DERMATOLOGY Flashcards
what kind of skin disease is acne?
a) infective
b) inflammatory
c) degenerative
b) inflammatory
what percentage of teenagers suffer from acne?
a) 5%
b) 20%
c) 50%
d) 85%
d) 85%
acne is characterised by excess ____ production and _____ of the hair follicle causing _____.
sebum
hyperkeritinisation
blockage
what bacteria often colonises the skin of a patient with acne?
propionibacterium acnes
what part of the face is normally affected in a teenager or young adult with acne?
T zone
what part of the face is normally affected in a late onset acne?
chin and jaw
name both types of commedones than can be present on the face of a patient with acne
whiteheads
blackheads
which of these isn’t a classical sign of acne?
a) pustules
b) papules
c) hemangioma
d) nodules
e) cysts
c) hemangioma
give a complication of acne
scarring
aside from hormones, name 3 risk factors for acne
smoking
diet
psychological
how is acne severity scored?
leeds acne grading system
numerical with pictures
name 3 types of topical cream that can be given for acne
benzoyl peroxide
retinoids
antibiotics
how does benzoyl peroxidase work?
antibacterial
comedolytic
give a side effect of benzoyl peroxidase
skin bleaching/irritation
give an example of a retinoid topical cream
adapalene
tretinoin
how do retinoid topical creams work?
vitamin A precursors
regulate epithelial growth
give a side effect of retinoids
irritation
photosensitivity
give an example of an antibiotic topical combination cream that could be prescribed
erythromycin and zinc
clindamycin and benzoyl peroxide
give an example of anti-androgen oral therapy for acne
COCP
give an example of an oral antibiotic which may be prescribed for acne
erythromycin
trimethroprim
when should systemic/oral retinoids be used?
severe cases only
why shouldn’t oral retinoids be used in pregnancy?
90% risk of birth defects
give a side effect of oral retinoids
depression or suicide links??
how can steroids be administered in acne?
intra-lesion injections
oral steroids
what type of condition is eczema?
a) inflammatory
b) infective
c) haemorrhagic
a) inflammatory
in which age group is eczema most common
young children
give 4 risk factors for eczema
season of year
stress
infection
allergy
what type of eczema would these symptoms indicate?
weeping, crusting, blistering, redness, papule, swelling, scaling
acute
what type of eczema is characterised by greater pigmentation and scale and less exudate and vesicles?
chronic
where is visual dermatitis present in eczema?
flexures
name 2 tests that could be used to diagnose eczema
patch test
antibody testing
name the most mild form of treatment for eczema
emollient cream
why should steroids be used with caution in eczema?
rebound when treatment stopped
can have side effects
give 3 examples of immunosuppressants that can be used to treat eczema
tacrolimus
ciclosporin
methotrexate
azathioprine
give 3 advantages of using wet wraps for eczema
skin cooling
reduces itch
promotes steroid absorption
give a treatment therapy for eczema
phototherapy
give an example of 2 organisms that can cause infection of broken skin in eczema
s aureus
molluscum contagiosa
eczema herpeticum
do eczema lesions classically have sharp or hard-to-distinguish margins?
hard to distinguish
what are the two types of exogenous eczema?
allergic
irritant
what type of eczema makes up more than 80% of all cases of contact dermatitis?
irritant exogenous eczema
what is irritant eczema mediated by?
type 4 hypersensitivity reaction
what type of eczema is characterised by irreparable cell damage due to an irritant, with lesions limited to the area of contact?
irritant
what are the 5 types of endogenous eczema?
atopic seborrhoea discoid stasis/varicose pompholyx
what two diseases is atopic eczema coupled with?
asthma
hayfever
where does atopic asthma classically start on the body?
face
what antibody mediates atopic eczema hypersensitivity reaction?
