Dermatology Flashcards
What should be asked in a history for a dermatological condition ?
Site of onset And any evolution
Duration - acute / chronic
Distribution
Flexor / extensor
Sun exposed area
Affecting mucous membranes
Ask about symptoms - itchy or sore
Aggravating or relieving factors
PMH
Any atopy in the family
Drug history
Travel history
Any current stress
What is the medical term for a small lump ( less than 5mm ) ?
Papule
What is the medical term for a larger lump ( 5 - 10 mm ) ?
Nodule
What is the medical term for redness ?
Erythema
What is the medical term for a small water blister ?
Vesicle
What is the medical term for a large water blister ?
Bulla
What is the medical term for a pus filled vesicle ?
Pustule
What is the medical term for a hairiness ?
Hirsutism
What is the medical term for scratch marks ?
Excoriations
What is the medical term for stretch marks ?
Striae
What is the medical term for itching ?
Pruritus
What is a macule ?
A non palpable area of discolouration
what is a patch ?
Macule larger than 2cm
What is a plaque ?
Palpable, flat topped area 1-2cm
What is an ulcer ?
Loss of epidermis and dermis
What is lichenification ?
Thickening of the skin with exaggerated skin markings
What is cellulitis ?
A deep infection of the connective tissue, usually skin and subcutaneous tissues, in which there is obvious oedema.
What are the most commonly causative agents of cellulitis ?
Streptococcus pyogenes
Staphylococcus aureus
How does cellulitis present ?
Hot
Tender
Redness
Fever
Rigors
What investigations are done when suspecting cellulitis ?
FBC
Blood cultures
Swabs of the area
What is the treatment of cellulitis ?
Systemic antibiotics for example oral penicillin V plus flucloxacillin
What is erysipelas ?
A rapidly spreading streptococcal infection of the skin and subcutaneous tissue characterised by cellulitis and lymphangitis.
What is the most likely cause of erysipelas ?
Streptococcus pyogenes
What are some clinical features of erysipelas ?
Fever
Tachycardia
Chills
Malaise
Red, hot, tender ( usually red shiny plaque on face )
What investigations are performed when suspecting erysipelas ?
Swab to culture
There is also often Leucocytosis and a raised ESR
What are some differentials for erysipelas ?
Cellulitis
Erysipeloid
Necrotising fasciitis
What is the management of erysipelas ?
Offer antibiotics - flucloxacillin is first line or clarithromycin or doxycycline
What are some complications of erysipelas ?
Arthritis in near by joints
Sepsis ( rare )
Endocarditis ( rare )
What is impetigo ?
A highly contagious, superficial skin infection caused by staphylococcus aureus or streptococcus pyogenes.
What are some clinical features of impetigo ?
Multiple lesions affecting the face or extremities.
Honey coloured or golden crusts
Itching is common but should be resisted
What is the management of impetigo ?
Swab the lesions and culture
Topical treatment - topical fusidic acid or mupirocin
If systemically ill treat with oral antibiotics such as flucloxacillin
What are some complications of impetigo ?
Pneumonia
Glomerulonephritis
Osteomyelitis
What is candidiasis ?
An infection caused by the yeast Candida albicans
What is tinea ?
It is a very common superficial fungal skin infection caused by dermatophytes.
Usually causes athletes foot, nail infections, tinea corporis.
How can a dermatophyte infection be transmitted ?
Direct contact with the infected person or animal
Contact with the soil - rare
Indirect contact - through objects contaminated with the fungus
What is tinea ( a dermatophyte infection ) associated with ?
Hot, humid environments
Sweating or maceration of the skin
Use of hair greases or oils
Occlusive footwear
DM
What are some clinical features of tinea pedis ?
Affects toe webs, sole or lateral aspect of the foot
Itchy
Erythematous, soggy scaling
What are some clinical features of tinea corporis ?
Itchy erythematous rash
Usually on the groin or axillae
One or more scaly papules
What are the differences between the 2 types of herpes infections ?
