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Neuro and special senses > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What framework is used to describe individual skin lesions

A

SCAM

Size (at widest point), shape

Colour

Associated features

Morphology, margins

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2
Q

What framework is used to describe pigmented skin lesions

A

ABCDE

Asymmetry

Border

Colour

Diameter (> 6 mm)

Evolving

Used for assessing melanoma risk

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3
Q

What do you assess in the ‘palpate’ part of the skin assessment

A

Surface

Consistency

Mobility

Tenderness

Temperature

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4
Q

Which sites need to be checked as part of a systemic check for dermatology

A

Nails

Scalp

Hair

Mucous membranes

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5
Q

What are the functions of normal skin

A

Protective barrier against environmental insults

Temperature regulation

Sensation

Vitamin D synthesis

Immunosurveillance

Appearance/cosmetics

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6
Q

What are the 4 main cell types in the epidermis

A

Keratinocytes (produce keratin as a protective barrier)

Langerhan’s cells (immune protection)

Melanocytes (produce melanin)

Meckel cells (specialised nerve endings for sensation)

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7
Q

What are the layers of the epidermis

A

Stratum basale (basal layer): deepest, actively dividing cells

Stratum spinosum (prickle cell layer): differentiating cells

Stratum granulosum (granular cell layer): cells lose nuclei and contain granules of keratohyalin, cells secrete lipids into intercellular space

Stratum corneum (horny cell layer): layer of keratin, most superficial

Stratum lucidum: extra layer of thick skin in certain places

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8
Q

What pathology can be associated with the epidermis

A

Psoriasis: changes in turnover time

Scales, crusting, exudate, ulcers: changes in/loss of surface

Hyper/hypopigmented lesions

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9
Q

Describe the dermis

A

Made up of: collagen, elastin, glycosaminoglycans

Provide skin with strength and elasticity

Contains: immune cells, nerves, skin appendages, lymphatic vessels, blood vessels

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10
Q

What pathology can be associated with the dermis

A

Changes in contour (papules, nodules, skin atrophy, ulcers)

Disorders of appendages

Changes related to lymphatic/blood vessels (erythema, urticaria, purpura)

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11
Q

What are the different types of hair

A

Lanugo (fine, long, in foetus)

Vellus (fine, short, on body surface)

Terminal (coarse, long, on scalp, eyebrows, eyelashes, pubic area)

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12
Q

What are the phases of wound healing

A

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, angiogenesis, re-epithelialisation)

Remodelling (collagen fibre re-organisation, scar maturation)

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13
Q

What are the causes of urticaria, angioedema, and anaphylaxis

A

Idiopathic

Foods allergies

Drug allergies

Viral infection

Parasitic infection

Autoimmune

Hereditary

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14
Q

What is urticaria

A

Local increase in permeability of capillaries and small venules

Inflammatory mediators (mainly histamines from mast cells)

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15
Q

How might urticaria present

A

Itchy wheals

Swelling involves superficial dermis, raising epidermis

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16
Q

How might angioedema present

A

Swelling of tongue and lips

Deep swelling, involving dermis and subcutaneous tissue

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17
Q

How might anaphylaxis present

A

May initially present as urticaria or angioedema

Bronchospasms

Facial oedema

Laryngeal oedema

Hypotension

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18
Q

What is the management for urticaria

A

Mild: antihistamines

Moderate: corticosteroids

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19
Q

What is the management for angioedema

A

Corticosteroids

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20
Q

What is the management for anaphylaxis

A

Adrenaline

Corticosteroids

Antihistamine

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21
Q

What is erythema nodosum

A

Hypersensitivity response to various stimuli

Most commonly on shins

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22
Q

What are the causes of erythema nodosum

A

Group A strep

Primary TB

Pregnancy

Malignancy

Sarcoidosis

Inflammatory bowel disease

Chlamydia

Leprosy

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23
Q

How might erythema nodosum present

A

Discrete tender nodules

Lesions for 1-2 weeks

Leave bruise-like discolouration as they resolve

No ulceration, atrophy, or scarring

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24
Q

What is erythema multiforme

A

Acute, self-limiting inflammatory condition

Often idiopathic

Usually due to herpes simplex

Not often on mucosal surfaces

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25
Q

What is Stevens-Johnson syndrome

A

Mucocutaneous neurosis

At least 2 mucosal sites involved

Can be limited or extensive

Can be due to medications or infection

On histology: full-thickness epidermal necrosis, subepidermal detachment

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26
Q

What is the management for erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrosis

A

Early recognition

Involve seniors early

Full supportive care (to maintain haemodynamic status)