IgE
IgE hypersensitivity eczema causes:
a) decreased ability of skin to hold water
b) increased sensitivity of skin to sunlight
c) pruritus causing skin lesions
a) decreased ability of skin to hold water
what percentage of atopic eczema clears in early teens?
a) 5-10%
b) 20-30%
c) 60-70%
d) 85-90%
c) 60-70%
give 4 examples of where seborrheic eczema normally occurs
scalp, ears, eyebrows, nose, axilla, groin, pubis (areas rick in sebaceous glands)
what is the name of seborrheic eczema in babies?
cradle cap
who does seborrheic eczema normally affect?
a) infant males
b) infant females
c) adult males
d) adult females
c) adult males
what type of eczema is characterised by greasy yellow scales, lichenification, and exaggerated follicular orifices?
seborrheic eczema
name 2 special senses conditions associated with seborrheic eczema
otitis externa
chronic blepharitis
how would you describe a discoid eczema lesion?
coin shaped
well demarcated
which part of the body does discoid eczema normally affect?
limbs
which of these features would you NOT see on a discoid eczema lesion?
a) vesicles
b) crust
c) clots
c) clots
where does varicose eczema normally affect the body?
over varicose veins (lower legs)
what type of eczema is characterised by lichenification, oedema, purport, pigmentation and ulcers?
varicose
attacks of pompholyx are
a) recurrent, long-lasting
b) recurrent, acute
c) single, long-lasting
d) single, acute
b) recurrent, acute
where are pompholyx eczema lesions normally found?
palms and soles of feet
what is treatment for pompholyx eczema?
self-resolves in 2-3 weeks
name the 3 unclassified forms of eczema
asteatotic
lichen simplex
juvenile plantar dermatosis
who does asteatotic eczema normally affect?
elderly
what eczema is characterised by ‘crazy paving’ and red fissures?
asteatotic
which form of eczema can be caused by overwashing, low humidity, central heating, diuretics and hypothyroidism?
asteatotic
what is lichen simplex caused by?
skin damage due to repeated scratching
name 4 of the areas commonly affected by lichen simplex
nape of neck lower legs scalp upper thigh pubis forearm
what is juvenile plantar dermatosis caused by?
sweat gland blockage due to impermeable modern socks
where does juvenile plantar dermatosis affect?
weight bearing areas of skin
what do juvenile plantar dermatosis lesions look like?
shiny and dry
painful fissures
give 2 organisms that commonly cause cellulitis
staph aureus
group a strep
describe the broders of a cellulitic region
ill defined
which areas of flesh are swollen in cellulitis?
subcutaneous fat and dermis
illness of what type can also present with a cellulitis rash?
systemic
what bacterial skin infection is associated with diabetes, athletes foot, venous eczema and other skin lesions?
cellulitis
what antibiotic group is commonly prescribed for cellulitis and how is it adminstered?
IV beta lactam penicillins
give 2 dermatological complications of cellulitis
abscess
necrotising fasciitis
what is Ludwig’s angina?
complication of cellulitis - cellulitis in sublmandibular space due to dental infections
is erysipelas an acute or chronic infection?
acute
what part of the flesh does erysipelas affect
superficial skin layers
describe a classic erysipelatic rash
raised with erythema and well defined edges
what is erysipelas most commonly caused by?
strep pyogenes exotoxin
which of these group does NOT have an increased risk of erysipelas?
a) elderly
b) children
c) immuno-suppressed
d) poor dental hygiene
e) diabetes
d) poor dental hygiene
suggest 2 antibiotics that could be given oral or IV to treat erysipelas
penicillin
clindamicin
erythromycin
what treatment would you recommend to a patient with risk of re-infection of erysipelas?
prophylactic antibiotics
give 3 complications of erysipelas
necrotising fasciitis
sepsis
bone infection
what are the 2 main causative organisms for impetigo?
staph aureus
strep pyogenes
describe the spread of impetigo
highly contagious
direct contact
what is the classical description for an impetigo lesion?
a) purple & pus
b) golden lumps
c) purple crusts
d) golden crusts
d) golden crusts
what is ecthyma?
painful, deep ulcers
what are the two parallel treatments for impetigo?
antiseptic wash
oral penicillin/macrolide
give 3 organisms that can cause folliculitis
s aureus
strep pyogenes
pseudomonas aerug.
where does folliculitus normally affect?
hairy areas
folliculitis can commonly occur following what activity?
shaving
folliculitis is treated in the same way as what other bacterial skin infection?
impetigo
what is intertrigo?
inflammation of a body fold
describe 3 symptoms of intertrigo
raw red itchy painful oozing
where does intertrigo most normally affect?
