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Finals > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what are the features of eczema in children ?

A
  • ITCHY, erythematous rash
  • Infants : face and trunk
  • Younger children : extensor surfaces
  • Older children : flexor surfaces and creases of the face and neck
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2
Q

what are the 5 steps of management in eczema

A
  • Avoid irritants
  • Emollients
  • Topical steroids
  • Systemic treatment
  • Biologics
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3
Q

What is a severe primary infection more commonly seen in children with atopic eczema ?

A
  • Eczema herpeticum
  • Caused by HSV
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4
Q

How does eczema herpecticum present and how is it treated ?

A
  • Widespread painful vesicular rash. The vesciles contain pus which leaves a monomorphic punched out erosion
  • IV aciclovir
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5
Q

what quantities of emollients should be used in children under 12 with eczema

A

250-500g a week

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6
Q

What is the steroid ladder from mild - very potent

A
  • Hydrocortisone 1%
  • Eumovate (clobestasone butyrate 0.05%)
  • Betnovate (betamethasone valerate)
  • Dermovate (clovetasone propionate)
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7
Q

What are the local SE of topical steroids

A
  • Skin atrophy and easy bruising
  • Striae/stretch marks
  • Worsening or spreading of a skin infection
  • Contact dermatitis
  • Causing or worsening other skin conditions: folliculitis, acne, rosacea etc.
  • Changes in skin colour – this is usually more noticeable in people with dark skin
  • Excessive hair growth on the area of skin being treated
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8
Q

Where are the systemic SE of topical steroids

A
  • Cushing’s
  • Growth suppression in children
  • Adrenal suppression
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9
Q

what is the finger tip rule when using topical steroids

A
  • 1 finger tip unit (FTU) = 0.5 g, sufficient to treat a skin area about twice that of the flat of an adult hand
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10
Q

what are the recommended quantity of topical steroids that should be prescribed for an adult for a single daily application for 2 wks

A
  • Face and neck : 15 to 30g
  • Both hands : 15 to 30 g
  • Scalp : 15 to 30 g
  • Both arms : 30 to 60 g
  • Both legs : 100 g
  • Trunk : 100 g
  • Groin and genitalia : 15 to 30g
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11
Q

what are the steroid alternatives for eczema

A
  • Topical calcineurin inhibitors (Tacromilus)
  • Referral to secondary. care for : phototherapy / systemic therapies
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12
Q

Give 4 systemic treatment options for eczema

A

Courses of prednisolone
Methotrexate
Ciclosporin
Azathioprine

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13
Q

what are the 3 biologic options for eczema treatment

A
  • Dupilumab – IL 4 & 13
  • Tralokinumab – IL 13
  • JAK inhibitors : JAK 1 and Jak 2 – baricitinib. JAK 1 selective – upadacitinib, abrocitinib
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14
Q

what are the 2 types of contact dermatities

A
  • Irritant contact dermatitis
  • Allergic contact dermatitis
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15
Q

what is irritant contact dermatitis and how is it managed

A
  • Non allergic reaction to detergents.
  • Often on hands, causing red areas of crusting
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16
Q

What is allergic contact dermatitis and how is it managed

A
  • Type IV hypersensitivity reaction
  • Acute wheeping excema
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17
Q

Discoid eczema

A
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18
Q

Stasis dermatitis

A
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19
Q

Seborrhoeic dermatitis

A
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20
Q

what are the RF for melanoma ?

A
  • Older age
  • UV exposure
  • Skin type
  • > 100 melanocytic naevi
  • > 5 atypical naevi
  • Multiple solar lentigines
  • Family history of melanoma
  • Personal history of melanoma
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21
Q

what are the 4 subtypes of melanoma ?

A
  • Superficial spreading
  • Nodular
  • Lentigo maligna
  • Acral lentiginous
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22
Q

what is the most common type of melanoma, where does it affect

A
  • Superficial spreading
  • Affects arms, legs, back and chest in young people
  • Growing moles based on diagnostic criteria
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23
Q

what is the most aggressive form of melanoma, where does it affect and what is its appearance

A
  • Nodular
  • Sun exposed skin in middle aged people, more common in males
  • Red or black lump which bleeds or oozes
24
Q

What kind of melanoma occurs in chronically sun-exposed skin in older peoiple and how does it appear ?

A
  • Lentigo maligna
  • Face is the most common site
  • Growing mole based on diagnostic features
25
Q

What is a rare form of melanoma, where does it affect and how does it appear ?

A
  • Acral lentiginous
  • Nails, palms or soles in people woth darker skin pigmentation
  • Appears as subungual pigmentation (Hutchinson’s sign) on palms or feet
26
Q

what are the major criteria for diagnostic features in melanoma

A

Change in size
Change in shape
Change in colour

27
Q

what are the minor criteria for melanoma ?

A

Diameter >= 7mm
Inflammation
Oozing or bleeding
Altered sensation

28
Q

what are the margins of excisions-related to Breslow thickness following excision biopsy for diagnoses of a melanoma

A
  • Lesions 0-1mm thick : 1cm
  • Lesions 1-2mm thick : 1- 2cm (Depending upon site and pathological features)
  • Lesions 2-4mm thick : 2-3 cm (Depending upon site and pathological features)
  • Lesions >4 mm thick : 3cm
29
Q

what are the stages of melanome

A
  • 0 = in situ
  • 1 = thin, confined to skin
  • 2 = thicker, confined to skin
  • 3 = lymph node biopsy
  • 4 = distant metastasis
30
Q

what mutation is found in a large proportion of melanomas ?

