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GP block > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are important things to ask in the HxPC for a derm hx?

A
  • Nature, site and duration
  • Initial appearance and evolution of lesion
  • Sx esp itch and pain
  • Aggravating and relieving factors
  • Treatments and if worked
  • Recent contact, stressful events, illness and travel
  • Hx sunburn and sunbeds
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2
Q

What are some other important things to ask about in a derm history?

A

PMH - hx atopy + skin cancer, suspicious skin lesions
FH
SH - occupation, improvement of lesions when away from work
Impact of skin condition and meds.

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3
Q

What is the mneumonic for describing a lesion?

A 
SCAM or ABCDE
Size
Colour
Associated secondary change
Morphology/Margin
Asymmetry
ireg Border
no of Colours in lesion
Diameter
Evolution
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4
Q

What do you feel for on a lesion?

A 
Surface
Consistency
Mobility
Tenderness
Temperature
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5
Q

What is involved in a systemic check in a derm exam?

A
  • Nails
  • Scalp
  • Hair
  • Mucous membranes
  • General exam of systems if needed
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6
Q

What do naevus and comedone mean?

A

Naevus - benign melanocytic tumor, more commonly called a mole
Comedone - plug in a sebaceous follicle = alt sebum, bacteria and cell debris. Can be open = blackhead or closed = whitehead

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7
Q

What are the ways to describe configuration?

A

Discrete, confluent, linear, target, annular, discoid.

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8
Q

What are the ways to describe colour of lesions?

A

Erythema, purpura, hypopigmentation, depigmentation, hyperpigmentation

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9
Q

What does morphology mean?

A

Structure of a lesion

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10
Q

What are ways to describe the morphology of a lesion?

A 
Macule - flat, diff colour
Patch - large, flat
Papule - solid, raised <0.5cm
Nodule - solid raised >0.5cm
Plaque - raised scaling
Vesicle - fluid filled lesion <0.5cm 
Bulla - raised fluid filled lesion >0.5cm
Pustule -
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11
Q

What are the clinical features of eczema?

A
  • +ve FH atopy
  • Acute - itchy papules and vesicles, often exudative
  • Chronic - dry scaly itchy patches, can be erythematous in white skin or grey in dark skin
  • Common in flexors in children and adults
  • Chronic scratching
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12
Q

What is the management of eczema?

A
  • Avoid exacerbating agents
  • Freq emollients
  • Topical steroids, topical immunomodulators eg. tacrolimus
  • Oral antihistamimes for sx relief, abx for secondary bacterial infections, antivirals if herpes
  • Phototherapy and immunosuppressants - azathioprine, ciclosporin, methotrexate if severe and non responsive
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13
Q

What are the clinical features of acne vulgaris?

A
  • Open and closed comedones = non inflam and mild
  • Inflam lesions indicate mod and severe acne - papules, pustules, nodules and cysts
  • Hyerpigmentation in dark skin and non erythematous nodules on palpation
  • Commonly affects face, chest, upper back
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14
Q

What is the management of acne vulgaris?

A
  • Topical - benzoyl peroxide, abx, retinoids
  • Oral - abx and anti androgens in females eg. COCP
  • Oral retinoids for severe acne
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15
Q

What is the pathophysiology of urticaria?

A

Urticaria = local increase in permeability of capillaries = histamine from mast cells is released = swelling of superficial dermis raising epidermis.

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16
Q

What is the management of allergic rashes and urticaria?

A
  • Antihistamines eg. cetirizine
  • PO corticosteroids if severe eg. prednisolone 40mg 7 days
  • Avoidance of trigger factors, if don’t have one arrange for allergy testing
  • Sx diaries
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17
Q

What are the clinical features of a BCC?

A
  • Slow growing, locally invasive, malignant tumour unlikely to metastasise
  • Nodular = most common = skin coloured papule, small, pearly rolled edge w surface telangiectasia and maybe ulcerated centre
  • Most common over head and neck
18
Q

What is telangiectasia?

A

Broken blood vessels located near the surface of the skin - spider veins

19
Q

What are the RF for BCC?

A
  • UV exposure
  • Hx freq/severe sunburn
  • Always burns never tans
  • Increasing age
  • Male
  • Immunosuppressed
  • Previous hx
20
Q

How do you manage BCC?

A
  • Surgical excision
  • Mohs micrographic surgery
  • Radiotherapy when surgery not possible
  • Cryotherapy, cautery, curettage if low risk
21
Q

What are the clinical features of SCC?

