Dermatology Flashcards
what are the 2 main groups of lupus erythematosus
- systemic lupus erythematosus
- cutaneous lupus erythematosus
what are diagnostic criteria for systemic lupus erythematosus (3 aspects)
- mucocutaneous
- haematological
- immunological
what are the main diagnostic criteria in mucocutaneous aspect for systemic lupus erythematosus
oral ulcers
cutaneous lupus
alopecia (hair loss)
what are the main diagnostic criteria in haematological aspect for systemic lupus erythematosus (3)
haemolytic anaemia
thrombocytopenia
leukopenia
(usually blood cell types decrease)
what are the main diagnostic criteria in immunological aspect for systemic lupus erythematosus
ANA (Anti-nuclear antibodies)
anti dsDNA
anti Sm ( highly specific antibody for systemic lupus erythematosus)
antiphospholipid
low complement
Direct Coomb’s test (looks at your red blood cells to see if there are antibodies attached to them)
clinical presentations of pt in systemic lupus erythematosus (6)
- photodistributed rash
- cutaneous vasculitis
- alopecia
- livedo reticularis
- cutaneous vasculitis
- subacute cutaneous lupus (ring like pattern)
7.chilblains - palpable purapura
how does subacute cutaneous lupus (SCLE)look like on skin
ring like pattern
what does discoid/cutaneous lupus look like
scaring unlike SCLE
what kind of disease is dermatomyositis
autoimmune connective tissue disorder
main clinical presentations from pt in dermatomyositis (2)
proximal extensor inflammatory myopathy
photodistributed pink violet ras at scalp, periocular regional and extensor surfaces
what is Gottron’s papules in presentations of dermatomyostitis
red, often scaly, bumps overlying the knuckles of the fingers
other presentations of gottron’s papules of dermatoly
ragged cuticles
shawl sign (rash at upper trunk)
photosensitive erythema
heliotrope rash
can muscle myostitis be predicted depending on auto antibody profile
yes, as each subtype have very specific clinical features
what is Anti-p155/ TIF-1gamma associated with
cancer malignancy
what is anti-MDA5 associated with
interstitial lung disease
digital ulcer
ischaemia
how to diagnose dermatomyositis
1.blood tests (ANA, CK)
2. EMG
3. skin biopsy
4. LFT (ALT increased )
5. muscle MRI
6. screening for internal malignancy
what is Henoch–Schönlein purpura
IgA vasculitis(a disorder that causes the small blood vessels in your skin, joints, intestines and kidneys to become inflamed and bleed)
symptoms of IgA vasculitis
abdominal pain
bleeding
arthralgia (joint stiffness, pain)
glomerulonephritis (so we needa monitor urine)
which type of vessels are affected in IgA vasculitis
small vessels
manifestations of small vessel vasculitis
purpura (small flat spots on skin)
manifestations of medium vessel vasculitis
digital necrosis
retiform purpura ulcers
subcutaneous nodules along blood vessels
what is DRESS full form
Drug reaction with eosinophilia and systemic symptoms
DRESS symptoms
fever (>/=38.5)
tachycardia
lymphadenopathy (>/=2sites, >1cm)
circulating atypical lymphocytes
peripheral hypereosinophilia)
internal organs involved (liver, kidney, cardiac)
negative ANA
skin involvement
cutaneous eroption
is ANA positive or negative in DRESS
negative
what are internal organ involvements in DRESS
liver (hepatitis) associated with majority of death
kidneys (interstitial nephritis)
heart (myocarditis)
brain
thyroid (thyroiditis)
lungs (interstitial pneumonitis)
what are common triggers of DRESS
allopurinol (gout)
sulfonamides
anti-epileptics
antibiotics
ibuprofen
how do rash look like in DRESS
utricated papular exanthem (widespread papules)
maculopapular eruption
eryrthema multiforme-like
rash in abdomen region
will there be head neck oedema in DRESS
yes
treatment for DRESS
withdraw drug
corticosteroids as first line
mortality rate of DRESS
5-10%
what does pruritus ean
itchy
itching without rash suggest what
internal cause
internal organ dysfunction/ metabolic abnormalities
what are some internal causes of itchy without rash
haematological cause (lymphoma, polycythemia)
uraemia
cholestasis
iron deficiency or overload
HIV/ Hep A/B/C
cancer
drugs (opiods)
psuchogenic
old age
what can chronic rubbing and scratching when itchy
appearance of nodules
