Dermatology Flashcards
what is the best prognostic indicator of melanoma mortality
Breslow Thickness
What are the 5 year survival of individual breslow thickness with regards to melanoma?
4 mm = 50%
what are the clarke level invasion with regards to melanoma?
level 0 = carcinoma in situ level 1 = thin melanoma < 2mm thick level 2 = thick melanoma > 2mm thick level 3 = melanoma involves the LN level 4 = metastases are involved
what are the prognostic factors of melanoma
Breslow thickness Clarke level mitotic rate per mm2 ulceration lymphovascular invasion
what is the excisional margin of melanoma with regards to their thickness?
melanoma carcinoma in situ = < 1 mm thick = < 1 cm margin
melanoma 1 - 4 mm thick = 1 - 2 cm margin
melanoma > 4mm thick = 2 cm margin
what are the bio-markers associated with melanoma?
BRAF,
MEK
what are the classification of melanoma, their associations and their epidemiology?
superficial spreading melanoma (70%): more common subtype of melanoma, related to intermittent sun exposure, thin, curable tumors of less than 1mm thickness nodular melnoma (15%): rapid growth, 15% of all invasive melanomas, more common in older people and men lentigo maligna (in situ melanoma) (5%): most common in sun exposed areas, begin as a tan brown macule, enlarges and develops darker, assymetric foci, color variegation acral lentiginous (10%）：darker skinned people, palms/soles/under nails, usually risen from trauma
outline the management for mild plaque psoriasis (preventive, acute, maintenance)
preventive measures: avoid skin damage and stress, take rest and holidays, reassurance
address psychological effects of having psoriasis
pharmacological treatment: topical steroids, tars, calcipotriol, dithranol
what is the difference in clinical features between rosacea and acne?
rosacea lacks the presence of comedones c.f acne vulgaris
what is the management of rosaceas
avoid aggrevating factors such as alcohol, sun, warm environments, hot tea and coffee, spicy food, topical steroids
use mild soap free cleanser and a non irritant sun block
mild roscaea: (topical agents) metronidazole, clindamycin cream, erythromycin gel
severe rosacea: doxycycline, erythromycin (oral)
other treatments:
rhinophyma = co2 laser therapy w/ dermatologist
telengiectasia and erythema can be removed w/ laser
what are the 3 treatment approach to treating acne
comedolysis
decrease bacterial activity
decrease sebaceous gland activity
treatment for mild acne
if just comedones = topical retinioids
if pastulopapular = use topical antibiotics such as clindamycin, erythromycin OR topical antiseptics (benzoyl peroxide)
treatment for moderate acne
oral a/b: doxycycline or erthyromycin (first line), minocycline (has more side effects)
in females, hormonal treatment can be considered. They are OCP that contain anti-androgenic progestagens, spironolactone, cyproterone acetate
treatment for severe acne/nodulocystic acne
specialist referal for prescription of oral isotertinoin
scarring can be cured by laser treatment
what are some drugs that can cause acne
steroids lithium anti epileptics Oral contraceptives iodides/bromides quinine
what’s the management of peri-oral dermatitis
mild cases: topical erythromycin OR metronidazole gel, pimecrolimus, azelaic acid
if more severe: doxycycline oral 50mg BD, or ethryromycin oral for 6 - 8 weeks
what is the treatment for resistant localized psoriasis plaque
intralesional corticosteroid 1:1 normal saline injection w/ local anesthetic
what is the treatment of widespread plaque psoriasis
pharmacological mx: dithranol, tar, topical corticosteroids, phototherapy. others are: methotrexate, acitretin, cyclosporin, biological agents
what is the treatment for scalp psoriasis
tar shampoo, topical corticosteroid lotions
if severe, can use tar/dithranol pomades, tar shampoo, systemic therapy
what is the treatment for genital psoriasis
topical corticosteroids, tars
what is the gene associated with psoriasis
HLA-B27 gene
what are common agents that cause allergic contact dermatitis
Nickel Chrome epoxy resin fragrances and perfurmes latex plants neomycin preservatives rubber accelerators
what are common agents that cause irritant contact dermatitis
common and oftenly used agents: acids alkalis detergents soaps oils solvents
describe the distribution and morphology of irritant contact dermatitis
distirbution: usually areas in contact w/ irritating substances - most oftnely hands, eyelids
morphology: erythema, chapped skin, dryness and mild fissuring. +/- pruritus
what condition usually has a preceding herald patch in up to 80% of the patient population
Pityriasis rosea
describte the distribution and morphology of pityriasis rosea
christmas tree like on the trunk and back (+ upper arms, upper legs, lower neck)
old swimming suit distribution
morphology: oval, salmon pink spots, copper colored eruptions, that has scaly margins
treatment of pityriasis rosea
non pharm: bathe with soothing bath oil, use neutral pH soap
pharm: itch - calamine lotion, topical steroid 1% cream, methold 1% in aqeous cream. if itch is severe, use potent topical or oral steroid.
