Dermatology Flashcards
what is the general term given to skin disease
dermatosis
dermatitis definition
inflammation of the skin
seborrheic dermatitis/ cradle cap is a common condition that affects infants and is characterised by over production of
sebum
psoriasis affecting scalp appears different to seborrheic dermatitis how
powdery and silver surface. Scales are thicker and drier
give 2 symptoms of seborrheic dermatitis
greasy itchy scales and erythema
seborrheic dermatitis may involve infection by what yeast
malassezia fufur
in adults seborrheic dermatitis can affect any area with a large number of sebaceous glands (oily areas), list some different areas that could be affected
scalp
face
trunk
true or false, dandruff is a form of seborrheic dermatitis
true
what do: Clotrimazole
Econazole nitrate
Ketoconazole
Tioconazole
have in common
antifungals containing an imidazole group
list some different treatment options for seborrheic dermatitis
washing to remove scales
topical imidazoles and hydrocortisone and ketoconazole shampoo
How should ketoconazole shampoo be used to control seborrheic dermatitis?
Rinse area with water. Massage shampoo into scalp into a lather, leave shampoo on for 3-5 minutes, wash off with water
How should ketoconazole shampoo be used to prevent the recurrence of seborrheic dermatitis?
once every 1-2 weeks. Leave on scalp for 5 minutes before rinsing.
OTC first line for scalp psoriasis?
Salicylic acid shampoos and scalp solutions
what compound reduces keratinocyte proliferation and own inherent anti-inflammatory activities
Helps maintain cutaneous barrier homeostasis in psoriasis
vitamin D
what can you add to vitamin D preparation to increase its efficacy
Combination corticosteroid and Vitamin D preparations (calciptriol with betamethasone) ointment/ gel: Dovobet or foam: Enstilar
what OTC drugs linked to psoriasis onset/ flare ups?
NSAID naproxen and indomethacin
also exacerbated by:
bb
Li
antimalarials
terbinafine
ACEi
benzos
biologics
why should psoriatic patients be referred to the GP if they develop joint pain?
psoriatric arthritis
//ACNE VULGARIS
acne is what type of skin disease
pilosebaceous
acne is characterised by pustules, nodules, cysts and or open and closed:
comedones
give some different causes of acne 4
sebum overproduction
increase testosterone sensitivity
hormonal changes F
drug induced
in acne pores are usually blocked by a mixture of sebum and
dead skin cells
blocked pores in acne can be contaminated by the usually harmless bacteria known as
propionibacterium acnes
name a kerolytic product that can be purchased otc for the treatment of acne
salicylic acid
why should benzyl peroxide for the treatment of acne be initiated at a low dose and titrated up slowly
minimise irritancy
azaleic acid can be used to treat acne at what % strength
20
true or false, topical retinoids can be potentially irritant for use in acne treatment
true
topical abx may be used to treat inflammatory acne, what may be the risk of using these formulations
resistance
oral abx for the treatment of acne should be water or lipid soluble
lipid
would isotretinoin usually given to patients for acne treatment within primary or secondary conditions
secondary
// ATOPIC DERMATITIS
true or false, atopic dermatitis is one type of eczema which is considered a chronic condition but major improvements or complete disappearance can occur
true
Atopic dermatitis is more common in children with other atopic (i.e. allergic) conditions such as 3
food allergies
asthma
hayfever
what epidermal protein has recently been identified as having a potential contributing factor to the development of atopic dermatitis
filaggrin
what are some of the common symptoms of atopic dermatitis that patients may present with
itchy skin
red and dry cracks
mainstay treatment for atopic dermatitis?
topical emolients
emollients should be used freely and frequently to maintain skin hydration but should be applied gently, why should patients favour preparations with the fewest excipients
some can act as irritants
name of another severe complication of atopic dermatitis that can also occur in association with other inflammatory skin conditions
Erythroderma atopic dermatitis
How can the use of oral corticosteroids affect growth in children?