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27
Q

What is toxic epidermal necrosis

A

Usually drug-induced

Extensive skin and mucosal necrosis

Systemic toxicity

On histopathology: full-thickness epidermal necrosis, subepidermal detachment

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28
Q

What are the complications of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrosis

A

High mortality

Sepsis

Electrolyte imbalance

Multi-system organ failure

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29
Q

What is acute meningococcaemia

A

Bacteria get into circulating blood due to contagious respiratory infections

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30
Q

What are the causes of acute meningococcaemia

A

Gram negative diplococci (especially Neisseria meningitidis)

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31
Q

How might acute meningococcaemia present

A

Non-blanching purpuric rash (on trunk and extremities, can progress to tissue necrosis/haemorrhagic bullae)

Features of meningitis (headache, fever, neck stiffness)

Features of septicaemia (hypotension, fever, myalgia)

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32
Q

What is the management for acute meningococcaemia

A

Antibiotics (benzylpenicillin)

Prophylactic antibiotics for close contacts

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33
Q

What are the complications of acute meningococcaemia

A

Septic shock

Disseminated intravascular coagulation

Multi-organ failure

Death

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34
Q

What is erythroderma

A

Exfoliative dermatitis covering >90% of skin surface

Overall mortality 20-40%

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35
Q

What are the causes of erythroderma

A

Previous skin disease (eczema, psoriasis)

Lymphoma

Drugs (penicillin, allopurinol, sulphonylureas)

Idiopathic

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36
Q

How might erythroderma present

A

Inflamed, oedematous, scaly skin

Systemically unwell

Lymphadenopathy

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37
Q

What is the management for erythroderma

A

Treat underlying cause

Emollients

Wet wraps

Topical steroids

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38
Q

What are the complications of erythroderma

A

Secondary infection

Fluid loss

Electrolyte imbalance

Hypothermia

High-output heart failure

Capillary leak syndrome

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39
Q

What is eczema herpeticum

A

Aka Kaposi’s varicelliform eruption

Widespread eruption

Serious complication of common skin conditions

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40
Q

What causes eczema herpeticum

A

Herpes simplex virus

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41
Q

How might eczema herpeticum present

A

Extensive crusted papules

Blistering

Erosions

Systemically unwell

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42
Q

What is the management for eczema herpeticum

A

Aciclovir

Antibiotics (if have secondary infection)

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43
Q

What are the complications of eczema herpeticum

A

Herpes hepatitis

Encephalitis

Disseminated intravascular coagulation

Death

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44
Q

What is necrotising fasciitis

A

Infection of deep fascia

Secondary tissue necrosis

Rapidly spreading

50% in previously healthy people

Very high mortality

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45
Q

What are the causes of necrotising fasciitis

A

Group A haemolytic strep

Mixture of aerobic and anaerobic bacteria

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46
Q

What are the risk factors for necrotising fasciitis

A

Abdominal surgery

Diabetes

Malignancy

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47
Q

How might necrotising fasciitis present

A

Severe pain

Erythematous, blistering, necrotic skin

Systemically unwell

Crepitus (subcutaneous emphysema)

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48
Q

What are the investigations for necrotising fasciitis

A

X-ray (see soft tissue gas)

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49
Q

What is the management for necrotising fasciitis

A

Urgent referral for extensive surgical debridement

IV antibiotics

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50
Q

What is erysipelas

A

Acute superficial form of cellulitis

Involves dermis and upper subcutaneous tissue

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51
Q

What is cellulitis

A

Bacterial infection of the skin

Involves deep subcutaneous tissue

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52
Q

What are the causes of erysipelas and cellulitis

A

Strep pyogenes

Staph aureus

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53
Q

What are the risk factors for erysipelas and cellulitis

A

Immunosuppression

Wounds

Leg ulcers

Toe-web intertrigo

Minor skin injury

54
Q

How might erysipelas and cellulitis present

A

Most common in lower limbs

Local signs of inflammation

Systemically unwell

Erysipelas: well-defined, red, raised borders of lesions

55
Q

What is the management for erysipelas and cellulitis

A

Antibiotics (flucloxacillin, benzylpenicillin)

Supportive care

56
Q

What are the complications of erysipelas and cellulitis

A

Localised necrosis

Abscess

Septicaemia

57
Q

Who is staphylococcal scalded skin syndrome common in

A

Infants and children

58
Q

What are the causes of staphylococcal scalded skin syndrome

A

Benzylpenicillin-resistant staph

Production of circulating epidermolytic toxins from phages

59
Q

How might staphylococcal scalded skin syndrome present

A

Develops in hours-days

Worse over face, neck, axilla, groin

Scald-like skin appearance

Large flaccid bulla

Perioral crusting

Intraepidermal blistering

Painful lesions

60
Q

What is the management for staphylococcal scalded skin syndrome

A

Recover in 5-7 days

Antibiotics

Analgesia

61
Q

What are the causes of superficial fungal skin infection

A

Dermatophytes (tinea, ringworm)

