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Special senses > Dermatology > Flashcards

Dermatology Flashcards

1
Q

see primary care

A
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2
Q

see paeds

A
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3
Q

acanthosis nigricans clinical fx

A

symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin

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4
Q

causes acanthosis nigricans

A

type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
acromegaly
Cushing’s disease
hypothyroidism
familial
Prader-Willi syndrome
drugs
combined oral contraceptive pill
nicotinic acid

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5
Q

acanthosis nigricans patho

A

insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1

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6
Q

actinic keratoses definition

A

a common premalignant skin lesion that develops as a consequence of chronic sun exposure

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7
Q

clinical fx actinic keratoses

A

small, crusty or scaly, lesions
may be pink, red, brown or the same colour as the skin
typically on sun-exposed areas e.g. temples of head
multiple lesions may be present

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8
Q

actinic keratoses mx

A

sun avoidance/cream
fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
topical imiquimod
cryotherapy
curettage and cautery

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9
Q

sedating antihistamines

A

chlorpheniramine

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10
Q

non sedating antihistamines

A

loratidine
cetirizine

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11
Q

athlete’s foot cause

A

tinea pedis…genus Trichophyton

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12
Q

1st line tx athlete’s

A

topical imidazole, undecenoate, or terbinafine

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13
Q

bowen’s disease definition

A

a type of precancerous dermatosis that is a precursor to squamous cell carcinoma

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14
Q

bowen’s disease epid

A

elderly pts

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15
Q

clinical fx bowen’s disease

A

red, scaly patches
often 10-15 mm in size
slow-growing
often occur on sun-exposed areas such as the head (e.g. temples) and neck, lower limbs

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16
Q

bowen’s disease mx

A

topical 5-fluorouracil
typically used twice daily for 4 weeks
often results in significant inflammation/erythema. Topical steroids are often given to control this
cryotherapy
excision

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17
Q

bullous pemphigoid definition

A

an autoimmune condition causing sub-epidermal blistering of the skin

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18
Q

bullous pemphigoid patho

A

secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230

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19
Q

bullous pemphigoid epid

A

elderly pts

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20
Q

clinical fx bullous pemphigoid

A

itchy, tense blisters typically around flexures
the blisters usually heal without scarring
there is stereotypically no mucosal involvement

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21
Q

inv bullous pemphigoid

A

immunofluorescence - IgG and C3

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22
Q

mx bullous pemphigoid

A

oral corticosteroids
immunosupressants and abx

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23
Q

burns

A
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24
Q

cherry haemiangioma define

A

benign skin lesions which contain an abnormal proliferation of capillaries

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25
Q

cherry haemangioma prev

A

advancing age
men and women equally

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26
Q

clinical fx cherry haemiangioma

A

erythematous, papular lesions
typically 1-3 mm in size
non-blanching
not found on the mucous membranes

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27
Q

dermatofibroma define

A

common benign fibrous skin lesions.

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28
Q

dermatofibroma patho

A

abnormal growth of dermal dendritic histiocyte cells, often following a precipitating injury

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29
Q

clinical fx dermatofibroma

A

solitary firm papule or nodule, typically on a limb
typically around 5-10mm in size
overlying skin dimples on pinching the lesion

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30
Q

ersipelas definition

A

localised skin infection caused by Streptococcus pyogenes. In simple terms, it is a more superficial, limited version of cellulitis.

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31
Q

erysipelas tx

A

flucloxacillin

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32
Q

erythema ab igne definition

A

a skin disorder caused by over exposure to infrared radiation

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33
Q

clinical fx erythema ab igne

A

reticulated, erythematous patches with hyperpigmentation and telangiectasia

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34
Q

prev erythema ab igne

A

elderly woman (sit next to open fire)

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35
Q

erythema ab igne associated risk

A

if not tx may go onto develop S.C.C

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36
Q

erytheme multiforme definition

A

a hypersensitivity reaction that is most commonly triggered by infections. It may be divided into minor and major forms.c

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37
Q

clinical fx erythema multiforme

A

target lesions
initially seen on the back of the hands / feet before spreading to the torso
upper limbs are more commonly affected than the lower limbs
pruritus is occasionally seen and is usually mild

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38
Q

causes erythema multiforme

A

viruses: herpes simplex virus (the most common cause), Orf*
idiopathic
bacteria: Mycoplasma, Streptococcus
drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
connective tissue disease e.g. Systemic lupus erythematosus
sarcoidosis
malignancy

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39
Q

erythema multiforme major associated

A

mucosal involvement

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40
Q

erythrasma clinical fx

A

asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae

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41
Q

erythrasma cause

A

n overgrowth of the diphtheroid Corynebacterium minutissimum

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42
Q

erythrasma examination

A

Wood’s light reveals a coral-red fluorescence

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43
Q

erythrasma tx

A

Topical miconazole or antibacterial
oral erythromycin if extensive

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44
Q

hereditary haemorrhagic telangiectasia inheritance

A

aut dom

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45
Q

diagnostic criteria HHT

A

2 = possible
3 or more = definitive
epistaxis
telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
family history: a first-degree relative with HHT

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46
Q

hidradenitis suppuravita definition

A

a chronic, painful, inflammatory skin disorder. It is characterized by the development of inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas.

