Dermatology Flashcards
What is a vesicle?
Fluid-filled blister less than 0.5 cm in diameter
What is a bulla?
Fluid-filled blister more than 0.5 cm in diameter
What is a skin fissure?
Deep crack/crevice into skin
What is a macule?
Flat pigmented lesion less than 1 cm in diameter
What is a patch?
Flat pigmented lesion more than 1 cm in diamter
What is a papule?
Raised lesion less than 0.5 cm in diameter
What is a nodule?
Raised lesion more than 0.5 cm in diameter
What is a pustule?
Pus-filled lesion
What is a plaque?
Raised lesion more than 1 cm in diameter
What is lichenification?
Thickened skin
What is purpura?
Purple pigmentation that does not blanche
What is petechiae?
1-2 mm of purpura
What is erythema?
Red pigmentation that does blanche
What is an erosion?
Superficial break in epidermis
What is an ulcer?
Deep break in epidermis and dermis
What is a wheal?
Compressible dermal swelling
List skin manifestations of diabetes
Flexural candidiasis Folliculitis, infection Necrobiosis lipoidica Acanthosis nigricans Ulcers Xanthomata
What is necrobiosis lipoidica?
Waxy, shiny red-brown plaques with atrophic yellow lesions on shins
What is acanthosis nigricans?
Velvety thickening of skin, usually in the axillae
What is the main skin manifestation of Coeliac disease?
Dermatitis herpetiformis
List skin manifestations of inflammatory bowel disease
Erythema nodosum
Pyoderma gangrenosum
What is erythema nodosum?
Tender, ill-defined nodules usually found on shins
What is pyoderma gangrenosum?
Recurring nodulo-pustular ulcers that have a red-blue necrotic edge
List skin manifestations of systemic lupus erythematosus
Butterfly rash
Photosensitivity
Alopecia
What is the main skin manifestation of herpes simplex infection?
Erythema multiforme
List skin manifestations of vasculitis
Purpura (may be palpable)
Nodules
Livedo reticularis
What is livedo reticularis?
Mottled red-blue lesions that don’t blanche
Usually triggered in the cold
List skin manifestations of dermatomyositis
Heliotrope rash
Gottron’s papules
Scaly red plaques over neck (V-sign)
Periungual redness
List aetiology/risk factors for atopic dermatitis
Genetic mutation in filaggrin gene
Overactive TH2 cells results in more circulating IL-4, IL-5, IgE
Infection (Staph aureus)
Exacerbators (dust, temperature, allergies)
List clinical features of atopic dermatitis
Itchy, dry skin Flexural scale and erythema Weepy vesicles Lichenification Hyperlinear pals Eczema herpeticum (HSV infection)
What investigations would you do for atopic dermatitis?
Serum IgE
What is the clinical criteria for diagnosing childhood eczema?
Itch + 3 of: Flexural rash Onset before 2 years of age History of atopy Dry skin
Outline treatment options for atopic dermatitis
Allergen/trigger avoidance
Emollients (Epaderm, Diprobase)
Topical steroid (hydrocortisone, clobetasone, betametasone, mometasone, clobetasol)
Immunomodulator (tacrolimus, ciclosporin)
Antibiotic if infection
Antihistamine
Paste bandaging
Phototherapy/systemic therapy if non-responsive
Ointments are more effective than emollients for dry skin. True/False?
True
What is contact allergic dermatitis?
Type IV hypersensitivity skin reaction to environmental allergens
List aetiology/risk factors for contact allergic dermatitis
Nickel
Chemicals, creams
Rubber
Occupational substances
List clinical features of contact allergic dermatitis
Localised rash with cut-off patern
Itch
Rhinitis
Wheal
What is contact irritant dermatitis?
Non-specific skin reaction to environmental substances
List aetiology/risk factors for contact irritant dermatitis
Soap, detergents Oil Bleach Trauma Occupational substances
List clinical features of contact irritant dermatitis
Localised rash/redness
Weeping
Dry fissures
Usually hands affected
How would you differentiate between contact allergic and irritant dermatitis?
Patch testing to check for allergic trigger
Outline treatment for contact dermatitis
Avoid allergen/trigger
Topical steroid
What is stasis dermatitis?
