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Phase 4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

what is the pathophysiology of acne?

A

chronic inflammation +/- localised infection in pileosebaceous units within the skin. increased sebum preduction traps keratin and blocks the pulosebaceous unit leading to swelling and inflammation. Androgenic hormones increase production of sebum => increased in puberty

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2
Q

what are macules?

A

flat marks on skin

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3
Q

what are papules?

A

small lumps on skin

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4
Q

what are pustules?

A

small lumps with pus

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5
Q

what are comedones?

A

skin coloured papules due to blocked pilosebaceous units

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6
Q

what are blackheads?

A

open comedones with black pigmentation in the middle

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7
Q

what are ice pink scars?

A

small indentations that remain in skin after acne lesion heals

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8
Q

what are hypertrophic scars?

A

small lumps in skin that remain after acne lesions heal

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9
Q

what are rolling scars?

A

irregular wave like irregularies of the skin that remain after acne lesions heal

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10
Q

what acne medication if teratogenic?

A

retinoids

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11
Q

what is general advice for acne? 5

A

Avoid overwashing
Use non-alkaline synthetic detergent BD
Avoid oil based cosmetics and suncream
Avoid picking
Treatment may irritate skin initially

not enough evidence to support diets for acne

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12
Q

what are the 5, 1st line treatments for acne?

A

Topical benzoyl peroxide + Topical Adapalene, OD - Any severity

Topical Tretinoin + Topical Clindamycin, OD - Any severity

Topical Benzoyl peroxide + Topical clindamycin, OD - Mild-moderate

Topical adapalene + Topical benzoyl peroxide, OD + Oral lymecycline/doxycycline OD - moderate-severe

Topical azelaic acid BD + oral lymecycline/docycycline OD - moderate-severe

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13
Q

what contraceptive pill is best at reducing acne?

A

COCP (co-cyprindiol (Dianette)) - anti-androgenic effect

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14
Q

what is the last line option for acne (specialist)?

A

oral retinoids (isotretinoin (accutane))

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15
Q

what are 5 side effects of isotretinoin?

A

dry skin and lips
photosensitivity of skin
depression, anxiety, aggression, suicidal ideation
Stevens-johnson syndrome and toxic epidermal necrolysis
Sexual dysfunction

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16
Q

what is the name for head lice?

A

Pedicures hymns capitis

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17
Q

what are the 2 first line management options of head lice?

A

Wet combing - systematically removing head lice with comb

Dimeticone 4% lotion - left on for 8 hours then washed off - repeat after 7 days to kill hatchlings - physical insecticide

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18
Q

How long can it take for scabies infection to appear after initial infestation?

A

up to 8 weeks - usually begin in 3-6 weeks

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19
Q

what is the presentation of scabies? 4

A

Very itchy erythematous papules often excoriated with hemorrhagic crusts

Itching usually worse at night

Track marks where mites have burrowed - thin brown-grey line

Classically between finger webs but can affect whole body - usually spares back and head in adults

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20
Q

what is the management of scabies?

A

Permethrin cream 5% - over 2 months old, to whole household

Applied all over body once weekly for 2 weeks, wash off after 8-12 hours

Also must wash all clothes and bedding on hot wash and hoover to destroy mites

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21
Q

How can scabies appear on genitals?

A

may be nodular even more itchy papules on genitals - usually indicative of sexually acquired scabies

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22
Q

what are Norwegian Scabies?

A

AKA Crusted scabies

In immunocompromised people
Mild/absent pruritus due to impaired immune response

Skin lesions generalised poorly defined erythematous fissured plaques covered by scales and crust - yellow-brown veracious aspect on bony prominences

need to be isolated

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23
Q

what are 2 tests that can be used to confirm scabies?

A

Ink burrow test - ink applied to suspect papule then wiped off with alcohol to remove surface ink - ink runs down burrow creating zigzag line

Microscopy of skin scrapings

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24
Q

what is the management of difficult to treat or Norwegian scabies?

A

Oral Ivermectin 200 micrograms/kg usually one dose, may be repeated a week later

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25
Q

what can be used to ease the itching from scabies?

A

Crotamiton crean and chlorphenamine

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26
Q

what is the name of the mite that causes scabies?

A

Sarcoptes Scabiei

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27
Q

what are 6 risk factors for scabies?

A

close living conditions
poor hygiene practices
socioeconomic factors
immunocompromised state
institutional settings
geographical distribution - higher in tropical regions

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28
Q

How long can pruritus continue after clearance of scabies?

A

4-6 weeks

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29
Q

what is folliculitis?

A

inflammation of the hair follicles

causes papules, pustules or nodules surrounding hair follicles

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30
Q

what are 4 infective causes of folliculitis?

A

Staph aureus
Pseudomonas aeruginosa
Candida
HSV

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31
Q

what are 3 non-infective causes of folliculitis?

A

dermatological - acne, hidradenitis suppurativa, epidermal cysts
Mechanical factors - tight clothes, shaving, plucking
Occlusive topical products - heavy creams, cosmetics, blocking hair follicles

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32
Q

what are 4 risk factors for folliculitis?

A

Immunosuppression
chronic diseases - impaired immunity and skin barrier
Obesity - increased skin folds
Prolonged Abx use - alters normal skin flora

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33
Q

what are 4 clinical features of folliculitis?

A

Erythematous papules and pustules
pruritus
pain
Folliculr hyperkeratosis - rough thick skin around hair follicle

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34
Q

what are 4 variations of folliculitis?

