Dermatology Flashcards
What makes acne worse
POP hormone changes around menstruation Thick, greasy make-up Picking / squeezing spots Heavy sweating Humidity Tight clothes Diet high in milk and sugar
Skin care advice for acne
Don’t wash more than normal
Mild soap, lukewarm water
Antiseptic washes
Fragrance free, water based moisturiser
Topical tx for acne
Azelaic acid
Salicylic acid
Benzoyl peroxide - antibacterial, anti-inflammatory, unlocks pores
Retinoids - unblock pores, anti-inflammatory
Topical antibiotics
Tablets for acne
Any systemic tx may take months to show effect.
- Antibiotics - tetracyclines (doxycycline, tetracycline, oxytetracycline) erythromycin, trimethoprim
- COCP esp Dianette
- Isotretinoin - specialist advice
Tx for scarring by acne
Laser resurfacing
Chemical peels
Microdermabrasion
Subcison - for depressed scars
Complications of acne
Anxiety Depression Low self esteem Social isolation Scarring Post-inflammatory hyper-pigmentation
What is acne excoriee
Excessive scratching / picking at normal skin / skin with minor abnormalities –> irritation, inflammation and scarring.
Picking continues until material is pulled from the skin
What is dermatitis herpetiformis
Autoimmune blistering condition - associated with coeliac
Presentation of dermatitis herpetiformis
Intense itch
Bullous rash - papules/blisters upto 1cm
Extensor surfaces - esp scalp, buttocks, elbows, knees
Tx of dermatitis herpetiformis
Dapsone (anti-leprotic)
Gluten free diet
What is pompholyx?
Type of eczema - itchy blisters on hands and feet
Followed by inflamed dry skin
Causes of pompholyx
Metals such as nickel or cobalt Antibiotic - neomycin Certain chemicals - e.g perfume Fungal infection of skin Emotional stress
Tx of pompholyx
Compresses / soaks Emollients Steroids Antibiotics Antifungal If severe / persistent --> dermatologist - PUVA, methotrexate, azathioprine, dapsone, tacrolimus
Prognosis of pompholyx
May clear up in 3-4 weeks + not return.
Or may be more persistent.
Some people have recurring short bouts.
What is seborrhoeic dermatitis
Skin inflammation, most common on the greasy areas of the skin - where most sebum is produced.
I.e scalp, forehead, sides of nose.
–> dry skin, red flaky patches
Tx of seborrhoeic dermatitis
Antifungal / antiyeast cream + shampoo - ketoconazole
Anti dandruff shampoo - zinc or coal tar based
Scale softener
Mild steroid cream
Pimecrolimus / tacrolimus cream
Anti fungal tablets
Phototherapy
Risk factors for compromised wound healing
DM
Peripheral vascular disease
Bleeding diathesis
Hx of keloid formation / scar hypertrophy
What is lichen planus?
Chronic mucocutaneous dermatosis White striae Plaques Erosions in mouth Skin papules Scalp involvement leads to alopecia
Features of seborrhoeic keratosis
Pigmented Benign tumour of basal keratinocytes Occur on face and trunk of elderly people Dark rough Greasy Stuck on appearance Well-defined edge
What is dercum’s disease
Multiple painful lipomas
Most common in obese, middle aged F
+/- headaches, amenorrhoea, reduced sweating
Features of a lipoma
Soft, mobile lesions
Composed of fatty tissue
Painless
What is a deep capillary naevus also known as
Port-wine stain
Features of a deep capillary naevus
Congenital
Malformation of capillaries in deep and superficial dermis
Most commonly - unilateral on the face
+/- seizures, learning difficulties, eye abnormalities
What is sturge-weber syndrome
Collection of symptoms: deep capillary naevus (port wine stain) Fits Developmental problems Glaucoma
What is a superficial capillary naevus also known as
Salmon patch
Features of a superficial capillary naevus
Small Flat Pink patch Poorly defined border Common on forehead and nape of neck
Features of a ganglion cyst
Benign Terse Cystic swelling Back of wrist Painless
What is a cavernous haemangioma also known as
Strawberry naevus
Features of a cavernous haemangioma
Appears in 1st few months Bright red lesion on face or trunk Rapidly growing Can ulcerate and bleed Eventually regresses and disappears
Appearance and cause of acanthosis nigricans
Black, velvety overgrowth in axillae/neck/groin
Associated with diabetes, Cushing’s syndrome, acromegaly, PCOS, Lymphoma, adenocarcinoma of GIT
Appearance and cause of Paget’s disease of the nipple
Scaly, dry rash on nipple
Caused by breast cancer
Appearance and cause of tylosis
Hyperkeratosis of palms and soles
Due to oesophageal cancer
Appearance and cause of dematomyositis
Purple heliotrope rash on eyelids
Scaly pink rash on knuckles
Autoimmune condition related to polymyositis
Or
Caused by lung or breast cancer
Appearance of diabetic dermopathy
Depressed pigmented scars on the shin
Associated with diabetic microangiopathy
Appearance of pretibial myxoedema
Raised erythematous plaques over the shins and dorsum of feet.
