cataract Steroid induced psychosis ```
171
List some side effects of oral Aciclovir
GI upset Raised liver enzymes Reversible neurological reactions Haematological disorder
172
Describe the side effects of oral antihistamines
Sedative | Anticholinergic - Dry mouth, blurred vision, urinary retention and constipation
173
List the side effects of isotretinoin
Mucocutaneous reaction - dry skin, dry lips and dry eyes, disordered liver function, hypercholesterolaemia, hypertriglyceridemia, myalgia, arthralgia and depression Teratogenic
174
Describe the SMART ways to avoid sun exposure
Spend time in the shade between 11am-3pm Make sure you never burn Aim to cover up with a T-shirt, wide brimmed hat and sunglasses Remember to take extra care with children Then remember SPF 30+
175
Describe the Fitzpatrick skin phototypes
``` 1 - always burns, never tans 2 - always burns, sometimes tans 3 - sometimes burns, always tans 4 - never burns, always tans 5 - tans very easily, rarely burns 6 - tans very easily, never burns ```
176
Rash after amoxicillin may indicate...
Glandular fever CLL ALL Side effect

Finals (18 decks)

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