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47
Q

HS when suspected

A

pubertal or post-pubertal patients who have a diagnosis of recurrent furuncles or boils, especially in intertriginous areas

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48
Q

HS epidemiology

A

women
<40

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49
Q

patho HS

A

Chronic inflammatory occlusion of folliculopilosebaceous units that obstructs the apocrine glands and prevents keratinocytes from properly shedding from the follicular epithelium.

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50
Q

HS risk fx

A

Family history
Smoking
Obesity, diabetes, polycystic ovarian syndrome
Mechanical stretching of skin

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51
Q

HS clinical fx

A

recurrent, painful, and inflamed nodules.
HS occurs most commonly on intertriginous skin. However, non-intertriginous skin involvement also can occur. The axilla is the most common site
Other areas include inguinal, inner thighs, perineal and perianal, inframammary skin.
The nodules may rupture, discharging purulent, malodorous material.
Coalescence of nodules can result in plaques, sinus tracts and ‘rope-like’ scarring

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52
Q

HS mx

A

good hygeine and loose fitting clothes
smoking cessation
weight loss
acute flares - steroids or fluclox
topical clindamycin or oral abx
lumps excised

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53
Q

HS complications

A

Sinus tracts, fistulas
Comedones
Scarring - severe scarring can lead to dense, rope-like bands in the skin with strictures and lymphedema
Contractures
Lymphatic obstruction

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54
Q

hyperhidrosis first line

A

topical aluminium chloride

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55
Q

hyperhidrosis other mx options

A

iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
botulinum toxin
surgery: e.g. Endoscopic transthoracic sympathectomy

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56
Q

keratoacanthoma define

A

a benign epithelial tumour.

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57
Q

keratoacanthoma age

A

advancing age

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58
Q

clinical fx keratoacanthoma

A

olcano or crater
initially a smooth dome-shaped papule

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59
Q

ddx keratoacanthoma

A

S.S.C

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60
Q

koebner phenomenon when occurs

A

psoriasis
vitiligo
warts
lichen planus
lichen sclerosus
molluscum contagiosum

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61
Q

lentigo maligna define

A

a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.

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62
Q

leukoplakia define

A

a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth

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63
Q

leukoplakia risk fx

A

smokers

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64
Q

leukoplakia how diagnosed and ddx

A

a diagnosis of exclusion. Candidiasis and lichen planus should be considered, especially if the lesions can be ‘rubbed off’

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65
Q

monitoring of leukoplakia

A

biopsy and regular f/u to exclude S.C.C

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66
Q

lichen planus clinical fx

A

itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
nails: thinning of nail plate, longitudinal ridging

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67
Q

causes of lichenoid drug eruptions

A

gold
quinine
thiazides

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68
Q

mx lichen planus

A

potent topical steroids
benzydamine mouthwash if oral

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69
Q

lichen sclerosus definition

A

an inflammatory condition that usually affects the genitalia and is more common in elderly females. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming

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70
Q

clinical fx lichen sclerosus

A

white patches that may scar
itch is prominent
may result in pain during intercourse or urination

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71
Q

mx lichen sclerosus

A

topical steroids and emollients

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72
Q

why follow up lichen sclerosus

A

increased risk of vulval cancer

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73
Q

lipoma patho

A

generally found in subcutaneous tissues
rarely, they may also occur in deeper adipose tissues
malignant transformation to liposarcoma is very rare

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74
Q

lipoma epidemiology

A

common
middle age adults

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75
Q

lump characteristics lipoma

A

smooth
mobile
painless

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76
Q

lipoma mx

A

observed

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77
Q

liposcarcoma fx

A

Size >5cm
Increasing size
Pain
Deep anatomical location

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78
Q

livedo reticularis define and clinical fx

A

an purplish, non-blanching, reticulated rash caused by obstruction of the capillaries resulting in swollen venules

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79
Q

causes livedo reticularis

A

idiopathic (most common)
polyarteritis nodosa
systemic lupus erythematosus
cryoglobulinaemia
antiphospholipid syndrome
Ehlers-Danlos Syndrome
homocystinuria

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80
Q

define milia

A

mall, benign, keratin-filled cysts that typically appear around the face. They may appear at any age but are more common in newborns

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81
Q

molloscum contagiosum caused

A

caused by molluscum contagiosum virus (MCV), a member of the Poxviridae family

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82
Q

molluscum contagiosum spread

A

Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannel

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83
Q

molloscum contagiosum incidence

A

children (with atopic eczema)
age 1-4

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84
Q

clinical fx molluscum contagiosum

A

pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter. Lesions appear in clusters in areas anywhere on the body (except the palms of the hands and the soles of the feet). In children, lesions are commonly seen on the trunk and in flexures, but anogenital lesions may also occur. In adults, sexual contact may lead to lesions developing on the genitalia, pubis, thighs, and lower abdomen.