UV therpay
describe distribution and morphology of a secondary syphillis rash
usually occurs 6 - 8 week after the presence
morphology: faint, pink maculopapular rash. it can be dull red, round on flexor surfaces.
distribution: flexor surfaces, palms, soles, can be around the whole body
what is the diagnostic test for syphillis? what is its treatment?
T pallidum hemagluttanin assay, FTA-ABS (fluorescent antibody- antibody test) IM benpen (first line) and oral azithromycin (second line)
describe the distribution and morphology of infective mononucleosis rash.
commonly associated with cervical lymphadenopathy and a sore throat (important to rule out HIV infection) primary rash; pinkish, maculopapular secondary rash (drug rash w/ ampicillin, amoxicillin): sometimes has a purplish brown tinge
what is the time period in which SJS/TEN usually presents
usually average of 14 days - but re-exposure may cause the onset of symptoms as little as 48 hours
describe the morphology/distribution of SJS
morphology: ill defined coalescing erythematous macules w/ purpuric centres or may present w/ diffuse erythema
distribution: mucocutaneous eruptions that are usually oral, facial, urogenital
describe the clinical course of SJS
prodrome: acute onset febrile illness and malaise, possibly myalgia and arthralgia
acute: cutaneous lesions that start at face, thorax then begins spreading. slowly progresses to formation of vesicles and bullaes, and sloughing of skin
describe mophology of erythema multiforme
target lesions with dusky central disc/bullae, and an infiltrated pale ring. erythematous edematous halo
describe the management of toxic epidermal necrolysis
stop causative drug and all non life sustaining drugs
admit burn units, ICU
give supportive treatment: wound care, fluids and nutrition, ocular care, prevention of infection
give systemic steroids and high dose IVIG
future drug avoidance
describe urticaria distribution and morphology
pruritic, circumscribed, raised/papular, erythematous eruption with central pallor. may coalesce with other lesions and disappear within 24 hours
what is the prognosis of pityriasis rosea
mild, self limiting illness with spontaneous remission in about 2 - 10 weeks
what is the most common cause of erythema nodosum
sarcoidosis
what are the other causes of erythema nodosum
sarcoidosis crohn's disease infections: TB, staph, viral infections chlamydia malignancy drugs: tetracycline, sulphonamides, oral contraceptives
what is the treatment of erythema nodosum
investigate causes and treat cause
mild: rest and give NSAIDs
severe: systemic steroids
describe the mophology and distribution of erythema nodosum
morphology: bright red, nodular, painful
distribution: most oftenly shins, but can also be found on the thighs and arms
what are the 4 types of rosacea
ocular
erythematous telangiectasia
papulopustular
fimeatous
what is ramsay hunt syndrome?
shingles in the facial nerve CN 7
describe the morphology and distribution of shingles
morphology: vesicular eruptions, erythematous
distribution: dermatomal distribution
describe the morphology and distribution of scabies
morphology: intensely pruritic, erythematous, papular. often scattered, red, small, monomorphous
distribution: found on hand webbings, wrists
what is the management of scabies
symptomatic relief: anti histamines
acute treatment: permethrin cream 5%, benzyl benzoate 25% emulsion. applied topically full body.
for children, use sulphur 5% cream OD for 2 - 3 days, then use crotamiton 10% cream
Prevention: wash bedsheet, clothings, hang in sun
what is the management of tinea
prevention: keep toes dry, carefully dry feet after bathing, use anti fungal between toes, remove flaky skins form beneath toes, wear light socks made of natural absorbent fibres, change socks and shoes daily, wear open sandals with porous soles and uppers when infected
pharmacological: clotrimazole, ketoconazole, terbinafine, cream/gel. If severe, add oral terbinafine, griseofulvin.
what is angular chelitis associated wtih?
chronic wetness of the lips
B12/folate deficiency
how do you differentiate between geographical tongue and candidiasis
geographical tongue that cannot be scraped off
what are the side effects of oral isotretinoin?
GI upset skin, mucosal, eye dryness headaches epistaxis myalgia, arthralgia, sport intolerance lethargy cannot be given with doxycycline (oral) as it can cause benign intracranial hypertension
what are the indications for oral isotertinoin?
severe acne
nodulocystic acne
scarring acne
patient in severe psychological distress
what are the indications for referral to specialist?