Yeast (candida, malassezia)

Moulds (aspergillus)

62
Q

How might superficial fungal skin infection present

A

Unilateral

Itchy

Tinea corporis (trunk and limbs)

Tinea cruris (groin or nasal cleft)

Tinea pedis (athlete’s foot)

Tinea mannum (hand)

Tinea caripis (scalp)

Tinea unguium (nail)

Tinea incognito (due to inappropriate treatment of tinea infections with corticosteroids)

63
Q

What is the management for superficial fungal skin infection

A

Establish correct diagnosis

Treat triggers

Topical antifungals

Oral antifungals (if severe or affecting nails)

Avoid topical steroids

64
Q

What is basal cell carcinoma

A

Slow-growing, locally invasive cancer of epidermal keratinocytes

Rarely metastasises

More common in elderly

65
Q

What are the risk factors for basal cell carcinoma

A

UV exposure

Frequent/severe sunburns (especially in childhood)

Skin type 1

Increasing age

M>F

Immunosuppression

Previous skin cancer

Genetic predisposition

66
Q

How might basal cell carcinoma present

A

Pearly

Skin coloured nodules/papules with surface telangiectasia

May have necrotic/ulcerated centre

67
Q

What is the management for basal cell carcinoma

A

Surgical excision (with margin)

Radiotherapy (if surgery not appropriate)

Cryotherapy

Curettage

Cautery

Topical photodynamic therapy

68
Q

What are the complications of basal cell carcinoma

A

Local tissue invasion and destruction

69
Q

What is squamous cell carcinoma

A

Locally invasive malignant tumour of epidermal keratinocytes or appendages

Potential to metastasise

70
Q

What are the risk factors for squamous cell carcinoma

A

UV exposure

Pre-malignant skin conditions (actinic keratosis)

Chronic inflammation (leg ulcer wound scars)

Immunosuppression

Genetic predisposition

71
Q

How might squamous cell carcinoma present

A

Scaly, crusting, ill-defined nodule

May have ulceration

72
Q

What is the management for squamous cell carcinoma

A

Surgical excision

Mohs micrographic surgery (for ill-defines, large, recurrent tumours)

Radiotherapy (if surgery not appropriate)

73
Q

What is malignant melanoma

A

Invasive tumour of epidermal melanocytes

Has potential to metastasise

74
Q

What are the different types of malignant melanoma

A

Superficial spreading melanoma (on legs, in young)

Nodular melanoma (on trunk, in young)

Lentigo melanoma (on face, in elderly)

Acral lentiginous melanoma (on palm, soles, nail beds, in elderly)

75
Q

What are the risk factors for malignant melanoma

A

Sun exposure

Skin type 1

History of multiple/atypical moles

Family history

76
Q

How might malignant melanoma present

A

On legs in women

On trunk in men

Assess using ABCDE

77
Q

What is the management for malignant melanoma

A

Surgical excision

Radiotherapy

Chemotherapy (for metastatic disease)

78
Q

What is the prognosis for malignant melanoma

A

Recurrence rates based on Breslow thickness

5 year survival based on TNM

79
Q

What is atopic eczema

A

Papules and vesicles on erythematous base

Usually develops in childhood, resolves by teens

80
Q

What are the causes of atopic eczema

A

Family history of atopy

Genetic defects in skin barrier function

Exacerbating factors: infection, allergens, sweating, heat, severe stress

81
Q

How might atopic eczema present

A

Itchy, erythematous, dry, scaly patch

Infants: face and extensors

Children and adults: flexors

May have excoriation and lichenification due to chronic itching or rubbing

May have pitting/ridging of mails

82
Q

What is the management for atopic eczema

A

Avoid exacerbating factors

Frequent emollient use

Topical steroids (for flare ups)

Antihistamines

Antibiotics (fluclox - for secondary bacterial infection)

Antivirals (for secondary herpes infection)

Phototherapy and immunosuppressants *for severe, non-responsive disease)

