Dermatology Flashcards
What are the 4 layers of skin?
Epidermis
Basement membrane
Dermis
Subcutaneous tissue
What is a pneumonic to help guide a dermatology consultation?
SCAM
S- Site, ditribution
C - Colour
A - Associated changes e.g surface feautures
M - Morphology of individual lesions
What does ABCD stand for in dermatology to describe pigmented lesions?
A - Assymetry
B - Border
C - Colour
D - Diameter
What does a generalised distribution mean?
It all over the body
What describes a rash confined to areas with joints that flex e.g elbow crease
Flexural
What distribution describes a rash confined to areas that extend e.g elbow
Extensor
What word describes when areas affected by the rash are only ones that see sunlight?
Photosensitive distrubution
What word decribes when lesions are separated from one another?
Discrete ( configuration)
What word describes when lesions overlap each other?
Confluent
What a linear configuration of a lesion indicate?
Koebner’s Phenomenon
What is Koebner’s Phenomenon?
Presence of inflammatory skin disease in response to trauma ( e.g scratching ) - usually psoriasis , lichen planus and vitiligo
What rash typically gives target shaped lesions?
Erythema Multiforme
What can cause Erythema Multiforme?
Herpes Simplex Virus
Mycoplasma Pneumoniae infection
What word describes when a skin change is red and blanching?
Erythematous
What word describes when a lesion is red/purple and non-blanching?
Purpuric
What is a purpuric rash?
Its when red blood cells have leaked out or extravasated to the skin
What word describes brown/ black pigmentation?
Pigmented or Hyperpigmented
What word describes loss of colour from skin?
Hypopigmentation
What word describes total loss of colour from the skin? What condition is this specific for?
Depigmentation , usually Vitiligo
What word describes a build up of keratin on the skin?
Scale
What word describes dried exudate on the skin?
Crust
What word describes the appearance of erosions from scratching ?
Excoriation, implies rash is pruritic
What word describes partial or full thickness loss of skin?
Erosion = partial
Ulceration = full
What is a macule?
Flat lesion of altered colour that is <1cm
What is a patch?
A large flat area of altered colour >1cm
What is a Papule?
An elevated palpable lesion <1cm
What is a Nodule?
An elevated palpable lesion > 1cm
What is a cyst?
A papule or nodule that contains fluid so is fluctuant
What is a Plaque?
An elevated thickened lesion >1cm
What is a vesicle?
A fluid filled blister >1cm
What is a bulla
A fluid filled blister >1cm
What is a pustule?
A circumscribed lesion containing pus
What is a wheal?
A transient elevation of the skin due to dermal oedema , indicates urticaria/ urticaria like condition
What is a Comedone?
Acne
Open - whiteheads
Closed - blackheads
What is hair loss called?
Alopecia
How can alopecia be described?
Patchy or Diffuse
What is excess hair growth called?
Hypertrichosis
What is excess hair growth in a masculine distribution called?
Hirsuitism
What is Koilonychia?
Spoon-shaped nails
What is Onycholysis ?
Splitting of the nail plate from the nail bed?
What word describes when lesion is affecting the distal extremities ( ears, fingers, toes, penis, nipples etc )
Acral
What word describes when lesions are confined to one or more segments of skin innervated by a single spinal nerve?
Dermatomal
What word describes when lesion is round?
Nummular
What word describes when lesion is ring-shaped?
Annular
What describes a lesion which has concentric rings?
A target lesions
What is the first line treatment for Acne Vulgaris?
Fixed combination of topical Adapalene and Benzyol Peroxide ( Epiduo )
12 week course of Oral doxycyline
What is the management for severe Acne Vulgaris that does not respond to initial treatment?
Dermatology referral
What is the presentation of Seborrhoeic dematitis?
An itchy rash that affects the gland-rich lesions of the face , scalp and trunk.
Its erythematous, yellow and scaly
What is the most common side effect of Isotretinoin?
Dry skin - reduces sebum production to reduce comedome formation in Severe Acne
How does Lichen Planus present?
Itchy rash which is purple, raised and has fine white lines on the surface
They also have Wickham Striae on the oral mucosa
What is the treatment for Lichen Planus?
Topical steroids
What is the treatment for athlete’s foot?
Topical Miconazole
What can topical corticosteroids cause on patients with darker skin?
Patchy depigmentation
What is Dermatitis Herpetiformis caused by? How does it present?
Coeliac Disease
Itchy, vesicular lesions on extensor surfaces
What is the first line treatment for Psoriasis?
Topical corticosteroid
What are the types of skin cancer?
Melanoma
Squamous Cell Carcinoma
Basal Cell Carcinoma
How does a Melanoma present?
A new mole or change in appearance of an existing mole ( Irregular shape, multiple colours, can be itchy, can bleed)
History of sun exposure / tanning beds
More common in Fitzpatrick Type 1 skin types
What is the treatment for Melanoma?
Surgical Excision
How does Basal Cell Carcinoma present?
Occurs mostly on the face, head, neck and hands
Appears as a flat, firm, pale area that is small, raised, pink or rer, translucent, shiny and waxy
They can look like ope sores and they may ooze, crust, itch and bleed
What are some risk factors for Basal Cell Carcinoma?
Sun exposure
Radiation therapy
Fitzpatrick Type 1 Skin
Older
Immune-suppressing drugs
Family History
How does a Squamous Cell Carcinoma appear?
Scaly red patches, open sores, rough, thickened or wart-like skin
Or raised growths with a central depression
What are some risk factors for Squamous Cell Carcinoma?
Sun exposure
Fitzpatrick Type 1 Skin
Tanning beds
Weakened Immune system
What is the treatment for Basal Cell Carcinoma?
Surgical Excision
What is the treatment for Basal Cell Carcinoma?
