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Y2 - SEM 1 - MED 2 > DERMATOLOGY > Flashcards

DERMATOLOGY Flashcards

1
Q

skin

A

largest organ in body
contains adnexal structures - hair, nails, glands, sensory structures
important role in protection, homeostasis and transmission of sensations

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2
Q

3 stages of hair cycle

A

anagen

catagen

telogen

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3
Q

anagen phase of hair cycle

A

active growing phase
80-90% of hair

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4
Q

catagen phase of hair cycle

A

2-3wk phase growth stops/follicle shrinks
1-3% of hairs

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5
Q

telogen phase of hair cycle

A

resting phase for 1-4months
up to 10% of hairs in a normal scalp

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6
Q

functions of skin

A

thermoregulation
skin immune system
barrier
Vit D synthesis
interpersonal communication

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7
Q

why skin disease is important

A

disfigurement
discomfort
disability
depression
death

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8
Q

external causes of skin disease

A

temp
UV
chemical
infection
trauma

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9
Q

internal causes of skin disease

A

systemic disease
genetics
drugs
infection

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10
Q

morphology

A

appearance of skin lesions

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11
Q

how big is “small”

A

usually means less than 5mm

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12
Q

small and large flat circumscribed areas

A

macule - small
patch - large

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13
Q

small and large raised areas

A

papule - small
plaque - large

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14
Q

small and large fluid filled

A

vesicle - small
bulla - large

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15
Q

small and large pus filled

A

pustule - small
abscess - large

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16
Q

loss of epidermis (& dermis)

A

erosion - loss of epidermis
ulcer - loss of epidermis & dermis

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17
Q

macule & patch

A

non-palpable change in skin colour with distinct borders

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18
Q

papule and plaque

A

papule - solid lesion < 1cm diameter
plaque - solid lesion > 1cm in diameter

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19
Q

nodule

A

palpable lesion > 1cm diameter which is taller than it is wide

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20
Q

vesicle & bulla

A

vesicle - fluid-containing, superficial, thin-walled cavity < 1cm
bulla - fluid-containing, superficial, thin-walled cavity > 1cm

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21
Q

erosion and ulcer

A

erosion - skin defect where there has been loss of the epidermis only
ulcer - skin defect where there has been loss of the epidermis and dermis

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22
Q

pustule and abscess

A

pustule - pus containing, superficial, thin-walled cavity
abscess - thick-walled cavity containing pus

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23
Q

most common skin conditions (give 5 examples)

A

psoriasis
acne
eczema
urticaria
leg ulcers

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24
Q

cutaneous signs

A

erythema nodosum
sarcoidosis
vasculitis
malignancy
autoimmune conditions

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25
Q

acanthosis nigricans

A

associated with insulin resistance, obesity, malignancy
flexural distribution
hyperkeratosis and hyperpigmentation, papules
‘velvety’ appearance

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26
Q

investigations in derm (if bacterial inf suspected)

A

charcoal swab
ask for MC&S
- microscopy
- culture
- sensitivities

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27
Q

investigations (if viral inf suspected)

A

viral swab for PCR
can swab vesicle/bulla if vesicular eruption
if systemic illness, can take throat swab

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28
Q

investigations (if fungal inf suspected)

A

skin scraping
nail clipping
hair sample

fungal cultures

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29
Q

skin biopsy

A

punch biopsy

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30
Q

homeothermic

A

tightly regulate temperature (37 +/- 0.5)

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31
Q

temperature varies with…

A

external temp
activity
circadian rhythm
menstrual cycle

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32
Q

location of peripheral thermoreceptors

A

skin, especially in face and scrotum

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33
Q

location of central thermoreceptors

A

spinal cord, abdominal organs, hypothalamus

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34
Q

response to cold stress - how is heat production within body increased?

A

general metabolism - oxidative phosphorylation and other chemical reactions are not 100% efficient
voluntary muscular activity - “futile” muscular activity
shivering thermogenesis - involuntary muscular activity
non-shivering thermogenesis - only significant in infants due to brown adipose tissue

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35
Q

response to cold stress - how is heat loss from body reduced?

