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MD2 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is acne vulgaris?

A

Hormonal inflammatory pilosebacious disease - Comedones (open are black heads and closed are white heads)
Papules (no pus), pustules (pus)
Nodular pseudocysts
Scarring

Onset in adolescence
genetic

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2
Q

Treatment of acne vulgaris

A

Mild disease: topical Abx

Moderate: topical ABx + oral ABx . If this fails after 3-6mo, add antiandrogens

Severe: Systemic retinoids (isoretinoin = Roacutaine)

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3
Q

Characteristics of rosacea

How is this different from acne?

A

Tendency to flush/blush
+/- burning sensation
Florid ruddy complexion all the time - affecting convexities of face
+ Papules, pustules

Telangiectasia

Worse w vasodilation, wind, stress etc

Doens’t have comedones, unlike acne

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4
Q

Complications of rosacea

A

Rhinophyma in men (swelling and hypertrophy of subcutaneous tissue of nose)

Ocular: conjunctivitis, keratitis, iritis

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5
Q

Treatment rosacea

A

No cure - avoid triggers (sunlight)
Makeup, moisturiser, sunscreen

Topical Abx: Metronidazole and tetracycline

Systemic doxyclycine or systemic retinoids if inflammatory ethology

Vascular laser if vascular etiology

Ablative laser if rhinopehyma

TOPICAL STEROIDS MAKE THINGS WORSE!

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6
Q

Contact dermatitis - compare the 2 types

A

Irritant (non-immune) - redness, dry skin, fine scale, burning
- commonly due to nickel in belt buckles

Allergic (t4 hypersensitivity) - vesicular, redness, swelling, itchy .

  • usually flexor surfaces
  • commonly due to poison ivy.
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7
Q

Eczema vs Psoriasis

Signs

A

Eczema: flexor
Acute - weepy, crusting, red, blistered lesions. diffuse.
Chronic - dry thickened, scaly and itchy lesions

Psoriasis: extensor
Salmon pink erythematous plaques, with silvery scales

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8
Q

Eczema vs Psoriasis

HS response

A

Eczema - Type 4

Psoriasis - Type 1

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9
Q

Eczema treatment

chronic vs acute flare

A

E:
Prevention:
- avoid triggers (extremes of temp, dry/extreme heat, soap and detergents)
- regular emollients
- warm/cool (soap-free) baths, wet compress
- if above doesn’t work, can try low dose topical steroid

Acute flare:

  • Potent topical steroids (mild ones for face)
  • Topical/oral abx if suspect bacterial infection (golden crusty)

Severe: oral steroids or immunosuppressants (methotrexate, azathioprine etc)

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10
Q

Eczema vs Psoriasis

exacerbators

A

E - worse in heat

P - worse in cold

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11
Q

Which type of psoriasis is associated w strep pharyngitis (strep throught)?

A

1-2 weeks after strep URTI.

Guttate psoriasis. (small plaque psoriasis, almost looks like red mosquito bites)

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12
Q

What is erythema multiform characterised by?

A 
Target lesions (macules, papules) w central vesicles 
start on dorsum of hands and feet first then spread towards trunk. 
Mucus membrane involvement

Often triggered by infections

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13
Q

Treatment of Erythema multiforme vs Steven Johnson syndrome

A

EM:

  • TX: Do nothing -> Self-healing within 2 weeks
  • SX treatment: antihistamines for itch and mouthwash (oral steroids if severe) for oral pain

SJS:
- TX: hospitalisation w supportive care + STOP CAUSATIVE MEDS + skin care (wet dressings, abx etc)

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14
Q

What is Stven johnson syndrome characterised by?

A

Starts on TRUNK, then spreads to limbs. + mucus membrane
Targetoid lesions (like target lesion but no vesicle in centre)
Blisters
Sheet-like epidermal detachment on contact of skin.

prodrome is flu-like illness up to 14 days

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15
Q

What is Steven johnson syndrome caused by?

A

Adverse effect of medication

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16
Q

What is a keratoacanthoma?

What is it’s natural history?

Tx?

