Dermatology Flashcards
learn those skin
What is this?
Herpes zoster/ Shingles
What is this?
Atheles foot, tinea pedis
What could this be?
basal cell carcinoma
What is this called? This is a type of ____.
Pyogenic granuloma
Nodule: Solid raised lesion >5mm in diameter with a deeper component
What is this called? This is a type of ____.
pompholyx from eczema of the palms and feet
Vesicle: Raised clear fluid filled lesion <5mm in diameter e.g.
What kind of lesion is this?
macule
what kind of lesion is this?
Patch: Larger flat area of altered colour or texture >10mm e.g. Port wine stain (naevus flammeus
what kind of lesion is this?
Plaque
Plaque: Palpable raised scaling lesion
>5mm in diameter e.g. psoriasis
what kind of lesion is this?
papule
what kind of lesion is this?
bulla
Raised clear fluid filled lesion >5mm in diameter e.g. blister
What is a naevus and an example?
Naevus: Localised malformation of tissue structures e.g. mole
What is this? what type of lesion?
mole. naevus.
What is a comedone and an example?
Comedone: A plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris e.g. acne
What is this? What type?
acne. comedone.
blackheads are a type of ___ lesion and they are (open/closed)
comedone, open
WHiteheads are a type of ___ lesion and they are (open/closed)
comedone, closed
This is an example of _____.
Pustule: Pus-containing lesion <5mm in diameter e.g. Mod-severe acne
A absecess is a localised accumulation of ____ in ________ tissues. an example is?
Localised accumulation of pus in dermis or SC tissues e.g. Periungal abscess in acute paronychia
Describe this
Acne:
Open and closed Heads.
Open- Blackheads
Closed- Whiteheads
Describe this
Infected eczema of the back of the knees/ atopic dermatitis
Shiny and red (wet/moist)
Crust formation
Erythematous
Papular
Describe and what could this be?
Malignant melanoma.
Asymmetrical, irregular border, colour variance
What are the red flags of benign skin lesions?
Sudden change in size
Irregularity, itching or bleeding
Sudden appearance of new lesions
Describe.
Management?
Sebacesous cyst
Skin coloured nodule with central punctum, regular border, symmetrical, mobile, overlying telangiectasia.
Commonly found on:
Neck
Face
Trunk
Treatment:
No intervention necessary
Excision- Whole cyst wall must be excised
Describe.
Management?
Large, dome-shaped, subcutaneous lesion, soft to medium consistency, regular surface and border. No surface changes.
What is it?
Benign, slow-growing subcutaneous tumours made of adipose cells
Usually asymptomatic
Management:
If dx uncertain do US +/- biopsy
No intervention necessary
Can be surgically excised
Describe what you see
Seborrhoeic keratosis:
Usually appears as a brown, black or light tan growth on the face, chest shoulders and back.
The growth has a waxy, scaly slightly elevated appearance
SCAM is used when describing skin lesions. What does it stand for?
Describe (SCAM)
Site and number of the lesions
Size (the widest diameter) and Shape
Colour
Associated secondary change and Area (Distribution)
Morphology and Margin
When describing pigmented lesions, ABCDE is recommended. What does it stand for?
Asymmetry
Border: irregular
Colour: Variegation (2 or more colours within the lesion)
Diameter: >6mm
Evolving: change in size/colour/bleeding
Describe. What is it?
Seborrhoeic keratosis
Darkly pigmented papule (or plaque)
Irregular, hard surface - Rough dry crumbling
‘stuck on’ appearance
No malignant potential
Can become irritated
Treatment:
None
Surgical excision
Cryotherapy (freezing or near freezing temperatures to destroy the tissue)
Describe what you see. What are these?
Skin tags
Multiple, flesh coloured or brown polypoid lesions attached by a stalk. Soft. Mobile.
Commonly found on:
Neck
Groin
Body folds
Management:
No treatment necessary
Can be removed by excision, cryotherapy, diathermy
What is this?
Sebaceous cyst
What are the 2 pre-malignant skin conditions?
Actinic keratosis
Bowen’s disease (SCC in situ)
Describe. What might it be?
Erythematous, scaly rough patches, somewhat papular.
+/- Adherent yellow crusts
Actinic keratosis
Actinic keratosis has a risk of progressing to ______
Squamous cell carcinoma
What might this be?
Actinic keratosis
What might this be?
