Dermatology Flashcards
Name some causes of erythema nodosum
- Inflammatory bowel disease
- Streptococcal infection
- Drugs - OCP, sulfonamides
- Malignancy
- Acute sarcoidosis
- TB
What is rosacea? Name some aggravating factors
Relapsing-remitting chronic inflammatory facial dermatosis characterised by erythema and pustules.
- Sun exposure
- Emotional stress
- Hot/cold weather
- Alcohol
- Spicy foods
- Exercise
How is rosacea managed?
- Avoid triggers
- Antibiotics - prolonged courses of topical or systemic
- Refer to dermatology if:
- Rhinophyma
- Ocular complications
- Failure to respond to treatment
What is lyme disease? Name some clinical features
Infectious skin disease caused by the bacteria Borrelia burgdorferi which is spread by ticks (usually from deer or sheep)
- Erythema migrans (red macule/papule) on upper arm/leg/trunk 7-10d after a tick bite
- Expands to form a ring with central clearing
- Flu like symptoms
- Lymphadenopathy
- Splenomegaly
- Arthralgia
How is lyme disease managed?
- Confirm diagnosis with serology (antibodies)
- Doxycycline 2-3 weeks
- Removal of ticks using fine tweezers
What is vitiligo?
Autoimmune destruction of melanocytes which cause smooth, sharply defined white macules or patches
- Often symmetrical
- May also affect hair
- Associated with pernicious anaemia, Addisons and thyroid disease
How is vitiligo managed?
- Sunscreen use for affected areas
- Camouflage cosmetics
- Refer to dermatology:
- Topical steroids
- Topical calcineurin inhibitors (tacrolimus)
- Phototherapy
Name some causes of hair loss
- Male pattern baldness
- Hypothyroid/pituitary
- Iron deficiency
- Malnutrition
- Alopecia
- Ringworm
- Trauma
- SLE
- Burns
- Radiation
How is alopecia managed?
- Topical/local injection/systemic steroids
- +/- contact immunotherapy
- Pscyhological support
How is eczema diagnosed?
Itchy skin + >/3 of:
- Itching in skin creases
- History of asthma or hay fever
- Onset in first 2 years of life
- Generally dry skin
- Visible flexural eczema
Also: lichenification and dry skin, psychological issues, sleep problems
How is eczema treated?
- Advice:
- Loose cotton clothing (avoid wool)
- Avoid excessive heat and other irritants
- Keep nails short
- Gloves in bed
- Emollients 3-4/day
- Antipruritic (lauromacrogol)
- Topical/oral steroids
- Antibiotics if infected
- Topical immunosuppressants (tacrolimus)
- Antihistamines
How does contact dermatitis present?
Most commonly affects hands
- Acute
- Itchy erythema
- Skin oedema
- Papules/vesciles/blisters
- Chronic
- Lichenification
- Scaling
- Fissuring
How is contact dermatitis managed?
- Identification of allergen/irritant - occupation, hobbies, sports, chemical use, detergent etc
- Patch testing
- Exclude irritant from environment
- General advice on hand care
- Avoid detergents, cleaning fluids, shampoos
- Wear plastic gloves when chopping veg/fruit
- Emollients
- Topical steroids
- Exclude/treat secondary infection
What is seborrhoeic dermatitis?
Chronic scaly eruptions affecting the scalp, face and/or chest
- Excessive dandruff
- Itchy, scaly erythematous eruption affecting sides of nose, eyes, ears, hairline
- Most common in young men
- Can be indicator for HIV infection
How is seborrhoeic dermatitis managed?
- Imidazole (antifungal) and hydrocortisone
- Ketoconazole/coal tar shampoo if scalp lesion
- Offer HIV testing if severe
What is urticaria? How is urticaria managed?
Superficial, itchy, red swellings/weals on the skin
- Antihistamines for itching (cetirizine)
- Topical menthol cream
- If severe - short course steroids (prednisolone)
What is acne? Name some causes
Chronic inflammatory condition characterised by comedones, papules, pustules, cysts and scars.
- Androgen secretion increases sebum excretion
- Pilosebaceous duct blockage
- Colonisation with propionibacterium acnes
- Endocrine - PCOS, Cushings
- Cosmetics
- Drugs - steroids, androgens
How is acne treated?
