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ABPI Unit 7 Dermatology > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is the average area of the skin?

A

2 square metres

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2
Q

How much does the skin weigh?

A

4-5kg

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3
Q

What is the average thickness of skin

A

1-2mm

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4
Q

What are the three layers of the skin?

A
  1. Epidermis
  2. Dermis
  3. Subcutaneous layer
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5
Q

Skin structure

A
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6
Q

Epidermis structure

A
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7
Q

What is acne?

A

Characterised by formation of comedones (black and whiteheads) and spots known as papules and pustules

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8
Q

What causes acne?

A

Inflammation of the pilosebaceous units of skin

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9
Q

What factors can combine to form acne?

A
  1. Rise in sebum secretion in response to sex hormones in adolescence
  2. Overgrowth of bacterium in follicular duct
  3. Formation of bacterial plug blocking follicle
  4. Inflammation caused by body’s immune response
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10
Q

What are the four main skin changes in acne?

A
  1. Open comedomes - blackheads
  2. Closed comedomes - whiteheads, completely blocked follicle
  3. Papules - red or flesh-coloured bumps on surface of skin
  4. Pustules - white or yellow pus-filled pimples
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11
Q

How is acne classified by severity?

A

Mild - comedomes, papules/pustules
Moderate - papules, pustules, nodules
Severe - scarring, nodulocystic acne

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12
Q

What are the aims of acne treatment?

A
  1. Reduce sebum secretion
  2. Prevent blockage of the pilosebaceous duct
  3. Reduce or eliminate colonisation by P. acnes
  4. Reduce inflammation
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13
Q

How were the recommendations for the treatment of acne produced by the Guidance Alliance to Improve Outcomes in Acne in 2003 updated in 2009?

A

Reduced reliance on antibiotics and increased focus on acne as a chronic

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14
Q

What topical therapies can be used for acne?

A

Benzyl peroxide
Retinoids - reduce sebum production and inflammation
Comedolytics and keratolytics - soften hard keratin and slowing shedding of skin cells
Topical antibiotics - erythromycin and clindamycin

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15
Q

What are the effects of topical medicines used to treat acne?

A
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16
Q

What oral therapies can be used to treat acne?

A

Oral ABX - tetra, oxytetra, doxy or lymecycline
Hormonal - COC, co-cyprindiol
Retinoids isotretinoin

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17
Q

What is rosacea?

A

Chronic skin condition that affects the face. Begins with episodes of facial flushing, may progress to acne-like symptoms as well as thickened, bumpy skin and eye problems

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18
Q

How is rosacea classified?

A

Type 1-4

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19
Q

How is type 1 rosacea classified?

A

Erythematolangiectatic - flushing and redness around centre of face. May also see swelling and red blood vessels, rough patches of skin, burning and stinging sensations

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20
Q

How is type 2 rosacea classified?

A

Papulopustular - persistent redness around centre of face, with bumps and pimples resembling acne. Burning and stinging may also occur. Often seen after or in combo with type 1

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21
Q

How is type 3 rosacea classified?

A

Phymatous - thickened skin with bumpy surface. Most often affects nose (rhinophyma)

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22
Q

How is type 4 rosacea classified?

A

Red, irritated eyes. Feeling like there is something in eye, burning, dryness, light sensitivity, blurred vision. May occur with or without rosacea

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23
Q

What are the triggers of rosacea?

A 
Exposure to sunlight
Stress
Exercise 
Cold weather (wind)
Heat 
Menopause 
Vasodilator drugs
Hot drinks
Alcohol and caffeine 
Spicy foods
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24
Q

What are the topical treatments for mild rosacea?

A

Topical ABX - metronidazole, sodium sulfacetamide to treat pustules
Topical comedolytic agents - azelaic acid to unblock pores and reduce inflammation

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25
Q

What oral treatments can be used to treat moderate-to-severe rosacea?

A

ABX - tetracyclines or erythromycin

Retinoids - isotretinoin

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26
Q

What is dermatitis?