A

pseudofolliculitis barbae - beard bumps in men with curly hair

Hot tup folliculitis - sudden onset widespread

Eosinophilic folliculitis - in immunocompromised - intensely itchy pustules predominantly on upper body

Folliculitis decal vans - chronic deep folliculitis leading to scaring and permanent hair loss

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35
Q

what is the management of folliculitis?

A

conservative - hygiene, warm compress, avoid hair removal in area

Topical
- antiseptics - chlorhexidine
- antibiotics - fusidic acid
- antifungals - ketoconazole

Systemic Flucloxacillin if severe or recurrent

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36
Q

what are 6 complications of folliculitis?

A

Recurrent/chronic folliculitis
furuncles (boils) or carbuncles - deeper infection
Abscess
Sycosis barbae - scaring and hair loss in beard
Infection/sepsis
Post strep glomerulonephritis

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37
Q

what is the only 1st line acne management that can be used during pregnancy/breast feeding?

A

Topical benzoyl peroxide + topical clindamycin

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38
Q

How long to review 1st line acne management?

A

review after 12 weeks

if fails:
mild-mod - try another
moderate-severe - +Abx if prev treatment didn’t have them
Severe - if prev included abx - refer to derm

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39
Q

what are 6 complications of acne?

A

Scarring
Nodulocystic lesions
secondary infections
Hyperpigmentation
Post inflammation erythema
Psychological complications - anxiety, depression, social withdrawal, suicidal ideation

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40
Q

what are 3 complications of acne treatment?

A

Abx resistance
Tetracycline staining - staining to teeth if used in children and pregnant women
Isotretinoin side effects

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41
Q

what is the most common type of cancer in the west?

A

basal cell carcinoma

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42
Q

what are 4 features of basal cell carcinoma?

A

slow growth and local invasion
in sun-exposed sites - head and neck usually
pearly/flesh coloured papule with telangiectasia and rolled edge
may have ulcerated central crater

https://docs.google.com/document/d/1OTYukCgnWzNJWKFq39WzxtylmSEFxB-0RB5AD-IM71k/edit

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43
Q

what are 6 risk factors for basal cell carcinoma?

A

Male
UV exposure
Fair skin - Fitzpatrick I/II
Xeroderma pigemtosum
Immunosuppression
Arsenic exposure

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44
Q

what are 5 management options for BCC?

A

surgical removal or Mohs surgery
curettage
cryotherapy
topical cream - imiquimod , fluorouracil
radiotherapy

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45
Q

what are 2 medications for BCC?

A

Imiquimod
Fluorouracil

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46
Q

what 2 pathogen cause impetigo?

A

staph aureus - most common
strep pyogenes

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47
Q

what is the characteristic sign of impetigo?

A

golden crusted rash/skin infection

https://docs.google.com/document/d/1qoy21wpl4IiMomdMZYuv3hWnrli6vTGbrQIFKhZ3uJQ/edit

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48
Q

what are the two different types of impetigo?

A

bullous - 1-2cm fluid filled vesicles which grow and burst to form golden crusts. may be itchy
non-bullous - golden crusts

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49
Q

what is the cause of bullous impetigo?

A

always staph aureus

produces epidermolytic toxins that break down proteins and hold skin cells together causing fluid filled vesicles to form on skin

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50
Q

what is the management of non-bullous impetigo in children and adults? 3

A

1st line - hydrogen peroxide cream 1%, BD/TDS for 5 days

2nd - If unsuitable - topical fusidic acid 2% TDS

OR if fuscidic acid resistance - Mupirocin 2% TDS 5 days

3rd - oral flucloxacillin - when more widespread/unwell

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51
Q

what is the name of severe bullous impetigo?

A

staphylococcus scalded skin syndrome

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52
Q

what is the management of bullous impetigo?

A

abx - usually flucloxacillin

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53
Q

what are 6 complications of impetigo?

A

cellulitis
sepsis
scarring
post-streptococcal glomerulonephritis
staphylococcus scalded skin syndrome
scarlet fever

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54
Q

Can children go to school with impetigo?

A

Not until lesions are crusted and healed or 48 hours after starting Abx

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55
Q

what is the dose of flucloxacillin in adults for impetigo?

A

500mg QDS for 5 days

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56
Q

what abx is used in penicillin allergy in impetigo and what is the dose in adults?

A

Clarithromycin 250mg BD 5 days

IN PREGNANCY
Erythromycin 250mg-500mg QDS

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57
Q

what are the 2 different types of contact dermatitis/?

A

irritant - more common, due to exposure to damaging substances

Allergic - commonly due to nickel, fragrances, rubber accelerators and preservatives

Can also have mixed picture

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58
Q

what are the 3 layers of the skin?

A

epidermis
dermis
hypodermis

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59
Q

what are the 5 layers of the epidermis? mnemonic

A

Come Lets Get Sun Burnt - top to bottom

Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basalae

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60
Q

What are 3 variants of contact dermatitis?

A

phototoxic ad photoallergic contact dermatitis
Sysetemic contact dermatitis
Pigmented contact dermatitis

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61
Q

what does contact dermatitis look like?

A

Erythema, vesicles and bulae, oedema and puritus - in acute phase
Lichenification, fissuring and hypo/hyperpigmentation - in chronic phase

https://docs.google.com/document/d/1ajjHdB60SsDgKx_ZVqD6-o80DAZ2ZMwgWxdrzLKv5zw/edit

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62
Q

what are 3 ways to investigate contact dermatitis?

