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MSRA > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is BCC?

A

Basal cell carcinoma::: slow growing :::: locally invasive :::: malignant :::: irregular growth :::: sun exposure :::: white ppl

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2
Q

What is the classic description of BCC?

A

small, translucent, pearly, raised areas with telangiectasia
rodent ulcer - indurated edge and ulcerate centre

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3
Q

What are the different types of BCC?

A

Nodular - solitary, shiny red with large telangiectasia

Superficial - erythematous well-demarcated scaly plaques

Morphoeic - thickened yellow plaques, poorly defined borders

Pigmented - brown, blue or greyish

Basosquamous - mixed BCC and SCC

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4
Q

What is SCC? How does it present?

A

Squamous cell carcinoma ::: malignant tumour ::: can metastasise ::: UV light exposure

Presentation:
- usually indurated nodular keratinising or crusting tumour, may ulcerate
- non-healing growth or ulcer
- very variable clinical appearance

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5
Q

What is the management of SCC?

A

2ww referral

Surgical excision with 4mm margin is lesion <20mm in diameter, 6mm if >20mm in diameter

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6
Q

What are some indications of poor prognosis in SCC?

A
  • poorly differentiated tumour
  • > 20mm in diameter
  • > 4mm deep
  • immunosuppression
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7
Q

What bacteria causes inflammation in acne?

A

Propionibacterium acnes

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8
Q

How does acne present?

A

open or closed comedones (blackheads and whiteheads)
papules, pustules, nodules, cysts

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9
Q

What is the pathophysiology of acne?

A
  • increased sebum production
  • follicular hyperkeratinisation
  • colonisation with P. acnes
  • inflammation
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10
Q

What is the management of mild to moderate acne vulgaris?

A

a 12-week course of topical combination therapy should be tried first-line:
- 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

topical benzoyl peroxide may be used as monotherapy if these options are contraindicated or the person wishes to avoid using a topical retinoid or an antibiotic

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11
Q

What is the management of moderate to severe acne?

A

a 12-week course of one of the following options:
- a fixed combination of topical adapalene with topical benzoyl peroxide (same as mild)
- a fixed combination of topical tretinoin with topical clindamycin (same as mild)
- 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

avoid tetracyclines in pregnant and breastfeeding women

COCP

oral isotretinoin under specialist supervision

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12
Q

What is the management of eczema?

A

topical emollients
soap substitutes
avoid triggers

topical steroids :
- Mild: Hydrocortisone 0.5%, 1% and 2.5%
- Moderate: Eumovate (clobetasone butyrate 0.05%)
- Potent: Betnovate (betamethasone 0.1%)
- Very potent: Dermovate (clobetasol propionate 0.05%)

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13
Q

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

A

Acanthosis nigricans

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14
Q

What are some causes of acanthosis nigricans?

A
  • things to do with insulin resistance e.g. T2DM, obesity, PCOS, acromegaly, Cushing’s, hypothyroid, Prader-Willi
  • GI cancer
  • familial
  • drugs (COCP, nicotinic acid)
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15
Q

“multiple small crusty/scaly lesions, pink/red/brown/skin colour, sun-exposed areas”

A

actinic keratoses

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16
Q

What is the risk of actinic keratosis?

What are management options for it?

A

it’s premalignant

Mx:
- avoid sun exposure
- fluorouracil cream (2-3wks) - causes redness and inflammation
- topical diclofenac, topical imiquimod
- cryotherapy
- curettage and cautery

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17
Q

What are the types of alopecia?

A
  • Scarring (trauma, burns, other skin conditions - destruction of hair follicle)
  • Non-scarring (male-pattern baldness, drugs, iron/zinc deficiency, telogen effluvium/stress)
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18
Q

What drugs can cause alopecia?

A

cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine

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19
Q

What are treatments for alopecia areata?

A

hair usually regrows in 50% of pts within 1 yr
- topical or intralesional corticosteroids
- topical minoxidil
- phototherapy
- dithranol
- contact immunotherapy
- wigs

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20
Q

“elderly patient, itchy, tense blisters around flexures heal without scarring, no mucosal involvement”

A

Bullous pemphigoid

Skin biopsy shows: immunofluorescence shows IgG and C3 at the dermoepidermal junction

Mx: referral to derm for biopsy, PO corticosteroids

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21
Q

How can you assess extent of burns?