A

vasomotor control - sympathetic arteriolar constriction reduces delivery of blood to the skin
behavioural responses - adding clothing, moving to warmer environment, reducing surface area

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36
Q

hypothermia - response to cold stress

A

a fall in deep body temp to below 35

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37
Q

who is at risk of hypothermia

A

neonates
elderly
homeless people
cold store workers
outdoor pursuits

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38
Q

treatment of cold stress

A

dry/insulate to prevent further heat loss
slow re-warming with bag/blankets
internal re-warming with hot drinks and/or warm air
rapid re-warming by immersion in water, extracoporeal circulation

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39
Q

frost bite: vascular component

A

vasoconstriction
increase in viscosity
promotes thrombosis
causes anoxia

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40
Q

frost bite: cellular component

A

ice crystals form in extracellular space
increases extracellular osmolality
causes movement of water from intracellular space
cell dehydration and death

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41
Q

how is heat production minimised? response to heat stress

A

decreased physical activity and food intake

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42
Q

as a response to heat stress, how is heat loss from the body increased?

A

vasomotor control - arteriolar dilation increases delivery of blood to the skin
sweating - sympathetic cholinergic fibres increase evaporative heat loss
behavioural responses - removing clothing, moving to shaded area, increasing surface area

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43
Q

heat exhaustion is a consequence of heat stress (heat illness) - explain

A

body temp raised in range 37.5-40
results in vasodilation and drop in central blood volume
caused by a disturbance of the body’s fluid/salt balance due to excessive sweating
symptoms include
headache
confusion
nausea
profuse sweating
clammy skin
tachycardia
hypotension
weak pulse
fainting and collapse

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44
Q

heat stroke (heat injury) - consequence of heat stress explain

A

body temp raised above 40
body’s temp control mechanisms fail
symptoms include hot dry skin (sweating stops) and circulatory collapse

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45
Q

who is most at risk of heat stress

A

neonates
elderly
people doing physical work in hot, humid environments
workers wearing non-breathable protective clothing

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46
Q

treatment of heat stress

A

move to cool environment
remove clothing
fan
sponge with tepid water
give fluids (oral, IV)

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47
Q

fever

A

part of body’s mechanism for fighting infection
caused by endogenous pyrogens (IL-1, IL-6)
concept of ‘set point’ controlled by hypothalamus
- endogenous pyrogens shift set point
- caused by local production of prostaglandins by cyclo-oxygenase in the hypothalamus
- explains why aspirin and paracetamol reduce fever

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48
Q

what agencies to meds have to be approved/licensed by

A

MHRA - Medicines and Healthcare Products Regulatory Agency
EMA - European Medicines Agency
SMC - Scottish Medicines Consortium

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49
Q

unlicensed

A

not approved for use in UK

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50
Q

‘off-label’

A

a licensed medication that is being used for an unlicensed indication

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51
Q

‘specials’

A

unlicensed dermatological preparations
long history of use, no strong evidence base but clinically effective

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52
Q

causes of prescription errors

A

lack of knowledge - about patient, meds or allergies
mistake writing/generating prescription
poor communication
no local/national guidelines

pharmacy/medicine info service

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53
Q

factors associated with poor adherence

A

psychiatric co-morbidities
slower acting agents
multiple applications per day
lack of patient education
cosmetic acceptability of treatments
unintentional non-adherence

the NHS spends £100 million annually on unused medicine

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54
Q

pharmacology

A

branch of medicine concerned with uses, effects and modes of action of drugs

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55
Q

define pharmacokinetics

A

effect of body on drug

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56
Q

define pharmacodynamics

A

effect of drug on body

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57
Q

pharmacokinetics

A

need to think about route of administration - topically where possible, if oral, optimal absorption important

distribution - where drug goes
metabolism - esp in liver disease
excretion - esp in renal disease

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58
Q

pharmacodynamics

A

individual variation in response
think about
- age of patient
- pregnancy risk
- drug interactions
- pharmacogenetics

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59
Q

topical therapy

A

medication applied to skin
vehicle + active drug

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60
Q

vehicle

A

pharmacologically inert, physically and chemically stable substance that carries the active drug