In hyperthyroidism
Dermatological manifestations of hyperthyroidism
Pretibial myxoedema
Alopeica
Palmar erythema
Hyperhidrosis
Appearance and cause of erythema an igne
Brown lacy rash on skin
Due to exposure to heat for long periods
E.g. Hot water bottles, sitting against radiators
Common in hypothyroid patients who are cold
Dermatological manifestations of hypothyroidism
Alopecia Dry coarse hair Puffy skin Peri orbital oedema Xanthoma Malar flush
Appearance and cause of xanthelasma
Yellow plaques around eyelid
Hyperlipidaemia
Appearance and cause of granuloma annulare
Small red-purple papules arranged in a ring
On back of hands or feet
Often due to DM
Appearance of a neurofibroma
Firm and rubbery
Single or multiple
Features of cellulitis
Erythema Swelling Local pain Blistering Pyrexial patient
What is a pyogenic granuloma
An acquired haemangioma
Commonly at the site of a thorn prick
Bright red nodule.
Bleeds easily
Enlarges rapidly over 2-3 weeks
Appearance of kaposi’s sarcoma
Plaque / nodules in skin and mucous membrane
Bruise like appearance
Features of a sebaceous cyst
Arise from hair follicle
Common on scalp, face, ears, back, upper arms
Contain keratin
Painless Mobile Central punctum Fixed to overlying skin Not tethered to underlying subcutaneous tissue
Commonest cause of necrotising fasciitis
Group A streptococcus (e.g. Strep pyogenes)
Appearance of necrotising fasciitis
Erythema
Swelling
Necrotic tissue
Systemically unwell + fever
Appearance of impetigo
Thin walled blisters
Itch
Bleed
Golden crust
What causes livedo reticularis
Can be normal - response to cold Vasculitis Anti phospholipid syndrome Polycythaemia rubra Vera Cholesterol emboli
What is the most common form of skin cancer
Basal cell carcinoma
Risk factors for basal cell carcinoma
UV light exposure X-ray exposure Chronic scar Genetic predisposition Male
Presentation of basal cell carcinoma
Small, skin coloured papules
Telangiectasia
Pearly edge
Central necrosis
What is a rodent ulcer
Basal cell carcinoma
What is acrodermatitis enteropathica
Features
Rare inherited disorder of zinc malabsorption
Perianal and oral red scaly, pusular rash
Failure to thrive
Diarrhoea
Poor wound healing
Skin conditions associated with HIV
Leukoplakia Oral candidiasis Severe herpes episodes Kaposi's sarcoma Molluscum contagiosum
What 2 skin conditions can develop along side Reiter’s syndrome
- keratoderma blenorrhagicum
- circinate balanitis
Appearance of keratoderma blenorrhagicum
Pustular Crusty Yellow-brown Papular lesion On soles of feet Indistinguishable from pustular psoriasis
What is erythema nodosum
Presumed hypersensitivity reaction.
Dermatological manifestation of infectious, or other, disease
Appearance of erythema nodosum
Start as red, tender nodules. Poorly defined border - 2 to 6 cms.
Become tense, hard and painful.
May become fluctuant.
DO NOT suppurate or ulcerate.
What are lisch nodules and when do they occur
Fibromas on the iris
Occurs in neurofibromatosis
Difference between nodule and papule
Both raised
Nodule > 5mm
Papule <5mm
How many cafe au lait spots are significant
More than 5
What is a macule
Flat , non-palpable, colour change
<1cm
What is a papule
Raised, palpable, circumscribed lesion,
< 1cm
What is a plaque
palpable, circumscribed, relatively flat topped lesion, greater in surface area than in thickness, > 1 cm, can be smooth or irregular and scaly
What is a nodule
palpable, circrumscribed lesion,
larger than a papule - > 1cm and < 2 cm
What is a vesicle
clear fluid –filled lesion,
<0.5 cm = smaller than a bulla
What is a bulla
clear fluid-filled lesion,
>0.5cm = larger than a vesicle
What is a pustule
turbid fluid-filled lesion,
filled with inflammatory cells
What is lichenification
accentuated skin markings due to thickening of the epidermis
Conditions associated with pyoderma gangrenosum
Crohn's UC Rheumatoid arthritis Beçhets Active Hepatitis Primary biliary cirrhosis Myelo proliferative disorders (leukaemia, myeloma, lymphoma)
Appearance of pyoderma gangrenosum
solitary nodules / deep-seated pustules rupture - form an ulcer. Ulcer border has a deep purple / dusky colour usually undermined edge. bright erythematous / violaceous halo. Necrosis is a common feature.
extremely painful
Most common organisms in cellulitis
Strep pyogenes
Staph aureus
(In infants - blood borne group B strep)