what test need when itchy
blood tests
lymph nodes
imaging
investigations for pruritus
FBC, LDH (lactate dehydrogenase test)
LFT
CXR
HIV
Hep A,B,C
what is SJS
stevens-johnson syndrome
toxic epidermal crisis
symptoms of SJS
flu like symptoms
abrupt onset of lesions on trunk more often than in face/limbs
macules, nlisters, erythema (atypical targetoid)
blisters merge (sheets of skin detachment ) to reflect extensive full thickness mucocutaneous necrosis
blisters merge are seen in which dermatology disease
SJS
what is macules
a flat, distinct, discolored area of skin
does SJS have lymphadenopathy
no
which has a larger BSA detachment , SJS or Toxic Epidermal necrolysis (TEN)
TEN
which has a higher mortality rate, SJS or Toxic Epidermal necrolysis (TEN)
TEN
cause of SJS / TEM
drugs
cell mediated cytotoxic reaction against epidermal cells
what are differential diagnosis for SJS / TEN
Staphylococcal scalded skin syndrome (SSSS)
thermal burns
cutaneous graft versus host disease
common drugs that cause SJS
antibiotics
anti-epileptic drugs
NSAIDs
what is the scoring system to helpa ssess severity of SJS / TEN
SCROTEN
what are the criterias for SJS severity
> 40yo
initial % epidermal detachment
serum urea, glucose, bicarbonate
presence of malignancy
complications of SJS/ TEN(9)
death
blindness
dehydration
hypothermia/hyperthermia
renal tubular necrosis
eroded GIT
interstitial pneumonitis
neutropenia
liver, heart failure
what is psoriasis
skin condition that causes flaky patches of skin, which form silvery-white or grey scales
which condition does psoriasis flare usually follow
recent streptococcal throat treated with oral steroids
what are systemic manifestations of erythema to reflect impariment in skin function
peripheral oedema
tachycardia
loss of fluids and proteins
disturbances in thermoregulation
risk of sepsis
why erythroderma cause peripheral oedema
loss of protein across epidermis
why erythroderma cause risk of sepsis
loss microbial biological barrier
what are aetiologies of erythroderma
psoriasis
atopic eczema
drug reaction
cutaneous Tcell lymphoma
idiopathic
what is sezary syndrome
cutaneous T cell lymphoma
management of erythroderma
treated psoriases
withdraw drug that caused it
restore fluid and electrolyte imbalance
manage body temp
emollients to support skin barrier
what is folliculitis
inflammation of hair follicles
apperance of folliculitis (2)
follicular erythema
sometimes pustular
HIV is associated with which type of folliculitis
eosinophilic folliculitis (non-infectious)
is folliculitis infectious or non
can be both
which bacteria is recurrent folliculitis associate with
Staphylococcus aureus
strains expressing PVL (panton valentine leukocidin)
treatment for folliculitis
antibiotics (erythromycin or flucloxacillin)
incision and drainage
in folliculitis, what is the difference between furuncle and carbuncle
furuncle is deep follicular abscess, while carbuncle involves adjacent connected follicles
carbuncle more likely to lead to complications eg cellulitis and septicaemia
how is staphyloccocus aureus established
Establishment as a part of the resident microbial flora
abundant in nasal flora
what is PVL from Staphylococcus aureus
B pore forming exotoxin produced by Staph. aureus
what do PCL cause to leukocyte and tissue
Leukocyte destruction and tissue necrosis
characteristics of PVL Staphy. Aureus
Often painful, more than 1 site, recurrent, present in contacts
what are the risks of acquiring PVL Staphylococcus Aureus (5C)
- close contact
- contaminated items (gym, towel)
- crowding (living condition)
- cleanliness of environement
- cuts and grazes (allow bacterial entry)
treatment for PVL Staphylococcus Aureus
antibiotics (tettracycline)
chlorhexidine body wash for 7 days
nasal application of mupirocin ointment
what is cellulitis
Infection of lower dermis and subcutaneous tissue
symptoms of cellulitis (3)
Tender swelling with ill-defined
blanching erythema
oedema
bacteria that cause cellulitis (2)
Streptococcus pyogenes Staphylococcus aureus
what is predisposing factor of cellulitis
oedema
treatment for cellulitis
oral or IV antibiotics
what is impetigo
Superficial bacterial infection, stuck-on, honey-coloured crusts overlying an erosion.