A

Patch testing
Skin biopsy - differential for psoriasis or T-cell lymphoma
Lab tests - ??underlying HIV/hep C

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63
Q

that is the management of contact dermatitis?

A

Identification and avoidance of trigger
Symptomatic Tx - ~Topical steroids, emollients
Referral to derm if symptoms persist

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64
Q

what are 4 complications of contact dermatitis?

A

secondary infections - impetigo, cellulitis
Chronic skin changes - lichenification, hypo/hyperpigmentation
Mental health
Sensitivity spread - allergic contact dermatitis spreading to wider allergic reactions

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65
Q

what virus causes cutaneous warts?

A

HPV

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66
Q

what are 5 risk factors for cutaneous warts?

A

Age - most common in children and young adults
Impaired immunity
Skin integrity
Contact with infected individuals
Environmental factors - moist environments, communal showers

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67
Q

what cells does HPV invade in the formation of cutaneous warts?

A

keratinocytes

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68
Q

what are 6 different types of cutaneous warts?

A

common warts - verruca vulgaris
Flat warts - verruca plana
Filiform warts
Palntar warts - verruca plantaris
Mosaic warts
Anogenital warts - condyloma acuminatum

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69
Q

what are the features of common warts?

A

firm, hyperkerototic papules or nodules with roughened surface - commonly found on hands, can be anywhere

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70
Q

what are the features of flat warts?

A

small, smooth, flat toped papules
often appear in large numbers
most common on face, dorm of hands and shins

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71
Q

what are features of filiform warts?

A

predominantly on face, lips and eyelids
threadlike or fingerlike in appearance, may have a stalk

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72
Q

what are plantar warts?

A

located on soles or feet or weight bearing areas

Flat appearance with central black speck

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73
Q

what are mosaic warts?

A

when plantar wats coalesce together to form a large plaque with a mosaic pattern

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74
Q

what are anogenital warts?

A

occur in anogenital region
appearance ranging from small smooth papules to large cauliflower like masses

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75
Q

what is the 1st line management of cutaneous warts?

A

Salicylic acid daily for up to 12 weeks
OR
Cryotherapy - every 2 weeks for up to 6 treatments

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76
Q

what advice should be given to people with warts?

A

Generally go away on own
Contagious but low risk of transmission
Avoid scratching to reduce personal spread

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77
Q

what are 5 cutaneous wart treatment options in secondary care?

A

physical ablation
Antimitotic treatment - podophyllotoxin, retinoids
Immunomodulatory therapy - imiquimod 5%
Virucidal Tx - formaldehyde and glutaraldehyde
Cantharidin

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78
Q

what is nappy rash?

A

contact dermatitis in the nappy area usually caused by friction and contact with urine and faeces in a dirty nappy

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79
Q

when is nappy rash most common?

A

between 9-12 months

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80
Q

what are 3 forms of rare severe nappy rash?

A

jacquet’s erosive diaper dermatitis - punch out ulcers/erosions with elevated borders

Peianal pseudoverrucous papules and nodules

Granuloma gluteal infant - 0.5-4cm large cherry red plaques and nodules, asymptomatic

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81
Q

How long does it take nappy rash to resolve?

A

within 1 week

can take up to 21 days with candida infection also

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82
Q

what are 6 risk factors for nappy rash?

A

delay in changing
iritant products and vigorous cleaning
Poorly absorbant nappies
diarrhoea
oral antibiotics - predispose candida
Pre-term infants

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83
Q

what is the presentation of nappy rash?

A

sore, red inflamed skin in nappy areas

Individual patches on exposure areas that come into contact with nappy

Spares folds

If severe may lead to erosions and ulcerations

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84
Q

what are 5 signs that indicate candida infection over nappy rash?

A

rash extending into skin folds
large red macules
well demarcated scaly border
circular pattern of rash spreading outwards
satellite lesions

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85
Q

what is the management of uncomplicated nappy rash?

A

Switch to higher absorbency nappy - disposable Gel matrix
Change and clean skin after soiling
Use water or alcohol free products for cleaning area
ensure nappy area dry before replacing nappy
maximise nappy free time

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86
Q

what is the management of inflamed nappy rash?

A

apply barrier treatment - soft paraffin ointment, zinc or caster oil ointment

Consider 1% hydrocortisone >1month old

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87
Q

what is given for nappy rash + suspected candida?

A

Clotrimazole 1%
Econazole 1%
miconazole 2%

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88
Q

what is given for nappy rash + bacterial infection suspected?

A

Oral flucloxacillin 7 days QDS
- 1 month-1year = 62.5-125mg
- 2-9 years = 125-250mg

IN ALLERGY - Clarithromycin - dose based off weight

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89
Q

what are the most common pathogen for cutaneous fungal infections?

A

Tichophyton

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90
Q

what are 5 risk factors for fungal skin infection?

A

Hot, humid climates or high temperatures
Tight fitting clothing
Obesity
Hyperhidrosis
Immunocompromised states

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91
Q

what are 4 complications of cutaneous fungal infection?

A

Secondary bacterial infection

Majocchi granuloma formation - dermatophte invades via hair follicle and penetrates deeper into skin

Fungal infection of the hand - tinea manuum

Tinea Incognito - due to inappropriate use of topical corticosteroids leads to changes in appearance of lesions

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92
Q

what are the different names of fungal infection in different parts of the body?