Actinic keratosis
Pharmacological management options for actinic keratosis?
Topical 5-fluorouracil (OD x 4/52)
3% diclofenac gel (BD x 2-3/12)
5-Fck You & Die
surgical management options for actinic keatosis
Cryotherapy
Curettage and cautery
Describe what you see. What might it be?
Irregular scaly patch,
with irregular surface and scattered papules.
Pink/red surface.
Bowen’s disease (SCC in situ)
What is Bowen’s disease?
Intradermal SCC i.e. SCC in-situ
treatment options for bowen’s disease?
Cryotherapy
Superficial skin surgery
Photodynamic therapy
medical: Topical Treatment- 5-Fluorouracil/Imiquimod
Describe this. What might it be?
Irregular scaly patch, with irregular surface and scattered papules.
May also present as plaques.
Pink/red surface.
Mildly ulcerated
Can bleed
Can progress to SCC (3-5%)
Assd w/ sun damage, immunosuppression
Bowen’s disease
Uses of Imiquimod?
Uses: Genital warts, Superficial BCC, Actinic keratosis
Aldara 5% is brand name of ______
Imiquimod’s brand name is Aldara 5%
Actinic Keratosis VS Bowen’s Disease? Think SCAM
3 malignant skin lesions
Malignant melanoma
Basal cell carcinoma (BCC)
Squamous cell carcinoma (SCC)
malignant melanoma accounts for ___% of skin cancers
and ___% of skin cancer deaths
1% of skin cancers
Accounts for 80% of skin cancer deaths
Describe features of a malignant melanoma lesion with ABCDE
Asymmetry
Border: irregular
Colour: Variegation Two or more colours within the lesion
Diameter: >6mm
Evolving: change in size/colour/bleeding
Ugly duckling sign is a feature of _____
Malignant melanoma
Risk factors of malignant melanoma?
UV exposure
History of frequent or severe sunburn in childhood
Skin type I (always burns, never tans)
Increasing age
Male
Immunosuppression
Previous history of skin cancer
Genetic predisposition
Manaegment of malignant melanoma?
Surgical excision - definitive treatment (plastic surgery team)
+/- Radiotherapy
Chemotherapy for metastatic disease (oncology team)
melanoma in situ is confined to ______ but is considered _____ melanoma when cells grow past it.
basement membrane
invasive melanoma
what is this?
melanoma in situ
what is this?
melanoma in situ
Picture shows a (superficial/nodular) type of melanoma.
Superficial spreading (50-75%)
(Superficial spreading/ nodular) melanoma is common on the lower limbs in young and middle aged adults
superficial spreading melanoma Common on the lower limbs in young and middle aged adults.
Related to intermittent high intensity UV exposure
Picture shows a (superficial/nodular) type of melanoma.
Nodular melanoma:
Common on the trunk in young and middle aged adults.
Related to intermittent high intensity UV exposure
(Superficial spreading/ nodular) melanoma is common on the trunks in young and middle aged adults
nodular
what is this?
lentigo maligna (5-15%) melanoma:
Common on the face in elderly population.
Related to long term cumulative UV exposure.
What is this?
Acral lentiginous melanoma:
Common on palms, soles and nail beds in elderly population.
No clear relation with UV exposure
What is this?
Squamous cell carcinoma:
Nodule, irregular, with central ulceration. Crusty, scaly.
Describe
Squamous cell carcinoma:
Hyperkeratotic skin coloured to erythematous papule/nodule/plaque.
Scaling, ulceration, crusting
Treatment for SCC?
Depends on site, size, location and number of SCCs
Surgical excision
Radiotherapy
____ is the 2nd most common skin cancer
SCC
SCC on a chronic wound/ scar is called ____
Marjolin’s ulcer
4 types of BCC?
Nodular, Superficial, Pigmented, Morphoeic
treatment for BCC?
Surgical excision
Radiotherapy
Topical therapies- 5-fluorouracil/Imiquimod 5% cream
Cryotherapy
5-fluorouracil: Anti metabolite chemotherapy
Imiquimod 5% cream: Immune response modifier
What is this?
atopic dermatitis/ eczema
Presents as itchy erythematous dry scaly patches, with associated papules and/or vesicles
Dermatitis is asociated with family/personal history of ____
Associations:
Personal/Family history of Asthma
Allergic rhinitis
Atopy
What is this?
atopic dermatitis/ Eczema
Presents as itchy erythematous dry scaly patches, with associated papules and/or vesicles
Management of atopic eczema?