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61
Q

factors affecting topical absorption

A

concentration
base/vehicle
chemical properties of drug
thickness and hydration of stratum corneum
temperature
skin site
occlusion

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62
Q

examples of vehicle

A

solution
cream
lotion
gel
foam
tape
paste
spray powder
shampoo
ointment
paint

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63
Q

examples of topically used drugs (give 6 examples)

A

corticosteroid
antibiotic
antiviral
chemo
antiinflam
salicyclic acid

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64
Q

topical steroids - anti-inflam and immunosuppressive properties

A

regulate pro inflam cytokines
suppress fibroblast, endothelial and leukocyte function
vasoconstriction
inhibit vascular permeability

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65
Q

topical steroids

A

range of potencies
used appropriately - very safe
prescribe enough - see BNF , can use finger-tip units - 0.5g , should treat area double size of one hand - useful in young children , charts available for age

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66
Q

6 examples of side effects of topical steroids

A

thinning/atrophy
bruising
telangiectasia
acne/rosacea
glaucoma
cataracts

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67
Q

systemic treatments in derm

A

retinoids
traditional immunosuppressants
biologics (also immunosuppressive)

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68
Q

retinoids

A

vit A analogues
- normalise keratinocyte function
- anti inflam and anti cancer effects
teratogenic - careful patient selection

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69
Q

side effects of retinoids

A

cheilitis and xerosis
increase transaminases and triglycerides
rarely psychiatric, eye, bone side effects

70
Q

4 diff molecules used orally in derm

A

acne - isotretinoin
psoriasis - acitretin
cutaneous T cell lymphoma - bexarotene
hand eczema - alitretinoin

71
Q

immunosuppressants

A

treatment of inflam skin disorders

oral steroids
azathioprine
ciclosporin
methotrexate
mycophenolate mofetil

risk of malignancy and serious infection
need regular blood test monitoring
- FBC
- renal and liver function (ciclosporin and methotrexate)

72
Q

biologics in derm

A

next generation in treatment of inflam conditions
- genetically engineered proteins derived from human genes
- designed to inhibit specific components of the immune system
- very effective, but expensive

73
Q

‘cept’ suffix

A

indicates it is a receptor fusion

74
Q

‘mab’ suffix

A

used to denote monoclonal antibodies

75
Q

risk of infection with biologics

A

TB reactivation
serious infection
avoid line vaccines
malignancy
TNF inhibitors - risk of demyelination

76
Q

how can we make a diagnosis of a skin inf

A

history
examination
investigations

77
Q

signs of an infection

A

erythema
hot
tender
pus
exudate
fever

78
Q

impetigo

A

superficial skin condition - most common bacterial skin inf in children
can be bullous
staph aureus, strep pyogenes

79
Q

treatment for impetigo

A

always check local formulary
if localised: fusidic acid 2% cream 3-4times daily for 5 days
mupirocin 2% cream up to 3x daily for 5 days
if widespread, severe, bullous:
flucloxacillin 500mg oral 4x daily for 7 days
erythromycin 500mg oral 4x daily for 7 days

80
Q

likely organism of cellulitis/erysipelas

A

streptococcus pyogenes
staphylococcus aureus

81
Q

1st choice antibiotic for cellulitis/erysipelas

A

flucloxacillin 1g IV every 6hrs
plus benzylpenicillin 1.8g IV every 6hrs

82
Q

differential diagnosis of cellulitis

A

DVT
venous eczema
allergic contact dermatitis
necrotising fasciitis

83
Q

oedema blisters

A

acute exacerbation of oedema
dorsum of feet
often erythematous
can feel hot

84
Q

lipodermatosclerosis

A

if acute can be hot and tender
- look for signs of venous disease
- bilateral (often misdiagnosed as cellulitis)
treatment
- treat underlying venous disease
- topical steroids

85
Q

fungal infections

A

tinea - infection by a dermatophyte
candidiasis

86
Q

tinea on body

A

ringworm or tinea corporis

87
Q

tinea on head

A

tinea capitis

88
Q

tinea on feet

A

tinea pedis (athlete’s foot)