slows growth rate
why are ointments preferred to creams and lotions
higher water content
why might creams and lotions be more acceptable for patients
they do not leave a greasy film on the skin
why might patients be required to change their emollients over time
loss of efficacy or irritancy
atopic dermatitis is typically treated with a short course of topical
corticosteroids
prolonged use of corticosteroids is not recommended due to side effects including
change in skin colour
withdrawal
secondary infections
acne
cataracts
nice recommends that corticosteroids for eczema are used od below 12 and if above 12 they are used
bd
what 2 topical calcineurin inhibitors may be prescribed to patients as second line treatment but only by expert clinicians
tacrolimus and picrolimus
how can calcineurin inhibitors help to treat atopic dermatitis/ eczema
blocking calcineurin prevents inflammatory reaction at basis of atopic dermatitis
true or false, unlike topical corticosteroids, calcineurin inhibitors do not cause skin atrophy
true
list some different treatment options for atopic dermatitis
uv light
abx
corticosteroids
azathioprine
cyclosporine
mtx
biologicals
// PSORIASIS
psoriasis is an inflammatory condition characterised by the presence of red flaky crusty patched covered with scales, what colour are these scales
silver
what causes patches to form in psoriasis
hyperproliferation of epidermal cells
in psoriasis the turnover of epidermal cells is significantly accelerated meaning it takes x instead of weeks
days
what is the most common type of psoriasis
plaque
guttate psoriasis is more common in young adults and children and often follows a bacterial infection such as as strep throat. how is its presentation different to plaque psoriasis
smaller and thinner lesions and can appear on trunk, limbs and scalp
give one differential for the presentation of scalp psoriasis
seborrheic dermatitis
what different things does the classification of psoriasis depend on
age of onset
surface area affected
localisation of lesions
size and thickness of lesions
psoriasis is considered to be a x lymphocyte auto immune disease
t
true or false, in psoriasis t cells do not appear to accumulate on the skin
false
how can t cells trigger an immune response resulting in psoriasis
apc present antigen
t cell activated
trigger immune response
cytokines release
fast growth and maturation of epidermal cells
epidermis thickens
what does increased blood supply to the site cause in psoriasis
reddening of lesions
give one tool that is available to assess the severity of psoriasis
PASI
which of the following is not an additional physiological consequence of psoriasis
erythrodermic dermatitis
pustular psoriasis
arthritis
nail disease
cardiovascular disease
kidney disease
kidney disease
list some different topical treatment options for psoriasis
emollients
corticosteroids
vitamin d analogues
coal tar
dithranol
what light therapies are available to treat psoriasis
uvb and puva
what different systemic therapies are available for the treatment of psoriasis
mtx
cyclosporine
apremilast
what is the drug class of apremilast
anti tnf alpha
what 2 classes of biological drugs can be used for the treatment of psoriasis
anti tnf alpha
anti interleukins
// ECZEMA
Eczema is often used in place of dermatitis; both refer to inflammation of the skin, anme some diff types
- Atopic
- Pytiriasis Alba
- Lichen nitidus
- Discoid
- Seborrheic
- Photo-aggravated
- Chronic actinic
- Varicose/venous
- Irritant
- Contact
Corticosteroids share a common structure with which endogenic molecule
Cholesterol
Corticosteroids can possess glucocorticoid and mineralocorticoid activity. Which activity is the most desirable in atopic eczema?
GC, dampen immune response and prevent flare up
MC: Na, K, not relevant here
Skin thinner for kids. Potent meds for adults, even more for kids
Eczema manifests at young age
main risks associated with prolonged use of topical corticosteroids?
What factors can increase the risk of developing these SEs?
rebound flares
atrophy
rosocea
- extremities of age
- body site e.g. intertriginous areas,
- high-potency topical steroid, occlusion and moisture.
common name for erythema
redness
common name for pruritus
itchy skin
common name for xerosis
dry skin
main differences between allergic contact dermatitis and irritant contact dermatitis?
ICD caused by the non–immune-modulated irritation of skin by a substance, -> skin changes.