Type 1 or HSV I - spread by infected saliva, oral facial lesions
Type 2 or HSV II - spread by genital contact, vesicles on the genitalia
How does herpes simplex infections present ?
Blisters or sores around the mouth, nose, genitals and buttocks but may occur Lamotrigine anywhere on the skin.
What are some investigations to perform when suspecting herpes simplex infection ?
Diagnosis is usually clinical
Swab and send for culture
What is the management of a herpes simplex infection ?
The infection can be self limiting
Oral anti-viral medications include Acyclovir
Used to reduce pain, viral shedding and healing time
What is molluscum contagiosum ?
A viral skin disease characterised by firm, round, translucent, multiple, dome shaped papules. Is it usually benign.
How does molluscum contagiosum spread ?
Direct skin - skin contact
What are some clinical features of molluscum contagiosum ?
Pink or white shiny wax-like papules
Dome shaped - central pit
Mildly itchy
Usually on trunk, inner thighs and genitalia
What are some differentials for molluscum contagiosum ?
Warts
Sebaceous cysts
What is the management of molluscum contagiosum ?
No specific treatment is required - usually self limiting
Can use cryotherapy or expression of the contents of the pearly core
What is shingles ?
An acute, unilateral, self limiting inflammatory disease of cerebral ganglia and the ganglia of posterior nerve roots and peripheral nerves in a segmented distribution caused by the varicella zoster virus.
What are the clinical features of the shingles ?
Occurs 1 - 5 days before the onset of the rash
Malaise
Headache
Photophobia
Itchy
Burning
Affects singular dermatomes
What are some differentials for shingles ?
HSV
Impetigo
Candidiasis
Contact dermatitis
Insect bites
What are some complications of shingles ?
Neuralgia
Temporary paralysis
Neurological complications - encephalitis, hemiparesis, Guillian-Barre syndrome
What treatment can be given for shingles ?55
Oral antivirals
Analgesics
What is chicken pox ?
A highly infective disease predominately of children under the age of 10 caused by the varicella zoster virus
How is chicken pox transmitted ?
Direct person to person contact
Airborne droplet infection
Contact with infected articles of clothing
What are some clinical features of chicken pox ?
Incubation 14 - 21 days
Macular lesions which develop it not papular or vesicular lesions
Mostly affects the face, trunk and sparsely on the limbs
Erythema
Itchy
What are some differentials for chicken pox ?
Herpes simplex
Impetigo
Contact dermatitis
Scabies
What treatment options are there for chicken pox ?
Paracetamol
Calamine lotion
Oral acyclovir can be given for adults
What are some complications of chicken pox ?
Pneumonia
Cerebellar ataxia
Encephalitis
Bacterial infection of the lesion
What is basal cell carcinoma ?
A locally invasive carcinoma of the basal layer of the epidermis. It almost never metastasises.
What are some features of basal cell carcinoma ?
Slow growing
locally invasive
Malignant
What are some clinical features of basal cell carcinoma ?
Usually affects elderly and middle aged people
Common sites are in scar tissue or sun damaged skin
Small pearly white nodule with visible blood vessels
What are some causes of basal cell carcinoma ?
Sun exposure
Related to Gorlin’s disease
What is the treatment for basal cell carcinoma ?
Surgery - excision
Radiotherapy
Chemotherapy
What is a squamous cell carcinoma ?
A malignant tumour of the epidermis in which the cells, if differentiated, show keratin formation.
What are some causes of squamous cell carcinoma ?
Exposure to UV light
Chronic exposure to industrial carcinogens
Premalignant conditions - bowens disease
Immunosuppression
What are some differentials for squamous cell carcinoma ?
Basal cell carcinoma
Keratocanthoma
Malignant melanoma
What are some clinical features of squamous cell carcinoma ?
Develop on sun exposed skin
Rapidly expanding
Painless
Ulcerated nodules
Cauliflower appearance
Metastatic spread may occur via local lymph nodes
What is the management of squamous cell carcinoma ?
