Dermatology Flashcards
Who is usually affected by Asteotic dermatitis and where?
Elderly people and it’s more common in the winter time.
Predominantly affects the shins!
What is atopic eczema?
Inflammation of the skin due to Atopic (IgE mediated cause)
Filaggrin gene and leads to dry skin caused by decrease of fatty acids in the epidermis is associated with…
Atopic Eczema
What is the pathophysiology behind Atopic Asthma?
o largely a T-cell driven process with epidermal barrier dysfunction
What are some common triggers for atopic dermatitis?
Detergents, Soaps, Contact allergens, Environmental allergens, Inappropriate bathing habits ) long hot showers, Microbes
What investigations to Ix eczema?
Usually clinical diagnosis
Skin biopsy, Serum immunoglobulin (IgE), patch testing and skin prick test
Management of Atopic Eczema?
- Avoid dryness:
- Avoid long hot showers,avoid over heating, Avoid irritative clothing/soaps - Moisturise!
- Topical steroids - Ointments over creams!. At earliest sign of flare
- Wet dressings?
- Manage complications - Abx
- can consider topic immunomodulators (calcineurin inhibitor)
Can consider antihistamines and psychological interventions
What are side effects of Topical steroids?
Skin atrophy, Steroid acne/rosacea, glaucoma, cataracts, Purpura, striae
What part of infant affected by Atopic Eczema?
And in an older child?
Scalp and face predominants affects infants. Skin flexures (cubittal and popliteal fossae) in older kids and frictional areas (wrists, ankles)
Malassezia is a yeast that plays a part in _____ eczema
Seborrhoeic dermatitis
Cradle cap in infants is generally caused by
Seborrheic dermatitis
Diffuse involvement of scalp with yellow to white flakes, pruritus and underlying erythema…?
Seborrheic dermatitis
Management of Seborrheic dermatitis?
Face – Ketoconazole cream daily or bid + mild steroid cream
Scalp: Salicylic acid in olive oil
Small vesiculopapular outbursts affecting the soles of feet and hands?
Pomphoylx dermatitis/Dishydrotic dermatitis
Papulovascular dermatitis of hands and feet that coalesce into plaques followed by painful_______
Papulovascular dermatitis of hands and feet that coalesce into plaques followed by painful fissuring
Management of Pompholyx eczema:
High potency steroid with plastic cling wrap to increase penetration. Use Pred in severe cases.
- Can use intralesional triamcinolone injections
Circular dry, scaly rash resembling tinnea?
Discoid Eczema
Lipodermatosclerosis is associated with ________ in ________
Associated with chronic venous insufficiency and Status Dermatitis
How would you manage Status Dermatitis?
- Compression stocking, rest and elevate legs, moisturize.
- Possibly steroids and Abx for infections?
How would you manage Lichen Simplex chronicus?
Treat pruritus to break the itch-scratch cycle: antihistamines, topical antipuritics
Allergic contact dermatitis is a Type ___ hypersensitivity reaction
Type IV
Difference in causes of Irritant contact dermatitis and Allergen contact dermatitis?
Most causes of irritant contact can cause Allergen. Irritant caused by Soaps, Alkali, acids whereas Allergic caused by metals (nickel in watches and belts).
Erythema with a papulovascular eruption swelling, pruritius in response to nickel belt:
Allergic contact dermatitis
localised, well demarcated patches of hair loss. Exclamation mark hairs
Alopecia Areata
What differentiates first degree and second degree tears?
First degree - superficial epidermal - red and painful
Second degree - Pale pink and blistered. Superficial dermal
Two common skin disorders of pregnancy?
How to differentiate them?
Polymorphic eruption of pregnancy - last trimester. Often first appear in abdominal striae.
Pemphigoid gestationis - Pruritic blistering lesions. Often develop in umbilical region. Large red and demarcated
Widespread pruritus- Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
Scabies
How do you manage Scabies?
Permethrin
Lifestyle stuff: Wash clothing, avoid contact and treat linen
What fungal species have a role in Seborrheic dermatitis?
Malassezia
Infants having cradle cap - dx?
Seboherreic dermatitis
Histologically has a rapid turn over of keratinocytes
Psoriasis
Signs of nail psoriasis (3)?
Thickening, pitting and onycholysis
Raindrop shaped erythematous lesions - triggered by streptococcal throat infection
Guttate Psoriasis
How to differentiate Type II and Type III acne?
