Dermatology Flashcards
usually starts with a single ‘herald patch’, followed by a ‘Christmas-tree’ distribution of smaller patches along skin cleavage lines, predominantly on the trunk.
Pityriasis rosea
late pregnancy
benign
erythematous papules, vesicles or plaques. The rash often starts on the abdomen, particularly within stretch marks (striae), and can spread to the thighs and buttocks but rarely involves the face or mucous membranes
Polymorphic eruption of pregnancy
is a rare autoimmune blistering disorder associated with pregnancy. It usually begins in the second or third trimester or immediately postpartum. Lesions often start around the umbilicus before spreading to other parts of the body but unlike PEP, pemphigoid gestationis frequently involves the palms, soles and mucous membranes.
Pemphigoid gestationis
poxvirus
multiple dome-shaped papules with central umbilication
small, multiple lesions
umbilicated
6-12 months
Molluscum contagiosum
purple, polygonal, pruritic papules and plaques, often with a white lacy pattern (Wickham’s striae) visible on their surface. The lesions are typically larger than 1-2mm and lack umbilication. They commonly affect the flexor surfaces of wrists, legs, and oral mucosa.
lichen planus
congenital haemangioma occurring in around one in 20 babies. They tend to grown rapidly over the first few months of life then spontaneously regress over the course of a few years.
strawberry naevus
when is strawberry naevus a problem?
if over the spine (or impairing vision/ hearing)
The rolled, pearly edges with telangiectasia on the inferior border of the lesion
BCC
hand eczema, precipitated by humidity (e.g. sweating) and high temperatures
Pompholyx eczema (dyshidrotic eczema)
how to manage sebaceous cyst?
Excision of the cyst wall needs to be complete to prevent recurrence.
stress ulcer that can occur after severe burns
Curling’s ulcer
areas of bluish discolouration over the lower back and buttock which often disappear by 1 year of age.
mongolian blue spots
raised brown/black nodules which can be hairy and up to 20cm in diameter. There is a risk of developing melanomas from these and so they should be closely monitored.
melanocytic naevi
white patches in the oral cavity that cannot be rubbed off and are not attributed to any other identifiable cause. It is important to exclude other conditions such as lichen planus and squamous cell carcinoma through biopsy,
leukoplakia
well-demarcated areas of depigmentation due to destruction of melanocytes.
vitiligo
management scabies
permethrin 5% is first-line
malathion 0.5% is second-line
apply the insecticide cream or liquid to cool, dry skin
pay close attention to areas between fingers and toes, under nails, armpit area, creases of the skin such as at the wrist and elbow
allow to dry and leave on the skin for 8-12 hours for permethrin, or for 24 hours for malathion, before washing off
reapply if insecticide is removed during the treatment period, e.g. If wash hands, change nappy, etc
repeat treatment 7 days later
itching can persist for up to 6 weeks after successful treatment due to a delayed hypersensitivity reaction to the mites, even if all the mites have been killed. Retreatment should only be considered if new burrows or rashes appear, or if living mites are found upon examination.
Causes of scarring alopecia
include trauma/burns, radiotherapy, lichen planus, discoid lupus, tinea capitis
non scaring alopecia causes
male-pattern baldness
drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine
nutritional: iron and zinc deficiency
autoimmune: alopecia areata
telogen effluvium: hair loss following stressful period e.g. surgery
trichotillomania
molloscum contagious - do they need to go off school?
Time off school is not necessary but, as the condition is infectious, it is advised to avoid sharing baths, towels, or clothing with others to prevent transmission.
flexural psoriasis treatment
only mild/moderate steroid NOT fit D
Remember that the treatment of flexural psoriasis differs from extensor psoriasis. The skin of flexure areas of the body is much thinner and more sensitive to steroids compared to the extensor surfaces. Flexural surfaces that tend to be affected are the groin, genital region, axillae, inframammary folds, abdominal folds, sacral and gluteal cleft.