If it is localised and well differentiated ( producing keratin pearls ) can excise it
Poorly differentiated lesions may require the addition of radiotherapy
What is melanoma ?
Malignant tumour of the pigment producing cells of the skin - melanocytes.
It is not restricted to the skin and can affect the eyes, mucosa, GI tract and Genitourinary tract.
What are some risk factors of melanoma ?
UV radio audio exposure
Family history
History of 3 more severe sun burns
Presence of freckles
Immunosuppression
Blonde or red hair
What are some clinical features of melanoma ?
May arise from moles
Ulcerated
Inflamed
Irregular edges
Changes in colour
Changes in shape
Changes in size
Itching
What are some differentials for melanoma ?
Benign naevi
Pigmented basal cell carcinoma
Kaposi’s sarcoma
What investigations are performed when melanoma is suspected ?
Excision biopsy
CXR
LFT’S
FBC
CT scan
Sentinel lymph node biopsy
What is the management of melanoma ?
Excision biopsy and histological examination
Surgery to excise the cancer
May need additional radiotherapy or immunotherapy if more advanced.
What is the ABCDE guide to checking moles ?
Asymmetry
Border - irregular
Colour - uneven and different shades of colour
Diameter - at least 6mm
Evolution - has changed in appearance
What is eczema ?
A common and chronic relapsing inflammatory skin disorder characterised by intense pruritis and excoriation.
What are some characteristic features of eczema ?
Itch
Hot skin
Oedema
Oozing and weeping
Crusting
Excoriation
Secondary infection
What is the management of eczema ?
Emollients - combat dry skin
Topical corticosteroids
Topical calcineurin inhibitors - Tacrolimus
Antibiotcs if infected
Antihistamines
What is psoriasis ?
A common chronic skin disease characterised by cutaneous inflammation and epidermal hyper proliferation usually over the extensor aspect of the knees and elbows.
What causes psoriasis ?
Genetics
Infection
Stress
Trauma
Drugs
Smoking and alcohol
How is a diagnosis of psoriasis made ?
Based on clinical features
Rarely a biopsy is needed
Scalp lesions and nail lesions
How does psoriasis present ?
Raised, erythematous and scaly lesions
Red and silvery scales
Bleeding
Itching
Oozing
What are the treatment options for psoriasis ?
Corticosteroids
Vitamin D analogues
Phototherapies
What is the referral criteria for psoriasis ?
Diagnosis is uncertain
Psoriasis is severe
Nail disease
Children
What is acne vulgaris ?
A common chronic inflammatory disease of the pilosebaceous unit. It is characterised by the obstruction of the pilosebaceous follicle with keratin plugs resulting in comedones, inflammation and pustules.
What are some clinical features of acne vulgaris ?
Comedones - blackheads, whiteheads, sandpaper
Papules ( inflamed )
Pustules ( contains pus )
Lesions usually present on the forehead, nose and chin. It can also affect the upper chest and back.
Scarring can occur
What are some treatment options for acne vulgaris ?
Topical retinoid
Topical antibiotic
+ benzoyl peroxide
Topical corticosteroids shouldn’t be used
When should a referral be made to a dermatologist be made for acne vulgaris ?
Hasn’t responded to 2 completed courses of treatment
Acne with scarring
Persistent pigmentary changes
Psychological harm
What is urticaria ?
Vascular reaction of the skin marked by transient appearance of slightly elevated patches and red or pale swellings with severe itching.
What are the clinical features of urticaria ?
Rapid change
erythematous
Itchy
Swellings
Blotches
What investigations should be performed when suspecting urticaria ?
Diagnosis is mainly clinical
FBC - Hb, WBC, eosinophils, platelets
ESR
LFT’s
Urinalysis
What is the management of urticaria ?
Avoid triggers
Antihistamines
Antileukotrienes
Corticosteroids
Adrenaline - acute