ACD: delayed hypersensitivity reaction in which a foreign substance comes into contact with skin; skin changes occur after reexposure
// NAPKIN DERMATITIS
(nappy rash) what 3 possible therapeutic management used to treat
- Barrier cream (zinc pastes)
- Non-pharmacological interventions
- Antibacterial or antifungal cream if infection confirmed
chicken pox, Molluscum Contagiosum,impetigo, cold sores
all examples of what
Infectious dermatoses/ viral rashes
chicken pox characterised by fever and blistered rash and caused by what virus?
varicella zoster virus
Chicken pox is usually self-limiting in healthy children but complications can include
pneumonia and secondary bacterial infection of skin lesions from scratching
After first chicken pox infection, virus can be re-activated to cause
shingles (herpes zoster)
Shingles targets one dermatome (region of the skin innervated by a single spinal nerve) often located where
thorax or abdomen
how do shingles lesions appear?
grouped vesicles on top of reddened skin (erythema).
within how long will chicken pox/ shingles vesicles dry up, crust, and clear
2 weeks
t/f shingles may cause scarring
true.
some patients may experience lingering pain after lesions have healed (postherpetic neuralgia).
Antipyretics and antihistamines can be used for chickenpox tx but why should you avoid ibu and aspirin
due to increased risk of secondary infections (ibuprofen) and Reyes syndrome (aspirin)
what lotion can be used for topical application for chickenpox
calamine
for severe chickenpox and at-risk patients, treat w what 2?
o Immunoglobulins
o Antivirals (should be started early within 24h of rash starting)
//MOLLUSCUM
Molluscum Contagiosum is a viral skin infection and symtoms include
small, painless papules
t/f Molluscum Contagiosum in children
is usually self-limiting and does not require treatment. However, treatment may be required in adults and immunocompromised patients.
true
how is molluscum contagiosum treated/ counselled
tell px avoid scratching
Tx: destruction of the lesions and various topical treatments. This conditions is sometimes associated with atopic dermatitis.
name of common bacterial infection cause by Staph aureus or Strep pyogenes
impetigo
// IMPETIGO
impetigo px are contagious until Xh after treatment is started or lesions have healed.
48
what may symptoms include for non-bullous impetigo
non-bullous: small pustules, break down, leaving honey-coloured crusted lesions and exudation; with time, and will be replaced with reddish lesions that should disappear without scarring.
what may symptoms include for bullous impetigo
bullae. blisters will rupture, leaving crusted skin lesions, exudation and eventually peeling.
what should px be told to avoid, for impetigo
scratching to limit transmission and complications.
Impetigo often clears-up on its own, but treatment can help to fasten healing. name 3 options
- Antiseptic washes
- Antibacterial cream (e.g. mupirocin 2%; for localised lesions/mild cases)
- Oral antiobiotics (severe cases)
// COLD SORES
= visible manifestation of a viral infection by which virus
herpes simplex virus (HSV) type 1 or type 2.
When the virus becomes active again, cold sores will manifest as
vesicles (small blisters).
cold sores is self limitng (7-10 days) but remains contagious when?
until the lesions have healed.
which px may be at risk of complications of cold sores
Immunocompromised patients, neonates and patients suffering from other skin conditions
what can trigger cold sores
stress, injury, systemic infection (fever), immunosuppression (disease or drug-induced), tiredness, menstruation and sunlight.
…
what tx can be used to speed up cold sore healing
antiviral creams
name 3 therap options for cold sore tx (many available w/out prec)
- Antiviral creams
- Oral antivirals (severe cases and at-risk populations)
- Non-antiviral topical preparations
name 2 antiviral creams for cold sores
acyclovir, penciclovir
why would you give non-antiviral topical preparations for cold sore management
to alleviate symptoms
What advice should you give to patients wishing to use antiviral creams for the treatment of cold sores?
Do not apply other skin products unless told to do so
Do not cover area with plastic or waterproof bandages unless told to do so
apply affected area five times a day at approx 4h intervals for 4 days. Wash your hands, apply cream and wash hands again. Use enough to completely cover sore and surrounding area.
