Dermatology Flashcards
what are the features of eczema in children ?
- ITCHY, erythematous rash
- Infants : face and trunk
- Younger children : extensor surfaces
- Older children : flexor surfaces and creases of the face and neck
what are the 5 steps of management in eczema
- Avoid irritants
- Emollients
- Topical steroids
- Systemic treatment
- Biologics
What is a severe primary infection more commonly seen in children with atopic eczema ?
- Eczema herpeticum
- Caused by HSV
How does eczema herpecticum present and how is it treated ?
- Widespread painful vesicular rash. The vesciles contain pus which leaves a monomorphic punched out erosion
- IV aciclovir
what quantities of emollients should be used in children under 12 with eczema
250-500g a week
What is the steroid ladder from mild - very potent
- Hydrocortisone 1%
- Eumovate (clobestasone butyrate 0.05%)
- Betnovate (betamethasone valerate)
- Dermovate (clovetasone propionate)
What are the local SE of topical steroids
- 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
Where are the systemic SE of topical steroids
- Cushing’s
- Growth suppression in children
- Adrenal suppression
what is the finger tip rule when using topical steroids
- 1 finger tip unit (FTU) = 0.5 g, sufficient to treat a skin area about twice that of the flat of an adult hand
what are the recommended quantity of topical steroids that should be prescribed for an adult for a single daily application for 2 wks
- 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
what are the steroid alternatives for eczema
- Topical calcineurin inhibitors (Tacromilus)
- Referral to secondary. care for : phototherapy / systemic therapies
Give 4 systemic treatment options for eczema
Courses of prednisolone
Methotrexate
Ciclosporin
Azathioprine
what are the 3 biologic options for eczema treatment
- Dupilumab – IL 4 & 13
- Tralokinumab – IL 13
- JAK inhibitors : JAK 1 and Jak 2 – baricitinib. JAK 1 selective – upadacitinib, abrocitinib
what are the 2 types of contact dermatities
- Irritant contact dermatitis
- Allergic contact dermatitis
what is irritant contact dermatitis and how is it managed
- Non allergic reaction to detergents.
- Often on hands, causing red areas of crusting
What is allergic contact dermatitis and how is it managed
- Type IV hypersensitivity reaction
- Acute wheeping excema
Discoid eczema
Stasis dermatitis
Seborrhoeic dermatitis
what are the RF for melanoma ?
- Older age
- UV exposure
- Skin type
- > 100 melanocytic naevi
- > 5 atypical naevi
- Multiple solar lentigines
- Family history of melanoma
- Personal history of melanoma
what are the 4 subtypes of melanoma ?
- Superficial spreading
- Nodular
- Lentigo maligna
- Acral lentiginous
what is the most common type of melanoma, where does it affect
- Superficial spreading
- Affects arms, legs, back and chest in young people
- Growing moles based on diagnostic criteria
what is the most aggressive form of melanoma, where does it affect and what is its appearance
- Nodular
- Sun exposed skin in middle aged people, more common in males
- Red or black lump which bleeds or oozes
What kind of melanoma occurs in chronically sun-exposed skin in older peoiple and how does it appear ?
- Lentigo maligna
- Face is the most common site
- Growing mole based on diagnostic features
What is a rare form of melanoma, where does it affect and how does it appear ?
- Acral lentiginous
- Nails, palms or soles in people woth darker skin pigmentation
- Appears as subungual pigmentation (Hutchinson’s sign) on palms or feet
what are the major criteria for diagnostic features in melanoma
Change in size
Change in shape
Change in colour
what are the minor criteria for melanoma ?
Diameter >= 7mm
Inflammation
Oozing or bleeding
Altered sensation
what are the margins of excisions-related to Breslow thickness following excision biopsy for diagnoses of a melanoma
- 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
what are the stages of melanome
- 0 = in situ
- 1 = thin, confined to skin
- 2 = thicker, confined to skin
- 3 = lymph node biopsy
- 4 = distant metastasis
what mutation is found in a large proportion of melanomas ?
BRAF mutation
what are two pre malignant skin conditions that can develop into SCC?
- Actinic keratoses : partial thickness dysplasia of epidermal keratinocytes
- Bowen’s disease : full thickness dysplasia of epidermal keratinocytes
How does actinic keratoses present ?
- 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
how is actinic keratosis managed ?
- Field change : topical (Fluorouracil cream : 2/3 wk course, diclofenac, imiquimod)
- Discrete : cryotherapy, curettage and cautery
How does Bowen’s present
- 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
How is Bowen’s managed ?
- Topical 5-flurouracil : twice daily for 4 wks.
- Cryotherapy
- C&C
- PDT : photo dynamic therapy
How does SCC present ?
- 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
Give 6 RF for SCC
- 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
How is a SCC manged ?
- Surgical excision with 4mm margins if lesion <20mm
- If tumour >20mm then 6mm margins
How does a BCC present ?
- 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
What is the most common type of BCC and how is it managed
- Nodular : surgical removal
How are superficial BCC managed ?
- Curettage
- Cryotherapy
- Topical cream: imiquimod, fluorouracil
what causes viral warts ?
Human papilloma virus (HPV)
what benign skin lesion is caused by pox virus (MCV)
Molloscum contagiosum
What is an epidermoid cyst
Benign cyst derived from infundibulum hair follicle
How does a epidermoid cyst present and who does it affecrt ?
- Central punctum filled with keratin and lipid riuch debris
- Common on the neck
- Young-middle aged adults
- Males !
How does a pilar cysts present and where are they found
- Scalp, scrotum
- Benign keratin filled cyst with no central punctum
What is seborrhoeic keratoses and how does it present ?
- 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
How does a dermatofibroma present and where are they commonly found ?
- 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
What is a lipoma and the lump characteristics
- Benign tumours of adipocytes
- Smooth, mobile and painless
What features are suggestive of sarcomatous change to a lipoma = liposarcoma
Size >5cm
Increasing size
Pain
Deep anatomical location
- Itchy blistering lesions (papulovesicular eruptions) on knees and elbows.
- Appears malnurished
- Diagnose and treat
Deramtitis herpetiformis
GF diet, dapsone
Psoriasis
Chronic skin disorder causing red, scaly patches on the skin
Chronic plaque psoriais
- Most common
- Areas of well demarcated red plaques covered with silvery white scale
- Dry
- Affects extensor surfaces
Stepwise manaegement of chronic plaque psoriasis
- Potent corticosteroid OD + Vitamin D analogue e.g. calcipotriol OD.
- No improv after 8 wks. Vitamin D analogue BD
- No improv after 8-12 wks = potent topical corticosteroids BD or coal tar prep
Secondary care options for chronic plaque psoriasis
- Phototherapy with narrowband UVB
- Oral methotrexateA
Action of vit D analogues
reduce cell division and differentiation leading to reduced epidermal proliferation