A
  • Locally invasive malignant tumour, has potential to met

- Keratotic = scaly, crusty, ill defined nodule that can ulcerate

22
Q

How is SCC managed?

A
  • Surgical excision/Mohs micrographic if ill defined or recurrent
  • Radiotherapy if large and non resectable
23
Q

What are the RF of SCC?

A
  • UV exposure
  • Pre malignant skin conditions eg. actinic keratosis
  • Chronic inflam eg. ulcers
  • Immunosuppression
  • Genetic predisposition
24
Q

What is a malignant melanoma?

A
  • Invasive malignant tumour of melanocytes, has potential to metastasise
  • Use ABCDE sx to describe
  • More common on legs of women and trunk of men
  • Most common type = superficial spreading melanoma, on lower limbs in young adults
25
Q

What is the management of malignant melanoma?

A
  • Surgical excision is the definitive treatment, maybe radiotherapy
  • Chemotherapy used for mets
26
Q

What are the RF of malignant melanoma?

A
  • Excessive UV exposure
  • Always burns never tans
  • > 100 moles or atypical neavus syndrome moles
  • FH
  • Previous hx
27
Q

What is the structure of the skin?

A
  • Epidermis at top
  • Dermis in middle
  • Fat layer at the bottom
28
Q

Give examples of 4 topical steroids and their potency used in treatment of eczema

A
  1. Mildly potent = hydrocortisone
  2. Mod potent = betamethasone 0.025%
  3. Potent = betamethasone 0.1%
  4. Very potent = clobetasol
29
Q

When do patients with eczema need referral to secondary care?

A
  • Eczema herpeticum = dermatological emergency and needs hospital admission
  • Refer to derm if uncertain diagnosis, not responding to treatment, recurrent secondary infection, high risk complication, if consider food allergy
  • Refer to clinical psychologist if struggling w mental health
30
Q

Give examples of 3 emollients used to treat eczema

A
  1. E45 lotion
  2. Epaderma cream
  3. Epimax cream
31
Q

How should emollients be used?

A

Applied immediately after showers or baths. Should remove the product with a clean spoon to reduce bacterial contamination. Apply in the direction of hair growth.

32
Q

What is the advice on how to use topical steroids?

A
  • Apply a thin layer to all affected areas
  • Use emollient first and then wait 15-30 mins then topical steroid
  • For flares = twice a day and maintenance = once a day
  • One finger tip unit enough to treat skin area of two hands
33
Q

How does urticaria present?

A
  • Acute urticaria <6 weeks and chronic >6
  • Swollen itchy wheals surrounded by area of redness - flare
  • Skin returns to normal appearance usually w/i 1-24 hours
34
Q

What are important aspects in an urticaria history?

A
  • Knowledge of trigger factors eg. stress, drugs, insect bites and stings, exercise, foods
  • Treatments tried and response
  • FH and co morbidities
  • GI sx
35
Q

What is the management of psoriasis?

A
  • General = avoid triggers, emollients
  • Topical = Vit D, topical corticosteroids, coal tar preps, topical retinoids, keratolytics, scalp preps
  • Phototherapy for extensive disease
  • Severe disease = methotrexate, retinoids, ciclosporin, mycophenolate mofetil
36
Q

What is the presentation of psoriasis?

A
  • Well demarcated erythematous scaly plaques
  • Itchy, burning, painful lesions
  • Common on extensors and scalp
  • 50% have associated nail changes
  • Can have arthropathy
37
Q

What is cellulitis and erysipelas?

A

Cellulitis - bacterial infection of deep subcut tissue

Erysipelas - superficial dermis and upper subcut

38
Q

What is the presentation of cellultitis?

A
  • Most common in lower limbs
  • Tumor, rubor, calor, dalor (oedema, erythema, warmth, pain)
  • Systemically unwell w fever, malaise and rigors
39
Q

How can you distinguish erysipelas from cellulitis o/e?

A

Well defined, red, raised border

40
Q

What is the management of cellulitis?

A

Flucloxacillin - treat Staph.aureus or Strep.pyogenes

41
Q

What are the types of fungal skin infections?

A
  • Tinea corporis - ringworm
  • Tinea cruris - similar to ringworm but of groin and natal cleft
  • Tinea pedis - athletes foot
  • Candidiasis - white plaques on mucosal areas
42
Q

How are fungal skin infections managed?

A
  • Skin scrapings/swab for correct diagnosis
  • Topical antifungal agents eg. terbinafine cream
  • Oral antifunfals - intraconazole for severe/widespread/nail infections

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