83
Q

What are the complications of atopic eczema

A

Secondary bacterial infection

Secondary viral infection

84
Q

What is acne vulgaris

A

Inflammatory disease of pilosebaceous follicles

85
Q

What are the causes of acne vulgaris

A

Androgens

Increased sebum production

Abnormal follicular keratization

Bacterial colonisation

Inflammation

86
Q

How might acne vulgaris present

A

Usually on face, chest, or upper back

Non-inflammatory lesions (mild acne, open and closed comedones)

Inflammatory lesions (moderate to severe acne, papules, pustules, nodules, cysts)

87
Q

What is the management for acne vulgaris

A

Mild acne: topical benzoyl peroxide, topical antibiotics, topical retinoids

Moderate to severe acne: oral antibiotics, anti-androgens (females), oral retinoids

88
Q

What are the complications of acne vulgaris

A

Post-inflammatory hyperpigmentation

Scarring

Deformity

Psychological and social effects

89
Q

What is psoriasis

A

Chronic inflammatory skin disease

Due to hyperproliferation of keratinocytes and inflammatory cell infiltrates

90
Q

What are the different types of psoriasis

A

Chronic plaque psoriasis (most common)

Guttate (raindrop lesions)

Seborrhoeic

Flexural

Pustular (palmar and plantar)

Erythrodermic (total body redness)

91
Q

What are the risk factors for psoriasis

A

Previous trauma to skin

Infection

Certain drugs

Stress

Alcohol

92
Q

How might psoriasis present

A

Well-demarcated erythematous scaly plaques

Itchy, burning, painful lesions

Common on extensor surfaces and scalp

Auspitz sigh (scratching/gently removing scales causes capillary bleeding)

Commonly have associated nail changes

93
Q

What is the management for psoriasis

A

Frequent emollient use

Localised and mild disease: topical therapies (vitamin D analogues, corticosteroids, coal tar presentation)

Extensive disease: phototherapy, oral therapies (methotrexate, retinoids, ciclosporin, biological agents)

94
Q

What are the complications of psoriasis

A

Erythroderma

Psychological and social effects

95
Q

What is bullous pemphigoid

A

Blistering skin disorder

Usually affects elderly

96
Q

What are the causes of bullous pemphigoid

A

Autoantibodies against antigens between epidermis and dermis (get sub-epithelial split in skin)

97
Q

How might bullous pemphigoid present

A

Tense, fluid-filled blisters on erythematous base

Itchy lesions

Often preceded by non-specific itchy rash

Usually affects trunk and limbs

98
Q

How is bullous pemphigoid managed

A

Wound dressing

Monitor for signs of infection

Localised: topical steroids

Widespread: oral steroids, oral tetracycline, oral nicotinamide, immunosuppressants

99
Q

What is pemphigus vulgaris

A

Blistering skin disorder

Usually in middle age

100
Q

What are the causes of pemphigus vulgaris

A

Antibodies against antigens within epidermis (intraepithelial split in skin)

101
Q

How might pemphigus vulgaris present

A

Flaccid, easily ruptured blisters forming erosions and crusts

Painful lesions

Usually in mucosal surfaces

102
Q

What is the management for pemphigus vulgaris

A

Wound dressing

Monitor for signs of infection

Good oral care

High dose oral steroids

Immunosuppressants

103
Q

What are the 3 types of chronic leg ulcers

A

Arterial

Venous

Neuropathic

104
Q

Give an overview of arterial ulcers

A

Presentation: pain, worse on leg elevation, history of arterial disease

Commonly in pressure areas and trauma sites

Lesions: small, sharply defined, deep ulcers necrotic base

Associated features: cold skin, weak/absent peripheral pulses, shiny pale skin, hair loss

Investigations: ABPI < 0.8 (arterial insufficiency), doppler, angiography

Management: vascular reconstruction

105
Q

Give an overview of venous ulcers

A

Presentation: painful, worse on standing, history of venous disease

Commonly in malleolar areas

Lesions: large, shallow, irregular ulcers, exudative and granulating base

Associated features: warm skin, normal peripheral pulses, leg oedema, brown pigmentation, liposclerosis, atropine blanche (white scarring, dilated capillaries)

Investigations: normal ABPI (0.8-1)

Management: compression bandaging (after excluding arterial insufficiency)

106
Q

Give an overview of neuropathic ulcers

A

Presentation: painless, abnormal sensation, history of diabetes or neurological disease

Commonly on pressure sites

Lesions: variable size and depth, granulating base, may be surrounded by/underneath a callus

Associated features: warm skin, normal peripheral pulses, peripheral neuropathy

Investigations: ABPI < 0.8, X-ray (exclude osteomyelitis)

Management: wound debridement, regular repositioning, appropriate footwear, good nutrition