A

tinea pedis - athletes foot
tinea capitis - ringworm of scalp
tinea cruis - groin
tinea coporis - body
onchomycosis - nail

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93
Q

what does cutaneous fungal infection look like?

A

Single or multiple red/pink flat or slightly raised ring shape lesion with scaly advancing edge and clear central area

May have accumulated scales and have white/yellow curd like substance over infected area - if candida

Itchy

https://docs.google.com/document/d/1eHz4s6_7lqU8QmEmr7Fj-5giV8Ro4sg9LHW18YYMBP8/edit

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94
Q

what is a Kerion?

A

an abscess causes by a fungal infection most often caused by tinea capitis - causes boggy pus filled lump on scalp with localised alopecia

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95
Q

what is the 1st line management of mild-moderate cutaneous fungal infection?

A

Terbinafine 1% - >12 years - apply OD/BD for 1-2 weeks

CLotrimazole 1% - 2-3x a day for 4 weeks

Miconazole 2% - BD 10 days

Econazole 1% - BD till healed

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96
Q

what is the management of severe cutaneous fungal infection (tinea)?

A

Oral antifungals

1 - Terbinafine PO 250mg BD for 4 weeks

Itraconazol or griseofulvin if terbinafine contraindicated

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97
Q

what are 2 contraindications and 3 cautions to prescribing oral terbinafine?

A

Contraindications
- hepatic impairment
- severe renal impairment

Cautions
- autoimmune disease - risk of lupus like effect
- psoriasis - increases risk of exacerbation
- renal impairment - if eGFR <50, half dose

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98
Q

when can topical steroid be prescribed in cutaneous fungal infection?

A

if especially inflamed or itchy prescribe 1% hydrocortisone

99
Q

what is the management of severe cutaneous candida infection?

A

Oral FLuconazole 50mg PO OD for 2 weeks

100
Q

what are 3 contraindication to fluconazole?

A

acute porphyria
pregnancy
drug interactions - erythromycin, pimozide, quetiapine

101
Q

what are 3 instances where fluconazole should be prescribed with caution?

A

Risk of QT prolongation - cardiomyopathy, sinus Brady, arrhythmia, hypokalaemia etc…
Hepatic impairment
Renal impairment <50 eGFR

102
Q

what is the presentation of fungal scalp infection?

A

scaling and itching of scalp, may have circular patches of hair loss and erythema with scattered crusting pustules

103
Q

what is the management of fungal scalp infection?

A

1 - Oral griseofulvin - 1000mg OD for 4-8 weeks - for adults

+ Ketoconazole shampoo 2x weekly for 2-4 weeks

104
Q

what are 3 different types of fugal foot infections?

A

interdigital
moccasin/dry type - more diffuse, chronic presentation causing scaling an derythema
Vesicobullous type - vesicles and bullae

105
Q

what is the appearance of fungal nail infection?

A

Superficial white small flaky patches and pit son top of nail

Begins distally and spreads to nail plate

White or yellow opaque streaks along one side of nail

Sublingual hyperkeratosis

106
Q

what is the management of fungal nail?

A

1 - amorolfine 5% nail lacquer 2x weekly for 9-12 months

2 - oral terbinafine 250mg OD for 6 weeks /itraconazole 200mg BD for 1 week then repeat after 21 days

107
Q

what is the pathophysiology of urticaria?

A

caused by release of histamine and por-inflammatory chemicals by mast cells

may be part of allergic reaction or autoimmune reaction

108
Q

what are 6 causes of acute urticaria?

A

Allergies
Contact with chemicals. latex, stinging nettles
medications
Viral infections
insect bites
dermatographism

109
Q

what is chronic idiopathic urticaria?

A

describes recurrent episodes of chronic urticaria without a clear trigger

110
Q

what is chronic inducible urticaria?

A

chronic urticaria inducible by certain triggers

sunlights
temperature change
exercise
strong emotion
hot or cold weather
pressure

111
Q

what is autoimmune urticaria?

A

chronic urticaria associated with underlying autoimmune conditions such as SLE

112
Q

what is the management of urticaria?

A

1 - Non-sedating antihistamines
- Certirizine, fexofenadine or loratadine - can consider up to 4x licensed dose

if severe short course of steroids for 7 days

Leukotriene receptor antagonist - montelukast or leukotriene receptor antagonist

113
Q

what classes as chronic urticaria?

A

> 6 weeks

114
Q

what score can be used to assess severity of urticaria?

A

urticaria activity score - UAS7

115
Q

what are 4 subtypes of psoriasis?

A

plaque psoriasis
flexural psoriasis
guttate psoriasis
pustular psoriasis

116
Q

what are 4 nail changes in psoriasis?

A

pitting
oncholysis
sublingual hyperkeratosis
loss of nail

dactylisis - sausage fingers

117
Q

what infection often triggers guttate psoriasis?

A

streptococcal infection 2-4 weeks prior

118
Q

what are 4 medications know to trigger psoriasis?

A

Lithium
beta blockers
antimalarials
NSAIDs

119
Q

What is the pathophysiology of psoriasis?

A

abnormal activation of T cells leading to keratinocyte hyperproliferation

120
Q

what is plaque psoriasis (psoriasis vulgaris)?

A

well-demarcated erythematous plaques with silvery scales typically located on elbows, knees, scalp and lower back

https://docs.google.com/document/d/1IKNTFez0ZKzcx5rMylEo3n6XHePlfhvkTvgDyIsUmhY/edit?tab=t.0

121
Q

what is guttate psoriasis?