A

Immunological, inflammatory reaction in skin. Many different forms, including eczema. Can be acute or chronic

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27
Q

What are exogenous factors?

A

Those outside the body that cause disease e.g. chemical in soap, sunlight

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28
Q

What are endogenous factors?

A

Those within the body that cause disease

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29
Q

What are some types of dermatitis and what ages to they affect?

A
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30
Q

What is irritant contact dermatitis?

A

Skin reaction where causative agent is external. Immediate or cumulative reaction, irritation occurs once chemicals are able to penetrate the keratinous part of skin and trigger inflammatory immune response within dermis cells

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31
Q

What are characteristics of irritant contact dermatitis?

A

Rash - localised to area of exposure, may be erythematous (reddened), inflamed, itchy, swollen. Small vesicles may be present. Prolonged exposure gives cracked, scaly skin

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32
Q

What is allergic contact dermatitis?

A

Hypersensitivity reactions which has potential to appear on other parts of body as well as area directly exposed to allergen

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33
Q

What are the stages of development of allergic dermatitis?

A
  1. An allergen enters skin and encounters Langerhans cells, found scattered in epidermis
  2. These take up the allergen which pass on the identification to T-cells
  3. T-cells multiply, circulate round body and begin to accumulate at site of reaction
  4. If allergen still detected, T-cell activated and respond by releasing variety of inflammatory molecules , causing redness, swelling, inflammation
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34
Q

What is atopic eczema?

A

Most common form of eczema. Chronic. Inflammation and disruption of various layers throughout skin

Skin initially itchy, flaky, erythematous and dry in acute phase

Thickened, cracked and crusted as condition progresses

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35
Q

What gene is atopic eczema associated with?

A

Filaggrin gene

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36
Q

What is seborrhoeic dermatitis in infants?

A

Caused by overactive sebaceous glands and results in oily skin. Common in nappy area or head
Not itchy or sore however secondary infection may occur

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37
Q

What is seborrhoeic dermatitis in adults?

A

Affects areas where there are most sebaceous glands (face, scalp, chest), but sebum secretion appears normal

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38
Q

What factors cause adult seborrhoeic eczema?

A

Genetic and endogenous factors which permit excessive growth of a yeast Malassezia furfur

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39
Q

What is an un-inflamed form of seborrhoeic dermatitis?

A

Dandruff

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40
Q

What is gravitational eczema?

A

Arises in lower legs, affects mainly middle-aged and elderly people
Due to underlying disease of deep vein valves, causes increased pressure, leakage of fluid into skin, reddish-brown pigmentation, itching, blistering

41
Q

What is discoid eczema?

A

Circular, coin-sized rings of itchy red lesions on limbs or small pustules on hands. Lesions weep, become crusted and infected. Cause unknown

42
Q

What is pompholyx eczema>

A

Restricted to hands and feet, characterised by blistering

43
Q

What is asteatotic eczema?

A

Affects elderly, mostly on lower legs, occasionally on upper arms, thighs and lower back. Cause unknown
Distinctive banded pattern with cracking

44
Q

What are treatment options for dermatitis?

A

Emollients
Topical corticosteroids - reduce inflammation, potency depends of severity of inflammation and location
Antibiotics or antimicrobials
Antipruritics - reduce itching and break itch-scratch cycle
Immunosuppressants

45
Q

What is psoriasis?

A

Chronic, autoimmune inflammatory condition characterised by inflamed, thickened areas of skin, often topped by silvery scales

46
Q

What triggers psoriasis?

A

Thought to be genetically determined but triggered by environmental factors such as stress

47
Q

What is a secondary condition to psoriasis?

A

5-10% patients suffer from psoriatic arthritis

48
Q

What is the most obvious symptom of psoriasis?

A

Flaky lesions on skin or in hair. Sometimes when scratched off, small blood droplets appear (Auspitz’s sign)

49
Q

Why do skin lesions of psoriasis occur?