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85
Q

self care advice molluscum contagiosum

A

reassure
within 18 mths resolve
lesions contagious…avoid sharing
not scratch
eclusde from school, gym or swimming not necessary

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86
Q

molloscum contagiosum tx

A

not usually recommending
Squeezing (with fingernails) or piercing (orange stick) lesions may be tried, following a bath. Treatment should be limited to a few lesions at one time
Cryotherapy may be used in older children or adults, if the healthcare professional is experienced in the procedure
if itching similar to eczema and if infected topical fusidic acid

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87
Q

molluscum contagiosum referral

A

people who are HIV-positive with extensive lesions urgent referral to a HIV specialist
For people with eyelid-margin or ocular lesions and associated red eye urgent referral to an ophthalmologist
Adults with anogenital lesions should be referred to genito-urinary medicine, for screening for other sexually transmitted infections

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88
Q

mycosis fungoides define

A

a rare form of T-cell lymphoma that affects the skin

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89
Q

mycosis fungoides fx

A

itchy, red patches which are
lesions tend to be of different colours in contrast to eczema/psoriasis

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90
Q

pellegra cause

A

nicotinic acid (niacin) deficiency

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91
Q

pellagra clinical fx

A

3 D’s - dermatitis, diarrhoea and dementia

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92
Q

risk fx pellagra

A

a consequence of isoniazid therapy (isoniazid inhibits the conversion of tryptophan to niacin) and it is more common in alcoholics

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93
Q

pemphigus vulgaris define

A

an autoimmune disease caused by antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule

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94
Q

pemphigus vulgaris incidence

A

Ashkenazi Jewish population

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95
Q

fx pemphigus vulgaris

A

mucosal ulceration
skin blistering - flaccid, easily ruptured vesicles and bullae. Lesions are typically painful but not itchy. These may develop months after the initial mucosal symptoms. Nikolsky’s describes the spread of bullae following application of horizontal, tangential pressure to the skin
acantholysis on biopsy

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96
Q

pemphigus vulgaris mx

A

steroids
immunosuppressants

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97
Q

periorificial dermatitis incidence

A

women 20-45 yrs
steroids

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98
Q

clinical fx periorficial dermatitis

A

clustered erythematous papules, papulovesicles and papulopustules
most commonly in the perioral region but also the perinasal and periocular region
skin immediately adjacent to the vermilion border of the lip is typically spared

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99
Q

mx periorficial dermatitis

A

avoid steroids
topical or oral abx

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100
Q

pityriasis vesicolour define and cause

A

a superficial cutaneous fungal infection caused by Malassezia furfur

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101
Q

pityriasis vesiclour fx

A

most commonly affects trunk
patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
scale is common
mild pruritus

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102
Q

predisposing fx pityriasis vesicolour

A

healthy individuals
immunosuppression
malnutrition
Cushing’s

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103
Q

pityriasis vesicolour tx

A

topical antifungals - ketoconazole shampoo
if not work consider other diagnosis

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104
Q

polymorphic eruption of pregnancy when

A

last trimesterp

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105
Q

PE of preg clinical fx

A

lesions often first appear in abdominal striae
the periumbilical area is often spared

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106
Q

PE of preg mx

A

emollients, mild potency topical steroids and oral steroids

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107
Q

pompholyx define

A

a type of eczema which affects both the hands (cheiropompholyx) and the feet (pedopompholyx)

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108
Q

pompholyx preciptated

A

humidity and high temps

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109
Q

pompholyx fx

A

small blisters on the palms and soles
pruritic
often intensely itchy
sometimes burning sensation
once blisters burst skin may become dry and crack

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110
Q

pompholyx mx

A

cool compresses
emollients
topical steroids

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111
Q

porphyria cutanea tarda define and patho

A

the most common hepatic porphyria. It is due to an inherited defect in uroporphyrinogen decarboxylase or caused by hepatocyte damage e.g. alcohol, hepatitis C, oestrogen

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112
Q

porphyria cutanea tarda fx

A

photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands (most common feature)
hypertrichosis
hyperpigmentation

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113
Q

porphyria cutanea tarda inv

A

urine: elevated uroporphyrinogen and pink fluorescence of urine under Wood’s lamp

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114
Q

mx porphyria cutanea tarda

A

cholorquine
venesection

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115
Q

port wine stain define

A

vascular birthmarks that tend to be unilateral. They are deep red or purple in colour

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116
Q

port wine stain prog

A

get darker
do not resolve

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117
Q

port wine stain tx

A

cosmetic camouflage or laser therapy

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118
Q

causes of pruritus

A

liver disease
iron def anaemia
polycythaemia
CKD
lymphoma

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119
Q

causes of purpura in adults

A
  • Immune thrombocytopenic purpura
  • Bone marrow failure (secondary to leukaemias, myelodysplasia or bone metastases)
  • Senile purpura
  • Drugs (quinine, antiepileptics, antithrombotics)
  • Nutritional deficiencies (vitamins B12, C and folate)
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120
Q

causes of purpura in children

A

Meningococcal septicaemia
* Acute lymphoblastic leukaemia

  • Congenital bleeding disorders
  • Immune thrombocytopenic purpura
  • Henoch-Schonlein purpura
  • Non-accidental injury
121
Q

pyoderma gangrenosum define

A

a rare, non-infectious, inflammatory disorder. It is an uncommon cause of very painful skin ulceration