107
Q

Give an overview of eczema

A

Presentation: history of atopy, clear exacerbating factors

Lesions: dry, erythematous patches. Acute eczema: erythematous, vesicular, exudative

Associated features: secondary bacterial or viral infection

Investigations: patch testing, serum IgE, skin swab

Management: emollients, corticosteroids, immunomodulators, antihistamines

108
Q

Give an overview of scabies

A

Presentation: contact with symptomatic people, pruritus, worse at night

Common sites: sides of fingers, finger webs, wrists, elbows, ankles, feet, nipples, genitalia

Lesions: linear burrows, rubbery nodules

Associated features: secondary eczema and impetigo

Investigations: skin scraping, extract mites for microscopy

Management: scabicides (permethrin, malathion), antihistamine

109
Q

Give an overview of urticaria

A

Lesions: pink wheals, round, annular, polycystic

Associated features: angioedema, anaphylaxis

Investigations: bloods, urinalysis

Management: antihistamines, corticosteroids

110
Q

Give an overview of lichen planus

A

Presentation: family history, may be drug-induced

Common sites: forearms, wrists, legs, oral mucosa

Lesions: lilac, flat-topped papules, systemic distribution

Associated features: nail changes, hair loss, lacy white streaks on oral mucosa and skin lesions (Wickham’s striae)

Management: corticosteroids, antihistamines

111
Q

Give an overview of melanocytic naevi

A

Presentation: develop until adolescence, asymptomatic

Congenital naevi: large, pigmented, protuberant, hairy

Junctional naevi: small, flat, dark

Intradermal naevi: dome-shaped papules or nodules

Compound naevi: raised, warty, hyperkeratotic, hairy

Management: rarely needed

112
Q

Give an overview of seborrhoeic warts

A

Presentation: in middle or older age, often multiple and asymptomatic

Commonly on face and trunk

Lesions: warty, greasy papules or nodules, ‘stuck-on’ appearance, well-defined edges

Management: rarely needed

113
Q

Give an overview of disseminated intravascular coagulation

A

Presentation: history of trauma, malignancy, sepsis, obstetric complications, transfusions, liver failure

Spontaneous bleeding from: ear, nose, throat, GI tract, respiratory tract, wound site

Lesions: petechiae, ecchymoses, haemorrhagic bullae, tissue necrosis

Often systemically unwell

Investigations: bloods (clotting screen)

Management: treat underlying cause, transfuse for coagulation deficiency, anticoagulants for thrombosis

114
Q

Give an overview of vasculitis

A

Painful lesions on legs, buttocks, flank

Lesions: palpable purpura

Often systemically unwell

Investigations: bloods, urinalysis, skin biopsy

Management: treat underlying cause, steroids, immunosuppressants

115
Q

Give an overview of senile purpura

A

Non-palpable purpura, surrounding skin atrophic and thin

In elderly with sun-damaged skin

On extensor surfaces of hands and forearms

No investigation or management needed

116
Q

Give an overview of emollients

A

Indications: rehydrate skin, re-establish surface lipid layer, for dry scaling conditions

Side effects: irritation, allergy

117
Q

Give on overview of topical/oral corticosteroids

A

Indications: inflammation, excessive perforation

Local side effects: skin atrophy, telangiectasia, striae, exacerbation of skin infection, perioral dermatitis, allergic contact dermatitis

Systemic side effects: Cushing’s, immunosuppression, hypertension, diabetes osteoporosis, cataracts, steroid-induced psychosis

118
Q

What are the steps of topical corticosteroids

A

Hydrocortisone

Eumovate

Betnovate

Dermovate

119
Q

Give an overview of oral retinoids

A

Indications: acne, psoriasis, disorders of keratinisation

Side effects: mucocutaneous reactions (dry skin, dry lips, dry eyes, LFT disorder, hypercholesterolaemia, myalgia, arthralgia, depression) , teratogenic effects

120
Q

What are small lumps < 5mm called

A

Papules

121
Q

What are large lumps > 5mm called

A

Nodules

122
Q

What are small, watery blisters called

A

Vesicles

123
Q

What are large, watery blisters called

A

Bulla

124
Q

What are thready veins called

A

Telangiectasia

125
Q

What is a non-palpable area of discolouration called

A

Macule

126
Q

What is a macule > 2 cm called

A

Patch

127
Q

What are palpable, flat-topped areas of 1-2 cm called

A

Plaques

128
Q

What is superficial loss of epidermis caller

A

Erosion

129
Q

What is deep loss of epidermis called

A

Ulceration

130
Q

What is thickening of skin with exaggerated skin marks called

A

Lichenification

Neuro and special senses (4 decks)

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