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bds3 human systems > dermatology > Flashcards

dermatology Flashcards

1
Q

skin function

A

Provides an anatomical barrier
Main method of Heat Regulation
Sensory input from the body
Storage for lipids and water
Drug absorbtion and waste excretion

Commensal flora
  Normal colonisation that inhibits
pathogens in healthy hosts
  Mainly Bacteria and Fungi
  Staphylocci and Candida

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2
Q

oily skin

A

More secretion from sebaceous glands (Sebum)
More bacterial colonisation
Skin becomes heavier & thicker
More risk of pore blockage
More ‘spots & pimples’
Less likely to wrinkle and ageing?

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3
Q

blackheads = comedones

A

Feature of Acne Vulgaris
Build up of keratin & sebum
Block pores and oxidise giving ‘black’
appearance

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4
Q

furuncles

A

Infection of skin – pockets filled with pus
Furuncles grouped together are ‘carbuncles’
Folliculitis is furuncle in a hair follicle

Organism “Staphylococcus Aureus”
Red, painful and swollen
Drain pus -

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5
Q

acne

A

Usually a term for lesions arising from
  comedones
  papules
  pustules
  nodules and
  inflammatory cysts.
Usually in cosmetically sensitive areas

Follicular sensitivity to testosterone
  Increase around puberty
  Build up of comedones
  Propionibacterium acnes overgrows
and leads to infection & cysts
  Scars can form if cysts rupture

Made worse by
  Some contraceptive pills (progestogen)
  Greasy skin cleansers
  Systemic steroid treatment
  Some anticonvulsant drugs
  Squeezing the spots!

Local management
Reduce excess skin oil
  Cleansers – gentle soap
  Antibacterial agents
  Benzoyl peroxide
  Retinoids
  Antibiotic lotions

If local treatments fail
  Antibiotics
  Tetracycline based (minocyclin)
  Retinoids
  Isotretinoin
  Hormone manipulation
  Anti-androgens (cyproterone)

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6
Q

erysipelas

A

Streptoccus pyogenes
  Defined sharp raised border
  May blister and peel
  Usually systemic symptoms
  Fever
  Rigors

Manage with SYSTEMIC antibiotics
  Oral or sometimes IV
  Can progress to
  Necrotising fasciitis - death of fascial tissues
  Septic shock

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7
Q

impetigo

A

Highly infections skin disease
  Staphylococcal or Streptococcal
  Crusty red blister appearance
  Often associated with Eczema
  Treated with topical antibiotics
  Sometimes systemic antibiotics
  Antibiotic choice found from culture

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8
Q

viral skin infections

A

Herpes Simplex
  Shingles
  Molluscum Contagiosum
  Warts
Measles
  Rubella
  Fifth Disease
  Roseola
  Hand, Foot & Mouth
  HIV
  Kaposi’s Sarcoma

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9
Q

herpes virus infections

A

Herpes Simplex
  Perioral or Genital
  Shingles
  Herpes zoster
  Roseola
  HHV6
  Kaposi’s sarcoma
  HHV8

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10
Q

herpex simplex

A

Affect single dermatome or adjacent
dermatomes

Activated by ‘trauma’
Physical, chemical, UV light, ‘run down’

Treat with Aciclovir

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11
Q

herpes zoster

A

Recurrent’ HZV
  Affects SINGLE DERMATOME
  Causes SIGNIFICANT pain
  Neural inflammation from virus in the nerve
  Pain may persist after rash has gone
  Post herpetic neuralgia
  Treat with HIGH DOSE Aciclovir

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12
Q

mollusc contagiousim

A

Caused by MCV – a pox virus
  Resolve spontaneously in 1-2 years
  Usually infants and small children
  Clusters of small papules
  Warm, moist areas
  1-6mm size
  More troublesome in children with atopic
eczema
  Extensive in adults if HIV infection

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13
Q

warts

A

Human Papilloma Virus (HPV)
  Types 1-3 cause most warts
  Types 16 & 18 cause cervical cancer
  Contact spread
  Treat by
  Keratolysis
  Cryosurgery
  Excision
  If Immune competent then most resolve
spontaneously

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14
Q

skin infections

A

Fungal - dermatophytes
  Athlete’s foot (tinea pedis)
  Nail infections (onycholysis)
  Ringworm
  Intertrigo
  Pityriasis versicolor

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15
Q

athletes foot

A

Typically affect feet between toes
  groin involvement also common
  Usually mixed fungal and bacterial infection
  Scaling & sogginess of the skin
  Prevent by keeping skin clean dry and damage free
  Treat with antifungal/antibacterial cream
  miconazole

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16
Q

onycholysis

A

Nail bed fungal infection
  Usually Tinea unguium infection
  Nail becomes malformed, thick and
crumbly
  May be seen with athlete’s foot

17
Q

ringworm

A

Can affect different parts of the body
  Groin – tinea cruris
  Often spread from feet
  Body – tinea corporis
  Can be caught from infected animals
  Scalp – tinea capitis
  Inflammation of scalp leading to hair loss
  Mainly in young children

18
Q

intertrigo

A

Fungal infection due to chafing in moist
body folds:
  Under breasts
  Armpits
  Inner thighs
  Treat with topical
antifungal cream:
Clotrimazole
or Miconazole

19
Q

pityriasis versicolor

A

  Caused by Pityrosporum orbiculare
  Usually a harmless commensal
  Also involved in ‘cradle cap’
  Excessive growth causes the condition
  Results in patchy skin pigmentation
  Pale red or brownish
  Treat with topical or systemic antifungal
  Topical ketoconazole (in wash or shampoo)
  Systemic Itraconazole

