Dermatology Flashcards
What are important things to ask in the HxPC for a derm hx?
- 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
What are some other important things to ask about in a derm history?
PMH - hx atopy + skin cancer, suspicious skin lesions
FH
SH - occupation, improvement of lesions when away from work
Impact of skin condition and meds.
What is the mneumonic for describing a lesion?
SCAM or ABCDE Size Colour Associated secondary change Morphology/Margin
Asymmetry ireg Border no of Colours in lesion Diameter Evolution
What do you feel for on a lesion?
Surface Consistency Mobility Tenderness Temperature
What is involved in a systemic check in a derm exam?
- Nails
- Scalp
- Hair
- Mucous membranes
- General exam of systems if needed
What do naevus and comedone mean?
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
What are the ways to describe configuration?
Discrete, confluent, linear, target, annular, discoid.
What are the ways to describe colour of lesions?
Erythema, purpura, hypopigmentation, depigmentation, hyperpigmentation
What does morphology mean?
Structure of a lesion
What are ways to describe the morphology of a lesion?
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 -
What are the clinical features of eczema?
- +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
What is the management of eczema?
- 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
What are the clinical features of acne vulgaris?
- 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
What is the management of acne vulgaris?
- Topical - benzoyl peroxide, abx, retinoids
- Oral - abx and anti androgens in females eg. COCP
- Oral retinoids for severe acne
What is the pathophysiology of urticaria?
Urticaria = local increase in permeability of capillaries = histamine from mast cells is released = swelling of superficial dermis raising epidermis.
What is the management of allergic rashes and urticaria?
- 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
What are the clinical features of a BCC?
- 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
What is telangiectasia?
Broken blood vessels located near the surface of the skin - spider veins
What are the RF for BCC?
- UV exposure
- Hx freq/severe sunburn
- Always burns never tans
- Increasing age
- Male
- Immunosuppressed
- Previous hx
How do you manage BCC?
- Surgical excision
- Mohs micrographic surgery
- Radiotherapy when surgery not possible
- Cryotherapy, cautery, curettage if low risk
What are the clinical features of SCC?
- Locally invasive malignant tumour, has potential to met
- Keratotic = scaly, crusty, ill defined nodule that can ulcerate
How is SCC managed?
- Surgical excision/Mohs micrographic if ill defined or recurrent
- Radiotherapy if large and non resectable
What are the RF of SCC?
- UV exposure
- Pre malignant skin conditions eg. actinic keratosis
- Chronic inflam eg. ulcers
- Immunosuppression
- Genetic predisposition
What is a malignant melanoma?
- 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
What is the management of malignant melanoma?
- Surgical excision is the definitive treatment, maybe radiotherapy
- Chemotherapy used for mets
What are the RF of malignant melanoma?
- Excessive UV exposure
- Always burns never tans
- > 100 moles or atypical neavus syndrome moles
- FH
- Previous hx
What is the structure of the skin?
- Epidermis at top
- Dermis in middle
- Fat layer at the bottom
Give examples of 4 topical steroids and their potency used in treatment of eczema
- Mildly potent = hydrocortisone
- Mod potent = betamethasone 0.025%
- Potent = betamethasone 0.1%
- Very potent = clobetasol
When do patients with eczema need referral to secondary care?
- 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
Give examples of 3 emollients used to treat eczema
- E45 lotion
- Epaderma cream
- Epimax cream
How should emollients be used?
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.
What is the advice on how to use topical steroids?
- 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
How does urticaria present?
- 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
What are important aspects in an urticaria history?
- Knowledge of trigger factors eg. stress, drugs, insect bites and stings, exercise, foods
- Treatments tried and response
- FH and co morbidities
- GI sx
What is the management of psoriasis?
- 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
What is the presentation of psoriasis?
- Well demarcated erythematous scaly plaques
- Itchy, burning, painful lesions
- Common on extensors and scalp
- 50% have associated nail changes
- Can have arthropathy
What is cellulitis and erysipelas?
Cellulitis - bacterial infection of deep subcut tissue
Erysipelas - superficial dermis and upper subcut
What is the presentation of cellultitis?
- Most common in lower limbs
- Tumor, rubor, calor, dalor (oedema, erythema, warmth, pain)
- Systemically unwell w fever, malaise and rigors
How can you distinguish erysipelas from cellulitis o/e?
Well defined, red, raised border
What is the management of cellulitis?
Flucloxacillin - treat Staph.aureus or Strep.pyogenes
What are the types of fungal skin infections?
- Tinea corporis - ringworm
- Tinea cruris - similar to ringworm but of groin and natal cleft
- Tinea pedis - athletes foot
- Candidiasis - white plaques on mucosal areas
How are fungal skin infections managed?
- Skin scrapings/swab for correct diagnosis
- Topical antifungal agents eg. terbinafine cream
- Oral antifunfals - intraconazole for severe/widespread/nail infections