122
Q

pyoderma gangrenosum patho

A

AKA neutrophilic dermatosis
neutrophilic dermatoses are skin conditions characterised by dense infiltration of neutrophils in the affected tissue and this is often seen on biopsy

123
Q

causes pyoderma gangrenosum

A

idiopathic
IBD
RA
SLE
myeloproliferative disorders
lymphoma
myeloid leukaemias
monoclonal gammopathy (IgA)
granulomatosis with polyangiitis
primary biliary cirrhosis

124
Q

fx pyoderma gangrenosum

A

typically on the lower limb
soften at the site of a minor injury as in this patient’s case and this is known as pathergy
initially features:
usually starts quite suddenly
small pustule, red bump or blood-blister
later features:
the skin then breaks down resulting in an ulcer which is often painful
the edge of the ulcer is often described as purple, violaceous and undermined.
the ulcer itself may be deep and necrotic
may be accompanied by systemic symptoms
fever
myalgia

125
Q

pyoderma gangrenosum mx

A

oral steroids

126
Q

pyogenic granuloma define

A

a relatively common benign skin lesion

127
Q

factors risk pyogenic granuloma

A

trauma
pregnancy
women and young adults

128
Q

fx pyogenic granuloma

A

most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy
initially small red/brown spot
rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
the lesions may bleed profusely or ulcerate

129
Q

mx pyogenic granuloma

A

if preg associated resolve spotaneously post partum
curettage and cauterisation, cryotherapy, excision

130
Q

adverse effects of retinoids

A

teratogenicity
females should ideally be using two forms of contraception (e.g. Combined oral contraceptive pill and condoms)
dry skin, eyes and lips/mouth
the most common side-effect of isotretinoin
low mood
whilst this is a controversial topic, depression and other psychiatric problems are listed in the BNF
raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
photosensitivity

131
Q

salmon patches define

A

vascular birthmark
pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck. They usually fade over a few months, though marks on the neck may persist.

132
Q

sebaceous cyst patho

A

a proliferation of epidermal cells within the dermis. Pilar cysts (also known as trichilemmal cysts or wen) derive from the outer root sheath of the hair follicle.

133
Q

clinical fx sebaceous cyst

A

most common scalp, ears, back, face, and upper arm (not palms of the hands and soles of the feet).

They will typically contain a punctum.

134
Q

sebaceous cyst tx

A

excision to prevent recurrence

135
Q

seborrhoeic keratoses

A

benign epidermal skin lesions seen in older people

136
Q

seborrhoeic keratoses fx

A

large variation in colour from flesh to light-brown to black
have a ‘stuck-on’ appearance
keratotic plugs may be seen on the surface

137
Q

seborrhoeic keratosis mx

A

reassurance
removal include curettage, cryosurgery and shave biopsy

138
Q

ddx of shin lesions

A

erythema nodosum
pretibial myxoedema
pyoderma gangrenosum
necrobiosis lipoidica diabeticorum

139
Q

pretibial myxoedema

A

symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin

140
Q

necrobiosis lipoidica diabeticorum

A

shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia

141
Q

atopic eruption of pregnancy

A

the commonest skin disorder found in pregnancy
it typically presents as an eczematous, itchy red rash.
no specific treatment is needed

142
Q

pemphigoid gestationis

A

pruritic blistering lesions
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
oral corticosteroids are usually required

143
Q

possible skin manifestations of SLE

A

photosensitive ‘butterfly’ rash
discoid lupus
alopecia
livedo reticularis: net-like rash

144
Q

spider naevi define

A

a central red papule with surrounding capillaries. The lesions blanch upon pressure

145
Q

ddx spider naevi

A

differentiated from telangiectasia by pressing on them and watching them fill. Spider naevi fill from the centre, telangiectasia from the edge

146
Q

associations of spider naevi

A

liver disease
pregnancy
combined oral contraceptive pill

147
Q

strawberry naevi when

A

first mth of life

148
Q

Strawberry naevus
clinical fx

A

erythematous, raised and multilobed tumours.

Typically they increase in size until around 6-9 months before regressing over the next few years (around 95% resolve before 10 years of age).