- General advice
- Try not to pick
- Wash with soap and warm water BD
- Use water-based emollient
- Medication
- Benzoyl peroxide
- Topical retinoids
- Topical antibiotics (clindamycin)
- Oral antibiotics
- Anti-androgen (for girls)
What is psoriasis?
A chronic, non-infectious inflammatory skin condition characterised by epidermal cell proliferation (x20) and decreased turnover time (4 days)
- Associated with inflammatory bowel disease
- Crohns > UC
Name some causes of psoriasis
- Genetic
- Environmental triggers
- Trauma
- Infection
- Drugs - Beta blockers, NSAIDs, lithium
- Alcohol
- Sunlight
- Stress
How is psoriasis managed?
- Psychological reassurance / self help groups
- Emollients
- Drugs
- Salicylic acid (paste)
- Coal tar - anti-inflammatory
- Vitamin D analogue
- Dithranol
- Topical retinoids
- Topical steroids
What is this?
Basal cell papilloma
- Common in >60y
- Multiple
- Common on trunk
- Warty, pigmented nodule
- Can be picked off
- Removal not always required
What is this?
Malignant melanoma (ABCDEF)
- Asymmetrical outline
- Border irregularity
- Colour variation
- Diameter (>/=7mm)
- Evolution - changes in size, shape, colour, elevation
- ‘Funny-looking’ mole
How is malignant melanoma treated?
- Refer suspcious lesions to dermatology
- Complete excision
- Regional node dissection if involved
- Adjuvants (minimise relapse)
- Interferon alpha-2b
- Bevacizumab (VEGF inhibitor)
NOT chemo or radio sensitive
What is this?
Squamous cell carcinoma
- Most common in men aged >55
- Develops in sun-exposed sites (face, neck, hands) or areas of chronic inflammation
- Rapidly growing red papule/non-healing skin lesion
- +/- background of actinic keratosis
- Ulcerated nodule
- Bleeding
- 5-10% metastasise
What is this? What types are there?
Basal cell carcinoma (superficial)
- Most common form of skin cancer
- More common in older patients
- Hair-bearing skin
- Light-exposed areas
- 3 types:
- Nodular - small, pearly nodule (associated with telangiectasia)
- Superficial - scaly, erythematous plaque
- Morphoeic - waxy indurated plaque
What is impetigo?
Superficial skin infection due to staph aureus
- Common in childhood
- Thin walled blister - yellow crusted lesion
- Most common on face
- Treat with topical antibiotics
What is this? How is it treated?
Cellulitis - painful, tender reddened area with well-defined edges
- Mark the area
- Flucloxacillin or clarithromycin
- If severe/systemically unwell - admit for IV antibiotics
What is this? Name some risk factors and treatment
Necrotising fasciitis = soft tissue infection
Risk factors = trauma/surgery, IV drug user, alcoholic, diabetes, immunosuppression
Treatment = IV antibiotics, surgical debridement
How is melanoma investigated?
- Clinical - skin, lymph nodes, abdo, neuro
- Dermoscopy
- Biopsy (usually excision) - histological analysis and staging
- CXR - mets
- Serum biochemistry (+LDH)
Name some causes of melanoma
- Sunlight (UV radiation)
- Sunburn
- Sunbeds
- Genetics
- Benign pigmented naevi
- Immunosuppression (organ transplant)
What indicated poor prognosis in melanoma?
- Deep Clarke’s level
- Large Breslow thickness
- Ulceration
- Mucosal or nodular
- Male
- Age > 50
How is squamous cell carcinoma managed?
- Surgical excision- histological assessment of margins
- Regional lymph node dissection if involved
- Moh’s micrographic surgery if at difficult site
- Cryotherapy or electrosurgery (small/low-risk)
- Radiotherapy (small/well-localised)
- Chemotherapy is disseminated disease
- Cetuximab
How is basal cell carcinoma managed?
- Surgical excision - assess histology and resection margin
- Moh’s micrographic surgery if >2cm or difficult margins
- Cryotherapy/electrosurgery/radiotherapy
Name the risk factors for BCC and SCC
- UV radiation
- Previous skin cancer
- HPV
- Ionising radiation
- Chronic inflammation
- Immunosuppression