(surround mouth)
which bacteria cause non bullous impetigo
streptococci
which bacteria cause bullous impetigo
staphylococci
where do impetigo often affect
face
ears, nares
treatment of impetigo
topical with or without systemic antibiotics
which bacteria cause impetiginisation
staphylococcus aureus
appearnace of impetiginisation
gold crust
what is impetiginsation
atopic dermatitis
superficial infection of eczema skin
what is Borreliosis (lyme disease)
Annular erythema develops at site of the bite of a Borrelia-infected tick
what do lxodes tick infected to cause borreliosis
Borrelia burgdorferi
initial manifestation of borreliosis
erythema migrans
appearance of borreliosis
Erythematous papule at the bite site
Progression to annular erythema of >20cm
symptoms of borreliosis
infection, fever, headache
secondary lesions develop
arthritis
carditis
symptoms of neuroborreliosis
facial palsy
aseptic meningitis
polyradiculitis
can we take biopsy for borreliosis
no, serology not sensitive
treatment for borreliosis (3)
Doxycycline
Amoxicillin
Azithromycin
which bacteria cause syphilis
treponema pallidum
pathology of syphilis
Primary infection Chancre -painless ulcer with a firm indurated border
Painless regional lymphadenopathy one week after the primary chancre
Chancre appears within 10-90 days
symptoms of secondary syphilis
Malaise, fever, headache, pruritus, loss of appetite, iritis
when will we develop secondary syphilis
if sypholis untreated, 50 days after chancre
can syphilis have oral lesion
yes in secondary syphilis
can vary from ulcers to mucous patches
what is lues maligna
manifestation of secondary sphilitis
frequent in HIV patient due to immunosuppresant
appearance of syphilis
pleomorphic skin lesions with pustules, nodules, ulcers with necrotising vasculitis
appearance of tertiary syphitis
Gumma Skin lesions - nodules and plaques
Extend peripherally while central areas heal with scarring and atrophy
Mucosal lesions extend to and destroy the nasal cartilage
systemic symtpoms of tertiary syphilis
cardiovascular disease
neurosyphilis
how to diagnose syphilis
serology
clinical findings
treatment for syphilis
oral tetracycline
IM benzylpenicillin
how to transmit HSV-1
direct contact with contaminated saliva/infected secretions
how to transmit HSV-2
sexual contact
how does HSV virus replicate and travel to dorsal root ganglia
replicate at mucocutaneous site of infection
retrograde axonal flow
when can HSV transmit
Transmission can occur even during asymptomatic periods of viral shedding
symptoms of HSV
Preceded by tender lymphadenopathy, malaise, anorexia
± Burning, tingling
Painful rouped vesicles on erythematous base → ulceration / pustules / erosions with scalloped border
Crusting and resolution within 2-6 weeks
Orolabial lesions – often asymptomatic
Genital involvement – often excruciatingly painful→ urinary retention
reactive symptoms of HSV
spontaneous, UV, fever, local tissue damage, stress
appearnace of Eczema herpeticum HSV
Monomorphic, punched out erosions (excoriated vesicles)
is eczema herpeticum emergency
yes
treatment for HSV eczema herpeticum
IV aciclovir
what is HSV Herpetic whitlow
HSV infection of digits, often in children
symptoms of HSV Herpetic whitlow
pain, swelling, vesicles
blisters on digits
what is HSV herpetic whitlow often misdiagnosed with
paronychia
dactylitis
what is neonatal HSV infection
exposure to HSV during vaginal delivery
can be HSV 1 or 2
onset from birth to 2 weeks
appearance of neonatal HSV
Localised usually – scalp or trunk
Vesicles → bullae erosions
Encephalitis → mortality >50% without treatment, 15% with treatment → neurological deficits
treatment for neonatal HSV
IV antivirals
how to diagnose HSV
swab for PCR
treatment for chronic HSV
oral valacyclovir
acyclovir x5 a day in immunocompetent localised infection
IV
what is pityriasis versicolor
fungal skin infection
appearance of pityriasis versicolor
Hypopigmented, hyperpigmented or erythematous macules +/- fine scale