A

small, raindrop-sized lesions often occurring after a streptococcal pharyngitis infection in children and young adults

https://docs.google.com/document/d/1rmtC2AwmgjuLYXW9lu3SSoX4uGJj4hZhGJZJFcFhNUY/edit?tab=t.0

122
Q

what is flexural psoriasis?

A

variant is seen in skin folds such as axillae, inguinal region and under breasts. Lesions are smooth, shiny and lack scales due to moisture in these areas

123
Q

what is pustular psoriasis?

A

Localised or generalised sterile pustules on an erythematous base.

Palmoplantar pustulosis (localised to hands and feet)

Generalised pustular psoriasis which can be life-threatening requiring immediate medical intervention

124
Q

what is erythrodermic psoriasis?

A

severe inflammatory form leading to widespread erythema covering almost the entire body surface area - skin comes away in large patches. This type can be potentially life-threatening due to high risk of infection and fluid loss

125
Q

what are 5 signs of psoriasis?

A

plaques - raised ret patches covered in silvery white dead skin cells or scales

Nail changes

Auspitz sign - removal of scales causes pinpoint bleeding due to ruptures in dermis

Koebner phenomenon - new psoriatic plaques form at sign of skin injury or trauma

residual pigmentation

126
Q

what is the management of mild to moderate plaque psoriasis?

A

1 - emollients, topical corticosteroid + vitamin d analogues (calcipotriol)

2 - coal tar preparations, dithranol

127
Q

what are some options for the management of severe/unresponsive psoriasis?

A

narrow band UVB phototherapy
Non-biological therapies - methotrexate, ciclosporin, acitreitin
Biological therapies

128
Q

what are the names of two combo vitamin d analogue and steroid preparations prescribed by a specialist?

A

dovobet
enstilar

129
Q

what 3 conditions does psoriasis increase the risk of?

A

cardiovascular disease - assess Qrisk every 5 years
Psoriatic arthritis
mental health issues

130
Q

how long does it tae lesions to resolve in guttate psoriasis?

A

2-3 months

131
Q

what are the 3 key clinical features of pityriasis rosea?

A

large oval ‘herald’ patch on trunk 2 weeks before rest of plaques

itchy rash

erythematous oval papular scaly patches on trunk and extremities in fir tree pattern

132
Q

what is the presentation of molluscum contagiosum?

A

pink/pearly white papule with central umbilication up to 5mm

https://docs.google.com/document/d/1P17Nkki4zqHr3LvtD0-fZgdLeRC-nq6PRSqAqBE5WgM/edit?tab=t.0

133
Q

what are3 conditions which can lead to arterial ulcers?

A

Peripheral arterial disease
Diabetes Mellitus
Rheumatoid Arthritis - due to vasculitis

134
Q

what are 5 non-medical risk factors for arterial ulcers?

A

Smoking
poor nutrition - impaired wound healing
Older age
Obesity
Immobility

135
Q

what are 8 features of arterial ulcers?

A

Distal, affecting toes or dorsum of foot
PAD symptoms
Smaller and deeper than venous
Well defined borders
Punched out appearance
Pale
Less likely to bleed
Painful - worse when lying horizontally and on elevation

136
Q

what are 8 features of venous ulcers?

A

In gaiter areas - between top of foot and bottom of calf muscle
Chronic venous changes - hyperpigmentation, venous eczema, haemosiderosis, lipodermatosclerosis
Often after minor injury
More superficial
irregular sloping borders
more likely to bleed
Less painful, relieved by elevation

137
Q

where do arterial ulcers usually occur?

A

pressure area - toes, heels, lateral malleoli

138
Q

what are 4 investigations for ulcers?

A

Ankle brachial plexus index
Doppler USS
MRA or CTA
Tissue biopsy and charcoal swabs

139
Q

what is the management of arterial ulcers?

A

Revascularisation surgery - if ABPI <0.8

Wound care - maintain moist wound environment, hydrocolloids, hydrogels, foam dressings
Pain management
Lifestyle modification

140
Q

what are 5 complications of arterial ulcers?

A

Infection
gangrene
limb amputation
sepsis
pain

141
Q

what is the pathophysiology of venous ulcers?

A

Chronic venous insufficiency leads to venous hypotension and increased capillary pressure leading fluid and blood cells to leak into interstitial space. This leads to local hypoxia, inflammation, skin and subcutaneous tissue damage

142
Q

what is the management of venous ulcers?

A

Would cleaning, debridement, dressing

Compassion therapy (after arterial disease ruled out with ABPI) - 4 layer compression

Pentoxifylline - orally - not licenced

ABx and analgesia

r/f to vascular, derm, tissue viability, pain, diabetes depending

143
Q

what is a stage one pressure ulcer?

A

non-blanching erythema, may be warm and darkly pigmented

144
Q

what is stage 3 pressure ulcer?

A

full thickness - with loss of subcutaneous fat some f which may still be visible. May slough

145
Q

what is a stage 2 pressure ulcer?

A

partial thickness with loss of dermis presenting as shallow open ulcer

146
Q

what is stage 4 pressure ulcer?

A

full thickness and affecting bone/tendon/muscle which is visible/palpable, may slough

147
Q

what scoring system is used for risk of pressure ulcers?

A

Waterloo score

148
Q

what are 4 risk factors or pressure ulcers/

A

malnourishment
incontinence - urinary or faecal
lack of mobility
significant cognitive impairment

149
Q

what is the management of pressure ulcers?