89
Q

tinea on groin

A

tinea cruris

90
Q

tinea on nails

A

onychomycosis

91
Q

treatment of tinea

A

topical treatment - terbinafine or clotrimazole cream
requires antifungals - if affecting scalp or nails
check and treat other family members

92
Q

treatment for candida

A

nystatin
miconazole
ketoconazole cream

93
Q

acne vulgaris

A

disease of pilo-sebaceous unit (PSU) - face, chest, back
causes “sticky” keratinocytes + increased sebum viscosity
blocked follicles = COMEDONES
change in commensal bacteria behaviour (propionobacterium) = INFLAMMATION
papules, pustules, nodules, cysts, scars

94
Q

comedones

A

blocked follicles

95
Q

topical treatment for acne vulgaris

A

benzoyl peroxide
antibiotic: clindamycin, dalacin T lotion, erythromycin
retinoids: adapalene
combination: duac (BPO and clindamicin)
treclin (tretinoin and clindamicin)
epiduo gel - adapalene and BPO

others - azaleic acid, nicatinamide gel

96
Q

systemic treatment for acne vulgaris

A

antibiotics: tetracyclines, erythromycin, trimethoprim
anti-androgens: combined oral contraceptive pill
isotretinoin (roaccutane)
UVB
dapsone

97
Q

isotretinoin

A

retinoid medication - vit A derivative
most effective treatment - reserved for treatment failure, evidence of scarring, severe acne, acne fuminans
prescribed by dermatologists and dispensed by hospital pharmacy
weight based treatment - aim to achieve total cumulative dose 120mg/kg
can have multiple treatment courses if needed

multiple side effects - dry skin, lips, epistaxis, dry brittle hair, myalgia
counselling required prior to treatment -risk of low mood
teratogenic
can raise triglycerides

98
Q

acne fulminans

A

sudden onset acneform eruption
feverish and unwell
joint pains
start low dose isotretinoin but cover with prednisolone

99
Q

treatment for scarring

A

treat inflam first
if had isotretinoin usually should wait for 1yr before looking into treatment for scarring
- depends on type of scarring
- intralesional steroid
- excision of ice pick scars
- laser
- dermabraison
- chemical peels

100
Q

acne rosacea

A

chronic inflam
- PSU
- cutaneous vasculature

ace of clubs distribution
unusual on non-facial sites

101
Q

subtypes of acne rosacea

A

erythemato-telangiectatic
papulo-pustular
phymatous (M»>F)
ocular

no comedones

102
Q

topical treatment for acne rosacea

A

metronidazole - rosex, metrogel
azeleic acid - finacea
ivermectin - soolantra
brimonidine - mirvaso

103
Q

systemic treatment for acne rosacea

A

oral antibiotics - tetracyclines and erythromycin
isotretinoin - low dose
light based treatments
laser

104
Q

atopic eczema

A

aka atopic dermatitis
inflammatory skin condition
commonly affects flexural areas
multiple types and a spectrum of severity

wide range of external or internal factors can induce condition

105
Q

definition of atopic eczema

A

an itchy skin condition in the last 12 months
plus 3 of following:
- onset before age 2
- history of flexural involvement
- history of generally dry skin
- history of other atopic disease - history in 1st degree relative if under 4yrs

106
Q

pathogenesis of atopic eczema

A

genetics
- many genes implicated
- key role for filaggrin gene
- atopic FH - atopic eczema, asthma, hay fever (allergic rhinitis), food allergy
- epidermal barrier dysfunction
- environmental factors
- immune system dysregulation

107
Q

pathology of atopic eczema

A

spongiosis (intercellular oedema) within the epidermis
acanthosis - thickening of epidermis
inflammation - superficial perivascular lymphohistiocytic infiltrate

108
Q

clinical features of atopic eczema

A

itch
distribution - flexures, neck, eyelids, face, hands and feet
tends to spare nappy area
acute changes - pruritus, erythema, scale, papules, vesicles
exudate, crusting, excoriation
chronic changes - lichenification, plaques, fissuring

109
Q

exogenous (external) types of eczema

A

contact dermatitis - irritant and allergic
lichen simplex
photoallergic or photoaggravated eczema