Common sites include the face, scalp and back. Rarely they may be present in the upper respiratory tract leading to potential airway obstruction

149
Q

strawberry
naevi increased risk

A

female
premature
mother had chorionic villous sampling

150
Q

strawberry
naevi complications

A

mechanical e.g. Obstructing visual fields or airway
bleeding
ulceration
thrombocytopaenia

151
Q

strawberry naevus tx

A

propranolol

152
Q

3 types of tinea

A

tinea capitis - scalp
tinea corporis - trunk, legs or arms
tinea pedis - feet

153
Q

scalp ringworm complications

A

scarring alopecia

154
Q

if untreated scalp ringworm

A

a raised, pustular, spongy/boggy mass called a kerion

155
Q

scalp ringworm cause

A

Trichophyton tonsurans in the UK and the USA
may also be caused by Microsporum canis acquired from cats or dogs

156
Q

scalp ringworm diagnosis

A

Microsporum canis green fluorescence under Wood’s lamp*. However the most useful investigation is scalp scrapings

157
Q

mx of scalp ringworm

A

terbinafine for Trichophyton tonsurans infections and griseofulvin for Microsporum infections. Topical ketoconazole shampoo should be given for the first two weeks to reduce transmission

158
Q

general ringworm causes

A

Trichophyton rubrum and Trichophyton verrucosum (e.g. From contact with cattle)

159
Q

general ringworm clinical fx

A

well-defined annular, erythematous lesions with pustules and papules

160
Q

general ringworm tx

A

may be tx with oral fluconazole

161
Q

athlete#s foot clinical fx

A

itchy, peeling skin between the toes

162
Q

toxic epidermal necrolysis define

A

a potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction

163
Q

TEN clinical fx

A

a scalded appearance over an extensive area
systemically unwell e.g. pyrexia, tachycardic
positive Nikolsky’s sign: the epidermis separates with mild lateral pressure

164
Q

drugs which induce TEN

A

phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs

165
Q

TEN mx

A

stop precipitating factor
supportive care
often in an intensive care unit
volume loss and electrolyte derangement are potential complications
intravenous immunoglobulin now first line

166
Q

small vessel vasculitis

A

ANCA-associated vasculitides
granulomatosis with polyangiitis (Wegener’s granulomatosis)
eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
microscopic polyangiitis
immune complex small-vessel vasculitis
Henoch-Schonlein purpura
Goodpasture’s syndrome (anti-glomerular basement membrane disease)
cryoglobulinaemic vasculitis
hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)

167
Q

medium vessel vasculitis

A

polyarteritis nodosa
Kawasaki disease

168
Q

large vessel vasculitis

A

temporal arteritis
Takayasu’s arteritis

169
Q

clinical fx zinc deficiency

A

acrodermatitis: red, crusted lesions
acral distribution
peri-orificial
perianal
alopecia
short stature
hypogonadism
hepatosplenomegaly
geophagia (ingesting clay/soil)
cognitive impairment

170
Q

acne patho

A

disease of pilosebaceous unit

171
Q

acne describe

A

comedones - open if blackhead, closed if whitehead
papules, pustules
nodules, cysts
scarring

172
Q

acne v drug induced acne

A

drug induced - monomorphic - pustules in steroid used

173
Q

severe form of acne

A

acne fulminans - systemic upset
tx with hospital admission and oral steroids

174
Q

severe acne character

A

extensive lesions, nodules, pitting, scarring

175
Q

mild to mod acne mx

A

12 week course of topical combo-
a fixed combination of topical adapalene with topical benzoyl peroxide
a fixed combination of topical tretinoin with topical clindamycin
a fixed combination of topical benzoyl peroxide with topical clindamycin

176
Q

mod to severe acne mx

A

12 week course of topical + maybe oral:
a fixed combination of topical adapalene with topical benzoyl peroxide
a fixed combination of topical tretinoin with topical clindamycin
a fixed combination of topical adapalene with topical benzoyl peroxide + either oral lymecycline or oral doxycycline
a topical azelaic acid + either oral lymecycline or oral doxycycline

177
Q

teracyclines c/i

A

pregnant or breastfeeding
children less than 12

178
Q

how long abx therapy in acne used for

A

no more than 6 mths generally

179
Q

what prescribe with abx in acne

A

topical retinoid or benzoyl peroxide to reduce abx resistance

180
Q

long term abx use in acne complication

A

gram negative folliculitis - give trimethoprim

181
Q

acne options for fertile woman

A

COCP - co-cyprindiol - anti androgen (increased VTE risk)

182
Q

when refer for acne

A

conglobate acne: a rare and severe form of acne found mostly in men that presents with extensive inflammatory papules, suppurative nodules (that may coalesce to form sinuses) and cysts on the trunk.
patients with nodulo-cystic acne

183
Q

consider referral acne

A

mild to moderate acne has not responded to two completed courses of treatment
moderate to severe acne has not responded to previous treatment that includes an oral antibiotic
acne with scarring
acne with persistent pigmentary changes
acne is causing or contributing to persistent psychological distress or a mental health disorder

184
Q

what bacteria in acne vulgaris

A

Propionibacterium acnes

185
Q

alopecia mx

A

topical or intralesional corticosteroids
topical minoxidil
phototherapy
dithranol
contact immunotherapy
wigs

