Dermatology Flashcards
Define and name 3 features of hyperlipidemia
Xanthelsama
Xanthoma - Yellow flat plaques of lipid-containing macrophages on the body
Corneal arcus - Lipid deposition around the corneal margin
What is Basal cell carcinoma and what are the types
Slow-growing invasive malignant tumor of epidermal keratinocytes - common at head and neck
Nodular
Rarely metastases
Name 5 RF for BCC
UV exposure
sunbeds
Hx of sunburn
Skin injury - burns and scarring
Increased age
FHx
Immunosuppression
How do you describe a BCC
Round
Rolled edges
Raised
Telangiectasia
Central depression
Non-tender
Spontaneous bleeding
Shiny - pearly
How do you describe a skin lesion
SCAM
S
- Size
- Shape
- Site
Colour
Associations
M
- Margins
- morphology
How is a BCC managed
Cryotherapy
Surgical excision and histology
Radiotherapy
What is a SCC
First growing invasive tumor of epidermal keratinocytes
RF for SCC
Bowens disease
Actinic keratosis
Immunosuppresion
Skin scarring / burns
Radiation
UV exposure
Elderly
Fair skin
Smoking
What is Bowens disease
Precancerous SCC in-situ
What are the features of SCC and how is it managed
Rapidly expanding nodule
Ulceration
Areas of bleeding
High risk of mets
- sentinel biopsy
- CT scan
Management
- surgery
- Radiotherapy
What is malignant melanoma
Invasive malignant tumour of epidermal melanocytes
What are the types of melanoma
Superficial spreading
Nodular - easily bleeds
most aggressive
Lentigo - older / sun exposure
Acral lentiginous - Black
What is impetigo and name 2 common organisms
Superficial skin infection
Staph aureus
Strep pyogenes
How does impetigo present
pruritus
golden crusted lesions
Management of impetigo
Limited + Non bullous - Hydrogen peroxide / fusidic acid
bullous / extensive - flucloxacillin
48hr after starting Abx / until all lesions crusted over
What is urticaria and what causes it
Small itchy lumps associated with erythematous rash - can be localised or widespread
swelling of epidermis and dermis
Due to mast cell activation and histamine release
allergens - food / animals
contact with chemicals
medications
insect bites
Management of urticaria
Nonsedating - Loratidine / Cetirizine
severe flare - oral steroids
What is angio-oedema
Swelling of SC and submucosal tissue
Painful
No pruritus
Name 3 drugs that can cause SJS
Penicillin
Lamotrigine
Carbamazepine
Pheytoin
Allopurinol
What is shingles
Acute dermatomal painful blistering rash
Name 3 RF for a pressure sore
Incontinence
reduced mobility
Malnourished
What is cellulitis and name 2 causative organisms
bacterial infection affecting dermis and SC tissue
Strep pyogenes
Staph aureus
Clinical features of cellulitis
erythema
swelling
fever
blisters / bullae
malaise
nausea
pain
breach of skin barrier
What is erisypalis
Acute superficial cellulitis involving upper dermis
Strep pyogenes
clinicla features of erisypilis
boarders sharply defined
red
painful
swollen
RF for cellulitis and erysipelas
DM
Immunosuppression
Venous insufficiency
Obesity
Ulcers
Pressure sore
Trauma
Lymphoedema
Management of scabies
Topical Permethrin
Management of head lice
4% dimeticone lotion
Outline a venous ulcers
caused by venous insufficiency
Ulcer is gaiter region - medial mallelous
Large
Shallow
Granulated base
Irregular - sloping borders
pain less than arterial
pain relieved by elevation
chronic venous changes
Varicose eczema
Lipodermatosclerosis
Haemosiderin deposition
Thrombophlebitis
Outline an arterial ulcer
affect toes / dorsum of foot - pressure points
smaller than venous
deep
well defined boarders
punched out apperance
less likely to bleed
painful
pain worse on elevation
Assosciated with PAD
- Absent pulses
- pallor
- Intermitent claudication
what is a leg ulcer
wound or break in the skin that doe snot heal or heals slowly due to underlying pathology
Investigations for leg ulcers
ABPI
Arterial <0.9
Bloods - assess for infection and co-morbidities
FBC
CRP
HbA1c
Charcoal swabs
Management of venous ulcers
compression bandaging
Management of arteril ulcers
reduce modifiable RF
treat HTN
Prescribe statin
Prescribe antilpatlet
Causes of leukonychia
Hypoalbuminemia
Fungal nail infections
Lymphoma
causes of clubbing
CHD
CF
IBD
IPF
Lung cancer
Bronchiectasis
IE
Cirrhosis
causes of onycholysis
trauma
psoriasis
fungal
What is Acne
Chronic inflammation of pilosebaceous unit
Describe the pathophysiology of acne
Increased sebum production, trapping of keratin and blockage of the pilosebaceous unit
Leads to swelling and inflammation in the unit
blocked unit = comedomes
Clinicla features of acne
Non inflammatory lesions