20
Q

skin infestations

A

scabies
lice

21
Q

scabies

A

Infection with the ‘Scabies Mite’
  Sarcoptes scabiei
  From contact with an infected individual
(skin-to-skin)
  Occasionally from bedding
  Usually 10-12 mites infect the host
  3 eggs a day for life of mite – up to 2 months

Burrows appear on the skin
  Folds between fingers & on wrists
  ITCH is often most troublesome feature
  More severe at night
  On trunk and limbs
  RASH appears on trunk and limbs
  Tiny red intensely itchy bumps
  May get secondary impetigo
  Rash and Itch are ALLERGY and can persist long
after the infestation is gone

Use chemical insecticides – Scabicides
  Benzyl benzoate
  Permethrin
  Malathion
  Apply to the WHOLE body from the chin
down including under the nails
  Treat ALL close contacts whether obviously
infected or not

22
Q

lice

A

Three types
  Head
  Pubic
  Body
  Transmitted by close contact with an
infected individual
  Transmitted by shared items
  Clothing combs, bedding, brushes and toilet
seats!

Head lice most commonly affect
children
  Can spread to rest of family though!
  Look for ‘nits’ – eggs cemented to the
hair near the scalp
  Need to go through hair with a ‘fine
toothed comb’!
  NOT hygiene related

Body lice treated by personal and
clothing hygiene
  Hot water washing and drying
  Chemical Insecticides
  Permethrin
  Malathion
  Phenothrin

23
Q

inflammatory skin disease

A

eczema
occupational dermatitis
psoriasis

24
Q

eczema

A

Inflammation of the skin
  Becomes itchy, dry, flaky
  Occasionally weeps
 
2 main types
  atopic & contact
  Usually affect FLEXOR surfaces of skin or trunk

25
Q

atopic eczema

A

Commonest form

Develops in childhood
Usually improves with age
Tends to run in families
Associated with other ‘atopic’ conditions
Hay fever, asthma

26
Q

other eczema

A

Contact - most likely for adult onset
Contact with allergen = perfumes, detergents, soaps

Seborrhoeic – scalp & eye lashes
Appears as severe form of dandruff

Discoid – circular patches on the body

Gravitational – related to poor circulation in legs

Triggers?
  Some find stress, menstruation, illness,
changes in the weather
 

Management
  Cotton clothing
  Emollients
  Soap substitutes
  Corticosteroids – usually topical

27
Q

eczema management

A

Emollients
Oily and prevent drying of the irritated
skin
Apply after bathing to trap moisture

Corticosteroid
Remove the inflammation and allow skin
to return to normal

28
Q

occupational contact dermatitis

A

Reaction to an environmental agent
  Usually results in an rash
  May blister or get urticarial swelling
  Can be immediate or up to 72hrs after
exposure
  Usually an intense itch

Treatment = remove source
Problem is identifying source
Topical steroid can help

29
Q

psoriasis

A

Inflammatory skin disease – 2% pop

Cause unknown
Dysregulated epidermal proliferation = new cells produced faster than old cells lost
Skin surface builds up & thickens
 
EXTENSOR surfaces of limbs & trunk
Can be associated with a severe form of arthritis – psoriatic arthropathy
 
Red scaly patches – can itch
Can run in families

30
Q

psoriasis - treatment

A

No one clear treatment – initially topical
  Emollients
  Topical steroids
  Tar
  Dithranol
  Vitamin A derivatives
 
PUVA – psoralen uv light A
  Topical drug, activated by UV light

31
Q

psoriasis systemic treatment

A

Drugs to reduce cell turnover
  Methotrexate
  Ciclosporin
  Aitretin
  Infliximab
  Etanercept

32
Q

immunological skin diseases

A

ATTACKING PROTEINS IN SKIN

Blistering Conditions
  Pemphigoid
  Pemphigus
  Epidermolysis bullosa
 
Lichen Planus
 
Connective Tissue diseases
  Scleroderma
  Dermatomyositis
  Raynauds

Skin and oral/genital mucosa share many common
antigens and epitopes
Many blistering skin conditions also affect the mouth

Auto-antibody attack on skin
components causing loss of cell-cell
adhesion
 
‘Split’ forms in skin
  Fills with inflammatory exudate
  Forms vesicle/blister

33
Q

blistering conditions vesiculobullous diseases

A

Pemphigoid
Pemphigus
Epidermolysis Bullosa
Linear IgA Disease
Dermatitis Herpetiformis

34
Q

pemphigoid

A

SUB epithelial antibody attack
Thick walled blisters (full epidermis)
  Usually persist to be seen
  Clear or blood filled blisters

Different forms and presentations
  Bullous Pemphigoid
  Mucous Membrane Pemphigoid
  Cicatritial Pemphigoid

Oral & Skin Lesions
  Both can cause lesions in either place
  Bullous usually skin
  Mucous Membrane usually mouth/eye/genital
  Scarring a feature in some cases
  Manage with immunosuppresants
  Steroids
  ‘steroid sparing’ drugs

35
Q

pemphigus

A

Vulgaris
  Affects mucosa and skin
  Usually oral lesions before skin

RARELY see intact bullae
  Intra-epithelial blister
  Surface easily lost
 
Fatal disease without treatment
  Now often complications of the treatment are major cause of death

36
Q

epidermolysis bullosa

A

Group of conditions
  Some very mild – may appear later in
life
  Some incompatible with life – death
in-utero or shortly after birth
 
Genetically determined
Severity determined by epitopes involved
Scarring determined by epitopes involved

EB Simplex
  Junctional EB
  Dystrophic EB
  EB Acquisita *

Problems
  Infection
  Fluid loss
  Scarring

bds3 human systems (11 decks)

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