warm moist skin folds (chaffing)
these risk factors are most likely to predispose to what bacterial skin infection?
overweight, diabetes, immobile, incontinant
intertrigo
how is intertrigo treated?
remove moisture from area, antiperspirants etc
what genus of fungi causes tinea infections?
dermatophytosis
give 2 examples of dermatophytosis fungi
trichophyton
epidermophyton
microsporum
what is a common name for tinea pedis?
athletes foot
which 2 parts of the foot does athletes foot affect?
plantar
interdigital
how is athletes foot spread?
contact e.g. swimming pools, locker rooms
give a complication of athlete’s foot
ontchomycosis - spread to nails
what is tinea manuum?
infection of hand
which of tinea pedis and tinea manuum is more aggressive?
tinea manuum
which of these is not a symptom of tinea manuum
a) itching
b) burning
c) crackling
d) open bleeding
e) scaling
d) open bleeding
how is tinea manuum transmitted?
sexually
what is tinea unguium?
onychomycosis - nail fungal infection
does tinea unguium more commonly affect finger or toe nails?
toes
what are the first and second most common tinea infections?
pedis
unguium
what is tinea cruris?
groin infection
in which gender is tinea cruris most common in?
males
what is tinea corporis?
fungal infection of body
where does tinea corporis most commonly affect?
arms
legs
glabrous skin
what is tinea capitis?
fungal scalp infection
name an additional symptom of tinea capitis
patches of hair loss
who does tinea capitis normally affect?
a) infants
b) pre-pubescent children
c) middle-aged
d) elderly
b) pre-pubescent children
what is tinea faciei?
facial fungal skin infection
what is tinea nigra?
dark painless patches on bottom of feet and hands
what are the 2 most common forms of candida?
oral
vaginal
name 4 rarer types of candida
oesophageal angular stomatitis antibiotic-triggered perianal systemic onychomycosis
what kind of genital discharge might you expect with candida?
cottage-cheese
what is the most common candida organism that causes infection?
candida albicans
what is dual treatment for candida infection?
chlorahexidine mouth wash
topical antifungals e.g. clotrimazole
where does pityriasis versicolor normally affect on the body?
trunk and extremities
how does the skin eruption classical of pityriasis versicolor change in summer and winter?
hypopigmentation in sun
reddish-brown in winter
what fungal skin condition is caused by malasseria globosa fungus?
pityriasis versicolor
suggest a drug that you could use to treat pityriasis versicolor
grisoflivine
ketoconazole
in what type of climate is pityriasis versicolor more common?
warm, humid
which age group does pityriasis most commonly affect?
a) infants
b) adolescents
c) middle aged
d) elderly
b) adolescents
give 3 examples of antifungal creams and how long they should be given
terbinafine clotrimazole trimovate ketoconazole four week course
what skin infestation is caused by pediculus humanus capitis?
headlice
how do headlice survive?
parasites, feed on human blood
what disease do headlice cause?
pediculosis capitis
how are headlice spread?
direct contact
who do headlice most commonly infest?
school children
give 2 treatment options for headlice
combing
shaving
topical ointments
what type of skin disease is scabies?
mite infestation
what organism causes scabies?
sarcoptes scabiei
how is scabies spread?
direct skin contact
when is the itch of scabies worse?
night time
what skin infestation has a pimple like rash?
scabies
what form of scabies has scaled lesions?
norwegian crusted scabies
what infestation is characterised by papules, nodules and burrows?
scabies
how is scabies transmitted?
skin to skin contact for more than 10 mins
how is scabies treated? (3 thing)
topical cream all over body
disinfect household items
prophylaxis of household contacts
malathion, ivermectin, dimeticone and permethrin are examples of treatment for what kind of skin disease?
infestation
what is the difference between mosquito and midge bites?
midge last several days
mosquito several hours
what is the difference between a mosquito bite and a biting fly (tabanidae) bite?
mosquito = low welt
biting fly = painful welt
which areas of skin are most commonly affected by mosquito, midge, flea, bed bug and biting fly bites?
exposed skin and appendages
how do bed bug bites differ from midge and mosquito bites?
bed bug bites can look like a rash and can last weeks
can you feel a bed bug bite?
no
where do lice commonly bite?
pubic area
scalp
where do larval and adult ticks normally bite?