PCOS caused acne
not sure about diagnosis
patient requires oral isotretinoin
trouble tolerating medications
what is the treatment for infantile acne?
infant sebaceous glands stimulated from testosterone from babies acne which respond to intrauterine hormones
topical retinoids and/or anitbiotics (similar to mild acne treatment)
what agent can be used when acne has crusting?
keratolytic = salicylic acid 2%
what are some lifestyle modifications for acne prevention/
avoid greasy sunscreen/moisturizer avoid hot bathes/steam rooms avoid hot humid working situations stop squeezing or picking avoid over exposure to sun
what is the clinical features of rosacea?
no comedones
commonly facial erythema w/ telengectisia and flushing
presence of pustules and papules
easy flushing, experiencing burning, stinging, itching
irritated by cream and sun exposure
what are some complication of rosacea
rhinophyma and facial oedema
what is the treatment of corticosteroid induced rosacea?
stop corticosteroid treatment immediately and use oral tetracyclines for 6 weeks
what is the treatment of childhood rosacea?
use erythromycin as doxycycline is contraindicated in children less than 8 years old
what is the duration in which it takes for treatment to act for rosacea?
takes 6 - 12 weeks for response. maintenance treatment is often required for the long term
when would you refer atopic dermatitis to the dermatologist?
chronic, recurrent infections
severe eczema that cannot be controlled w/ topical therapy
not sure with the diagnosis
what is the feature of asteatotic eczema? what is the management of asteatotic eczema?
dry skin, scaling, crazy ‘paving’ on the lower limbs
dryness management: avoid soap, use a soap substitute and use daily application of emollionts at least 2ice a day
if there is inflammation, use a mild - moderate topical corticosteroid w/ wet dressing and antibiotics
what is the feature of stasis dermatitis? what is the most important part of treatment?
hyperpigmentation
swelling of the legs
dryness, scale and brown pigmentation (hemosiderin staining)
associated varicose veins, ulcerations
elevation and graded compression is most important + dry management (w/ wet dressings, daily emollioants twicea day, using a soap substitute)
what is the feature of nummular/discoid eczema? and what is its management?
ITCHY, round/oval shaped with well defined edges (not much scaling)
common to have superinfection w/ s. auerues
treatment:
use potent topical corticosteroids + wet dressing (even in children)
if non responsive to topical treatment, oral antibiotics may be required
topical steroids/steroid injections for lichenified lesions
what is the feature of pompholyx or dyshidrotic eczema?
found on soles and palms. characterstically bullous and vesicular. has severe attacks that can prevent patient from attending work. can be trigged by physical or emotional stress.
treatment:
potent topical steroid + wet dressing
rest is important
patient needs to protect their hands from irritating soap substances for the next 3 months
if severe attacks = refer to derm, may require 2 - 3 weeks course of oral prednisolone
what is the features of child seborrheic dermatitis?
site: scalp, face, neck, groin, axillae, nappy areas
morphology: erytheatous w/ crusting (if superinfection), non itchy!! well defined lesions w/ greasy scale covering
management:
topical steroids (mild) + anti fungal/antibiotics if necessary
keratolytics can be used to get rid of scales
what is the feature of adult seborrheoic dermatitis?
erythema and fine greasy scale in cheeks, nose and nasolabial folds
sites: scalp, central face, eyebrows/lids, chests, flexures, axillae, genital regions
triggers; physical stress, emotional stress
management:
topical steroids (mild) + topical anti fungals if necessary
if scalp involvement, use anti-fungal shampoos containing selenium sulphide, ketonazole, miconazole
what is the treatment for atopic dermatitis?
patient education about its chornicity, prgnosis,
lifestyle modifications by avoiding triggers and using emollionts on a daily basis
possible allergen testing and allergen avoidance
pharmacological treatment: mild topical steroid first OR TIMS (pimecrolimus, tacrolimus)
preventions; use wet dressing over topical emollients and anti-inflammatory agents
address psychological issues
what are the triggers for atopic dermatitis
wool clothes, blankets, lambskins synthetic fabrics soap, shampoo, bubble bath hot baths and very hot weather sand at the beach and sand in the sandpits
name some examples of mild, moderate, potent topical corticosteroids
mild: hydrocortisone 1%, hydrocortisone acetate 1% and 0.05% cream, desonide 0.05%, clobetasone butyrate 0.05% cream
moderate: betamethasone valerate 0.02%, triamcinolone acetonide 0.02%
potent: betamethasone valerate 0.1%, betamethasone diproprionate 0.05% cream, ointment, lotion, methylprednisolone aceponate 0.1% cream, ointment, lotion
what is the treatment for palmoplantar psoriasis (both pustular and hyperkeratotic forms)
pustular forms: tars, topical corticosteroids, tetracyclines, acitretin, calcipotriol, phototherapy. if severe methotrexate, cyclosporin
hyperkeratotic: keratolytics (salicylic acid), tars, calcipotriol, acitretin
give some examples of treatment options for psoriasis?
emollients - used when irritating /scaling is a prominent feature
keratolytics (salicylic acid 2% - 10%）－ can be used to soften an dlift scale
corticosteroids - used to reduce itch in pulse treatment
tars (2% - 10% cream/ointment) - used as an anti-inflammatory or anti pruritic
calcipotriol - proliferation, differentiation of keratinocytes, useful for widespread psoriasis
dithranol - antiproliferative effect, especially useful for thick plaque psoriasis