A
  • Low grade SCC
  • Spontaneous regression within 1 year with scar
  • Tx: excision
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17
Q

What is the significance of solar or actinic keratosis ?

What are red flags?

What do you do about them?

A

10% can develop to SCC

Watchful waiting

If suspicious for transformation to SCC (growing, hyperkeratotic, TENDER):

Cryotherapy
Topical medications (5-Fu, imiquimod)
Surgical excision

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18
Q

Actinic keratosis:

Where are they generally found and what are key features?

A

Found on sun exposed skin - face, scalp, forearms and hands

Scaly erythematous lesions, sand-papery texture +/- actinic horn

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19
Q

What is Bowen’s disease?

Appearance?

SX?

What is the significance of them?

A 
Intraepithelial SCC 
(early non-invasive stage of SCC = full thickness epithelial dysplasia without breaching BM)

Appearance: perisistant red-brown scaly patch, NOT indurated

Location: sun exposed sites, particularly lower limbs!

SX: may be itchy/painful/bleed but often asymptomatic

Significance: 5% progress to invasive SCC.

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20
Q

MX of Bowen’s disease

A

Excision and biopsy if suspicious

Topical 5FU or imiquimod

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21
Q

Topical meds for removing skin lesions

A

5-fluorouracil cream
Imiquimod cream (IFN)
Photodynamic therapy

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22
Q

BCC

  1. level of invasion
  2. where are they found?
A

Local invasion (almost never metastasise)

Found on face

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23
Q

BCC characteristics

A

Pearly/transulent firm nodule
Rolled edges
+/- central indentation or ulceration (“rodent ulcers”)

Telangiectic border (red)
painless bleeding

Indolent growth

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24
Q

SCC characteristics

A

Erythematous nodule or plaque
Hyperkeratotitic surface crust (keratinocyte proliferation)
Ulceration, bleeding

Grows quickly, over weeks-months
May be tender to palpation

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25
Q

SCC

  1. level of invasion
  2. where are they found?
A
  1. More likely to spread than BCC (to regional lymph nodes first)
  2. Sun exposed sites
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26
Q

Management of SCC

A

COMPLETE wide local excision with biopsy +/- adj. radiotherapy

Not for surgery: radiotherapy alone

lifelong follow up

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27
Q

Descibring skin lesions ABCDE

A 
Asymmetry
Borders (irregular)
Colour (variated)
Diameter (>6mm)
Evolution
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28
Q

Risk factors for melanoma

A

> 5 dysplastic nevi
100 congenital nevi

Fair skin, red hair
PHX/FHX of melanoma
frequent blistering sunburns

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29
Q

IX and Treatment of melanoma

A

IX: wide excisional biopsy

MX: surgical excision +/ high dose IFN +/- chemo +/- radiotherapy

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30
Q

risk factors SCC

A 
Chronic sun exposure
Ionising radiation
Smoking
HPV 16, 18
Immunosuppression (more aggressive, metastatic disease carrying higher rate of mortality)
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31
Q

WHAT WOULD you use to characterise the prognosis of melanoma?

A

Breslow thickness - thickness of lesion based on biopsy histology determines recommended margin for wide local excision

32
Q

What do you do about a suspicious lesion if they are:

  • Raised
  • Flat
  • Pigmented/suspicious for melanoma
A

Raised: shave biopsy

Flat:

  • Large: Punch biopsies of most suspicious areas
  • Small: Wide excision if small

Pigmented/melanoma - complete wide excision

33
Q

What are the terms for fluid-filled blisters?

A

Vesicle <5mm

Bullae >5mm

34
Q

What is a pustule and what can cause these?

A

Pus-containing vesicle or bullae (>5mm)

Bacterial folliculitis (staph aureus) or pustular psoriasis

35
Q

What are the terms for elevated skin lumps?

A

Papule <5mm

Nodule >5mm

36
Q

What is the term for hardening of the skin so you are no longer able to pinch it?

A

Systemic sclerosis

37
Q

What is a scale?

