Dermatology Flashcards
How should we describe a skin lesion systematically?
- Site and distribution
- Configuration
- Colour
- Morphology/primary lesions
- Surface features/secondary lesions (evolved from primary lesions)
- Hair and nail findings
What are some common skin conditions?
- Atopic eczema
- Acne vulgaris
- Psoriasis
- Urticaria
- Molluscum contagiosum
Outline atopic eczema
- Characterised by pruritis and inflammation
- Epidermal changes e.g. papules, vesicles
- Can occur anywhere but often flexural
- Exogenous vs endogenous causes
- Acute vs chronic
- Clinical diagnosis including: personal or family history of atopy e.g. hay fever, asthma
How is eczema treated?
- Treatment
- Education and support
- Avoidance of exacerbating factors
- Topical therapies e.g. emollients, use of soap substitute, steroids/calcineurin inhibitors
- Phototherapy
- Systemic therapies
How might eczema present?
- Generalised
- Hyperpigmented
- Patches
- Scaly
- Lichenification
How might acne present?
- Localised
- Well defined
- Discrete
- Erythema
- Papules
- Vesicles
- Pustules
- Crusts
- Comedones
Outline acne vulgaris
- Found mostly in skin of face, neck and upper body (back or chest)
- Chronic skin disease due to blockage of hair follicles in skin
- Clinical diagnosis
What are the causes of acne vulgaris?
- Increased sebum production (androgen influence)
- Excessive deposition of keratin in pores
- Overgrowth of Cutibacterium acnes (skin commensal)
- Pro-inflammatory chemicals released into skin
How is acne vulgaris treated?
- Topical
- Non-antibiotic treatments e.g. benzoyl peroxide, retinoids etc
- Antibiotic treatments e.g. erythromycin, tetracycline, clindamycin
- Systemic treatments such as antibiotics, oral contraceptive pill, isotretinoin
How might psoriasis present?
- Extensor
- Well-defined
- Hyperpigmented
- Plaque
- Scaly
- Can be symmetrical
- Can be erythematous
Outline psoriasis
- Chronic skin condition
- Occurs equally in men and women
- Often occurs between 20-30 years old and 50-60 years old
- Strong genetic predisposition
- Has a relapsing and remitting course
- Most common type is plaque psoriasis
What can cause psoriasis?
- Immune mediated inflammatory disease
- T cells cytokine production is stimulated
- Causes keratinocyte proliferation
- Identify any triggers or iatrogenic causes (including medications such as ACEi, B blockers, NSAIDs, Lithium, anti-malaria)
How is psoriasis treated?
- Topical e.g. emollients, corticosteroids, vit D analogues, calcineurin inhibitors, salicylic acid, vit A, tar preparations
- Phototherapy broad-band or narrow-band UV B light
- Oral systemic medication e.g. acitretin, ciclosporin, methotrexate
- Injectable systemic medication e.g. TNF antagonists, monoclonal antibodies
Outline urticaria
- Transient (<24 hours) +/- angioedema
- Acute vs. chronic (persists for over 6 weeks)
- Mast cell degranulation and histamine release
- Leads to increased capillary permeability and leakage of fluid into surrounding tissue
How is urticaria treated?
- Suppress symptoms
- H1 anti-histamines (fexofenadine, cetirizine, loratadine)
- H2 anti-histamines (cimetidine, ranitidine)
- Steroids, ciclosporin, montelukast
Outline molluscum contagiosum
- Pox virus infection
- 2-6 week incubation period
- More common in atopic and immunocompromised patients
- Most self-resolve within 6-9 months
- No treatment required
How do we take a dermatological history?
- Presenting complaint
- History of presenting complaint
- Past medical history
- Family history
- Social history
- Drug history and allergies
- Impact on quality of life/ICE
What information do we need to ascertain when a patient presents with a skin problem?
- Nature e.g. rash vs lesion
- Site
- Duration - how long has it been there? how rapidly did it appear?
How do we find out the history of presenting complaint of a skin problem?
- Initial appearance and evolution
- Symptoms (particularly itch and pain)
- Aggravating and relieving factors (triggers)
- Previous and current treatments - effective or not
- Which treatments have worked before? Which treatments have not? Why did they stop taking treatment?
What past medical history should we obtain from a patient with a skin problem?
- Systemic diseases
- History of atopy (asthma, hay fever, eczema)
- History of skin cancer or pre-cancer
- History of sunburn/sunbathing/sun-bed use
- Skin type
What family history should we obtain from a patient with a skin problem?
- Family history of skin disease
- Family history of atopy
- Family history of autoimmune disease
What social history should we obtain from a patient with a skin problem?
- Occupation
- Sun exposure
- Contactants
- Improvement in skin condition when away from work
What drug history should we obtain from a patient with a skin problem?
- Regular and recent
- Systemic and topical
- Get specific with topical treatments (find out what treatment is, find out what strength it is)
- Where?
- How much?
- How long for?
How do we examine the skin?
- Inspect
- Palpate
- Describe
- Systemic check (whole skin, hair, nails, mucous membranes)
How do we describe skin problems?
- S - site, distribution (rash) or size and shape (lesion)
- C - colour and configuration
- A - associated changes e.g. surface features
- M - morphology
How do we describe pigmented lesions?
- Asymmetry
- Border (irregular or blurred)
- Colour
- Diameter
How can we describe the site and distribution of a skin rash/lesion?
- Generalised
- Flexural
- Extensor
- Photosensitive
How can we describe the configuration of a skin rash/lesion?
- Discrete (separate little lesions)
- Confluent (spots merge into each other)
- Linear
- Target (darker centre with a lighter border)
How can we describe the colour of a skin rash/lesion?
- Erythematous (red and blanching)
- Purpuric (red or purple and non-blanching)
- Brown or black (pigmented or hyperpigmented)
- Hypo pigmented (depigmented if total loss of colour)
How can we describe the surface features of a skin rash/lesion?
- Scale (built-up keratin)
- Crust (dried exudate)
- Excoriation (erosion from scratching)
- Erosion/ulceration (partial or full thickness loss)
How can we describe the morphology of a skin rash/lesion?
- Macule (flat and small)
- Patch (flat and bigger)
- Papule (raised and little)
- Plaque (raised and extensive)
- Nodule (large solid lump)
- Vesicle (small fluid-filled blister e.g. chickenpox)
- Pustule (skin blister filled with pus)
- Bulla (large fluid-filled blister)
- Annular (ring-shaped e.g. fungal skin presentation)
- Wheal (lesions become raised due to oedema in dermis of skin)
- Discoid/nummular
- Comedones
How can we describe hair findings?
- Alopecia (patchy or diffuse)
- Hypertrichosis
- Hirsutism
How can we describe nail findings?
- Koilonychia (spoon shaped nails)
- Pitting
- Onycholysis
- Clubbing