A

moist wound environment - hydrocolloid dressings and hydrogels
Tissue viability nurse

150
Q

what are 6 risk factors for cellulitis?

A

Venous insufficiency and PAD
Skin breaks + conditions that disrupt dermis
T2DM
Immunocompromised
Obesity
Pregnancy

151
Q

what is the most common pathogen causing cellulitis?

A

1 - Strep pyogenes
also other group A beta haemolytic strep

2 - Staph Aureus

152
Q

what are 4 complications of cellulitis?

A

Necrotising fasciitis + myositis
Sepsis
Subcutaneous abscess

153
Q

what are the clinical features of cellulitis?

A

Swelling, erythema, warmth, tenderness

fever, malaise, nausea

154
Q

what classification is used for cellulitis?

A

Eron classification

155
Q

what is Eron 1?

A

For cellulitis

no sign of systemic toxicity, no co-morbidities

156
Q

what is eron 2?

A

cellulitis

systemically unwell or well but with co-morbidities - PAD, venous insufficiency, morbid obesity

157
Q

what is eron 3?

A

for cellulitis

significant systemic upset - acute confusion, tachycardia/pnoea, hypotension

158
Q

what is eron 4?

A

for cellulitis

sepsis or necrotising fasciitis

159
Q

what is the 1st line management of cellulitis in adults?

A

Flucloxacillin 500-1000mg QDS 5-7 days

ALLERGY - Clarithromycin 500mg BD, Doxycycline 200mg day 1 then 100mg OD

Pregnancy + Allergy - Erythromycin 500mg QDS

5-7 days

160
Q

when should IV Abx be given in cellulitis?

A

Eron III or IV
Severe dapidly deteriorating cellulitis
very young or very old
immunocompromised
significant lymphoedema

161
Q

what is the 1st line abx in cellulitis near eyes or nose?

A

Co-amoxiclav 500/125mg TDS for 7 days

ALLERGY - Clarithromycin 500mg BD + Metronidazole 400mg TDS

162
Q

mutations in what gene can cause increased risk of eczema?

A

Filaggrin genes (FLG)

163
Q

what is the most common cause of necrotising fasciitis?

A

streptococcus pyogenes

164
Q

what are 7 risk factors for necrotising fasciitis?

A

recent trauma, burn or skin infection
advancing age
immunosuppression
diabetes
SGLT-2 inhibitors
Marine exposure
close contact with others with nec fasc

165
Q

what is the clinical presentation of necrotising fasciitis?

A

early - intense pain, skin puncture injury, flu like symptoms, erythema, hypersensitive skin

Late - subcutaneous emphysema, skin necrosis (blue, white, dark, mottled), fever, reduced sensation, hypotension, tachycardia

166
Q

what is the management of necrotising fasciitis?

A

Immediate surgical debridement

IV Abx - broad spectrum - Iv fluclox, benpen, metronidazole, clindamycin, gent

Supportive care - aggressive fluids

Amputation

167
Q

what are the 2 growth phases of melanomas?

A

Radical - growth in the epidermis
vertical - growth downwards into the dermis - more likely to lead to metastasis

168
Q

what are 9 risk factors for melanoma?

A

Increasing age
FHx
Pale skin - fitzpatrick I/II
Red/blonde/light hair
UV exposure
Precursor lesions - dysplastic naevi
Previous skin cancers
immunosuppression
xeroderma pigmentosum - autosomal recessive condition

169
Q

How do you assess a possible melanoma?

A

ABCDE

Asymmetry of lesion
Border irregularities
Colour - non-uniform
Diameter >6mm
Evolution - shape, size, colour

170
Q

what is the most common type of melanoma?

A

Superficial spreading

171
Q

what are the 5 different types of melanoma?

A

superficial spreading
nodular
lentigo maligna
acral lentiginous
amelanotic

172
Q

what is a superficial spreading melanoma?

A

Flat pigmented lesion with asymmetrical or irregular borders
Horizontal growth
Sun exposed areas

173
Q

what is a nodular melanoma?

A

2nd most common

Red/brown nodule that may ulcerate/bleed easily

Vertical growth

sun exposed areas

174
Q

what is lentigo maligna melanoma?

A

irregularly shaped macule
slow horizontal growth
seen in elderly
common on face

175
Q

what is acral lentiginous melanoma?

A

palms, soles, nail bed

Hutchinson sign - dark linear subunggual patch

more common in darker skin

not related to UV exposure

176
Q

what is an amelanotic melanoma?

A

pink nodule lacking pigmentation

177
Q

what are the major and minor criteria for melanoma referral and what score means increased suspicion?

A

> 3 points

Major +2 point
- Change in size
- irregular shape/border
- Irregular colour

Minor +1 point
- largest diameter >7mm
- inflammation
- oozing or crusting of lesion
- change in sensation - including itch

178
Q

What is the investigation for melanoma?

A

dermoscopy

Excision biopsy

CT TAP for staging

179
Q

what is the management for early stage melanoma?

A

Excision
topical iquimod

stage 0-II

180
Q

what is the management of advanced stage melanoma?

A

stage III

Lymph node dissection or lymphadenectomy
Radiotherapy
Resection of mets

181
Q

what is the management of late stage melanoma?

A

systemic tx - BRAF inhibitors, immunotherapy, chemo
radiotherapy
resection of mets

182
Q

where does melanoma spread to?

A

Lymph nodes
Brain
Bone
Liver
Lung
GI tract

183
Q

what is actinic keratosis?