which fungi cause pityriasis versicolor
Trichophyton rubrum Malassezia spp. (e.g. M. furfur) overgrowth
symptoms of superficialfungal infections
Flares when temperatures and humidity are high – e.g. in summer months
treatment for superficial fungal infection
topical azole (miconazole and clotrimazole)
medical term for athlete foot
tinea pedis
what is kerion
inflammatory fungal infection that may mimic a bacterial folliculitis or an abscess of the scalp; scalp is tender and patient usually has posterior cervical lymphadenopathy
what is candidiasis in superficial fungal infections predisposed
Predisposed by occlusion, moisture, warm temperature, diabetes mellitus
appearance of candidiasis in superficial fungal infections
Most sites show erythema oedema, thin purulent discharge
symptoms of candidiasis
Most sites show erythema oedema, thin purulent discharge
Usually an intertriginous infection (skin folds) or of oral mucosa.
A common cause of vulvovaginiti
example fo opportunisitc fungal infection
mucormycosis
presentations of mucormycosis
oedema, then pain, then eschar
fever, headache proptosis, facial pain, orbital cellulitis ± cranial nerve dysfunction
associations of mucormycosis
Diabetes mellitus (1/3 of patients - DKA very high risk
Malnutrition
Uraemia
Neutropaenia
Medications: Steroids / antibiotics / desferoxamine
Burns
HIV
treatment of mucormycosis
aggressive debridement & antifungal therapy amphoteracin
what is scabies
Contagious infestation caused by Sarcoptes species
Female mates, burrows into upper epidermis, lays her eggs and dies after one month
treatment for scabies
permethrin, oral ivermectin
- Two cycles of treatment are required
appearance of scabies
Insidious onset of red to flesh-coloured pruritic papules
Affects interdigital areas of digits, volar wrists, axillary areas, genitalia
diffenece between pigmented and non pigmented lesions appearance in skin cancer
pigmented: brown/black
non-pigmented: skin color/reddish
layer of epidermis from top to bottom (6)
striatum corneum
striatum lucidum
striatum granulosum
striatum spinosum
straitum basale
dermis
which 2 kinds of pigmented lesions are cancerous
lentigo maligna
malignant melanoma
which 3 kinds of non pigmented lesions are cancerous
bowen’s
squamous cell carcinoma
basal cell carcinoma
where is lentigo maligna spread
stay in epidermis (some can escape to dermis while some stay in epidermis
how does lentigo maligna appear on skin (regular or irregular shape, color, size)
Irregular shape
Light & dark brown colours
Size usually >2.0 cm
if the lesion/melanocytes travelled to deep dermis, is it still lentigo maligna
no, lentigo maligna stays in epidermis
what are the 2 growths that can have when developing a malignant melanoma from a junctional naevus (flat mole with single color)
horizontal/ lateral and vertical growth
which growth does superficial spreading malignant melanoma has
horizontal
so it’s flat
what does white color on the nevus/mole mean
regression
immune system trying to eliminate melanoma
what is the diagnosis rule of superficial spreading malignant melanoma
A–Asymmetry
B–Border
C–Color
D–Diameter
E–Evolving
what is nodular malignant melanoma
Vertical proliferation/growth of malignant melanocytes
(no previous horizontal growth)
what is nodular melanoma arising within a superficial spreading melanoma
a combination of both vertical and horizontal proliferation in melanoma
what is the name of melanoma on sole of feet
acral lentiginous melanoma
why acral lentiginous melanoma usually flat
walking applies pressure
what is longitudinal melanonychia
dark band on nail
cuz at nail matrix there’s melanocytes and proliferated in a good way due to pressure
Usually benign
what is subungual melanoma
melanocytes at nail matrix proliferated in a bad way
appearance of subungual melanoma
wider band, uneven color (mostly black)
use what tool to do examination of the skin using skin surface microscopy
