Dermatology Flashcards by Nicholas Williams

How long does it take for a new fingernail and toenail to grow?

Fingernail = 3 months
Toenail = 6 months

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What is a comedone and what are the types?

Open = black heads
Closed = White heads

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What is excoriation?

Loss of epidermis following trauma

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What is lichenification?

Well defined thickening of skin with accentuation of skin markings due to repeated rubbing and scratching

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What is Auspitz sign and in what condition do you see it?

Peeling off of surface scale reveals regular areas of pinpoint bleeding

Psoriasis

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What is koebner phenomenon and what conditions can you see it in?

Formation of lesions from pre-existing skin condition at site of trauma / irritation. E.g. Psoriasis, vitiligo

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What is impetigo and what causes it?

common superficial bacterial infection - usually staphylococcus aureus and streptococcus pyogenes

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What are the three types of impetigo and their causes?

Bullous - staph
Crusted / Non-bullous either staph or strep
Ulcerated - strep

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What are some complications of impetigo?

Acute glomerulonephritis
RHD
SSS
Cellulitis
Toxic shock syndrome

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What is the management of impetigo?

Use wet compressions to remove crust
Good hygiene
Cover affected areas
Keep home from school (until lesions crusted over or had 24hrs of treatment)
Separate towels and launder in hot water
Muciprocin 2% ointment
Abx for serious infections e.g. flucloxacillin

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What is ecthyma and how is it treated?

Deep form of impetigo with ulcers forming beneath crusted sores. Scars and treated with oral Abx

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What are some signs of folliculitis?

Tender red papule, with surface pustule centered on a hair follicle

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What is furunculosis?

Deep form of folliculitis (usually staph)

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What is the difference between steven johnson syndrome and toxic epidermal necrolysis?

SJS = <10% body surface area
10 - 30% = overla
TEN = >30% body surface area

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Erysipelas vs Cellulitis. What is the difference?

Erysipelas is upper dermis and superficial lymphatics
Cellulitis is lower dermis and subcut tissue
Cellulitis is less marginated

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What is the Mx of cellulitis?

Rest and elevation of area
Mark outline
Analgesia
IV Abx - flucloxacilin
Compression bandage

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What is the cause of molluscum contagiosum who gets it?

Poxvirus
Two peaks: Children 3-9 years and young adults

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How is molluscum spread?

skin to skin
Indirect contact e.g. shared towels
Auto-inoculation by scratching
Sexual transmission

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How do you describe molluscum?

Waxy pinkish look with small central pit

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What are some DDX for viral exanthem?

Measles
Rubella
Varicella
Fifth disease
Roseola
Infectious Mononucleosis
Enterovirus infections such as hand foot and mouth
Pityriasis Rosea
Herpes zoster and simplex
Molluscum contagiosum
HIV

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What is the clinical presentation of measles?

incubates 7-14 days
Infective 2 days prior to sx till 5 days
URTI symptoms with fever and conjunctivitis
Kopplik spots (white spots on mucosa)
erythematous macular rash

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What are some complications of measles?

Dehydration leading to death
Otitis media
Pneumonia
Encephalitis

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What is congenital rubella syndrome?

Sensorineural deafness
CNS dysfunction
Cataracts
Cardiac defects

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Where does the varicella virus remain dormant before reappearing as shingles / herpes zoster infection?

Anterior Horn cells of spinal cord

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What type of lesions does varicella typically present as?

Vesicles - itchy

What is the distinguishing feature of fifth disease (parvovirus infection)?

"slapped cheek appearance" - firm red cheeks which feel burning hot

What pathogen causes hand, foot and mouth disease?

Coxsackie virus

What are some symptoms of roseola?

High Fever, URTI and red maculo-papular rash appearing as fever subsides

What are some complications of herpes zoster and management?

Post-herpetic Neuralgia Corneal damage Encephalitis Anti-viral medication within 72hrs

How do you describe meningococcal infection in terms of skin symptoms and describe the bacteria?

Haemorrhagic rash with petechiae and then purpura on trunk and limbs Gram negative coccus

HSV 1 is associated with ______? HSV 2 is associated with ______?

HSV 1 = facial infections (cold sore) HSV 2 = genital

How can you treat oral HSV (cold sores)?

Topical antiviral (acyclovir)

What is tinea called in the following locations? 1 - head 2 - body 3 - groin 4 - foot

1 - Tinea Capitis 2 - Tinea Corporis (ring Worm) 3 - Tinea Cruris 4 - Tinea Pedis

What is the cause of tinea pedis?