A

There are increased numbers of cells in the basal later that divide up to 20x faster than normal skin. This causes new skin cells to rise to the surface of epidermis much more quickly than normal skin cell division

50
Q

In which two periods of life is psoriasis most likely to develop?

A

Teenage years into twenties, and in sixties

51
Q

What is the most common form of psoriasis?

A

Plaque psoriasis - usually occurs on knees, elbows, lower back, scalp
Lesions appear as circular red patches with a well-defined edge and silvery scaly surface. Symmetrical lesions

52
Q

What are the characteristics of guttate psoriasis?

A

Rash-like lesions on truck/limbs

53
Q

What are the characteristics of guttate psoriasis?

A

Rash-like lesions on truck/limbs

54
Q

What are the characteristics of flexural psoriasis?

A

Lesions smooth and glazed appearance. Under arms, groin, folds under breasts and cleft of buttocks

55
Q

What are the characteristics of palmoplantar psoriasis?

A

Sterile pustules on palms of hands or soles of feet

56
Q

What are the characteristics or erythrodermic psoriasis?

A

Serious condition in which entire skin inflamed

57
Q

Apart from skin, psoriasis can also affect what?

A

Nails of up to 50% people with condition, causing nails to become pitted and ridged

58
Q

Is there a cure for psoriasis?

A

No, however, medicine can control the lesions and improve quality of life

59
Q

How can psoriasis be treated with emollients?

A

Help soften and moisturised skin to reduce cracking, inflammation and pain

60
Q

How can psoriasis be treated with tar preparations?

A

Impregnated bandages and dressings. Coal tar is thought to inhibit DNA synthesis to reduce rate of cell division

61
Q

How can psoriasis be treated with corticosteroids?

A

Treat inflamed, stubborn plaques on body

62
Q

How can psoriasis be treated with vitamin D analogues?

A

Topical preparations closely related to vitamin D. Control rate of cell multiplication and formation of excess keratinocytes

63
Q

How can psoriasis be treated with phototherapy?

A

Narrow band UVB and/or UVA can be used to slow the growth of affected skin cells

64
Q

How can psoriasis be treated with retinoids?

A

Reduce inflammatory changes in skin and change rate of turnover of keratinocytes

65
Q

How can psoriasis be treated with dithranol?

A

Chemical derivative of natural product that can be applied to lesions as a paste, blocks cell division

66
Q

How can psoriasis be treated with immunosuppressants?

A

Methotrexate can slow cell division and is valuable in severe psoriasis

67
Q

How can psoriasis be treated with biologic agents?

A

Reduce inflammation by targeting specific overactive cells or chemicals in immune system
Common targets - Tumour necrosis factor alpha (TNFa), IL-12 and IL-13

68
Q

What are actinic keratoses?

A

Areas of sun-damaged skin which develop on areas of body frequently exposed to sunlight. Can be skin coloured, pink, red or brown, feels rough and dry

69
Q

What percentage of actinic keratoses transform into squamous cell carcinoma?

70
Q

What are the two classifications of skin cancer?

A

Melanoma and non-melanoma

71
Q

What is the main cause of all skin cancers?

A

Excessive UV exposure

72
Q

What is superficial spreading melanoma?

A

Most common type of skin melanoma
Most common on chest and back in men and legs in women
Melanoma cells spread out across surface of skin

73
Q

What is a nodular melanoma?

A

Cells grow more quickly than other melanomas and is usually found on chest, back, head or neck

74
Q

What is lentigo maligna melanoma?

A

Found on areas of skin with lots of sunlight exposure

Develops from slow-growing precancerous lentigo maligna which looks like a stain on the skin

75
Q

What is acral melanoma?

A

Rarest type, found on palms of hands, soles of feet, under nails

76
Q

How is early melanoma treated?

A

Local surgery

77
Q

How is melanoma treated if it returns?

A

Further surgery with chemo and/or radiotherapy. Further mABs may be used to stop spread

78
Q

What is basal cell carcinoma?