186
Q

alopecia prognosis

A

hair regrow in 50% by 1 yr and mostly all eventually

187
Q

basal cell hx

A

slow growth
local invasion
mets rare
sun exposed sites

188
Q

basal cell describe

A

pearly, flesh coloured papule with telangiectasia
may ulcerate and leave central crater

189
Q

referral BCC

A

routine

190
Q

mx of BCC

A

surgical removal
curettage
cryotherapy
topical cream: imiquimod, fluorouracil
radiotherapy

191
Q

burns types

A

superficial epidermal- painful and red, dry, no blisters
partial thickness - pale pink, blistered, slow CRT
partial thickness, - white and non blanching ertherma, reduced sensation, pain to deep pressure
full thickness - white/bnrown/black, no blisters or pain

192
Q

features of CHRONIC PLAQUE psoriasis

A

erythematous plaques with silvery white scales
extensor surfaces or trunk, scalp, buttocks
clear demyelination between normal and affected skin
auspitz sign

193
Q

2 types of contact dermatitis

A

irritant contact dermatitis: common - non-allergic reaction due to weak acids or alkalis (e.g. detergents). Often seen on the hands. Erythema is typical, crusting and vesicles are rare
allergic contact dermatitis: type IV hypersensitivity reaction. Uncommon - often seen on the head following hair dyes. Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Topical treatment with a potent steroid is indicated

194
Q

common cause of dermatitis

A

cement

195
Q

dermatitis herpetiformis patho

A

deposition of IgA in dermis

196
Q

fx of dermatitis herpetiformis

A

itchy, vesicular lesions on extensor surfaces

197
Q

diagnosis of dermatitis hermitofrmis

A

skin biopsy - iga

198
Q

mx of dermaittis herpetiformis

A

dapsone
gluten free diet

199
Q

define eczema herpeticum

A

severe primary infection of the skin by herpes simplex virus 1 or 2.

200
Q

eczema herpeitcum present

A

rapidly progressing painful rash

201
Q

clinical fx of eczema herpeticum

A

monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm in diameter are typically seen.

202
Q

how mx eczema herpeticum

A

admit
IV acliclovir

203
Q

eczema steroid strengths

A

mild - hydrocortisone
mod - betamethasone valerate
potent - fluticasone propionate 0.05, betamethasone valerate
very potent - clobetasol propionate

204
Q

how much steroid use eczeme

A

1 finger tip = twice size of adult hand

205
Q

define erythrema nodosum

A

inflammation of subcut fat

206
Q

presentation erythrema nodosum

A

typically causes tender, erythematous, nodular lesions
usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
usually resolves within 6 weeks
lesions heal without scarring

207
Q

causes erythema nodosum

A

infection - strep, TB
sarcoidosis
IBD
malignancy or lymphoma
drugs - penicillin, sulphonamide, COCP
preg

208
Q

define erythroderma

A

more than 95% of the skin is involved in a rash of any kind.

209
Q

causes of erythroderma

A

eczema
psoriasis
drugs e.g. gold
lymphomas, leukaemias
idiopathic

210
Q

triggers of erythroderma

A

withdrawal of steroidsmx

211
Q

mx of erythroderma

A

admit

212
Q

causative organsmis of fungal nail infections

A

dermatophytes
account for around 90% of cases
mainly Trichophyton rubrum
yeasts
account for around 5-10% of cases
e.g. Candida
non-dermatophyte moulds

213
Q

risk fx of fungal nail infections

A

age
DM
psoriasis
repeated trauma

214
Q

fx of fungal nail

A

unsightly
thickened, rough, opaque

215
Q

ddx of fungal nail

A

psoriasis
trauma
yellow nail syndrome

216
Q

ix of fungal nail

A

nail clippings +/- scrapings of the affected nail
microscopy and culture

217
Q

fungal nail mx

A

if asx and pt unbothered - no tx
if limited involvement (≤50% nail affected, ≤ 2 nails affected, more superficial white onychomycosis): topical treatment with amorolfine 5% nail lacquer; 6 months for fingernails and 9 - 12 months for toenails
if more extensive involvement due to a dermatophyte infection: oral terbinafine is currently recommended first-line; 6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months
if more extensive involvement due to a Candida infection: oral itraconazole is recommended first-line; ‘pulsed’ weekly therapy is recommended

218
Q

guttate psoriasis triggers

A

strep infection 2-4 weeks ago

219
Q

fx of guttate psoriasis

A

tear drop papules on trunks or limbs

220
Q

mx of guttate

A

resolve within 2-3 mths
topical agents as per psoriasis
UVB phototherapy
tonsillectomy may be necessary with recurrent episodes

221
Q

ddx of guttatr

A

pityriasis rosea

222
Q

hirscutism causes

A

PCOS
Cushing’s syndrome
congenital adrenal hyperplasia
androgen therapy
obesity: thought to be due to insulin resistance
adrenal tumour
androgen secreting ovarian tumour
drugs: phenytoin, corticosteroids

223
Q

assessment of hirscuitism

A

Ferriman-Gallwey scoring system: 9 body areas are assigned a score of 0 - 4, a score > 15 is considered to indicate moderate or severe hirsutism