dermascopy
is ameloanotic melanoma pigmented or non-pigmented
non-pigmented
how does ameloanotic melanoma appear
red nodule
what are the types of malignant melanoma (6)
lentigo maligna melanoma
superficial spreading
nodular
acral lentiginous
subungual melanoma
ameloanotic melanoma
what to measure in melanoma for prognosis
breslow thickness (how deep a melanoma has grown into the layers of skin)
where does breslow thickness measure from in the skin
from granular layer to bottom of tumor
risk factor of developing melanoma
family history of dysplastic nevi/melanoma
UV irradiation
childhood sunburns
intermittent burning exposure in unacclimatized fair skin
atypical/ dysplastic nevus syndrome
personal history of melanoma
skin type l,ll
management of for urgent cut in melanoma
primary excision down to subcutaneous fat/ wide excision with margin determined by breslow depth
management of all melanoma
excision and wide local excision (WLE)
followed by sentinel lymph node biopsy
scans for melanoma
PET-CT
MRI Brain (cuz may spread)
appearance of pyogenic melanoma
red nodule
is pyogenic melanoma benign or malignant
benign
what are types of non-pigmented skin cancer (4)
Actinic keratosis- precancerous
Bowen’s disease
Squamous cell carcinoma
Basal cell carcinoma
cause of actinic keratosis
sun exposure
appearance of actinic keratosis
scaly patch
red flaky areas on skin
is actinic keratosis cancerous
precancerous
what s bowen’s disease
squamous cell carcinoma in situ
what are treatments for actinic keratosis and bowen’s disease (6)
5 fluorouracil cream
cryotherapy
imiquimod cream
photodynamic therapy
currettage and cautery
excision
where does squamous cell carcinoma (SCC) travel to from epidermis
travel to dermis
clinical appearance of squamous cell carcinoma (SCC)
- Erythematous to skin coloured
- Papule
- Plaque-like
- Exophytic
- Hyperkeratotic
- Ulcerated
causes of SCC
Arises within background of sun-damaged skin
appearance of keratoacanthoma
dome shape
Rapidly enlarging papule that evolves into a sharply circumscribed, crateriform nodule with keratotic core (like a volcano)
where is keratoacanthoma most often found
sun exposed areas
how fast does keratoacanthoma resolve
slowly over months
what is keratoacanthoma difficult to distinguish clinically and histologically from
SCC
how does basal cell carcinoma present (BCC)
shiny, pearly papule(smaller) or nodule (bigger)
causes of basal cell carcinoma (BCC)
chronic sun exposure
what is the most common type of skin cancer
basal cell carcinoma
what are different types of basal cell carcinoma (2)
- nodular BCC
- basisquamous BCC
Treatment for Basal or Squamous cell carcinoma
Surgery
Mohs surgery at high risk sites
radiotherapy
what are considered as high risk areas in treatment of basal cell carcinoma
close to nose (hard to remove)
how to distinguish BCC and SCC in appearance
BCC: usually flat, shiny , with vessels visible
SCC: usually nodule, red
common treatment for basal cell carcinoma
MOHS Surgery treatment
which melanoma is most common variant in pale skin types
superficial spreading melanoma
does nodular melanoma have a rapid radial growth phase
no
what is the ABCDE rule for detecting in skin cancer
radial growth phase melanoma
(NOT present in nodular malignant melanoma)
what should suspected melanoma undergo for diagnosis
complete excision
what can BRAF mutation status tell
inform prognosis and treatment decisions
is keratinocyte carcinomas more common in men or women
men
when will BCC metastasis
when left untreated over many years
which therapy is used for unresectable BCC
vismodegib
when is MOHS micrographic surgery given
aggressive subtypes, critical sites and recurrent BCC
which therapy is for unresectable or metastatic SCC
cemiplimab
which of the following treatment is not for actinic keratoses
(cryotherapy, radiation therapy, imiquimod, topical 5-fluorouracil)
radiation therapy
what is radiation therapy for in skin cancer
BCC
SCC
MCC