A

Most common non-melanoma skin cancer
Originates from cells lining bottom of epidermis (basal cells)
Appears red or pink lump, or flat, flesh-coloured or brown patches of skin. Pearly rolled edges

79
Q

What is an alternative BCC treatment to surgery?

A 
Photodynamic therapy (PDT) 
Administer cream containing 5-aminolaevulinic acid (ALA) which is absorbed into cells 
Skin exposed to light and cells containing ALA destroyed
80
Q

What is squamous cell carcinoma?

A

Originates from cells lining top of epidermis (squamous cells)
Firm red lump or flat, scaly, crusty scab-like lesion that doesn’t heal
Don’t spread easily

81
Q

What is cutaneous T cell lymphoma?

A

Non-melanoma skin cancer
Caused by T cells in skin growing in uncontrolled manner
Symptoms can look like eczema, may be one or more tumours on skin
Topical chemo, UVA, radiotherapy

82
Q

What is Kaposi’s sarcoma?

A

Rare type of cancer commonly affecting HIV patients
Main cause is HHV8 virus
Not a true cancer - rather reactive hyperplasia
Antiviral treatments in HIV pts, switching immunosuppressants
Radiotherapy to shrink lesions and chemo for internal tumours

83
Q

What is angiosarcoma?

A 
Rare cancer of inner lining of blood vessels 
Usually found on scalp and face 
Usually fast, aggressive tumours 
Surgery with chemo/radiation
Poor prognosis
84
Q

What is Merkel cell carcinoma?

A

Rare, forms when Merkel cells (found in epidermis) grow out of control
Single lump that is fast-growing, painless, firm, dome-shaped or raised, red or violet in colour
Spreads to lymph nodes
Surgery with chemo/radiotherapy

85
Q

When do boils occur?

A

Hair follicle becomes infected, producing pus-filled lump on skin
Drained, ABX (fluclox, clarithromycin)
S. aureus

86
Q

What are carbuncles?

A

Multiple boils occurring when hair follicles next to each other become infected
Drain, ABX

87
Q

What is chronic furunculosis?

A

Groups of boils occur over a period of time, episodically or continuously
ABX or surgery

88
Q

What is folliculitis?

A

Inflammation of hair follicles in skin. Very small pustules develop at base of hair
Can resolve itself or need ABX
S. aureus

89
Q

What are three types of folliculitis?

A
  1. Hot-tub - avoid by keeping hot tubs clean and showering after use
  2. Sycosis barbae - associated with bearded area of man’s face
  3. Gram-negative - associated with long term ABX treatment for acne
90
Q

What is herpes simplex virus?

A

Lies dormant in nerve root, virus reactivated when individual unwell or stressed causing sore blisters

91
Q

Which HSVs cause oral vs genital herpes?

A

Oral - HSV1

Genital - HSV2

92
Q

How is HSV treated?

A

Antiviral medication - aciclovir

93
Q

What is Varicella zoster?

A

Causes chickenpox in childhood

May lie dormant in a sensory nerve root and recur as shingles later in life

94
Q

What causes warts and verrucae?

95
Q

What is Orf?

A

Caused by parapox virus from lambs and goats
Small firm red or reddish-blue lesions develop, and will form blister tinged with blood
No treatment, regresses within 3-6 weeks

96
Q

What is athlete’s foot?

A

Fungal infection of foot that causes peeling, itching, redness, and sometimes blisters and sores
Caused by trichphyton rubrum

97
Q

What is ringworm?

A

Fungal infection, circular red flat sore, scaly skin

98
Q

What is thrush?

A

C. albicans is a common fungus often present in mouth, stomach, skin and vagina
Usually causes no problems, but if person is unwell, pregnant, has diabetes or is taking ABX, fungi can multiply causing thrush symptoms
Small white patches which leave red mark when rubbed off

ABPI Unit 7 Dermatology (1 decks)

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