224
Q

mx of hirscutiism

A

advise weight loss if overweight
cosmetic techniques such as waxing/bleaching - not available on the NHS
consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism
facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding

225
Q

hypertrichosis what and causes

A

androgen independent hair growth
drugs: minoxidil, ciclosporin, diazoxide
congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis
porphyria cutanea tarda
anorexia nervosa

226
Q

impetigo pathogen

A

staph aureus or strep pyogenes

227
Q

more common in scabies

A

eczema or insect bites

228
Q

how spread impetigo

A

direct contact and indirect
inc is 4-10 days

229
Q

fx of impetigo

A

‘golden’, crusted skin lesions typically found around the mouth
very contagious

230
Q

mx of impetigo

A

limited - hydrogen peroxide 1% or topical fusidic acid
extensive - oral flucoxacillin

231
Q

school impetigo

A

children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

232
Q

keloid scar mx

A

intra lesional steroids
excision not always possible and cause further scarring

233
Q

keloid scar define

A

tumour-like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original woun

234
Q

risk fx keloid scar

A

ethnicity
young
sternum, shouldner, neck, face, extensor

235
Q

lentigo maligna define

A

melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.

236
Q

malignant melanoma types

A

superficial spreading
nodular
lentigo maligna
acral lentiginous

237
Q

superficial spreading

A

most common
growing mole
young people

238
Q

nodular

A

second most common
sun exposed
middle aged
red or black lump which oozes or bleeds

239
Q

lentigo maligna

A

older, chronic

240
Q

acral lentiginous

A

rare
affects non exposured sights
darker skin pigment
subungal pigment - hutchinson’s sign or on palms or feet

241
Q

diagnostic fx of malignant melanoma

A

changes in size, shape, colour
diameter = same or more >7mm
inflammation
oozing or bleeding
altered sensationma

242
Q

malignant melanoma tx

A

excision biopsy and see if need re excision
may need sentinal node mapping or block dissection of regional LN’s

243
Q

margins melanoma

A

breslow
0-1 mm = 1cm
1-2mm thick = 1-2cm
2-4mm thick = 2-3 cm
>4mm = 3cm

244
Q

poor prog melanoma

A

breslow thickness

245
Q

nickel dermaitis

A

allergic contact dermatitis and is an example of a type IV hypersensitivity reaction. It is often caused by jewellery such as watches

It is diagnosed by a skin patch test

246
Q

pityriasis rosea patho

A

acute, self-limiting rash which tends to affect young adults. The aetiology is not fully understood but is thought that herpes hominis virus 7 (HHV-7) may play a role.

247
Q

hx of pityriasis rosea

A

no prodrome, but a minority may give a history of a recent viral infection
herald patch (usually on trunk)
followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance

248
Q

mx of pityriasis rosea

A

self limited - 6-12 weeks

249
Q

psoriasis increased risk

A

psoriatic arthropathy (around 10%)
increased incidence of metabolic syndrome
increased incidence of cardiovascular disease
increased incidence of venous thromboembolism
psychological distress

250
Q

patho of psoriasis

A

genetic - twins
: abnormal T cell activity stimulates keratinocyte proliferation.
environment - trauma, stress, infection

251
Q

types of psoriasis

A

plaque psoriasis: the most common sub-type resulting in the typical well-demarcated red, scaly patches affecting the extensor surfaces, sacrum and scalp
flexural psoriasis: in contrast to plaque psoriasis the skin is smooth
guttate psoriasis: transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
pustular psoriasis: commonly occurs on the palms and soles

252
Q

other fx of psoriais

A

nail signs: pitting, onycholysis, loss of nail, hyperkeratosis
arthritis

253
Q

exacerbating fx of psoriasis

A

trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

Streptococcal infection

254
Q

psoriasis mx

A

emollient
potent steroid once daily plus vit D analogue once daily, applied seperately for 4 weeks
if no improve after 8 weeks - vit d analogue
then no = potent steroids x2 daily or coal tar
secondary care - phototherapy narrowband ultraviolet B light
oral methotrexate, ciclosporin, biologics

255
Q

scalp psoriasis mx

A

use of potent topical corticosteroids used once daily for 4 weeks
if no improvement after 4 weeks then either use a different formulation of the potent corticosteroid (for example, a shampoo or mousse) and/or a topical agents to remove adherent scale

256
Q

face, flexural or genital psoriais mx

A

mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks

257
Q

s/e of steroids

A

atrophy, striae, rebound sx

258
Q

how long steroids

A

4 week break before another course
potent for no longer than 8 weeks at a time or 4 week if very potent

259
Q

how vit d analogues work

A

↓ cell division and differentiation → ↓ epidermal proliferation
reduce scale and thickness

260
Q

vit d analogue c/i

A

pregnancy

261
Q

dithranol how work and s/e

A

inhibits DNA synthesis
wash off after 30 mins
adverse effects include burning, staining