Both have comedones- but type III is pustular and with scarring.
Are blackheads open or closed comedones?
Open
Destruction of melanocytes characterized by sharply marginated white patches
Vitiligo
What surfaces are most affected by vitiligo?
Extensor surfaces and periorficial areas (Mouth, eyes, anus and genitalia), affects body folds (armpits, groins)
This is a dark skin discoloration on sun-exposed areas – face (forehead, upper lip, cheeks and skin). Its usually symmetrical and blotchy
Chloasma/Melasma
melasma is associated with an increased number and activity of melanocytes. It is associated with increased levels of ______
Ostrogen and progesterone
Presents with patchy lesions on the face and skin - This is a low-grade type of eczema/dermatitis that primarily affects children.. more apparent in summer and in darker children
Pityriasis Alba
This is the name for temporary hair loss due to shedding off resting or telogen hair after some shock to the system. New hair continues to grow
Telogen Effuvian
In Telogen Effluvium the Telogen has a _________ or ______ shaped tip
Bulb or club shaped tip
How to differentiate Tinea Cappitus and Alopecia Areata
Tinea Cappitus is more scaly and there are signs of inflammation
Pathogenesis of Alopecia Areata?
It is an autoimmune disorder characterised by T lymphocytes around the hair follicles - they release cytokines which reject the hair
transient psoriatic rash frequently triggered by a streptococcal infection. Multiple red, teardrop lesions appear on the body
Guttate Psoriasis
Pyoderma gangrenosum has an association with ______
Inflammatory bowel disease - UC and CD
How to differentiate Bullous Pemphigoid and Pemphigus vulgaris?
Bullous Pemphigoid has no mucosal involvement whereas Pemphigus vulgaris does.
Both are a blistery/Bullae appearance
________________ is an autoimmune condition causing sub-epidermal blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230
Bullous Pemphigoid
Bullous Pemphogoid is an autoimmune doncition affecting subepidermal or sub dermal skin?
Sub epidermal
Itchy tense blisters around the flexures - tend to heal without scarring. Mouth is spared
Bullous Pemphigoid
Pityriasis Versicolor is a superficial cutaenous fungal infection caused by _________
Malassenia Fur fur
A 22-year-old woman presents due to hypopigmented skin lesions on her chest and back. She has recently returned from holiday in Spain and has tanned skin. On examination the lesions are slightly scaly. What is the most likely diagnosis?
Pityriasis versicolor - geenrally presents as a christmas tree rash on the back
A 67-year-old man with a history of Parkinson’s disease presents due to the development of an itchy, red rash on his neck, behind his ears and around the nasolabial folds. He had a similar flare up last winter but did not seek medical attention
Seborrheic Dermatitis
How to manage Seborrheic dermatitis on the face and body?
Topical antifungals and topical steroids - best used for short periods of time
________ is a premalignant condition which presents as white, hard spots on the mucous membranes of the mouth. It is more common in smokers.
Leukoplakia
Leukoplakia can develop into which kind of cancer?
Squamous cell carcinoma
A large black epidermal lesion. Have a stuck on appearance - raised, symmetrical and lght brown to black in Colour. Keratonic plugs may be seen on the surface
Seborrhoeic Keratoses
__________ are benign skin lesions which contain an abnormal proliferation of capillaries. They are more common with advancing age and affect men and women equally.
Cherry Hemiangioma
Another name of Campbell de Morgan spots?
Cherry Hemangioma
___________________ describe a central red papule with surrounding capillaries. The lesions blanch upon pressure
Spider Naevi
Spider naevi are associated with …. (3)?
- Liver disease
- pregnancy
- COCP
Actinic Keratoses is another name for ____
Solar keratosis
rolled, pearly edges with telangiectasia surrounding a central crater
BCC
Onychomyosis is ______ of the nails
Fungal infection - Dermatophytes (trichophyton rubrum), Candida
How do you manage Onychomyosis?
Oral Terbinafine or Oral itraconazole
A 25-year-old man presents with a pruritic skin rash. This has been present for the past few weeks and has responded poorly to an emollient cream. The pruritus is described as ‘intense’ and has resulted in him having trouble sleeping. On inspecting the skin you notice a combination of papules and vesicles on his buttocks and the extensor aspect of the knees and elbows. What is the most likely diagnosis?
Dermatitis Herpetiform
an autoimmune blistering skin disorder associated with coeliac disease.