110
Q

endogenous (internal) types of eczema

A

atopic
discoid
venous
seborrhoeic dermatitis
pompholyx
juvenile plantar dermatitis
asteatotic

111
Q

allergic contact dermatitis

A

type 4 hypersensitivity
delayed hypersensitivity - 48-72hrs to develop reaction
antigen presenting cells take hapten/allergen to LN and present to naive T cells
clonal expansion of these T cells, released into blood stream
when these T cells next encounter hapten
- mast cell degranulation, vasodilatation and neutrophils

112
Q

irritant contact dermatitis

A

skin injured by…
1. friction - microtrauma, cumulative
2. environmental factors - cold, over-exposure to water, chemicals such as acids, alkalis, detergents and solvents

113
Q

patch testing

A

potential allergens applied (no needles involved)
baseline/standard series - applied to all patients
applied monday - removed wednesday - re-assess friday

114
Q

seborrheic dermatitis - infants

A

distinctive pattern
predilection for scalp, proximal flexures
<6months age usually
often clears within weeks of treatment

115
Q

seborrheic eczema - adults

A

chronic dermatitis
malassezia yeast increased in the scaly epidermis of dandruff and seborrheic dermatitis

red, sharply marginated lesions covered with greasy looking scales
distinctive distribution - areas rich in supply of sebaceous glands (scalp, face, upper trunk)

116
Q

discoid eczema

A

circular plaques of eczema
cause often unknown
may develop at sites of trauma/irritation

117
Q

asteatotic eczema

A

very dry skin
cracked scaly appearance
most commonly shins affected
climate - heat
excessive washing/soaps

118
Q

venous eczema

A

stasis eczema or varicose eczema
increased venous pressure
oedema
ankle and lower leg involved

resolution of oedema can help - compression stockings

119
Q

treatment of eczema

A

patient education
avoid causative/exacerbating factors
emollients (moisturisers)
- ointments - greasy but effective
- creams - lighter
- lotions - more watery
soap substitutes
intermittent topical steroids - different potency - hydrocortisone, betamethasone
sometimes need antihistamines or antimicrobials
calcineurin inhibitors - topical pimecrolimus and tacrolimus

120
Q

treatment of severe eczema

A

UV light
immunosuppression
- azathioprine
- ciclosporin
- mhycophenolate mofetil
- methotrexate
biologic - dupilumab (IL-4/IL-13 inhibitor)

121
Q

what is psoriasis

A

chronic, immune mediated disease
sharply demarcated erythematous plaques with micaceous scale
3% of UK pop
20-30yrs and 50-60yrs
75% before 40yrs

systemic disease
- 5-30% develop psoriatic arthritis
- psychosocial implications
- metabolic syndrome

122
Q

pathogenesis of psoriasis

A

polygenic predisposition + environmental triggers
35-90% have FH
infection
drugs
trauma
sunlight

123
Q

histology of psoriasis

A

hyperkeratosis
neutrophils in stratum corneum
psoriasiform hyperplasia : acanthosis with elongated rete ridges
dilated dermal capillaries
T cell infiltration

124
Q

subtypes of psoriasis

A

chronic plaque psoriasis
guttate psoriasis
palmo-plantar psoriasis, or pustulosis
scalp psoriasis
nail psoriasis
flexural/inverse psoriasis
pustular psoriasis
erythodermic psoriasis

125
Q

diagnosis of psoriasis

A

clinical
skin biopsy if atypical

126
Q

differential diagnosis of psoriasis

A

seborrheic dermatitis
lichen planus
mycosis fungoides
Bowens disease, drug eruption, infection, secondarry syphillis, contact dermatitis

127
Q

management of psoriasis

A

primary care
- emollients
- soap substitutes
- vit D3 analogues
- coal tar creams
- topical steroid - with care
- salicylic acid
secondary care
- optimise topical therapy
- crude coal tar
- dithranol
- UVB phototherapy
- oral retinoids - acitretin, teratogenic

128
Q

seborrheic keratoses

A

benign
warty growths, “stuck on appearance”
can have variable appearance
patients often have multiple +/- cherry angiomas
generally left untreated, but if troublesome - cryotherapy and curettage