Management
Emollients!!! (moisturiser)
Topical steroids for flare ups
Topical immunomodulators can be used as steroid sparing agents e.g. Tacrolimus
Phototherapy and immunosuppressants for severe non responsive cases
areas affected in eczema
Areas affected
Infants: Face and extensor aspects of limbs
Children and adults: Flexor aspects
What is this?
irritant dermatitis
What is this?
allergic dermatitis
Describe the lesion. What is this?
proximal to the medial malleolus
Hyper-pigmented, thickened, scaling skin
champange bottle appearence
This is a Venous eczema
Treatment for this condition?
Treatment for venous eczema:
Leg elevation
Support stockings (after excluding PAD)
Weight reduction
Emollients
Topical steroids (hydrocortisone to eumovate to betnovate)
Describe the picture. What might it be? Give other DDx.
Seborrhoeic dermatitis
White yellowish scale on erythematous patches/plaques
Chronic, superficial inflammation affecting hairy regions
Associated with contact dermatitis to Malassezia yeast
DDx:
Atopic eczema
Psoriasis
WHat is this? Treatment?
Seborrhoeic dermatitis on eyebrows and face
Treatment:
Ketoconazole shampoo +/- cream
Topical keratolytics and steroids
What is this?
Psoriasis. Sharply demarcated pruritic, erythematous plaques with overlying silvery scale
Psoriasis is an independent risk factor for ___
CVD
Precipitating factors of psoriasis?
Trauma
Infection
Drugs
Stress
Alcohol
plaque psoriasis
Guttate psoriasis
Multiple drop like lesions that is usually preceded by a streptococcal sore throat/ tonsillitis
WHat is this? Management?
Well outlined scaly plaques with thickened scales
Scalp psoriasis
Management:
T gel shampoo
Steroid scalp lotion and vitamin D analogue
If still problematic then:
Massage cocois oil into scalp and leave overnight followed by vitamin D/steroid scalp lotion
Treatment for localised and mild psoriasis?
Emollients to reduce scales
+ Topical therapies such as Vitamin D analogues, Corticosteroids, Coal tar, Dithranol
What does Dithranol do?
Anthralin- Inhbits keratinocyte hyperproliferation
Treatment for extensive psoriasis
referral to dermatology for phototherapy
Treatment for Extensive severe psoriasis or psoriasis with systemic involvement?
Oral therapies e.g. methotrexate
Biologics e.g TNF-alpha inhibitors
What is this called? In which disease do you find it?
Oncycholysis- Separation of the distal end of the nail plate from the nail bed
Psoriasis nail involvement
What might this be? what cause it?
Acne
Contributing factors:
Increased sebum production
Abnormal follicular keratinization
Bacterial colonization (propionbacteruim acnes)
Inflammation
Acne is defined as inflammation disease of the ______
An inflammatory disease of the pilosebaceous follicle
what parts of the body does acne commonly affect?
Face
Chest
Upper back
Mild acne is defined as <_____(number) lesions. They are mainly _____(type of lesion), consisting of _____ which are blackheads, ____ which are white heads
< 30 LESIONS
Mainly comedones = plug in sebaceous follicle containing sebum, bacteria, cellular debris
Open (blackheads)
Closed (whiteheads)
May have a few inflammatory papules and pustules
Moderate acne is defined as ____(number) of lesion,
______(type of lesion) with several inflammatory papules and pustules, a few nodules
30-125 LESIONS
Comedones with several inflammatory papules and pustules, a few nodules
Severe acne is defined as >___(number) lesions. It involves ____ unlike mild and moderate
> 125 LESIONS
Comedones, several inflammatory papules and pustules, multiple nodules,
- Involves SCARRING
1st line Treatment for mild comedonal acne
Topical retinoid (e.g. Adapalene)
Acne treatment with oral ABX is reviewed every ___ weeks
12 weeks
For ACNE, _____ might be used ONLY if all other rx failed for severe acne in AFAB (assigned female at birth) patients, due to risk of thrombosis
Co-cyprindiol
For ACNE, Patients are referred to dermatology if treatment fails after ___ months
6 months OR 6/12
Treatment for mild to moderate acne papules and pustules.
Treatment for Moderate to severe acne when OR when previous rx failed
For moderate to severe acne treatment, if patient if pregnant or < 12 years old, which ABX is/are recommended?