Dermatitis Herpetiform
What do you see on skin biopsy in Dermatitis Herpetiform (remember - related to Coeliac disease)
skin biopsy: direct immunofluorescence shows deposition of IgA in a granular pattern in the upper dermis
Itchy, vesicular skin lesions on the extensor surfaces (e.g. elbows, knees, buttocks). Associated with Coeliac disease
Dermatitis Herpetiform
A 25-year-old man presents with a widespread rash over his body. The torso and limbs are covered with multiple erythematous lesions less than 1 cm in diameter which in parts are covered by a fine scale. You note that two weeks earlier he was seen with to a sore throat when it was noted that he had exudative tonsillitis. Other than a history of asthma he is normally fit and well. What is the most likely diagnosis?
Guttate Psoriasis
How to differentiate Gutatte psoriasis and Pityriasis Rosea
Guattate psoriasis has tear drop rash - with scaly papules on the trunks and limbs.
Pityriasis rosea has a herald patch rash followed 1-2 weeks later by multiple erythematous slightly raised oval lesions - with a fine scale confined to the outer aspects of the lesions. Can have a fir tree appereance
How do you manage Guttate psoriasis?
Most cases resolve spontaneously in 2-3wks
- Topical agents as per psoriasis
- UVB phototherapy
Tonsillectomy if recurrent episodes?
4 differentials for shin lesions:
- Erythema Nodosum
- Pretibial Myxoedema
- Pyoderma Gangrenosum
- Necrobiosis Lioidica diabeticorum
symmetrical, erythematous, tender, nodules which heal without scarring. Associated with Strep infections, sarcoidosis and IBD
Erythema Nodosum
What illnesses is Erythema Nodosum linked to?
Streptococcal infections, sarcoidosis, IBD and drugs (Penicillin, Sulphonamide, oral contraceptive pill)
Behcet’s
Symmetrical, erythematous lesions seen in Graves’ disease - shiny orange peely skin
Pretibial Myxedema
Initially small red papule - later develops into deep red necrotic ulcer with violaceous border. Seen in IBD, Connective tissue disorder and Myeloproliferative disorders
Pyoderma gangrenosum
Shiny, painless areas of yellow/red skin typically on the shin of diabetics - often associated with telangiectasia
Necrobiosis lipoidica diabeticorum
Inflammation of subcutaneous fat
typically causes tender, erythematous, nodular lesions - usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
Erythema Nodosum
What Conditions is Vitiligo associated with?
T1DM, Addison’s disease, Autoimmune Thyroid disease, pernicious anaemia and alopecia areata
Lichen Planus is associated with a P___, P____, P______ P______ rash
Lichen Planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
Itchy white spots typically seen on the vulva of elderly women
Lichen Sclerosus
How do you treat Lichen Sclerosus?
With topical steroids and emollients
A 32 year old lady presents with hair-loss which she thinks started after the birth of her second child 7 months ago. She is normally fit and well and is not on any regular or over the counter medication. On examination you notice patches of hair loss around her occiput. The skin looks normal and a few short broken hairs are obvious at the edges of two of the patches. What
Alopecia areata
‘golden’, crusted skin lesions typically found around the mouth
Impetigo
How do you treat localised impetigo lesions?
And multiple skin sores or recurrent lesions?
Mupirocin 2% cream.
For Multiple or recurrent sores - Use Flucloxacillin
Painful mouth and gum ulcers that occur with HSV:
Gingivostomatitis
Where does atopic eczema affect infants?
In the face and trunk.
Thickened brown velvety pigmentation on the back of the neck and folds of the axilla, and groin
Acanthosis Nigricans
Tumour like lesions that arise form connective tissue of a scar and extend beyond the dimension of the original wound- overgrowth of granulation tissue.
Keloid scars
Common sites for Keloid scars?
Sternum, Shoulder, neck, face, extensor surface of limbs, trunk
Keloid scars are less likely if __________
Keloid scars are less likely if incisions are made along relaxed skin tension lines*.
*Langer lines were historically used to determine the optimal incision line. They were based on procedures done on cadavers but have been shown to produce worse cosmetic results than when following skin tension lines
How do you treat mild rosacea?
And moderate/severe/resistant?
Mild/Mod - Topical Metronidazole
Severe/Resistant: Oral Tetracycline
A 54-year-old man presents with a two month history of a rapidly growing lesion on his right forearm. The lesion initially appeared as a red papule but in the last two weeks has become a crater filled centrally with yellow/brown material. On examination the man has skin type II, the lesion is 4 mm in diameter and is morphologically as described above. What is the most likely diagnosis?