A

dysplastic epidermal lesions which are usually precursors to cutaneous squamous cell carcinomas

184
Q

what is the pathophysiology of actinic keratosis?

A

UVB radiation mutates p53 gene in DNA of keratinocytes preventing apoptosis and causing keratinocytes to undergo clonal expansion

185
Q

what are 6 risk factors for actinic keratosis?

A

Chronic UVB exposure
Pale skin
Male
Xeroderma pigmentosum
Immunosuppression
Increasing age

186
Q

what is the presentation of actinic keratosis?

A

Usually pink with yellow tinge
Rough scaly macule or papule
1-5mm
irregularly shaped
on sun exposed areas

187
Q

what is the management of actinic keratosis?

A

Cyotherapy
Curettage
excision
Topical therapy - fluorouracil, iquimod, diclofenac

188
Q

what are 6 complications of actinic keratosis?

A

pruritus
bleeding
progression to invasive squamous cell carcinoma
scaring
hypopigmentation
transient irritation

189
Q

what is another name for cutaneous squamous cell carcinoma in situ?

A

Bowen’s disease

190
Q

what is the second most common type of skin cancer?

A

squamous cell carcinoma

191
Q

what are 5 risk factors for squamous cell carcinoma?

A

Sun exposure and Hx of sunburn
use of tanning beds
chronic skin inflammation or injury
HPV
Immunosuppression

192
Q

what are 3 types of invasive squamous cell carcinoma?

A

cutaneous horn - produced by excess keratin production
Marjolin ulcer - develops with scar or ulcer
Keratoacanthoma

193
Q

what are 5 presentations of squamous cell carcinoma?

A

itchy tender or painful lesions
ulcerating lesions
UV exposed areas
Scaly or erythematous lesions
irregular borders

194
Q

what is the investigation for squamous cell carcinoma?

A

Dermoscopy
Skin biopsy

CT TAP for staging

195
Q

what is the management of squamous cell carcinoma?

A

Surgical excision - wide local (4/6mm margins) or Moh’s surgery
Aggressive cryotherapy
Radiotherapy

Topical 5-fluorouracil - in situ
Imiquimod - in situ

196
Q

what are 4 complications of squamous cell carcinoma?

A

Local recurrence
mets
nerve involvement - perineural invasion
Radiation dermatitis

197
Q

what is erythema multifome?

A

erythematous rash caused by hypersensitivity reaction

Associated with viral infection, medications, HSV and mycoplasma pneumonia

198
Q

what pneumonia is associated with erythema multiforme?

A

mycoplasma pneumoniae

199
Q

what pneumonia is associated with erythema multiforme?

A

mycoplasma pneumoniae pneumonia

200
Q

what is the presentation of erythema multiforme?

A

widespread itchy erythematous rash

Target lesions - red rings within larger red rings, darkest at the centre like a bullseye

Can appear anywhere on body, usually on palms and soles

Not on oral mucosa but can cause sore mouth (stomatitis)

https://docs.google.com/document/d/1wyVi10pgtM5EjQn2xPFkyTGvRLXTB_heTU-tvWeUmec/edit?tab=t.0

201
Q

where is eczema usually found?

A

flexor surfaces

202
Q

what is the pathophysiology of eczema?

A

there are defects in the skin barrier allowing entrance of microbes, irritants and allergens which leads to immune response

203
Q

what is the most significant genetic risk factor for eczema?

A

mutations in Filaggrin gene

204
Q

what ae 6 features of eczema?

A

Itch
Erythema
Skin lesions
Dry skin
Lichen simplex chronicus - thick hyperpigmented skin over chronic lesions
Distribution - flexor surfaces, hands, face, trunk

205
Q

what is the diagnostic criteria for eczema?

A

An itchy skin condition in last 12 months

+ 3 of
- onset <2 years
- Hx of flexural involvement
- Hx of generally dry skin
- PHx of atopy
- Visible flexural dermatitis

206
Q

How is eczema managed not in a flare?

A

emollients and trigger avoidance

207
Q

what is the management of eczema flares?

A

Thicker emollients
Topical steroids
Wet wrapping

IV ABx and oral steroids if very severe

208
Q

what are 4 specialist treatments for eczema?

A

Zinc impregnated bandages
Topical tacrolimus
Phototherapy
Systemic immunosuppression

209
Q

what are 3 thin emollients?

A

E45
Diprobase cream
Aveeno cream

210
Q

what are 3 thick emollients?

A

50:50 ointment
Hydromol ointment
Diprobase ointment

211
Q

what is the steroid cream ladder?

A

mild - hydrocortisone 0.5,1,2.5%
moderate - eumovate (clobetasol butyrate) 0.05%
potent - betamethasone 0.1%
very potent - clobetasol propionate 0.05%

212
Q

how should emollients and topical steroids be administered in relation to each other?

A

Emollients
wait 30 mins
Topical steroids

213
Q

what is the most common bacterial infection in eczema?

A

s aureus

214
Q

what abx can be used to treat bacterial infection of eczema?

A

Topical fusidic acid 2% 5-7 days

Oral flucloxacillin 500g QDS - 5-7 days

PEN ALLERGY - Oral Clarithromycin 250mg BD

215
Q

what are 3 complications of eczema?

A

Skin infection
eye complications - blepharitis and conjunctivitis more common
Psychosocial impact

216
Q

what is eczema herpeticum?

A

viral skin infection caused by HSV-1 most commonly or varicella zoster

217
Q

what is the presentation of eczema herpeticum?