covered skin and skin creases
can you feel a lice or tick bite?
no
why can adult ticks be dangerous?
can transmit diseases
which gender is lichen planus more common in?
females
what type of skin disease is lichen planus?
a) infective
b) inflammatory
c) infestation
d) haemorrhagic
b) inflammatory
what is the cause of lichen planus?
unknown maybe immune
shiny, itchy, purple plaques with a polygonal shape and flat topped are characteristic of what inflammatory skin disease?
lichen planus
what is wickham’s striae?
where are they normally present?
white lines in lichen planus papules
mainly in oral mucosa
which 4 areas does lichen planus normally affect?
wrist
ankle
mucus membranes
scalp
lichenplanopilaris and scarring alopecia are examples of what inflammatory skin disease
lichen planus of scalp
which of these does NOT describe a possible presentation of lichen planus lesions
a) annular
b) linear
c) bullous
d) infective
e) ulcerated
f) pigmented
d) infective
which skin layers are thickened in lichen planus?
stratum corneum
stratum granulosum
which skin layer is degenerated in lichen planus, and what appearance does this have?
stratum basale - saw tooth appearance
give 2 examples of potent topical steroids which could be given to treat lichen planus
elocon
betnovate
dermovate
when would you consider referring lichen planus to a dermatologist?
if evidence of neoplastic change
what type of skin disease is psoriasis?
a) infective
b) inflammatory
c) infestation
d) haemorrhagic
b) inflammatory
what age group most commonly gets psoriasis?
a) infants
b) young adults
c) middle aged
d) elderly
b) young adults
psoriasis is a _____ disease triggered by _____ factors
genetic
environmental
how is psoriasis mediated (gene mutations in this factor)
MHC
what part of joints does psoriasis affect?
extensors
give 2 environmental risk factors for psoriasis
seasonal change
stress
give 3 lifestyle risk factors for psoriasis
alcohol
smoking
obesity
give 3 drug risk factors for psoriasis
NSAIDs
beta blockers
fast withdrawal of topical corticosteroids
give 3 treatment options for psoriasis
steroid creams
photo-therapy
immuno-suppressants
what 2 immuno-suppressants are commonly used to treat psoriasis?
cyclosporin
methotrexate
what type of psoriasis makes up 90% of all cases?
plaque
how would you describe a plaque psoriatic lesion?
red patches with white scales
how would you describe guttate psoriasis?
drop shaped lesion
what is the main trigger for guttate psoriasis?
strep infection
strep pharyngitis
what is inverse psoriasis?
red patches in skin folds e.g. nappy area
what is inverse psoriasis in the nappy area often confused with?
napkin dermatitis
what is pustular dermatitis?
pus filled lesions
what is a severe for of pustular psoriasis that occurs in pregnancy?
impetigo herpetiformis
what is erythrodermic psoriasis and what causes it?
widespread rash, complication of other forms of psoriasis
what nail changes might you see in erythrodermic psoriasis?
pitting
oncholysis
how can erythrodermic psoriasis be fatal?
extreme inflammation and exfoliation disrupt thermoregulation and barrier function
what inflammatory skin condition is characterised by abnormal, excessive, rapid epidermal growth and proliferation
psoriasis
what is Koebner phenomenon?
skin injury can trigger psoriatic changes on skin
give a bone complication of psoriasis that affects 30% of patients with psoriasis
psoriatic arthritis
what is dactylitis?
finger and toes psoriatic arthritis
can psoriasis be pre-malignant?
yes
name a GI condition that psoriasis sufferers are more likely to get
Crohn’s
give an example of a co-morbidity that would cause psoriasis to be more extreme/severe
HIV
what type of skin disease is rosacea?
a) infective
b) inflammatory
c) infestation
d) haemorrhagic
b) inflammatory
in what gender is rosacea most common?
females
what age group is most commonly affected by rosacea?
middle aged
where do rosacea lesions most commonly appear on the body?
sun exposed sites such as face and chest
what inflammatory skin condition is characterised by papules, pustules, telangiectasia, flushing and erythema?
rosacea
name 2 ENT symptoms of rosacea
rhinophyma (large, red, bulbous nose)
blepharitis
what might you feel upon inspection of the neck of a patient with rosacea?
