Dermatology Flashcards
Pompholyx Dermatitis
(dyshidrotic eczema)
Triggered by Humidity and High Temperatures
P - Palms and soles (common areas affected)
O - Oozing and blistering lesions
M - Moisture (excessive sweating often triggers it)
P - Pruritus (intense itching is a hallmark symptom)
Porphyria Cutanea Tarda (Uroporphyrinogen Decarboxylase)
Feature
Investigation
Treatment
Photosensitive rash with blistering and skin fragility on the face and dorsal aspect of hands
+ Hypertrichosis + Hyperpigmentation
Serum Ferritin
Pink Fluorescence of Urine in Wood Lamp
Chloroquine
Venesection if Ferritin>600
Granuloma Annulare vs Necrobiosis Lipoidica Diabeticorum
Hyperpigmented and Centrally Depressed
vs
Well-defined, yellow-brown plaques with atrophic centres and telangiectasia
Seborrheic Dermatitis
Associations
Features
Treatment
HIV & Parkinsons
Otitis externa and blepharitis
Scalp -
1. Ketacanazole Shampoo
2. Shampoo with zinc pyrithione or Tar
Body
1. Ketacanazole Topical
2.
Centro Facial Telangiectasia + Pustules / Papules + Flushing –> Think What ?
Treatment ?
Acne Rosacea
- mild to moderate is topical ivermectin
- severe, add oral doxycycline
- If Persistent Flushing ONLY –> Topical Brimonidine Gel
Phemigoid Vulgaris vs Bullous Phemigoid
- no mucosal involvement: bullous pemphigoid
- mucosal involvement: pemphigus vulgaris
Phemigus Vulgaris
Pathophysiology and Treatment ?
Antibodies against Desmoglein 1&3
Steroids
Acantholysis on biopsy
Phemigus Vulgaris Biopsy Finding
Acantholysis on biopsy
Polymorphic Eruptions of Pregnancy (PEP)
vs
Phemigoid Gestationalis
Starts with Striae and SPARES UMBILICUS
START WITH UMBILICUS –> Trunk —> Arms
Guttate Psoriasis vs Pityriasis Rosea
Preceding Infections ?
Features ?
Treatment ?
Guttate Psoriasis
- Preceded by a Sore Throat 3-4 weeks prior
- Tear Drop
- Self Resolve or UVB
If Recurrent - Tonsillectomy
Pityriasis Rosea
- Preceeded by an URTI
- Herald Patch
Oval Lesions along Lines of Langer - ‘Fir Tree’ - Self Limited in 6 weeks time
Systemic Mastocytosis (Neoplastic Proliferation of Mast Cells)
Features
Investigations
- Urticaria Pigmentosa - produces a wheal on rubbing (Darier’s sign)
Urinary Histamine (Diagnostic)
Serum Tryptase
Acanthosis Agaricans Associations
Everything to do with WEIGHT GAIN except Gastric Ca
Grey PATCH
- Gastric adenocarcinoma (A for acanthos, a for adenocarcinoma. Not squamous cell)
- PCOS
- Acromegaly
- T2DM
- Cushing’s
- Hypothyroidism
Prader Willi too —> again Weight Gain
Management of Hirsutism ?
Weight Loss
COCP
Facial - Eflornithine
Management of Hypertrichosis ?
drugs: minoxidil, ciclosporin, diazoxide
Lichen Planus
- Features
- Treatment
- Planus - Polygonal , Pruritic, Purple Papules with White Lines Overlying - Wickenham Striae
- Mucosal Involvement - White Lacy in Buccal Mucosa
- Longitudinal Nail Ridges and Koebner Phenomenon
Treatment -
Topical Steroids
Benzydamine Oral Mouth Wash
Drugs that can cause Lichen Planus Eruptions ?