A

Abnormal accumulation of keratin on the skin surface

38
Q

DX, investigations and treatment: itchy rash with a gradually enlarging red scaly edge and clearing central pale region

A

Tinea Corporis (ring worm)

  • Fungal infection -> skin scraping for fungal MCS
  • Treat with topical anti fungal cream (imidazole)
39
Q

Where can tinea infect?

A

Skin -> T. Corporis

Between the toes -> T. pedis

Nails -> T. Unguium

Groin -> T. Cruris

Scalp, causing hair loss -> T. Capitis (more common in children)

40
Q

What is alopecia?

Common causes? list 3.

A

Hair loss

Common causes:

  1. Autoimmune
  2. Tinea capitis, common in children and transmitted by cats and dogs
  3. cutaneous lupus (irreversible hair loss)
41
Q

What virus causes shingles?

A

Herpes Zoster Virus - Varicella Zoster sits latent in DRG and reactivates when host is immunosuppressed or stressed and causes vesicular/papular crusty rash in dermotomal pattern.

May have prodrome of neuralgic pain and tingling

Diagnosis via PCR

Systemic antiviral treatment

42
Q

Which herpes viruses affect the skin?

A

HSV-1: cold sore.
(can be transmitted to genitals sexually causing 40% of genital herpes)
Systemic or topical antivirals

HSV-2: restricted to genital areas only; sexually transmitted
Systemic antiviral

Diagnosis via PCR

43
Q

DX and TX:

  • umbilicated (central white spot) skin-coloured papule, may be surrounded by eczema, can heal by scarring.
  • Common disease of childhood, spread in pools and baths, spreads through families
A

Molluscum Contagiosum

TX:

  • Preventative: take shows
  • Topical salicylic acid wart paint
  • Topical imiquimod cream
  • Tape stripping, topical cantharidine, curettage
44
Q

Treatment of warts

A

Destructive

  • liquid nitrogen
  • diathermy
  • curettage

Topical

  • salicylic acid
  • DCP immunotherapy
  • Imiquimod (genital warts)
  • Tape
45
Q

What sort of infection is a wart?

What sorts of warts are there?

A

Viral infection (HPV)

  1. Common wart - Verruca Vulgaris
  2. Plantar wart (on feet) - Verruca Planters
  3. Periungual (nail area and fingers)
  4. Plane warts (on face, looks similar to acne)
  5. Filiform - looks similar to a skin tag
  6. Anogenital - anal and penile
46
Q

What organicm usually causes folliculitis and what is the treatment?

A

Staph aureus

Systemic ABx (flucloxaillin or cephalexin) +/- antiseptic washes

47
Q

Impetigo: what is the generic name?

What organism causes impetigo and what is the characteristic appearance?

A

“School sores”

Staph aureus - treat w systemic flucloxaillin or cephalexin
Honey-comb crusting

48
Q

Cellulitis: common causative agents

TX

A

Strep pneumonia! Otherwise staph aureus, staph epidermis.

Requires IV antibiotics and usually overnight admission due to systemic illness

49
Q

Complications of eczema

A
  • lichenification of skin from chronic itching and scratching
  • bacterial (staph aureus) or viral (HSV) superinfection
  • s/e from chronic steroid use
  • eye changes from facial eczema around eyes
50
Q

what is pompholyx eczema>

A

worse/commonly on palms triggered by excessive washing or sweating on hands

51
Q

what is asteatotic eczema?

A

scaly and diffuse, often on legs of elderly patients w dry legs

seasonal - “winter itch” and also with heat and dryness

52
Q

DDX for annular disc-like patches on skin

A

Discoid eczema

Tinea

Psoriasis

53
Q

What sites is psoriasis generally found?

A

Extensor surfaces
Scalp
AnoGenital (more of a glazed appearance, less scaly)
palmar and plantar surfaces
Nails - psoriatic arthritis more likely with nail involvement

Auricular

54
Q

When are the peaks of onset of psoriasis?

A

20s and 50s

55
Q

Treatment for psoriasis

A

Topical steroids, topical vitD, keratinolytics
Emollients

UVB phototherapy

Systemic immunosuppressants and biologic agents

56
Q

what sort of psoriasis is a medical emergency?