If pregnant, <12 yo: erythromycin or trimethoprim
complications of acne
Post inflammatory hyperpigmentation
Scarring
Deformity
Psychological and social effects
What is this? Describe.
Rosacea
Erythema, flushing and papules
What is this?
Rhinophyma
____ is chronic inflammation of facial dermatosis
Rosacea
Rosacea is common in ____ years old
Common in 30-50 yo
Triggers of Rosacea
Sun exposure/heat
Stress, exercise
Alcohol
Treatment for Rosacea
Topical antibiotics e.g. metronidazole gel
Oral antibiotics e.g. tetracycline
For Rosacea, refer to dermatology if ….
Refer to dermatology if complications e.g. Rhinophyma or failure to respond
What is this? What is it caused by?
Impetigo
Usual pathogens:
Staph aureus
Strep pyogenes
Treatment for this condition
Treatmen for impetigo:
Topical antibiotics e.g. fusidic acid
Oral antibiotics e.g flucloxacillin
What is this? DDx?
Cellulitis
Redness, swelling, warmth, tenderness +/- pyrexia
Border ill-defined
DDx DVT
____ is the infection of deep subcutaneous tissues
Cellulitis
Treatment for cellulitis
Treatment:
Abx e.g. Flucloxacillin
If leg – rest and elevation
Cellulitis increases risk of developing…
Abscess
Sepsis
Recurrence
Lymphoedema
What is this? Aetiology?
Chicken pox/ varicella,
Herpes Varicella zoster virus
____ presents as grouped vesicles on erythematous base.
chicken pox/ varicella
Highly contagious airborne disease
Rash (very itchy!) + fever
Macular papular vesicular (on erythematous base)
Lesions dry and crust
Treatment for this condition?
Symptomatic management e.g.paracetamol, calamine lotion
Shingles AKA ____ is caused by reactivation of ____.
Herpes zoster, or shingles, is a painful blisteringrashcaused by reactivation of the herpes varicella-zoster virus.
(shingles/chicken pox) is itchy but (shingles/chicken pox) is painful
Chicken pox is itchy
Shingles is painful
Herpes zoster is _____(symmetrical/asymmetrical) and ____(unilateral/bilateral), in ______ distribution
Asymmetrical, unilateral
Dermatomal distribution
Treatment?
- Oral antivirals e.g. acyclovir/valciclovir
HSE antimicrobial guidelines specify that it may be commenced within 72 hours of rash onset, if patient >50 years old - Analgesia
What is this? Describe.
Ringworm/ Tinea corporis
Itchy circular/annular lesions with a clearly defined raised and scaly edge
Contagious
What is this? Describe.
Tinea cruris
(groin)
clearly defined raised skin, scaling lesions
Pruritic
What is this? treatment?
Tinea Pedis
Mild
Topical antifungal creams e.g. Miconazole
+/- topical corticosteroid if inflamed
Widespread/Severe
Oral antifungals e.g. Terbinafine
What might this be? DDx?
Tinea uinguium
Ddx: Psoriasis
Management for this?
Advised to confirm diagnosis by sending nail clippings to microbiology lab
use topical first
if severe (more than 1-2 digits)/ no response to topical rx, try oral antifungals.
However, Get baseline LFT as hepatotoxicity. WARN PATIENTS.
Oral anti-fungals 6-12 weeks if finger nails, 3-6 months if toes
What could this be?
Oral Candida
Ddx: leukoplakia
What could this be?
Urticaria/ Hives, sudden onset very itchy
What is this?
AngioOedema
Management?
Can be an emergency and can be life threatening – may accompany ANAPHYLAXIS
Treatment:
ABCDE
Call for help
Medications- Adrenaline, Hydrocortisone, Antihistamine
High flow oxygen
Monitor- Pulse oximetry, ECG, BP
Sx of anaphylaxis
Bronchospasm
Facial and laryngeal oedema
Hypotension
Angioedema and anaphylaxis can lead to:
Asphyxia
Cardiac arrest
Death
Fever, neck stiffness, photophobia… Non-blanching petechial or purpuric rash…what are we concerned about?
Meningitis/ Meningcoccal disease
Management of meningcoccal disease?
Management:
Call for help and phone an ambulance
ABCDE approach
IV access, IVFs and high flow oxygen (100%)
Benzypenicillin IM/IV (cefotaxime can also be given instead)