Keroacanthoma
Volcano or crater like papule. Rapidly growing (erupting ;))
Keratoacanthoma
Onchomyosis is a fungal infection of the nail caused 90% of the time by
Trichophyton Rubrum
Venous Ulceration is seen more commonly in Lateral or Medial malleolus?
Medial!
Which test is helpful in diagnosing contact dermatitis?
Skin Patch testing
What is Radioallergenosorbent test used for?
Determines the amount of IgE that reacts specifically with suspected or known allergens, for example IgE to egg protein. Results are given in grades from 0 (negative) to 6 (strongly positive).
Blood tests may be used when skin prick tests are not suitable, for example if there is extensive eczema or if the patient is taking antihistamines
What skin lesions are related to Tubeous Sclerosis?
Adenoma Sebaceum
What infections are related to erythema nodusum?
Streptococci, TB, Brucellosis
What are the dermatological manifestations of Dermatomyositis?
Photosensitive, Macular rash ver back and sholder
Heliotrope rash in the periorbital area
Gottron papules - roughened red papules over extensor surfaces of fingers
Nail fold capillary dilatation
How do you treat athletes foot?
Topical miconazole
A 22-year-old man presents with a 3 cm area of hyperkeratotic skin on the heel of his right foot. A number of pinpoint petechiae are seen in the lesion.
Verruca - mosaic wart
22 yo man with skin on his toes flaky and itchy and mosit
Tinea Pedis
22yo woman with a thickening of the skin on the soles of her feet..
keratoderma
A 15-year-old complains of excessively smelly feet. On examination he has white skin over the sole of the forefoot bilaterally. Small holes can be seen on the surface of the affected skin.
Pitted keratolysis
A 23-year-old female presents with red, thickened skin on the soles. On closer inspection a crop of raised lesions are seen.
Palmoplantar Pustulosis
12 yo kid with history astha - soles have become shiny and hard - cracks develop which become painful! Worse during summer
Juvenile plantar dermatosis
How to differentiate between polymorphic eruption of pregnancy vs. pemphigoid gestationis?
Polymorphic eruption of pregnancy is not associated with blistering
_________is a type of intraepidermal squamous cell carcinoma. More common in elderly females. There is around a 3% chance of developing invasive skin cancer
Bowen disease. It presents with red scaly patches that often occur on the lower limbs
How to differentiate solar keratosis of the ear and Chondrodermatitis nodularis helicis
Chondrodermatitis nodularis helicis is painful!
type IV hypersensitivity reaction. Uncommon - often seen on the head following hair dyes. Presents as an acute weeping eczema which predominately affects the margins of the hairline rather than the hairy scalp itself. Topical treatment with a potent steroid is indicated
Allergic contact dermatitis
common - non-allergic reaction due to weak acids or alkalis (e.g. detergents). Often seen on the hands. Erythema is typical, crusting and vesicles are rare
irritant contact dermatitis
Circinate balanitis (painless vesicles on the coronal margin of the prepuce), keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles) are associated with
Reactive arthritis
Factors leading to exacerbation of psoriasis?
- Trauma
- Alcohol
- Drugs: beta blockers, lithium, antimalarials (Chloroquine and hydroxychloroquine), NSAIDs and Aceinhibitors, Bioligics
- Withdrawal of systemic steroids
A 27-year-old man presents as he is feeling generally unwell. Around 5 days ago he started having a sore throat associated with myalgia and lethargy. Yesterday he developed a fever and over the course of the past 24 hours a rash has appeared. His past medical history includes anxiety and atopic eczema. On examination he has a widespread erythematous rash, with many of the lesions having a ‘target’ appearance. Some of the lesions are becoming bullous. His pulse is 120/min and temperature 38.4º. He also has conjunctivitis and some ulceration and sloughing around the mouth
Steven johnson syndrome
Eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds. Otitis externa and blepharitis may also be present
Seborrhoeic dermatitis - an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur
Most common cause of Hirsutism?
PCOS in females
mx of Hirsutism?
Co-cyprindiol (COCP) - Diana
8 yo - Sore throat (4 weeks ago), NOW: chorea (jerk, irregular movements) and polyarthralga. With a rash - erythema Marginatum:
Rheumatic fever