- comedomes
inflammatory lesions
- papules
- pustules
Outline the management of acne
Education and patient information
1st line:
Topical retinoid
+/- Benzoyl peroxide
+/- Topical antibiotic
+ Antibiotic - Lymecycline
Isotretinoin
What is the definition of atopic dermatitis / eczema
Chronic inflammatory skin disorder due to defects in normal continuity of skin barrier leading to inflammation
What is dermatitis hepatiformis
AI blistering rash
itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks)
What is erythema nodosum and give 4 causes
Inflammation of SC fat - tender nodular lesions over shins
NO - idiopathic
D - Drugs (Penicllins)
OCP
Sarcoidosis / TB
UC / Crohns
Micro - Strep pyogenes
Outline the pathophysiology of eczema
Defects in skin barrier due to damaged filaggrin provide entry point for irritants, microbes and allergens that create an immune response –> Inflammation
Describe the atopic triad
Allergic rhinitis
Asthma
Eczema
Describe the clinical features of eczema
dry skin
flares:
erythrematous
poorly demarcated
itchy patches
Lichenification
scaly
excoration marks
infants - face / trunk / extensor
adults - flexures
Outline the management of eczema
Avoid irritants / scratching / bathing in hot water / using soaps that remove natural oils
M - Emollients QDS (E45 / Diprobase cream)
Flares
- thicker emollients (Hydromol ointment )
- Steroid creams
Specialist
- topical tacrolimus
- phototherapy
- immunosuppresants - oral steroids / MXT
Name 2 organism that cause eczema herpeticum
HSV - 1
VZV
Clinical features of eczema herpeticum
Widespread painful vesicualr rash with systemic sx
- fever
- lethargy
- irritability
Investigation and management for eczema herpeticum
Virla swabs
Aciclovir
Name 4 RF for cellulitis
Obesity
Lymphoedema
Led ulcer
Wound
Immunocompromised
What is contact dermatitis
Inflammatory skin disorder triggered following exposure to irritant or allergen
Describe the 2 forms of contact dermatitis
Irritant - non allergic
- pain and burning sensation
- dry erythematous rash
Allergic - Type 4 hypersensitivity reaction
can extend beyond site of contact
What is seborrhoeic dermaitis
chronic dermatitis due to inflammatory reaction related to proliferation of normal skin inhabitant - fungus called malasseiza furfur
affects sebum richa reas:
scalp
periorbital
auricular
nasolabial folds
What is psoriasis
chronic autoimmune iflammation due to hyperproliferation of keratinocytes and inflammatory cell infiltration
characterised by well-demarcated erythematous scaly plaques
outline the classification of psoariasis
plaque - symmetrical plaques on extensor surfaces / back / scalp
flexural
guttate - small tear dropped shaped plaques on trunk following streptococcal infection
pustualr - palmes and soles
clinical features of plaque psoriasis
itchy
well-demarcated
red elevated lesions
silver scale appearance
symmetrical distribution
RF for psoariasis trigger
skin trauma
strep infection
drugs - b blocker / lithium / NSAIDs
withdrawl of steroids
alcohol
smoking
cold weather
stress
Outline the management of psoriasis
Education - avoid triggers
Emollients
Flare
- Steroids OD + Topical Vit D analogue OD (reduces keratinocyte proliferation)
- Vit D analogue BD
- Potent corticosteroid BD
Phototherapy
systemic treatment
- MXT
- Ciclosporin
Biologics
- Infliximab
Give 3 A/E of MXT
Pneumonitis
Hepatotoxicity
Myelosuppresion
give 3 common cuases of ithching with a rash
Utricaria
atopic eczema
psoriasis
scabies
give 3 common causes of itching with no rash
renal failure
jaundice
lymphoma
polycythaemia rubra vera
What is the difference between bacteriostatic and bacteriocidal
Bactericidal antibiotics kill the bacteria and bacteriostatic antibiotics suppress the growth of bacteria
What is the kobner phenomena
Skin lesions develop at site of injury
Name 4 types of psoriasis
Flexural
Guttate
Plaque
Pustular
Name 2 skin conditions associated with the kobner phenomenon
Psoriasis
Lichen planus
Vitiligo
4 factors to address in management of a pressure sore
Nutrition
Analgesia
Antibiotics
Regular dressing
Pressure relieving mattress
Tissue viability referral
Patient positioning
Need for debriedment
Outline a pressure score grading
1 - non blanching erythema
2 - partial thickness loss
3 - full thickness loss
4 - extensive destruction with muscle / bone involvement
4 features of lichen sclerosis
Ithcy
dyspareunia
pain on urination
3 differentials for lichen sclerosis
SCC
VIN
Lichen planus
vitiligo
Management of lichen sclerosis
topical steroids
avoid soaps / irritants
emollients - relive dryness