lymphadenopathy
what causes rosacea?
inflammatory response to sun damage
give an example of a topical treatment for rosacea
azelaic acid
metronidazole gel
give an example of a systemic drug which you could give for rosacea
doxycycline
lymecyclin
name a physical treatment for rosacea
laser
what type of skin disease is urticaria?
a) infective
b) inflammatory
c) infestation
d) haemorrhagic
b) inflammatory
what percentage of people will experience urticaria at some point in their life?
a) 5%
b) 15%
c) 25%
d) 35%
b) 15%
give 3 physical/environmental causes of urticaria
pressure
temperature
water
give 3 other causes of urticaria
idiopathic
medication reaction
vasculitis
hereditary
when would you suspect a hereditary cause for urticaria?
recurrent attacks
what inflammatory skin condition is described as transient pruritic swellings?
urticaria
wheals, hives and nettle rash are ways to describe which inflammatory skin condition?
urticaria
urticaria can cause swelling of which 3 areas apart from skin?
face
mouth
airway
urticaria is a medical emergency when it presents with what?
angioedema
what is the difference between acute and chronic urticaria?
acute
what causes oedema in urticaria?
leakage of capillaries in dermis
what two intrinsic substances trigger urticaria?
histamine
cytokines
what is acute treatment for urticaria?
adrenaline (epipen)
give 2 drug treatments for urticaria
antihistamines
oral steroids
what virus causes chicken pox and herpes zoster (shingles)?
varicella zoster virus
what happens to the immune system of a patient following infection with VZV?
initial immune reaction and infection
lifelong immunity
does the VZV virus get eradicated from the body following infection?
remains dormant in dorsal ganglion
what viral skin infection is characterised by small itchy blisters which scab alongside systemic fever, fatigue, headaches and muscle aches?
chicken pox/ shingles
when is a person with chicken pox infectious?
1-2 days before the rash appears until the lesion crusts over
what is a tzanck smear used to diagnose?
chicken pox and shingles vesicular fluid
why should aspirin not be given with chicken pox?
can lead to reye’s syndrome
what is reye’s syndrome?
swelling of liver and brain in children recovering from viral infection
suggest a drug used to treat shingles in adults
acyclovir
is there a vaccine available for chicken pox?
yes
where does a VZV rash lie in shingles?
follows nerve distribution
what is postherpetic neuralgia
complication of reactivation of VZV
what is ramsay hunt syndrome?
VZV reactivation in facial nerve ganglion
what VZV complication is characterised by facial paralysis, ear pain, taste loss and rash?
Ramsay Hunt
what is the name of VZV infection in a baby?
fetal varicella syndrome
when in pregnancy is VZV most dangerous for the mother?
third trimester
what strain of herpes simplex causes oral herpes?
HSV 1
what strain of herpes simplex causes genital herpes?
HSV 2
which of these does NOT describe herpes simplex
a) cycles between active and remission
b) first infection more severe
c) affects 40% adults
d) decreases in frequency and severity over time
c) affects 40% adults
what is hepatic whitlow?
herpes infection of fingers
what is Bell’s Palsy?
HSV reactivation causing facial paralysis
what antiviral treatment is recommended for herpes simplex?
aciclovir
what fungal disease are people with HIV more inclined to?
thrush
what disease (exacerbated by HIV) is characterised by purple/dark lesions of the skin and mucus membranes?
Kaposi’s sarcoma
what HIV related disease is characterised by white lesions on the bottom/side of tongue that can be flat or furry?
oral hairy leukoplakia
what virus causes oral hairy leukoplakia?
EBV
how is oral hairy leukoplakia treated?
acyclovir
give an example of a viral disease that can become chronic and progressive with HIV, that is normally self limiting
molluscum contageosum
how is HIV-exacarbeted molluscum contageosum treated?
imiquimod
name a dermatological condition that is more severe in HIV and only improves as HIV improves
seborrheic dermatitis
what vegetable do viral warts often look like?
a) tomato
b) cauliflower
c) carrot
d) potato
b) cauliflower
what is the major causative organism of viral warts?
human papilloma virus
what part of the skin does HPV infect?
squamous epithelium
what is the latin name for a common wart?
verruca vulgaris
where are verruca vulgaris?
hands
what is verruca plana? where do they lie?
flat wart
face, hands, neck, wrists, knees
what is a filiform/digitate wart and where do they lie?
thread/finger like
eyelids and lips
what is a condyloma acuminatum or a verruca acuminata?
genital wart
what is a periungal wart?
cauliflower cluster around nails
what is verruca planteris?
plantar wart
what are mosaic wart?
tight clusters of plantar warts
HPV warts type 2 and 4 are ____ warts.