// URTICARIA
what is urticaria/ hives characterised by
presence of wheals and itchy skin.
urticaria/ hives is non-infectious and fairly common due to release of what in skin
histamine and other messengers
what can cause sudden release of histamine
allergic reaction (food or insect bites…nettle), exposure to cold or heat, infections such as the common cold or can be drug-induced.
urticaria can be idiopathic or X
auto-immune
Urticaria can be one of the symptoms of anaphylaxis. what else can
itchy skin
swollen eyes
lightheaded
mouth swelline
unconscious
Some patients may develop an angioedema which is characterised by an abrupt, transient swelling of the deeper layer of the skin, including the hypodermis what does it often affect
eyes and lips, hands and feet. If the swelling affects the tongue or throat, the patient may experience trouble swallowing or breathing (beware!).
drug tx for urticaria?
- Oral antihistamines (H1)
- Adrenaline injection (rare cases; angioedema affecting breathing)
- Omalizumab (chronic spontaneous urticarial)
// SDL: dermatology
case 1 acne
how long should treatment with benzoyl peroxide or any acne treatment be tried for before switching
most people need 6 week course but treatment should be stopped if no response within a 2 month period
what factors should be checked before considering a switch in someones acne treatment
using correctly
why should benzoyl peroxide be used sparingly
irritation
true or false, benzyl peroxide can make skin more sensitive to sunlight
true
what are the advantages of using a combination of benzoyl peroxide and a topical antibacterial
topical abx can become resistant so combining with antiseptic reduces number of bacteria on the skin
topical abx works by killing bacteria on the skin that are responsible for causing clogged hair follicles, name 2 appropriate abx
clindamycin or erythromycin
name some different oral abx that may be used for moderate acne
lymecycline
doxycycline
oxytetracycline
tetracycline
trimethoprim
lymecycline dose
480mg od
doxycycline dose
100mg od
oxytetracycline and tetracycline doses
500mg bd
why is minacycline rarely used now
causes lupus like reaction and blue discolouration of face
true or false, trimethoprim works well for acne but is not licensed to treat it
true
what drug can be used for acne in younger children but runs the risk of resistance therefore requires close monitoring of response
erythromycin
list the indications for isotretinoin treatment
nodulocystic acne
acne at risk of permanent scarring
acne that hasnt responded to oral abx
what sexual side effects may be caused by isotretinoin treatment
erectile dysfunction and loss of libido
why should patients and their families be aware of mood changes on isotretinoin treatment
can cause depression and suicidal ideation
what skin lip eyes side effects might patients on isotretinoin experience
dryness
true or false, isotretinoin is not associated with sensitivity to sunlight and associated headaches
false
what are females required to undertake prior to isotretinoin treatment
pregnancy prevention programme
if sexually active 2 forms of contraception
monthly pregnancy tests
case 2
name of serious disorder which is an ADR and affects skin mucus membranes genital and eyes etc
SJS
sjs begins with x like symptoms
flu
sjs can be caused by infection but the most common cause is
ADR
how does sjs manifest
purple rash spread
blisters
affected skin dies and peels off
what ward/ unit would sjs patients be admitted to
intensive care or burns
sjs can cause x detachment from underlying areas
epidermis
how can sjs be officially diagnosed from TENS
sjs if epidermal detachment affects <10% total body area
TENS is diagnosed if epidermal detachment affects >x% total body area
30
scarring can occur if sjs is not treated properly true or false
true
what life threatening complication can occur as a result of tens
sepsis
list 3 common antibacterial causes of sjs
amoxicillin
cephalosporins
co trimoxazole
list 2 antiepileptics that can cause sjs
lamotrigine
carbamazepine
2 nsaids that can cause sjs
peroxicam
meloxicam
name some different drug classes that can cause sjs
antibacterials
antiretrovirals
sulfonamide derivatives
anticonvulsants
antiepileptics
what can increase your risk of developing sjs
recombinant viral infection
weakened immune system
family history
where should sjs be reported
mhra yellow card
for sjs what is the usual dose of immunoglobulin
2mg/kg
immunoglobulin only comes in vials of 2.5/5/10 and
20