129
Q

cryotherapy

A

liquid nitrogen
pros - cheap and easy to perform “on the day”
cons - can scar, failure/recurrence, no pathology result

130
Q

sign of leser-trelat

A

paraneoplastic phenomenon
abrupt onset of widespread seborrheic keratosis, particularly in a younger individual
SKs remain benign but may indicate underlying solid organ malignancy - GI adenocarcinoma

131
Q

viral warts

A

due to HPV
rough hyperkeratotic surface

difficult to treat
will clear when immunity developed to virus
cryotherapy or wart paints can stimulate immune system slightly
can curette in severe cases

132
Q

what is a cyst

A

encapsulated lesion containing fluid or semi-fluid material
usually firm and fluctuant

133
Q

different types of cysts

A

epidermoid cyst
pilar cyst
steatocystoma
dermoid cyst
hidrocystoma
ganglion cyst

134
Q

how to treat cysts

A

excision
if inflamed/infected
- antibiotics
- intralesional steroid
- incision & drainage

135
Q

dermatofibroma

A

benign, fibrous nodule, often on limbs - proliferation of fibroblasts
cause is unknown
firm nodule, tethered to skin but mobile over fat
pale pink/brown , often paler in centre
dimple sign positive
usually asymptomatic - can be itchy or tender
excision if concern or symptomatic

136
Q

lipoma

A

benign tumour consisting of fat cells
common
cause unknown
smooth and rubbery subcutaneous mass
usually asymptomatic

if tender - angiolipoma, liposarcoma - rare malignancy

137
Q

angioma

A

vascular lesion

138
Q

explain angiomas

A

overgrowth of blood vessels in the skin due to proliferating endothelial cells
generally asymptomatic - can be unsightly or bleed
occur in all age groups , both sexes
pregnancy and liver disease
excision or laser

139
Q

explain pyogenic granulomas

A

rapidly enlarging red/raw growth, often at a site of trauma
bleed easily
cause unknown
occur in up to 5% of pregnancies
common on head and hands
removed by curettage and cautery

140
Q

Bowen’s disease

A

aka intraepidermal squamous cell carcinoma
- full thickness dysplasia, entirely contained within the epidermis, no metastatic potential
- potential to become malignant
irregular, scaly erythematous plaque

141
Q

how to treat Bowen’s

A

cryotherapy
curettage - lesion scraped off and heat applied to seal vessels and destroy residual cancer cells
photodynamic therapy
imiquimod

142
Q

what is photodynamic therapy

A

photochemical reaction to selectively destroy cancer cells
topical photosensitising agent applied - concentrates in cancerous cells
red light applied (light colour dependant on which agent is used)
photodynamic reaction occurs between light, photosensitiser and oxygen causing inflammation and destruction of cells

143
Q

pros and cons of photodynamic therapy

A

pros :
done for patient by hosp staff
can treat multiple areas including those which would be hard to reach by patient
1 or 2 treatments

cons: requires hosp appts
can be painful and scar

144
Q

imquimod

A

aldara
immune response modifier - stimulates cytokine release

145
Q

actinic keratoses

A

rough scaly patches on sun damaged skin
low risk of transformation to SCC
treatment
- cryotherapy
- curettage
- diclofenac gel
- imiquimod

146
Q

melanoma in situ

A

melanoma cells entirely confined to epidermis
no metastatic potential
treated with excision

147
Q

lentigo maligna

A

type of melanoma in situ
usually facial

148
Q

sun protection

A

cover up
avoid sun at peak hours - 10am-4pm
don’t burn and try not to tan
avoid sunbeds
sunscreen
- UVA and UVB radiation
- at least SPF 30/4 star
- need to apply 2tbsps every 2hrs

149
Q

risk factors for non-melanoma skin cancer

A

UV radiation
photochemotherapy (PUVA)
chemical carcinogens
ionising radiation
human papilloma virus
familial cancer syndromes
immunosuppression

150
Q

basal cell carcinoma

A

slow growing
locally invasive
rarely metastasise
nodular
- pearly rolled edge
- telangiectasia
- central ulceration
- arborising vessels on endoscopy