Type 14 and 16 are _____ warts.
Type 1 are ____ warts
Type 6 and 11 are _____
common
dysplasic
plantar
genital
which of these layers of is not thickened in a viral wart?
a) corneum
b) spinosum
c) granulosum
d) basale
d) basale
what is the name of the HPV vaccine for girls?
gardasil
give 2 examples of topical treatments that you might give for viral warts
salicylic acid
imiquimod
what other therapy could you give for viral warts?
cryotherapy
what virus causes molluscum contageosum?
pox
what colour are the papules characteristic of molluscum contageosum?
pearly white
describe the shape of molluscum contageosum papules
smooth
umbilicate centre
what group of the population are most at risk of molluscum contageosum (spread by close contact)
school children
what is the name of a T1 drug eruption?
anaphylactic
give 2 examples of T1 drug eruptions
anaphylaxis
angioedema
urticaria
what is the name of a T2 drug eruption?
cytotoxic
give an example of a cytotoxic reaction
thrombocytopenia
toxic epidermal necrolysis
what is the name of a T3 drug eruption?
immune complex
give an example of a T3 immune reaction
serum sickness
vasculitis
what is the name of a T4 drug eruption?
cell mediated
give an example of a cell mediated drug eruption
maculopapular rash (morbilliform rash) toxic epidermal necrolysis
what is AGEP?
acute generalised exanthematous pustulosis
which two places on the body do the erythema and pustules of AGEP mainly affect?
face
flexures
what is DRESS?
drug reaction with eosinophilia and systemic symptoms
describe the rash present in DRESS
widespread
maculopapular
pustular
which drug reaction is characterised by a rash AND lymphadenopathy, hepatitis, pericarditis, nephritis, pneumonitis?
DRESS
which drug reaction is most commonly caused by
a) antibiotics, antifungals
b) anti epileptics, sulphonamides, allopurinol
a) AGEP
b) DRESS or EM minor
erythroderma is a _____ skin infection with _____, ____ ____ and _______
widespread
pruritus
hair loss
hyperkeratosis
give 3 causes of erythroderma
drugs dermatitis psoriasis immunobullous disorders cancer HIV
give 3 complications of erythroderma
deranged thermoregulation
fluid/electrolyte imbalance
hypoalbuminaemia
secondary infection
what type of reaction is erythema multiform minor?
T4 hypersensitivity
aside from skin, where does erythema multiform minor commonly affect?
mucus membranes
suggest 3 causes for EM minor
herpes
vaccines
drugs
what causes 50% of cases for EM minor?
idiopathic
name 3 related skin diseases characterised by widespread blisters and targetoid lesion with epidermal detachment and crusting
EM major
steven johnson
toxic epidermal necrolysis
what happens to the skin in SJS/TEM/EMmajor?
necrosis
what is the major cause of EMmajor/SJS/TEM?
drugs
what immune complexes have been linked to development of EMmajor/SJS/TEM?
HLA/MHC
the complications of EMmajor/SJS/TEM are similar to that of what major trauma?
severe burns
what dermatological condition is characterised by hyper pigmentation and thickening of skin with a velvety texture?
acanthosis nigricans
where in the body does acanthosis nigricans most commonly affect?
body folds
give 4 causes of acanthosis nigricans
increased insulin obesity drugs (steroids, COCP) increased growth factor cancer
what is the name of a necrotising skin condition associated with diabetes and rheumatoid arthritis?
necrobiosis lipiodica
what is the first presentation of necrobiosis lipiodica?
bruised lesion on skins with erythema
what causes necrobiosis lipiodica lesions to develop into open sores and ulcers?
local trauma
which of these is not true of necrobiosis lipiodica?
a) inflammatory
b) necrotic
c) granulomatous
d) can affect underlying fat
b) necrotic
in which gender is granuloma annulare more common in?