A

Generalised pustular psoriasis
- acute pustular flare w/ fever and chills

  • risk of pre-renal failure, high output cardiac failure and sepsis
57
Q

Acne congloblata

A

severe cystic acne with huge pustular white heads

58
Q

Treatment of acne

A

Topical
- salicylic acid and retinoic acid (act to dissolve comedones)
- antibacterials
(clindamycin, benzoyl peroxide, erythromycin)

Systemic

  • antibiotics (doxy, erythromycin, minocycline)
  • anti-androgenic OCP for females w hormonal-type acne
  • Systemic retinoids (roacutaine) - severe acne only. 60-70% Curative after 1 6-12mo course.
59
Q

SE of systemic retinoids

A

teratogenic
Mucosal dryness, photosensitivity
Depression

60
Q

DX, investigations and treatment

Small papule often between fingers with linear lesions on hands - VERY itchy, with itch worse at night.
Can spread to genitals in men or nipples in women.

Turns into generalised eczematous body rash as a late secondary hypersensitivity reaction.

A

Scabies

Skin scraping -> light microscopy

Treat w 5% permethrin cream + hot wash and dry of all clothes and beddings.
Treat ALL CONTACTS!

Treat accompanying eczema (topical steroids, emollients, oral antihistamines etc)

61
Q

What is the order of frequency of skin cancers?

A

BCC - 67%
SCC - 31%
Melanoma - 2%

62
Q

What disorders fall under the category characterised by keratinocyte dysplasia?

A

Actinic keratosis - 10% turn into SCC

SCC in situ (Bowen’s disease) - 5% turn into SCC

SCC

63
Q

Do BCCs have precursor lesions?

A

No!

64
Q

What are some atypical presentations of BCC to be aware of?

A

Superficial BCC - solitary red plaque (looks similar to rash) not responding to topical treatment, spreading radially

Infiltrative/sclerosing/morphoeic BCC - can present as a scar-like area of induration (scar tissue within BCC pulls in centrepidal pattern and can displace eyebrows/pull on lower eyelid)

65
Q

MX of BCC

A

Nodular or infiltrating BCCs: wide local excision and biopsy

Superficial BCCs:

  • excision
  • serial curettage
  • topical imiquimod
  • photodynamic therapy
66
Q

What is a benign junctional naevi?

A

Naevi appears during childhood
Located at epidermal side of dermal-epidermal junction

Macular, dark uniform colour, <1cm diameter

67
Q

What is a benign compound naevi

A

Naves cells in epidermis AND dermis - papule or nodule

smooth or uniform border with uniform colour, <1cm

68
Q

What is a benign intradermal naevi?

A

Naves cells are within the dermis only

Papule or nodule wiht even pale colour (skin-coloured/tan)

69
Q

What are freckles due to?

How are lentigenes different?

A

Sun-induced increase in melanin, NOT melanocytes

Lentigenes are sun-induced pigmented macule (bigger) in middle aged people that do not change with time due to a few incr melanocytes.

70
Q

What is a seborrhoeic keratose?

A

Skin lesion with a warty stuck-on appearance in older patients
Can get larger with time
May or may not be pigmented

71
Q

What is a dysplastic naves?

Why do we care?

A

Atypical features clinically and atypically but NOT a malignant melanoma.

Generally >5mm, atypical pigment on dermoscopy, smudgy borders with 2+ colours but relatively symmetrical

<1/1000 risk of malignant transformation BUT possessing >1 is an independent risk factor for development of melanoma

72
Q

Characteristics of nodular melanomas

A

Elevated, Firm, Growing
Often do NOT fulfil ABCDE criteria - do not LOOK like a melanoma
Rapid growth and early invasion

73
Q

Lentigo Maligna (Melanoma) characteristics)

A 
Gradually enlarging pigmented lesion usually on face
SLOW evolution (years)
74
Q

Superficial spreading melanoma characteristics

A

80% of melanomas

Follow ABCDE rules, evolving over weeks to months

75
Q

Where are acral lentiginous melanomas usually found>

A

Soles or palms

MD2 (16 decks)

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