Surgical excision
Cryotherapy
Radiotherapy
Contact Dermatitis is what type of sensitivity reaction?
Type IV Hypersensitivity
What is the first line treatment for Rosacea?
Topical ivermectin + oral doxycycline
What is Eczema Herpiticum?
When an area of eczema is infected by Herpes SImplex Virus. Presents with rash on torso and face and flu-like symptoms
What is the treatment for a dermatophyte nail infection?
Oral terbinafine
Which gastro condition is Dermatitis Herpetiformis associated with?
Coeliac Disease
What is Pityriasis Versicolor?
A common superficial fungal infection. Presents with hyperpigmented scaly macules and patches on trunk and proximal extremities
What is the treatment for pityriasis versicolor?
Ketoconazole shampoo ( anti-fungal shampoo)
An adult with erythematous target lesions on the hands which later spread to the torso following a herpes simplex infection
What is the likely diagnosis?
Erythema Multiforme
What is the treatment for seborrhoeic dermatitis?
Topical Ketoconazole
What is Psoriasis commonly worsened by?
Alcohol
ACE inhibitors
Lithium
NSAIDs
B-Blockers
Chloroquine
A middle-aged woman develops painful, erythematous, nodular lesions over both shins
What is the likely diagnosis?
Erythema nodosum
Purple, pruritic, polygonal plaques in a question is most likely to indicate?
Lichen Planus
An obese man with type 2 diabetes mellitus develops brown, velvety plaques on his neck and axillae
What is the likely diagnosis?
Acanthosis Nigricans
What is the treatment of choice for rosacea with predominant erythema/flushing?
Topical Brimonidine
What is the treatment for severe Acne Vulgaris?
Oral Isotretinoin ( Roaccutane )
What are side effects of Isotretinoin?
Dry mouth, skin, lips
Rashes
Mild pruritus
Arthralgia
Photosensitivity
Epistaxis
Hair thinning
Depression
An elderly women develops itchy, tense blisters around the flexures. There is no mucosal involvement s a stereotypical history of?
Bullous pemphigoid
A young adult notices hypopigmented patches on her trunk after coming getting a suntan. The patches are mildly pruritic with some scale is a stereotypical history of?
Pityriasis Versicolor
A man presents with a raised, red, spherical lesion on his neck. It initially was a red spot but rapidly grew over 4 weeks is a stereotypical history of?
Pyogenic Granuloma
An elderly woman develops a reticulated, hyperpigmented rash after using a hot water bottle excessively is a stereotypical history of?
Erythema ab igne
On examination, the child is alert and interactive but appears pale. Multiple discrete purple blotches around both ankles extending up his shins, which are non-blanching. The boy is afebrile and all other observations are within normal limits for his age.
What is the most appropriate next step in management?
Children with new-onset purpura should be referred immediately for investigations to exclude ALL and meningococcal disease
Where are Keloid scars most commonly formed?
Sternum
What is Livedo Reticularis?
A purplish, lace-patterned discolouration of the skin
What is Livedo Reticularis caused by?
Idiopathic (most common)
Polyarteritis nodosa
SLE
Cryoglobulinemia
Antiphospholipid syndrome
Ehlers-Danlos Syndrome
Homocystinuria
How does IgA Vasculitis ( Henoch-Schonlein Purpura) present?
Small cell vasculitis
Purpura on lower limbs
Abdominal pain
Arthritis
Often triggered by a viral URTI
What investigations will you do for IgA Vasculitis?
Urine dipstick ( nephritic or nephrotic syndrome)
BP
ESR/CRP
Immunoglobulin ( Raised IgA)
Skin/Renal biopsy
What type of hypersensitivity reaction is Contact Dermatitis?
Type IV - mediated by T lymphocytes
What are red flags for Eczema Herpeticum?
Red itchy, painful blisters over previous areas of eczema
Urgent hospital admission is recquired
What tests are indicated for contact dermatitis?
Patch test of substance for 48 hours
What are some triggers for Psoriasis?
sunburn
trauma
HIV
stress
streptococcal infection
medications ( B-Blockers, ACEi, Lithium, NSAIDs)
What is the treatment for Scabies?
Topical permethrin 5% + treat household members
What is the most important prognostic factor for Malignant Melanoma?
Depth
What is the A to E of irregular skin lesions?
A = asymmetry (one half of the spot is unlike the other half)
B = border (the spot has an irregular or poorly defined border)
C = colour (the spot has 2 or more colours that vary from one area to the next)
D = diameter (the diameter of the spot is equal to or more than 7mm)
E = evolution (the spot is changing over time).
What is the pathophysiology of a venous ulcer?
Oedema in the subcutaneous tissue with poor lymphatic and capillary drainage, leading to inadequate nutrients and oxygen reaching the skin. This causes skin to die and ulcers to arise
What is the treatment of shingles?
Oral antiviral ( V alaciclovir)
What is the treatment for Basal Cell Carcinoma?
Mohs micrographic surgery
Removal under a microscope for cosmetic purposes
What is the organism responsible for Scabies?
Sarcoptes Scabiei
What type of biopsy should be done for a suspected malignant melanoma?
Excisional - whole lesion should be removed , 1cm margin for every 1mm of depth
What is the first line treatment for Psoriasis?
Potent topical steroid e.g 0.1% Betamethasone
Vitamin D Cream
What is Bowen’s Disease?
A pre-cancerous skin disease for SCC
What is the cause of Atopic Dermatitis?
A defect in the skin barrier
Which rash is associated with HSV?
Erythema Multiforme
What is the treatment for Cradle Cap / infant Seborrheic Dermatitis?
Topical emollient
What is the treatment for adult Seborrheic Dermatitis?
2% Ketoconazole Shampoo