A

Wallace’s Rule of Nines:
head + neck = 9%, each arm = 9%, each anterior part of leg = 9%, each posterior part of leg = 9%, anterior chest = 9%, posterior chest = 9%, anterior abdomen = 9%, posterior abdomen = 9%

Lund and Browder chart is most accurate

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22
Q

How can you assess the depth of a burn?
1) 1st deg - superficial epidermal
2) 2nd deg - partial thickness, superficial dermal
3) 2nd deg - partial thickness, deep dermal
4) 3rd deg - full thickness

A

1) Red and painful, dry, no blisters
2) Pale pink, painful, blistered. Slow capillary refill
3) Typically white but may have patches of non-blanching erythema. Reduced sensation, painful to deep pressure
4) White (‘waxy’)/brown (‘leathery’)/black in colour, no blisters, no pain

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23
Q

When are IV fluids needed in burns?
How is fluid requirement calculated?

A

Children with burns >10%
Adults with burns >15%

Parkland formula: volume of fluid = total body surface area of the burn % x weight (Kg) x4.
Half of the fluid is administered in the first 8 hours.

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24
Q

When are escharotomies indicated in burns?

A

circumferential full thickness burns to torso or limbs

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25
Q

“painful nodule on the ear, usually in old men”

A

Chondrodermatitis nodularis helicis

benign condition

26
Q

“erythematous plaques covered with a silvery-white scale, typically on the extensor surfaces”

A

Chronic plaque psoriasis

27
Q

“autoimmune blistering skin disorder associated with coeliac disease, itchy, vesicular skin lesions on the extensor surfaces”

A

Dermatitis herpetiformis

skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis

Mx:
- gluten free diet
- dapsone

28
Q

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

A

Dermatofibroma

benign fibrous lesion

29
Q

“child with atopic eczema, rapidly progressive painful rash, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1-3 mm in diameter”

A

Eczema herpeticum

life-threatening
needs admission and IV aciclovir

30
Q

“reticulated, erythematous patches with hyperpigmentation and telangiectasia, exposure to infrared radiation”

A

Erythema ab igne

risk of SCC

31
Q

“target lesions, back of hands and feet spreads to torso , mild pruritis”

A

Erythema multiforme

Causes
- 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

32
Q

“tender, erythematous, nodular lesions, typically over shins”

A

Erythema nodosum

Causes
- infection: streptococci, tuberculosis, brucellosis
- systemic disease: sarcoidosis, IBD, Behcet’s
- malignancy/lymphoma
- drugs: penicillins, sulphonamides, COCP
- pregnancy

33
Q

“acute onset, tear drop papules on the trunk and limbs, 2-4wks after strep infection”

A

Guttate psoriasis

Mx: resolve spontaneously
- or same Tx as psoriasis, UVB phototherapy

34
Q

“2-3 of: epistaxis, telangectasia, visceral lesions (e.g. AVMs), family history”

A

hereditary haemorrhagic telangiectasia

35
Q

What are some treatment options for hyperhidrosis?

A

Management options include
- topical aluminium chloride preparations are first-line. Main side effect is skin irritation
- iontophoresis: particularly useful for patients with palmar, plantar and axillary hyperhidrosis
- botulinum toxin: currently licensed for axillary symptoms
- surgery: e.g. Endoscopic transthoracic sympathectomy. Patients should be made aware of the risk of compensatory sweating

36
Q

“‘golden’, crusted skin lesions typically found around the mouth”

A

Impetigo (staph aureus, strep pyogenes)

37
Q

What is the management for limited impetigo?

A
  • hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’
  • topical Abx cream: fusidic acid, mupirocin
38
Q

What is the management of extensive impetigo?

A

oral flucloxacillin, oral erythromycin if penicillin-allergic

39
Q

What are the rules around school exclusion for impetigo?

A

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

40
Q

How can keloid scars be treated?