women
in what shape are the red bumps of granuloma annulare arranged in?
circle
give 3 examples of common sites of granuloma annulare
hands
feet
knuckles
back of legs
what is granuloma annulare caused by?
t cell clustering below skin
what drug type is most common for treating granuloma annulare?
steroids
what part of the flesh is affected by erythema nodosum?
inflammation of fat
how does erythema nodosum present?
painful nodules on shins
in what age group is erythema nodusum most common?
a) infants
b) teenagers
c) middle aged
d) elderly
b) teenagers
what systemic symptoms can exist with erythema nodosum?
flu like
what is the name for the syndrome comprising acute sarcoidosis, erythema nodosum, fever and joint symptoms?
a) Hashimoto’s
b) Dressler’s
c) Steven-Johnson
d) Lofgren’s
d) Lofgren’s
what causes 30-50% of all cases of erythema nodosum?
idiopathic
give 3 other causes of erythema nodosum
infection autoimmune cancer pregnancy drugs
what is treatment for erythema nodosum?
self limiting
what is the main cause of recurrent attacks of erythema nodosum in children?
streptococcal infection
what is the effect of pyoderma gangrenosum on tissue?
necrolysis
where do pyoderma gangrenosum ulcers normally arise?
legs
what is pathergy pyoderma gangrenosum?
new ulcers at site of trauma
what is PAPA syndrome?
pyogenic sterile arthritis, pyoderma gangrenosum, acne
give 3 drug types used to treat pyoderma gangrenosum
steroids
immunosuppressants
antibiotics (aminoglycoside)
what is the rash characteristic of systemic lupus erythematous? give 2 of its features
butterfly
malar, discoid
how do patients with SLE react to light?
photophobia
what type of antibody cause SLE?
antinuclear
give 4 complications/systemic symptoms of SLE
renal disorder neurological disorders blood disorders immune disorders arthritis vasculitis Raynaud's alopecia
from what variant of lupus do 98% of patients go on to develop SLE?
acute cutaneous lupus
from what variant of lupus do 5-30% of patients go on to develop SLE?
chronic lupus
how is SLE treated?
immunosuppressants
give a cardiovascular complication of SLE
accelerated atherosclerosis
what kind of disease is scleroderma?
autoimmune
what causes hardening of the skin in scleroderma?
increased collagen synthesis
what peripheral temperature regulation disease is associated with scleroderma?
Raynaud’s
name 3 visible hand signs present in scleroderma
sclerodactyly
claw hand
telangectasia
name a systemic complication of scleroderma
oesophageal dysfunction
can scleroderma be multi systemic?
yes
what is treatment for scleroderma?
none present
what is lichen sclerosus characterised by?
white patches on skin
give a general complication of lichen sclerosus
scarring
why can lichen sclerosus lead to loss of genital function?
shrinking and thinning of genital area - pain, itching, loss
lichen sclerosus can affect the ___ and the ____ on women and the _____ on men
vulvu, anus (women)
foreskin (men)
lichen sclerosis leads to ___keratosis, dermal _____ and epidermal _____
hyperkeratosis
dermal sclerosis
epidermal atrophy
give 3 risk factors for development of lichen sclerosus
autoimmune
family history
infection
post-menopause
what bacteria can cause lichen sclerosus?
borrelia
give 2 viruses that can cause lichen sclerosus
HPV
hep C
lyme’s disease
what drug group is often given as treatment for lichen sclerosus?
steroids
what condition is characterised by chronic inflammation, erythema and scarring on the face, ears and scalp with scaling and crust
discoid lupus erythematosus
what are the 3 types of discoid lupus erythematous?
localised
generalised
childhood
what is morphoea a localised version of?
scleroderma
what 3 symptoms of scleroderma does morphoea lack?
raynaud’s
sclerodactyly
tenangectasia
nail fold changes
give an example of a topical steroid which could be given to treat morphoea
imiquimod
if morphoea is very deep/stubborn, what might treatment be?
