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Dermatology Flashcards

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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
SCC 1. level of invasion 2. where are they found?
1. More likely to spread than BCC (to regional lymph nodes first) 2. Sun exposed sites
26
Management of SCC
COMPLETE wide local excision with biopsy +/- adj. radiotherapy Not for surgery: radiotherapy alone lifelong follow up
27
Descibring skin lesions ABCDE
``` Asymmetry Borders (irregular) Colour (variated) Diameter (>6mm) Evolution ```
28
Risk factors for melanoma
>5 dysplastic nevi >100 congenital nevi Fair skin, red hair PHX/FHX of melanoma frequent blistering sunburns
29
IX and Treatment of melanoma
IX: wide excisional biopsy MX: surgical excision +/ high dose IFN +/- chemo +/- radiotherapy
30
risk factors SCC
``` Chronic sun exposure Ionising radiation Smoking HPV 16, 18 Immunosuppression (more aggressive, metastatic disease carrying higher rate of mortality) ```
31
WHAT WOULD you use to characterise the prognosis of melanoma?
Breslow thickness - thickness of lesion based on biopsy histology determines recommended margin for wide local excision
32
What do you do about a suspicious lesion if they are: - Raised - Flat - Pigmented/suspicious for melanoma
Raised: shave biopsy Flat: - Large: Punch biopsies of most suspicious areas - Small: Wide excision if small Pigmented/melanoma - complete wide excision
33
What are the terms for fluid-filled blisters?
Vesicle <5mm | Bullae >5mm
34
What is a pustule and what can cause these?
Pus-containing vesicle or bullae (>5mm) Bacterial folliculitis (staph aureus) or pustular psoriasis
35
What are the terms for elevated skin lumps?
Papule <5mm | Nodule >5mm
36
What is the term for hardening of the skin so you are no longer able to pinch it?
Systemic sclerosis
37
What is a scale?
Abnormal accumulation of keratin on the skin surface
38
DX, investigations and treatment: itchy rash with a gradually enlarging red scaly edge and clearing central pale region
Tinea Corporis (ring worm) - Fungal infection -> skin scraping for fungal MCS - Treat with topical anti fungal cream (imidazole)
39
Where can tinea infect?
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
What is alopecia? | Common causes? list 3.
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
What virus causes shingles?
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
Which herpes viruses affect the skin?
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
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
Molluscum Contagiosum TX: - Preventative: take shows - Topical salicylic acid wart paint - Topical imiquimod cream - Tape stripping, topical cantharidine, curettage
44
Treatment of warts
Destructive - liquid nitrogen - diathermy - curettage Topical - salicylic acid - DCP immunotherapy - Imiquimod (genital warts) - Tape
45
What sort of infection is a wart? What sorts of warts are there?
Viral infection (HPV) 1. Common wart - Verruca Vulgaris 2. Plantar wart (on feet) - Verruca Planters 2. Periungual (nail area and fingers) 3. Plane warts (on face, looks similar to acne) 4. Filiform - looks similar to a skin tag 5. Anogenital - anal and penile
46
What organicm usually causes folliculitis and what is the treatment?
Staph aureus Systemic ABx (flucloxaillin or cephalexin) +/- antiseptic washes
47
Impetigo: what is the generic name? What organism causes impetigo and what is the characteristic appearance?
"School sores" Staph aureus - treat w systemic flucloxaillin or cephalexin Honey-comb crusting
48
Cellulitis: common causative agents TX
Strep pneumonia! Otherwise staph aureus, staph epidermis. Requires IV antibiotics and usually overnight admission due to systemic illness
49
Complications of eczema
- 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
what is pompholyx eczema>
worse/commonly on palms triggered by excessive washing or sweating on hands
51
what is asteatotic eczema?
scaly and diffuse, often on legs of elderly patients w dry legs seasonal - "winter itch" and also with heat and dryness
52
DDX for annular disc-like patches on skin
Discoid eczema Tinea Psoriasis
53
What sites is psoriasis generally found?
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
When are the peaks of onset of psoriasis?
20s and 50s
55
Treatment for psoriasis
Topical steroids, topical vitD, keratinolytics Emollients UVB phototherapy Systemic immunosuppressants and biologic agents
56
what sort of psoriasis is a medical emergency?
Generalised pustular psoriasis - acute pustular flare w/ fever and chills - risk of pre-renal failure, high output cardiac failure and sepsis
57
Acne congloblata
severe cystic acne with huge pustular white heads
58
Treatment of acne
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
SE of systemic retinoids
teratogenic Mucosal dryness, photosensitivity Depression
60
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.
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
What is the order of frequency of skin cancers?
BCC - 67% SCC - 31% Melanoma - 2%
62
What disorders fall under the category characterised by keratinocyte dysplasia?
Actinic keratosis - 10% turn into SCC SCC in situ (Bowen's disease) - 5% turn into SCC SCC
63
Do BCCs have precursor lesions?
No!
64
What are some atypical presentations of BCC to be aware of?
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
MX of BCC
Nodular or infiltrating BCCs: wide local excision and biopsy Superficial BCCs: - excision - serial curettage - topical imiquimod - photodynamic therapy
66
What is a benign junctional naevi?
Naevi appears during childhood Located at epidermal side of dermal-epidermal junction Macular, dark uniform colour, <1cm diameter
67
What is a benign compound naevi
Naves cells in epidermis AND dermis - papule or nodule | smooth or uniform border with uniform colour, <1cm
68
What is a benign intradermal naevi?
Naves cells are within the dermis only Papule or nodule wiht even pale colour (skin-coloured/tan)
69
What are freckles due to? How are lentigenes different?
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
What is a seborrhoeic keratose?
Skin lesion with a warty stuck-on appearance in older patients Can get larger with time May or may not be pigmented
71
What is a dysplastic naves? Why do we care?
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
Characteristics of nodular melanomas
Elevated, Firm, Growing Often do NOT fulfil ABCDE criteria - do not LOOK like a melanoma Rapid growth and early invasion
73
Lentigo Maligna (Melanoma) characteristics)
``` Gradually enlarging pigmented lesion usually on face SLOW evolution (years) ```
74
Superficial spreading melanoma characteristics
80% of melanomas | Follow ABCDE rules, evolving over weeks to months
75
Where are acral lentiginous melanomas usually found>
Soles or palms

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