A

intra-lesional steroids e.g. triamcinolone

41
Q

“said to look like a volcano or crater, initially a smooth dome-shaped papule, rapidly grows to become a crater centrally-filled with keratin”

A

Keratoacanthoma

benign epithelial tumour, urgent surgical excision if difficult to differentiate from SCC

42
Q

“purple, polygonal, pruritic. white-lines (Wickham’s striae), Koebner phenomenon”

A

Lichen planus

Lichenoid drug eruptions - causes:
- gold, quinine, thiazides

Mx:
- topical steroids
- benxydamine mouthwash for oral lichen planus

43
Q

“white patches, itchy, usually on genitalia”

A

Lichen sclerosus

Mx: top steroids and emollients

inc risk of vulval Ca

44
Q

What are the main subtypes of malignant melanoma?

A
  • Superficial spreading
  • Nodular (most aggressive)
  • Lentigo maligna
  • Acral lentiginous
45
Q

What are the main diagnostic features of malignant melanoma?

A

The main diagnostic features (major criteria):
Change in size
Change in shape
Change in colour

45
Q

“pinkish or pearly white papules with a central umbilication, which are up to 5 mm in diameter, close contact transmission, mainly in children”

A

molluscum contagiosum

self-limiting

46
Q

“itchy, red patches which are typically confused with eczema or psoriasis initially, lesions tend to be of different colours in contrast to eczema/psoriasis where there is greater homogenicity”

A

Mycosis fungoides

  • rare form of T-cell lymphoma
47
Q

“dermatitis, diarrhoea, dementia”

A

Pellagra

48
Q

“mucosal ulceration, skin blistering (flaccid, easily ruptured)”

A

Pemphigus vulgaris

steroids first line

49
Q

“herald patch, erythematous, oval, scaly patches, a ‘fir-tree’ appearance”

A

Pityriasis rosea

self-limiting

50
Q

“type of eczema which affects both the hands and feet, precipitated by humidity and high temp”

A

Pompholyx

Mx: cool compress, emollients, topical steroids

51
Q

What is the 1st line treatment for chronic plaque psoriasis?

A

a potent corticosteroid applied once daily plus vitamin D analogue applied once daily

52
Q

“acute onset small pustule/red bump/blood blister on lower limb, develops into painful ulcer, with purple edge, may be deep/necrotic, associated with fever”

A

Pyoderma gangrenosum

  • PO steroids 1st line
53
Q

“small red/brown spot, rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape, may bleed profusely or ulcerate”

A

Pyogenic granuloma (misnomer)

benign

54
Q

What are some adverse effects of retinoids (e.g. isotretinoin)?

A
  • teratogenecity (use COCP)
  • dry skin/eye/mouth
  • low mood
  • raised triglycerides
  • hair thinning
  • epistaxis
  • ICH
  • photosensitivity
54
Q

What is the management of rosacea?

A
  • sunscreen
  • brimonidine
  • topical ivermectin for papules/pustules
  • topical vermectin and oral docycyline for mod-severe papules/pustules
54
Q

What is the management of scabies?

A

permethrin 5% is first-line
malathion 0.5% is second-line

55
Q

What are some causes of SJS?

A
  • penicillin
  • sulphonamides
  • lamotrigine, carbamazepine, phenytoin
  • allopurinol
  • NSAIDs
  • oral contraceptive pill
56
Q

“maculopapular with target lesions, Nikolsky sign is positive in erythematous areas - blisters and erosions appear when the skin is rubbed gently, mucosal involvement, fever, arthralgia”

A

Steven-Johnson Syndrome

57
Q

“scalded appearance over an extensive area, systemically unwell, positive Nikolsky’s sign: the epidermis separates with mild lateral pressure”

A

Toxic epidermal necrolysis

life-threatening

Drugs known to induce TEN:
- phenytoin
- sulphonamides
- allopurinol
- penicillins
- carbamazepine
- NSAID

Mx:
- supportive care
- IV Ig

58
Q

“ulceration above medial malleolus, ABPI 0.9-1.2”

A

Venous ulceration

Mx: compression bandaging
PO pentoxifylline

MSRA (21 decks)

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