IV steroids and methotrexate
what type of autoimmune disease is dermatomyositis?
neuromuscular
dermatomyositis is inflammation of what?
muscles and skin
where else in the body does dermatomyositis affect?
can have systemic symptoms
what causes damage of microscopic vessels in dermatomyositis?
complement mediated
dermatomyositis is characterised by muscle _____, tissue _____ and lymphatic _____.
muscle atrophy
tissue ischaemia
lymphatic infiltration
which gender does dermatomyositis normally affect?
women
how does dermatomyositis present on the skin of the body and face?
body - shawl, red rash on back and upper neck
face - lilac rash on upper eyelids
what other diseases is vitiligo linked to?
autoimmune
is vitiligo acute or chronic?
chronic
what occurs to the skin in vitiligo?
portions lose pigment
how does non-segmental vitiligo present?
symmetrical patches
what is focal non segmental vitiligo? who does it affect?
scattered macules
children
what is is acrofacial non segmental vitiligo?
fingers and orifices
what is mucosal non segmental vitiligo?
mucosal membranes
how is vitiligo treated?
steroids
phototherapy
cacineurin inhibitors
what causes destruction of blood vessels in vasculitis?
inflammation
what are the two types of vasculitis?
systemic
cutaneous (microvessels)
give 2 skin signs that might present with vasculitis?
purpura
livedo reticularis
give 4 systemic symptoms of vasculitis
myalgia
arthralgia
fever
malaise
give 2 other body system effects of vasculitis
systemic
nervous system
give 4 causes of vasculitis
autoimmune e.g. RA
cancer
infection
chemicals/drugs e.g. cocaine
give 3 possible treatments for vasculitis
corticosteroids
immunosuppressants
antimicrobials
what type of disease is immunobullous pemphigus?
autoimmune
what effect does pemphigus have on the skin and mucus membranes?
blistering
what is acantholyis and when does it occur?
un-glueing effect of epidermis
occurs in pemphigus
what occurs to pemphigus blisters?
slough into sores
how can pemphigus be fatal?
overwhelming infection in sores
what is pemphigus vulgarise and what condition is it associated with?
starts in mouth
associated with myasthenia gravis
what is folliaceus pemphigus and where does it mainly affect? how severe is it?
crusty sores on scalp like eczema
least severe form
what is intraepidermal pemphigus and how is it mediated?
intraepidermal blisters
IgA mediated
what is paraneoplastic pemphigus a complication of?
cancer in airways
how is pemphigus treated?
oral steroids
what antibodies mediate pemphigoid disease?
desmoglein autoantibodies
what type of disease is pemphigoid disease?
autoimmune
which part of the flesh does pemphigoid disease affect?
connective tissue
what type of hypersensitivity reaction is pemphigoid?
type 2
what two antibodies could mediate pemphigoid?
IgG
IgA (more difficult to treat)
what characteristic do pemphigus and pemphigoid NOT share?
a) blistering
b) autoimmune
c) acantholysis
d) can form sores
c) pemphigoid NEVER has acantholysis
which is more common? pemphigus or pemphigoid?
pemphigoid
give a cause of pemphigoid urticarial bullae on inner thighs, arms and trunk
drugs
furosemide, captopril, antibiotics
dermatitis herpetiformis is characterised by what?
chronic blistering rash with herpes-like appearance
does herpes cause dermatitis herpetiformis?
no
which surfaces of the body are normally affected by dermatitis herpatiformis?
extensors
what GI disease can often accompany dermatitis herpatiformis? why?
coeliac disease
can cause jejunal villous atrophy
in which skin layer does dermatitis herpatiformis start?
dermis
what antibody mediates dermatitis herpetiformis?
IgA
what lifestyle change can dramatically improve dermatitis herpetiformis?
gluten-free diet
what is juvenile spring eruption?
rash on helices of ears when exposed to sunlight
what causes benign summer light eruption?
sunbathing
what type of hypersensitivity reaction causes benign summer light eruption?
type 4 hypersensitivity triggered by UV rays
porphyrias are characterised by an accumulation of what?
porphyrins (precursors of heme, p450 etc)
what types of porphyria is caused by exposure to sunlight?
cutaneous
vesiulo-erosive
what is chronic actinic dermatitis and what causes it?
skin inflammation from Uv light
where does chronic actinide dermatitis normally erupt?
upper chest
hands
face
what is cutaneous lupus erythematous?
transient butterfly rash after sun exposure