Chronic venous insufficiency/hypertension causes blood pooling and skin disease
List aetiology/risk factors for stasis dermatitis
Obesity
Varicose veins
History of DVT
List clinical features of stasis dermatitis
Haemosiderin staining (brown pigments)
Ulcers
Hair loss
Painless scale, itch
Outline treatment for stasis dermatitis
Emollients
Topical steroid
Compression stockings, leg elevation
What is lichen simplex dermatitis?
Self-induced eczema due to repeated physical trauma
What is acne vulgaris?
Inflammation of pilosebaceous unit that causes a rash, typically in areas high in concentration of these glands (face, neck, chest, back)
What causes comedones in acne?
Abnormal keratinisation/desquamation within pilosebaceous unit causes blockage of secretions and comedone formation
Open comedones are white/black heads and closed comedones are white/black heads
Open comedones are blackheads and closed comedones are whiteheads
List aetiology/risk factors for acne vulgaris
Increased sebum production (increased androgens, CRH)
P. acnes infection
Occlusion of pilosebaceous unit
Dermal inflammation
List clinical features of acne
Comedones
Seborrhoea
Inflammatory papules and pustules, nodules
Scars and cysts in severe acne
Psych disturbance
Develop keloid scars: thick inflamed lesions on trunk and shoulders
Outline treatment for mild, moderate and severe acne
Education and psych support, dispel myths
Mild: topical benzoyl peroxide +/- azelaic acid, antibiotic
Moderate: topical doxycycline/erythromycin + benzoyl peroxide
Severe: oral isotretinoin
What is acne rosacea?
Chronic relapsing-remitting facial rash usually affecting convex areas
List aetiology/risk factors for acne rosacea
Largely unknown Chlamydia Demodex mite Spicy food Alcohol
List clinical features of acne rosacea
Rhinophyma Facial flushing NO COMEDONES Telangiectasia Erythema
Outline treatment of acne rosacea
Avoid irritants
Topical azelaic acid + metronidazole
Oral azithromycin for chlamydia
What is pemphigus vulgaris?
Autoimmune blistering condition caused by IgG produced against desmoglein 3, causing loss of adhesion of epidermis to basal layer
List aetiology/risk factors for pemphigus vulgaris
Autoimmunity
Genetics
Drugs (ACEi, NSAID, phenobarbitol, levodopa)
List clinical features of pemphigus vulgaris
Flaccid, superficial, fluid-filled blisters
Rupture leaves erosions
Nikolsky sign +ve
Oral mucosal ulcers
What investigation would you do for pemphigus vulgaris?
Skin biopsy for immunofluorescence shows IgG crazy-paving/chicken-wire pattern in epidermis
Outline treatment for pemphigus vulgaris
High-dose oral prednisolone
Immunosuppression (rituximab, azathioprine)
What is bullous pemphigoid?
Autoimmune blistering condition caused by IgG produced against hemidesmosomes and basement membrane, causing sub-epidermal separation
Which is more common - bullous pemphigoid or pemphigus vulgaris?
Bullous pemphigoid
List clinical features of bullous pemphigoid
Large, tense bullae
Urticated base
Nikolsky sign -ve
What investigation would you do for bullous pemphigoid?
Skin biopsy for immunofluorescence shows linear IgG deposition along basement membrane
Outline treatment for bullous pemphigoid
High-dose oral steroid
Clobetasol propionate cream
What is dermatitis herpetiformis?
Rare autoimmune blistering condition caused by IgA cross-reacting with connective tissue matrix proteins, causing sub-epidermal separation
Which condition is associated with dermatitis herpetiformis?
Coeliac disease (HLA DQ2)
List clinical features of dermatitis herpetiformis
Small, intense itchy blisters usually on elbow/scalp/shoulders/ankles
Crusting
What investigation would you do for dermatitis herpetiformis?
Skin biopsy histology shows dermal papillary microabscesses
IgA immunofluorescence
Outline treatment for dermatitis herpetiformis
Oral dapsone
Gluten-free diet
List skin manifestations of hyperthyroidism
Moist smooth skin Facial flushing Palmar erythema Fine, thin hair/alopecia Hyperhidrosis Nail changes Hyperpigmentation Pretibial myxoedema Urticaria
List skin manifestations of hypothyroidism
Cold, dry, pale skin Coarse, brittle hair Thickened nails Generalised myxoedema Peri-orbital oedema Facial puffiness
List skin manifestations of Addison’s disease
Palmar crease pigmentation
Buccal pigmentation
List skin manifestations of endocrine tumours
Hyperpigmentation
Hirsutism
Acne
Baldness
List skin manifestations of systemic sclerosis
Pinched mouth Radial furrows Beaked nose Facial telangiectasia Raynaud's phenomenon Dysphagia Sclerodactyly Calcinosis
What is pityriasis rosea?
