Dermatology Flashcards
What is acne vulgaris?
Affects face, neck & upper trunk
There’s obstruction of the pilosebaceous follicle with keratin plugs, which results in comedones, inflammation & pustules.
Who gets acne vulgaris?
80-90% of teenagers, 60% seek medical advice
What bacteria is present in acne vulgaris?
Propionibacterium acnes
Pathology of acne vulgaris
Ance is a disorder of the pilosebaceous unit (hair follicle + sebaceous gland)
There’s increased sebum production (due to androgenic hormones), bacterial colonisation (P. acnes) and inflammatory mediators
Development of acne is multifactorial
Risk factors for acne vulgaris
Puberty PCOS Congenital adrenal hyperplasia Exogenous steroids/testosterone Medications - steroids, anti epileptics, EGFR inhibitors High glycemic index foods
Symptoms of acne vulgaris
Comedones - dilated sebaceous follicle. If the top is closed = whitehead, if the top is open = blackhead
Inflammatory lesions when the follicle bursts = papules and pustules
an excessive inflammatory response = nodules and cysts
Scarring - ice pick scars and hypertrophic scars
Drug induced acne - monomorphic e.g. pustules in steroid use
what is a papule?
a solid or cystic raised spot on the skin that is less than 1cm
what is a pustule?
small inflamed pus filled blister like sore on the skin surface
What is acne fulminans?
very severe acne associated with systemic upset (fever). Hospital admission is often required and the condition usually responds to oral steroids
How can acne be classified?
mild: open and closed comedones with or without sparse inflammatory lesions
moderate acne: widespread non-inflammatory lesions and numerous papules and pustules
severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
What is the mx for acne vulgaris?
1st = single topical retinoid or benzoyl peroxide
2nd = topical combination therapy with topical abx, benzoyl peroxide or topical retinoid
3rd = oral abx (tetracyclines = lymecycline, oxytetracycline or doxycycline) OR COPC in women + co-prescribe topical retinid/benzoyl peroxide (but not a topical abx)
4th = oral isotretinoin under specialist supervision
What tx for acne can you not give to pregnant women?
Retinoids
Tetracyclines - lymecycline, oxytetracycline or doxycycline. Use erythromycin instead
Oral isotretinoin
What are the complications of acne?
Post inflammatory lesions - scarring and hyperpigmentation
Mental health impact
What are some prognostic markers associated with severe eczema?
onset at age 3-6 months severe disease in childhood associated asthma or hay fever small family size high IgE serum levels
What is the Mx for eczema?
- emollients (E45, diprobase, oilatum, aveeno), soap substitutes
- topical steroids - hydrocortisone, eumovate, betnovate, dermovate
- UV radiation
- immunosuppressants: e.g. ciclosporin, antihistamines and azathioprine
What is eczema?
chronic atopic condition caused by defects in the normal continuity of the skin barrier, leading to inflammation in the skin.
Symptoms of eczema
Dry, red, itchy and sore patches on the skin
On flexor surfaces - inside the elbows and knees & face/neck
Have flares
Side effects of topical steroids
thinning of the skin = skin is more prone to flares, bruising, tearing, stretch marks and telangiectasia
What bacteria opportunistically infect the skin of patients with eczema?
Staph aureus (tx flucloaxacillin)
What is eczema herpeticum?
a viral skin infection in patients with eczema caused by the herpes simplex virus (HSV) or varicella zoster virus (VZV).
What is basal cell carcinoma?
One of the 3 main types of skin cancer
Lesions are slow growing and only locally invade, metastases are extremely rare
Lesions are called rodent ulcers
Symptoms of basal cell carcinoma
Sun exposed sites are affected - head & neck, not the ear
Initially are pearly flesh coloured papules with telangiectasia
They then may ulcerate, leaving a central crater
How should patients with suspected BCC be referred?
Routine referral
Mx of BCC
surgical removal curettage cryotherapy topical cream: imiquimod, fluorouracil radiotherapy
Do a punch biopsy if treatment other than standard surgical excision is planned