Gold
Quinine
Thiazides
Eczema Herpeticum Features
Rapidly Progressing Painful Rash on a BACKGROUND OF EZCEMA
MONOMORPHIC ‘Punched Out Erosions’
LIFE THERATENING —> IV Acyclovir
Various HHV and their Skin Pathologies
HHV-1—–>HSV-1 (above the belt/cold sores)
HHV-2—-> HSV-2 (below the belt/genital herpes) (HSV 1-2 causes ezcema herpeticum)
HHV-3—–>VZV (chicken pox singles)
HHV-4—–>EBV
HHV-5—–>CMV
HHV-6——> Roseola infantum
HHV-7—–>Pityriasis Rosea
HHV-8—–>Kaposi’s Sarcoma
Actinic Keratosis Treatment
- Avoid Sun Exposure
- Topical Fluorouracil for 2-3 weeks
- Topical NSAID or Topical Imiquimod
Systemic Mastocytosis Diagnostic Criteria
Just remember aggressive !!!
Indolent:
No B or C findings
Smouldering = 2 or more B findings (B = burden of disease):
- Bone marrow >30% mast cells and/or Tryptase >200 ng/ml and/or KITD816V mutation with a variant allele frequency (VAF) of >10%
- Signs of dysplasia or myeloproliferation without frank associated haematological neoplasm, and a normal FBC
- Hepatomegaly without liver dysfunction and/or splenomegaly without hypersplenism
Aggressive = 1 or more C findings (C = cytoreduction-requiring i.e. organ dysfunction):
- One or more cytopenias (Hb <100, platelets <100, neutrophils <1.0)
- Hepatomegaly with liver dysfunction
- Osteolytic lesions or fractures
- Splenomegaly with hypersplenism
- Malabsorption with weight loss due to GI infiltration
Ulcerative Colitis with Ragged Edged Ulcer around Stoma Site ?
Pyoderma Gangrenosum
Erythema Ab Igne
Erythema Marginatum
Erythema Multiforme
Over exposure to Heat and Fireplaces
Raised outer area and pale center and also affect the torso (GAS and Rheumatic Fever)
Rad Patches in Hands —> Target Lesions
No treatment needed if asymptomatic and patient isn’t concerned
Confirmed dermatophyte or Candida infection:
- Mild (≤50% nail, ≤2 nails, superficial):
a. Topical amorolfine 5% lacquer
b. Duration: 6 months (fingernails), 9–12 months (toenails) - Extensive dermatophyte infection:
a. Oral terbinafine (1st-line)
b. Duration: 6 weeks–3 months (fingernails), 3–6 months (toenails)
Extensive Candida infection:
Oral itraconazole (1st-line), in pulsed weekly courses
Squamous Cell Skin Cancer
- Risk Factors
- Treatment
- Poor Prognostic Factors
- Renal Transplant
- Skin Exposure
- Long Standing Marjolin Ulcer
- Genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
Treatment
If >20mm then Surgical Excision with 6mm margin
If <20mm then Surgical Excision with 4mm margin
Mohs Surgery if Cosmetic Importance
Poor Prognosis if :
1. >20mm
2. >4mm deep
3. Immunosuppressed
4. Poorly Differentiated
Treatment for Hyperhidrosis ?
Topical Aluminum Chloride
Hereditary Hemorrhagic Telangiectasia
Inheritance ?
Diagnostic Criteria (4 things only)
Autosomal Dominant
Epistaxis + Telangiectasia + Visceral Lesions (GI Telengectasia or AVMs) + Family History
3 Diagnostic
2 Suspected
Impetigo Treatment ?
Limited —>
1. H2O2
2. Topical Fusidic
3. Topical Mupirocin (1st line if MSRA)
Extensive
1. Flucloxacillin or Erythromycin
Avoid School for 48 hours after Abx or until lesions healed
Molluscum Contagium
Pinkish or pearly white papules with a central umbilication
Alleviate and Encourage not Itch and CONTAGIOUS
Self Limiting
Ezcema or Inflammation around lesion prior to healing
If so -
Itch (Hydrocortisone 1%)
Infected (Fusidic Acid 2%)
Keratosis Piliaris Features
Chicken Skin
keratinized hair follicles (rough bumps) over extensors
Keloid Scars
Most Common Ethnicity
Most Common Site
Treatment
Africans
Sternum
Intra-lesional steroids e.g. triamcinolone
Bullous Phemigoid
Pathophysiology
Treatment
Antibodies against hemidesmosome proteins BP180 and BP230
Oral Steroids
What Antibody is responsible for Dermatitis Herpertiformis ?
IgA in the Dermis