Common skin rash tending to occur in epidemics, presenting with solitary herald patch with subsequent truncal eruption of pink oval lesions with scale
What is vitiligo?
Acquired de-pigmentation caused by loss of melanocytes
List aetiology/risk factors for generalised hair loss
Telogen effluvium Endocrine disease (thyroid) Drugs Dietary deficiency (iron, zinc, vit D) Alopecia areata Malnutrition
What investigations would you do for hair loss?
Skin scraping, hair plucking Woods lamp examination Dermoscopy Scalp biopsy Bloods: hormones, FBC, thyroid
What is alopecia areata?
Autoimmune cause of hair loss in round/spotty distribution all over the body
What is hirsutism?
Male-pattern hair growth in response to increased androgenic drive/levels
List aetiology/risk factors of hirsutism
Familial, genetics Adrenal hyperplasia/tumour PCOS Hyperprolactinaemia Drugs (danazol, glucocorticoids)
What investigations would you do for hirsutism?
Hormones: testosterone, DHEA, SHBG, LH, FSH
Ovarian USS if indicated
What is hypertrichosis?
Excessive hair growth in a non-androgenic distribution
List aetiology/risk factors for hypertrichosis
Naevi Chronic scarring/inflammation Malnutrition Anorexia Porphyria cutanea tarda Occult malignancy Drugs (minoxidil, phenytoin, ciclosporin)
What is the most common type of drug skin eruption?
Maculopapular/Exanthematous - up to 2-3 weeks after administration
List some drugs that cause exanthematous skin eruptions
Penicillin Carbamazepine Allopurinol NSAID Cephalosporins
When does drug-induced urticaria usually onset?
Within 36 hours of administration but may develop within minutes when re-challenged
What is Steven-Johnson syndrome?
Full-thickness epidermal necrolysis, involving mucosal erosions, occurring in response to drugs and/or illness
List some drugs that cause Steven-Johnson syndrome
Allopurinol
Antibiotics
Anticonvulsants
NSAID
What is the difference between Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?
SJS involves up to 30% epidermal detachment
TEN involves more than 30% epidermal detachment
List some drugs that cause erythroderma/exfoliative dermatitis
Barbiturates Gold Quinine Sulphonamides Carbamazepine Allopurinol
Fixed drug eruptions are mediated by what cells and occur when?
Mediated by T memory cells
Occur 1-2 weeks after exposure and may persist and reappear with further exposure
List some drugs that cause fixed drug eruptions
Tetracyclines Phenolphthalein NSAIDs Quinine Oral contraceptive
List some drugs that cause lichenoid eruptions
B blockers
Captopril
Thiazides
Furosemide
Outline general management of drug eruptions
Stop likely drug offender Regular emollients for dryness and itch Topical steroid IV hydrocortisone + antihistamine for urticaria Specialist/ICU management if severe
Outline management of an insect bite
Prevent with insect repellant
Topical steroid
Antihistamine
Treat affected animals and environment
What disease can tick bites cause and why?
Lyme disease
Ticks transmit Borrelia Burgdorferi, a spirochaete responsible for lyme disease
Describe the first clinical stage of lyme disease
Erythema chronicum migrans, usually up to 14 days after bite, seen as a solitary macule or annular lesion
May have mild systemic symptoms
Describe the second clinical stage of lyme disease
Borrelia lymphocytoma occurs up to 6 months after the bite, involving firm blue-red swelling or earlobes/nipples
Tender local lymphadenopathy
Associated numbness/arthralgia/myalgia/paralysis
Describe the third clinical stage of lyme disease
Acrodermatitis chronica atrophicans up to 8 years after initial infection, involving blue-red discolouration and atrophy
Early inflammation, late atrophy
Associated arthritis/neuropathy/pain
List non-cutaneous features of lyme disease
Fever, malaise, lymphadenopathy Cough Headache Conjunctivitis, keratitis, iritis Meningitis, encephalitis, GBS Heart block, arrhythmia, cardiomyopathy Arthralgia, tendonitis Orchitis, proteinuria, haematuria