A

eczema sufferer develops a rapidly progressing widespread painful vesicular rash with monomorphic punched out erosions 1-3mm

Also has fever, lethargy, irritability, reduced oral intake and swollen lymph nodes

218
Q

What is the management of eczema herpeticum?

A

Aciclovir - 10-14 days

Ganciclovir for ocular involvement

219
Q

what is seborrhoeic keratosis?

A

Common benign proliferation of keratinocytes associated with increasing age and UV exposure

220
Q

what is the appearance of seborrhoeic keratosis?

A

Warty skin lesions
Stuck on appearance
Usually multiple lesions
Usually brown but can range in colour

https://docs.google.com/document/d/1S_oYGYEw8lfWvzg4M3tNOvjA3A8GOESySV58HMXSIJU/edit?tab=t.0

221
Q

what is the management of troublesome seborrhoeic keratosis?

A

Curettage
cryotherapy
shave biopsy
ablative laser therapy

222
Q

what is Seborrhoeic dermatitis?

A

inflammatory condition of sebaceous glands causing erythema, dermatitis and crusted dry skin

223
Q

what is the medical name for cradle cap?

A

Seborrhoeic dermatitis

224
Q

what pathogenic colonisation is thought to play a role in Seborrhoeic dermatitis?

A

Malassezia yeast (furfur)

225
Q

what is the presentation of Seborrhoeic dermatitis?

A

Eczematous lesions on sebum rich areas - scalp, periorbital, auricular, nasolabial folds, back
Dandruff
Itching
Yellow or white scales
Erythematous greasy patches

Otitis externa and blepharitis may develop

https://docs.google.com/document/d/1ELUMg7_KGEmSYtllmztjzfBfZyDQ8RwUDoCXq1R1tqs/edit?tab=t.0

226
Q

what are 2 conditions associated with Seborrhoeic dermatitis?

A

Parkinsons
HIV

227
Q

what is the management of Scalp Seborrhoeic dermatitis?

A

1 - Ketoconazole 2% shampoo

OTC - Zinc pyrithione (head and shoulders), Tar (neutrogena t/gel)

Selenium sulphide and topical corticosteroids

228
Q

what is the managing of face and body Seborrhoeic dermatitis?

A

1 - Ketoconazole

2 - Clotrimazole or miconazole

topical steroids

229
Q

what is the management of cradle cap?

A

1 - Baby oil/oil and gentle brushing of scalp then washing off crusts

2 - whit petroleum jelly overnight then washing off crusts in morning

3 - Clotrimazole, miconazole

230
Q

what are 7 features of rosacea?

A

Affects nose, cheeks and forehead
Flushing often 1st symptom
Telangiectasia are common
Later persistent erythema, papules and pustules
Rhinophyma - thickened enlarge glands of nose
Blepharitis
Sunlight may exacerbate

https://docs.google.com/document/d/1TfJnT9_kR9LoAg-pURh0_k8g1XTQaiSWZn9dvjsFJc0/edit?tab=t.0

231
Q

what is the management of rosacea?

A

Prevention of flares - High factor sun cream
Topical brimonidine gel - reduces redness within 30 mins
Topical ivermectin - for papules/pustules
Severe papules/pustules = topical ivermectin PLUS oral doxycycline
Extensive telangiectasia - laser therapy

232
Q

what is stevens-johnson syndrome and toxic epidermal necrosis?

A

a disproportionate immune response causing epidermal necrosis resulting in blistering and shedding of top layer of skin

SJS <10% of body
TEN >10% of body

233
Q

what are 6 medications that can cause stevens-johnson syndrome?

A

anti-epileptics(lamotrigine, carbamazepine, phenytoin)
antibiotics - sulphonamides, penicillins
allopurinol
NSAIDs
COCP

234
Q

what are 7 infections that can cause stevens-johnson syndrome?

A

herpes
HIV
Mumps
FLu
EBV
mycoplasma pneumonia
CMV

235
Q

what is the natural history of stevens-johnson syndrome?

A

starts with fever, cough, sore throat, mouth, eyes and skin
then develop purple/red rash which blisters
the after a few days skin sheds leaving raw tissue underneath

can also affect internal organs

236
Q

what sign is positive in SJS/TEN?

A

Nikolsky sign - erythematous areas are rubbed gently and blisters and erosions appear where epidermis has separated

237
Q

what is the management of stevens-johnson syndrome?

A

admit to derm/burns unit

steroids
IVIG
Immunosuppression - ciclosporin, cyclophosphamide

238
Q

what are 4 complications of SJS/TEN?

A

secondary infection
permanent skin damage and scarring
visual complications with eye involvement
dehydration and electrolyte disturbance

239
Q

what is Pyoderma gangrenosum?

A

Rare non-infectious inflammatory disorder of painful skin ulceration most commonly in lower legs

240
Q

what is the pathophysiology of Pyoderma gangrenosum?

A

neutrophilic dermatosis - dense infiltration of neutrophils in affected tissue

241
Q

what are 6 risk factors for Pyoderma gangrenosum?

A

Idiopathic

IBD
Rheumatological - SLE, RhA
Haematological
Granulomatosis with polyangiitis
Primary biliary cirrhosis

242
Q

what is the presentation of Pyoderma gangrenosum?

A

small pustule, red bump or blood blister where skin breaks down to a deep necrotic ulcer with a purple edge

243
Q

what is the management of Pyoderma gangrenosum?

A

1 - oral steroids

Immunosuppression

Phase 4 (22 decks)

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