Swimming pools, showers and occlusive foot wear

What does pyoderma mean?

Any skins disease that is pyogenic

What does pityriasis versicolor look like and who does it commonly affect, and how can it be treated?

Hypopigmented scaly patches Affects Indigenous people and treated with ketoconazole shampoo

What is SLE?

Autoimmune disease leading to inflammation of connective tissue

Burkholderia pseudomallei is what type of bacteria?

Gram negative

How do you treat head lice?

Wet combing (conditioner) with fine tooth comb

How does scabies present and what is the treatment?

Itch worse as night Pruritic excoriated nonspecific rash on trunk Treat with permethrin cream

What is the management of atopic dermatitis?

Life style - avoid hot baths, cold weather exacerbates Use moisturizers (greasier is better) Avoid perfume emollients Topical corticosteroids

What is the management of nappy rash?

Use disposable nappies Increase frequency of changing nappy Apply barrier cream at every change Treat any candida infection Let child spend as long as possible without nappy on

Creams are ____ based: non greasy Ointments are _____ based: greasy Gels and lotions are _____ based

Water based Oil Based Alcohol Based

What are the causes of koilonychia?

Iron deficiency Anemia Haemachromatosis

What are the causes of splinter haemorrhages?

Trauma Infective endocarditis Psoriasis

What are some causes of terry nails?

Cirrhosis CHF Diabetes

Who gets necrobiosis lipodica?

Diabetic patients

How do you describe psoriasis lesions?

Well defined salmon-pink plaques with large adherent centrally located silver scale Affect body symmetrically

What are the causes of psoriasis?

Family Hx Strep infections Trauma (koebner phenomenon) Medications such as BB, Lithium, prednisolone withdrawal Excess alcohol consumption Metabolic Syndrome Stress

What are some DDX of psoriasis?

Tinea Folliculitis Dermatitis Skin Cancers Pityriasis Rosea

What is the management of psoriasis?

Education of chronicity Modify lifestyle / exacerbating factors (stress, smoking, alcohol, weight loss) Topical anti-inflammatories - Dithranol, tar, steroids, vit D Specialist referral Phototherapy (PUVA) Can use systemic treatments (Methotrexate, cyclosporins, retinoids, biologic agents)

Far sightedness is called _____ and corrected by _____ lens

Hyperopia Convex

Short sightedness is called ______ and corrected by ____ lens

Myopia Concave

What is erythroderma and why is it a skin emergency?

Erythema and scaling involving >90% of skin surface Causes high-output cardiac failure, hypothermia and dehydration

What is the DRESS clinical triad?

High fever Organ involvement Extensive skin rash

What is the characteristic feature of erythema multiforme and what is the most common causes?

Target lesions HSV2, CMV, EBV

What is the main management of erythema multiforme?

antivirals

What are the treatment options of acne?

Education - avoid squeezing, hot or humid environments Retinoids Topical antiseptic Topical / oral Abx Refer to specialist after 3-6 months of oral Abx not working

What is rosacea?

Chronic rash predominantly affecting central face of adults

What are some features of rosacea?

Pustules, papules, central facial erythema, telangiectasia

What aggravates rosacea?

Alcohol Hot showers Topical steroids Sun exposure Stress

What is the most common skin cancer?

BCC

Describe BCC look and features of it?

Red / translucent nodule with shiny or pearly rolled edge with central depression. Blood vessels across surface Locally invasive, low potential to metastasize

What treatment options are available for BCC?

Excision Liquid nitrogen cryotherapy Topical Imiquimod cream Curettage and cautery Photodynamic therapy

Describe the clinical features of SCC?

Firm papule / nodule Sometime tender No pearly edge/ telangiectasia Adherent crust Advanced lesions - rolled edge with ulceration / bleeding

What are common sites for SCC?

H&N - lip, ear, scalp

What margins do you use for wide excision of SCC?

Low risk = 4mm High risk = 6-10mm

How do you describe keratoacanthoma?

Well differentiated SCC - volcano shape with central keratotic plug

How do you describe melanoma?

Flat, usually pigmented, asymmetric macule changing in size, shape or colour Often on trunk / limbs

What is hidradenitis suppurativa?

Chronic inflammatory skin condition affecting apocrine glands, particularly in the axillae

What are some risk factors for hidradenitis suppurativa?

Family Hx Obesity and insulin resistance Smoking IBD

What is the cause of scarlet fever and what does the rash look like?

Strep throat / impetigo (GAS) Appears 12-48 hours after fever Starts below ears, neck, chest, armpits and groin Rough sandpaper skin By day 6 skin peels off and rash fades