262
Q

retinoids adverse effects

A

teratogenicity
females should ideally be using two forms of contraception (e.g. Combined oral contraceptive pill and condoms)
dry skin, eyes and lips/mouth
the most common side-effect of isotretinoin
low mood
whilst this is a controversial topic, depression and other psychiatric problems are listed in the BNF
raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
photosensitivity

263
Q

rosacea fx

A

typically affects nose, cheeks and forehead
flushing is often first symptom
telangiectasia are common
later develops into persistent erythema with papules and pustules
rhinophyma
ocular involvement: blepharitis
sunlight may exacerbate symptoms

264
Q

mx of rosacea

A

sunscreen
flushing - topical brimonidine gel
mild to mod - topical ivermectin
mod to severe - topical ivermectin and oral doxy
if not improved - laser therapy or if rhinophyma

265
Q

ocular associations of rosacea

A

blepharitis conjunctivitis

266
Q

scabies cause

A

Sarcoptes scabiei

267
Q

fx of scabies

A

widespread pruritus
linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
in infants, the face and scalp may also be affected
secondary features are seen due to scratching: excoriation, infection

268
Q

mx of scabies

A

permethrin 5%
household contact
8-12 hours and repeat 7 days later

269
Q

severe form of scabies

A

crusted norwegian scabies - HIV
tx with ivermectin

270
Q

sebaceous cysts fx

A

punctum

271
Q

sebaceous cyst mx

A

excision

272
Q

seborrhoiec dermatitis what cause

A

Malassezia furfur - chronic dermitis

273
Q

fx of seborrhoeic dermaittis

A

eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop

274
Q

a

A
275
Q

sscoiated conditions of seborrheic dermatiris

A

hiv
parkinsons

276
Q

seborrheic dermaitis mx

A

ketoconazole shampoo
head and shoulder
if face - topical antifungals

277
Q

shingles cause

A

herpes zoster infection
Following primary infection with VZV (chickenpox), the virus lies dormant in the dorsal root or cranial nerve ganglia.

278
Q

fx of shingles

A

acute, unilateral, painful blistering rash caused by reactivation of the varicella-zoster virus (VZV)

279
Q

risk fx shingles

A

age
HIV
steroids or chemo

280
Q

deramtomes shingles

A

T1-L2

281
Q

fx of shingles

A

prodromal period
burning pain over the affected dermatome for 2-3 days
pain may be severe and interfere with sleep
around 20% of patients will experience fever, headache, lethargy
rash
initially erythematous, macular rash over the affected dermatome
quickly becomes vesicular
characteristically is well demarcated by the dermatome and does not cross the midline. However, some ‘bleeding’ into adjacent areas may be seen

282
Q

mx of shingles

A

infecrtious - avoid pregannt or immunocomp until vesicles crusted over or 5-7 days after
paracetamol and nsaids or amitripytlline, can use steroids if not immunocomp for pain
antivirals within 72 hours

283
Q

complications of shingles

A

ost-herpetic neuralgia
the most common complications
more common in older patients
affects between 5%-30% of patients depending on age
most commonly resolves with 6 months but may last longer
herpes zoster ophthalmicus (shingles affecting affecting the ocular division of the trigeminal nerve) is associated with a variety of ocular complications
herpes zoster oticus (Ramsay Hunt syndrome): may result in ear lesions and facial paralysis

284
Q

risk fx of S.C.C

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

285
Q

clinical fx of S.C.C

A

sun-exposed sites such as the head and neck or dorsum of the hands and arms
rapidly expanding painless, ulcerate nodules
may have a cauliflower-like appearance
there may be areas of bleeding

286
Q

tx of s.c.c.

A

surgical excision
4mm margins if <20mm or 6mm if >20mm
moh’s micrographic if high risk or cosmetic sites

287
Q

poor prog S.C.C.

A

poorly differenitated
>20 mm in diameter
>4mm deep
immunosuppression

288
Q

causes of SJS

A

penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill

289
Q

fx of SJS

A

the rash is typically maculopapular with target lesions being characteristic
may develop into vesicles or bullae
Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently
mucosal involvement (diff to TEN)

systemic symptoms: fever, arthralgia

290
Q

SJS mx

A

admit
supportive tx

291
Q

strawberry naebus

A

raised, multilobed tumours
can cause obstruction, bleeding or ulceration
resolve by 10 yrs of age
propranolol used as tx

292
Q

venous ulceration where

A

above medial mallolus

293
Q

ix of venous ulceration

A

ABPI - if 0.9-1.2 can use compression stocking, less = arterial

294
Q

mx of venous ulceration

A

compression bandaging
oral pentoxifylline - vasodilator

295
Q

vitilligo mx

A

sunblick
camoflage make up
steroids if applied in early changes
maybe tacrolismus or phototherapy

296
Q

different atopy conditions with eczem

A

allergic rhinitis
asthma
food allergy
conjunctivits

297
Q

eczema topical v oral alternative

A

topical calcineurin inhibitors - tacrolismus
oral ciclosporin

298
Q
A

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