151
Q

treatment of BCCs

A

excision is gold standard
- ellipse with rim of unaffected skin
- curative if fully excised
- will leave scar
curettage in some circumstances
imiquimod if superficial

152
Q

indications for Mohs surgery

A

site
size
subtype
poor clinical margin definition
recurrent
perineural or perivascular involvement

153
Q

squamous cell carcinoma

A

derived from keratinising squamous cells
usually on sun exposed sites
can metastasise, up to 16% depending on study
faster growing, tender, scaly/crusted or fleshy growths
can ulcerate

154
Q

treatment of SCC

A

excision
+/- radiotherapy

follow up if high risked
immunosuppressed
>20mm diameter
>4mm depth
ear, nose, lip, eyelid
perineural invasion
poorly differentiated

155
Q

keratoacanthoma

A

varient of squamous cell carcinoma
erupts from hair follicles in sun damaged skin
grows rapidly, may shrink after few months and resolve
surgical excision

156
Q

risk factors for melanoma skin cancer

A

UV radiation
genetic susceptibility - fair skin, red hair, blue eyes, and tendency to burn easily
familial melanoma and melanoma susceptibility genes

157
Q

ABCDE rule

A

Asymmetry
Border
Colour
Diameter
Evolution

158
Q

7 point checklist

A

major features:
change in size, shape, colour
minor features:
diameter >5mm, inflammation, oozing/bleeding, mild itch or altered sensation

159
Q

cutaneous lymphoma

A

secondary cutaneous disease from systemic/nodal involvement
primary cutaneous disease - abnormal neoplastic proliferation of lymphocytes in the skin
- cutaneous T cell lymphoma (65%)
- cutaneous B cell lymphoma (20%)

160
Q

cutaneous T cell lymphoma

A

counts for 65%
mycosis fungoides
sezary syndrome
CD30+ lymphoproliferative disorders
subcutaneous panniculitis like T cell lymphoma
cutaneous CD4+ lymphoma
extranodal NK/T cell lymphoma

161
Q

cutaneous B cell lymphoma

A

counts for 20%
cutaneous follicle centre lymphoma
cutaneous marginal zone lymphoma
cutaneous diffuse large B cell lymphoma

162
Q

mycosis fungoides (MF)

A

most common CTCL & accounts for around 50% of all primary cutaneous lymphomas
incidence 6 per 1 mil pop
cause unknown
more common in older patients and more common in men than women
indolent course

163
Q

stages of MF

A

patch
plaque
tumour
metastatic

164
Q

sezary syndrome

A

CTCL affecting skin of entire body
lymph node involvement
sezary cells in peripheral blood
poor prognosis - median survival 2-4yrs

165
Q

treatment of cutaneous lymphoma

A

dependent on stage
topical steroids
PUVA or UVB
localised radiotherapy
interferon
bexarotene
low dose methotrexate
chemotherapy
total skin electron beam therapy
extracorporeal photophoresis
bone marrow transplantation

166
Q

total skin electron beam therapy

A

type of radiotherapy consisting of very small electrically charged particles
delivers radiation primarily to superficial layers

167
Q

extracorporeal photophoresis

A

step 1 - patients blood drawn and leukocytes collected
step 2 - collected white cells mixed with psoralen which makes T cells sensitive to UVA radiation
step 3 - exposed to UVA radiation, damaging diseased cells
step 4 - treated cells reinfused back to patient

168
Q

cutaneous metastases

A

can be secondary to primary skin malignancy such as melanoma or due to primary solid organ malignancy
- most commonly breast, colon and lung

169
Q

management of cutaneous metastases

A

treat the underlying malignancy
local excision
localised radiotherapy
symptomatic

170
Q

consequences of skin failure

A

sepsis
hypo and hyper thermia
protein and fluid loss
renal impairment
peripheral vasodilation

171
Q

erythroderma

A

descriptive term rather than diagnosis
“any inflam skin disease affecting >90% of total skin surface”

172
Q

causes of erythroderma

A

psoriasis
eczema
drugs
cutaneous lymphoma
hereditary disorders
unknown

Y2 - SEM 1 - MED 2 (5 decks)

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