chronic plaque psoriasis management
a potent corticosteroid applied once daily plus vitamin D analogue applied once daily
should be applied separately, one in the morning and the other in the evening)
for up to 4 weeks as initial treatment
2nd line= just vit D
scalp psoriasis management
just potent steroid NOT vit D
What is the defining feature of erythema multiforme major
associated with mucosal involvement
Blisters/bullae - what two skin disease? (2)
NO MUCOSAL INVOLVEMENT = bullous pemphigoid
MUCOSAL INVOLVEMENT =pemphigus vulgaris
(Vulgaris =mucus)
Skin disorders and malignancy:
acanthosis nigricans
gastric cancer
Skin disorders and malignancy:
acquired ichthyosis
lymphoma
Skin disorders and malignancy:
acquired hypertrichosis lanuginosa
gastrointestinal and lung cancer
Skin disorders and malignancy:
dermatomyositits
ovarian and lung
Skin disorders and malignancy:
erythroderma
lymphoma
Skin disorders and malignancy:
migratory thrombophlebitis
pancreatic
Skin disorders and malignancy:
pyoderma gangrenosum
myeloproliferative disorders
Skin disorders and malignancy:
sweet syndrome
haematologyical
Skin disorders and malignancy:
tylosis
oesophageal
Guttate psoriasis
2-4 weeks pre streptococcal infection
Guttate psoriasi vs pitiriasiis rosea
Guttate:
tear drops
PR:
Herald patch followed 1-2 weeks later by multiple erythematous, slightly raised oval lesions with a fine scale confined to the outer aspects of the lesions.
May 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
non sedating antihistamine
cetirizine AND Loratadine
Fitzpatrickk
I: Never tans, always burns (often red hair, freckles, and blue eyes)
II: Usually tans, always burns
III: Always tans, sometimes burns (usually dark hair and brown eyes)
IV: Always tans, rarely burns (olive skin)
V: Sunburn and tanning after extreme UV exposure (brown skin, e.g. Indian)
VI: Black skin (e.g. Afro-Caribbean), never tans, never burns
Diabetes, waxy yellow shin lesions
necrobiosis lipoidica diabeticorum
The characteristic clinical presentation includes shiny plaques on the anterior aspect of the lower legs that are yellowish-brown with telangiectasias and atrophic skin. The plaques may be asymptomatic or painful and usually start as small papules that slowly enlarge.
qsymmetrical, erythematous, tender, nodules which heal without scarring
most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill)
erythema nodosum
Shin skin problems:
symmetrical, erythematous lesions seen in Graves’ disease
shiny, orange peel skin
Pretibial myxoedema
Shin problems:
initially small red papule
later deep, red, necrotic ulcers with a violaceous border
idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders
Pyoderma gangrenosum
Shin problems:
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia
Necrobiosis lipoidica diabeticorum
Impetigo management
management
1st= hydrogen peroxide 1% cream
2nd= topic fuscidic acid
benign, painful nodule on the ear
Chondrodermatitis nodularis helicis
Pityriasis rosea - what is the cause ? (1)
self limiting
herpes hominis virus 7 (HHV-7)
herald patch
hyperhidrosis
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
Causes of puritis:
History of alcohol excess
Stigmata of chronic liver disease: spider naevi, bruising, palmar erythema, gynaecomastia etc
Evidence of decompensation: ascites, jaundice, encephalopathy
liver disease
Causes of puritis:
Pallor
Other signs: koilonychia, atrophic glossitis, post-cricoid webs, angular stomatitis
iron deficiency anaemia
Causes of puritis:
Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease
Polycythaemia
Causes of puritis:
Lethargy & pallor
Oedema & weight gain
Hypertension
Chronic kidney disease
Causes of puritis:
Night sweats
Lymphadenopathy
Splenomegaly, hepatomegaly
Fatigue
Lymphoma
first line plaque psoriasis
POTENT steroids + vit D (BETAMETHASON not hydrocortisone)
Ankylosing spondylitis is associated HLA B27, a risk factor for which skin disease?
psoriasis
Lichen Planus vs lichen schlerosus
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
sclerosus: itchy white spots typically seen on the vulva of elderly women
A 45-year-old woman presents with itchy, violaceous papules on the flexor aspects of her wrists. She is normally fit and well and has not had a similar rash previously. What is it?
lichen plants
Management lichen plants
potent topical steroids are the mainstay of treatment
benzydamine mouthwash or spray is recommended for oral lichen planus
extensive lichen planus may require oral steroids or immunosuppression
reatment of choice in capillary haemangiomas requiring intervention
AKA strawberry naevus
propanalol
Topical beta-blockers such as timolol are also sometimes used.
Eczema herpeticum is a primary infection of the skin caused by …
herpes simplex virus (HSV)
eczema herpeticum treatment
IV acyclovir
dermatofibroma: where usually found? (1)
can be started by (2)
lower limbs
trauma or insect bites
Renal transplant patients are at risk of what cancer
squamous cell due to immunosuppression