A

BRAF mutation

31
Q

what are two pre malignant skin conditions that can develop into SCC?

A
  • Actinic keratoses : partial thickness dysplasia of epidermal keratinocytes
  • Bowen’s disease : full thickness dysplasia of epidermal keratinocytes
32
Q

How does actinic keratoses present ?

A
  • Develop over years
  • Sun exposed sites : temples
  • Can involve a field change or discrete lesions
  • Small, crusty, scaly lesions
  • No history of rapid growth
  • No history of pain
  • No history of bleeding or ulceration
  • Base not raised
33
Q

how is actinic keratosis managed ?

A
  • Field change : topical (Fluorouracil cream : 2/3 wk course, diclofenac, imiquimod)
  • Discrete : cryotherapy, curettage and cautery
34
Q

How does Bowen’s present

A
  • Develop over years
  • Sun exposed sites
  • Red, scaly patches. slow growing on sun exposed areas.
  • No history of rapid growth
  • No history of pain
  • No history of bleeding or ulceration
  • Base not raised
35
Q

How is Bowen’s managed ?

A
  • Topical 5-flurouracil : twice daily for 4 wks.
  • Cryotherapy
  • C&C
  • PDT : photo dynamic therapy
36
Q

How does SCC present ?

A
  • Rapid growth – week to months
  • Raised base
  • Keratotic or scaly lesions
  • May ulcerate and/or bleed
  • May be painful
  • Sun exposed sites – Face, lips ears, hands, forearms, lower legs
37
Q

Give 6 RF for SCC

A
  • Excessive exposure to sunlight / psoralen UVA therapy
  • Actinic keratoses and Bowen’s disease
  • Immunosuppression e.g. following renal transplant, HIV
  • smoking
  • Long-standing leg ulcers (Marjolin’s ulcer)
  • Genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
38
Q

How is a SCC manged ?

A
  • Surgical excision with 4mm margins if lesion <20mm
  • If tumour >20mm then 6mm margins
39
Q

How does a BCC present ?

A
  • Slowly growing plaque or nodule
  • Sun exposed sites
  • Skin coloured, pink or pigmented, often shiny or pearly
  • Rolled edges
  • Telangiectasia
  • Ulceration and spontaneous bleeding
  • Very rarely metastesize
40
Q

What is the most common type of BCC and how is it managed

A
  • Nodular : surgical removal
41
Q

How are superficial BCC managed ?

A
  • Curettage
  • Cryotherapy
  • Topical cream: imiquimod, fluorouracil
42
Q

what causes viral warts ?

A

Human papilloma virus (HPV)

43
Q

what benign skin lesion is caused by pox virus (MCV)

A

Molloscum contagiosum

44
Q

What is an epidermoid cyst

A

Benign cyst derived from infundibulum hair follicle

45
Q

How does a epidermoid cyst present and who does it affecrt ?

A
  • Central punctum filled with keratin and lipid riuch debris
  • Common on the neck
  • Young-middle aged adults
  • Males !
46
Q

How does a pilar cysts present and where are they found

A
  • Scalp, scrotum
  • Benign keratin filled cyst with no central punctum
47
Q

What is seborrhoeic keratoses and how does it present ?

A
  • Benign epidermal lesion in older people
  • Large variation in colour from flesh to light-brown to black
  • Have a ‘stuck-on’ appearance
  • Keratotic plugs may be seen on the surface
48
Q

How does a dermatofibroma present and where are they commonly found ?

A
  • Arms and legs
  • Solitary firm papule or nodule, typically on a limb
    typically around 5-10mm in size
  • Overlying skin dimples on pinching the lesion
49
Q

What is a lipoma and the lump characteristics

A
  • Benign tumours of adipocytes
  • Smooth, mobile and painless
50
Q

What features are suggestive of sarcomatous change to a lipoma = liposarcoma

A

Size >5cm
Increasing size
Pain
Deep anatomical location

51
Q
  • Itchy blistering lesions (papulovesicular eruptions) on knees and elbows.
  • Appears malnurished
  • Diagnose and treat
A

Deramtitis herpetiformis
GF diet, dapsone

52
Q

Psoriasis

A

Chronic skin disorder causing red, scaly patches on the skin

53
Q

Chronic plaque psoriais

A
  • Most common
  • Areas of well demarcated red plaques covered with silvery white scale
  • Dry
  • Affects extensor surfaces
54
Q

Stepwise manaegement of chronic plaque psoriasis

A
  1. Potent corticosteroid OD + Vitamin D analogue e.g. calcipotriol OD.
  2. No improv after 8 wks. Vitamin D analogue BD
  3. No improv after 8-12 wks = potent topical corticosteroids BD or coal tar prep
55
Q

Secondary care options for chronic plaque psoriasis

A
  1. Phototherapy with narrowband UVB
  2. Oral methotrexateA
56
Q

Action of vit D analogues

A

reduce cell division and differentiation leading to reduced epidermal proliferation

57
Q
A

Finals (92 decks)

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