Dermatology Flashcards
1
Q
Cream def
A
water+oil
non greasy
easily absorbed into skin
2
Q
Ointment def
A
greasy
No added water
Mild anti-inflamm effect
3
Q
Lotion use
A
cooling effect eg calamine lotion
4
Q
Emollient use
A
Could be lotion, ointment or cream
Treats dry eczematous and scaling skin
5
Q
Describe macule
A
6
Q
Describe patch
A
7
Q
Describe vesicle
A
8
Q
Describe Blister
A
9
Q
Describe Bulla
A
10
Q
Describe Postule
A
11
Q
Describe papule
A
12
Q
Describe Nodule
A
13
Q
Describe Plaque
A
14
Q
Describe Wheal
A
15
Q
Describe Erosion
A
16
Q
Describe Ulcer
A
17
Q
Describe fissure
A
18
Q
Describe telangiectasia
A
19
Q
Describe purpura
A
20
Q
Describe Ecchymosis
A
21
Q
Describe Spider naevus
A
22
Q
Describe Petechia
A
23
Q
Descrbe crust
A
24
Q
Describe scale
A
25
Describe excoriation
26
Describe lichenfication
27
Purpura cause
small vessel vasculitis
| (palpabale)
28
Vitiligo sx
smooth white depigmented patches or macules
29
Vitiligo causes
autoimmune eg thyroid
30
Vitiligo management
Sun protection
Cosmetic camouflage
Strong steroids if recent onset
UVB/PUVA
31
Lentigo vs freckles
Lentigo:
- larger brown macules/patches,
persist in winter (unlike freckles)
32
Congenital melanocytic naevi
size
\>1cm
present at birth/early neonatal
if \>5 cm, risk of malignant change
33
Acquired melanocytic naevi development
Junctional naevus: flat
Comound naevus: raised- dome shaped
Intradermal naevus: pale brown papules
34
Halo naevi
- white halo around benign melanocyte naevi
- form in adolescence
- if in adults (40-50) may mean melanoma elsewhere
35
Seborrhoeic warts (keratoses)
Benign greasy-brown warts
On chest, back and face
36
Granuloma annulare
Chronic non infectious ring shaped lesion
Usually on the back of the hand
Associated DMI
37
Erythema multforme
Target-like lesion, often on extensor surface
3 different zones (outer ring, pale inner ring, central zone)
38
Causes of erythema multiforme
Mycoplasma pneumonia
herpes simplex
medication
39
2 types of erythema multiforme
Minor form: just the lesions
Major form: lesions + systemic upset (fever)
40
Treatment of erythema multiforme
No Rx
Topical steroids may aid sx, but dont speed recovery
Treat the cause (eg HSV with accivlovir)
41
Acne development stages
42
Mild acne sx
Mainly facial comedones (white/black heads)
43
Mild acne treatment
1st line: topical Rx: retinoids: eg isotretinoin or benzoyl peroxide
2nd line: azelaic acid
for up to 8 weeks
44
CI of retinoids
pregnancy as teratogenic (contraception for duration of rx + 1mo after)
45
Moderate acne sx
dominate papules + postules
affect face +/- torso
46
Management of moderate acne
1st line: Combined (abx + retinoid or abx + benzoyl peroxide) treatment
(Note: the abx could be either topical or PO)
Abx eg. tetracycline or doxycycline or lymecycline etc
In women: Consider COCP + 1st line
for \>4-6 months
47
Severe acne sx
cysts
scars
papules + postules
48
Mx of severe acne
Isotretinoin (reduces sebum production and pituitary hormones)
49
SE of isotretinoin
teratogenic
depression -\> suicidal
skin (esp lip) dryness
muscle aches
50
Different types of basal cell carcinoma
Nodular
Superficial
Morpheic
51
Superficial BCC
Multiple
develops over months to years
upper trunk and shoulders
bleed/ulcerate easiy
52
Nodular BCC
Pearly nodule with rolled telangiectatic edge +/- central ulcer
On face
could be Cystic
Often bleeds spontaneously, then heals
53
Morpheic BCC
AKA sclerosing bcc
skin coloured
found mid facial sites
may infiltrate nerve
54
Rx of nodular BCC
surgical excision
radiotherapy
55
Morpheic BCC mx
micrographic surgery (multiple biopsies and checking under microscope as tend to recur)
56
Superficial BCC mx
surgical excision
Cuerettage
cryotherapy
topical 5-FU (chemotherapy)
topical imiquimod (immune modulator)
57
Causes of BCC
uv exposure
immunosuppression
58
Describe Squamous cell carcinoma
Persistant ulcerated or crusted form irregular lesion
tenderness
hyperkeratosis
flesh colour
59
Risk factors for SCC
smoking
thermal burn
leg ulcers
immunosupperession
infection (HPV)
60
Risk of metastasis with BCC vs SCC
BCC rarely mets
SCC is locally invasive and may metastesize
61
Treatment of squamous cell cancer
local complete excision
62
Sunburn/exposure and risk of cancer
Sunburn increases risk of BCC and malenoma
Chronic sun exposure increases risk of SCC
63
Causes of atopic eczema
Multifactorial
genetic: FH of atopy (70%)
Infection: staphs colonize leision
Diet or allergens (dust mite) rarely cause it
64
Dx of eczema in a child
Itchy skin (or parent report scratching) + 3 or more of:
1- onset \<2yo
2- past flexural involvement
3- Hx general dry skin
4- personal hx of other atopy
5. Visible flexural dermatitis (or cheeks /forehead and outer side of limbs if \<4yrs)
65
Chronic atopic eczema
mostly grow out of it by 13 yo
66
Mx of atopic eczema
Emollients and soap substitute: 3-4 /day dry skin more susceptible
Topical corticosteroids: OD for 30 mins after emollient
67
Which topical steroids to use for atopic eczema
dermovate (clobetasol) hands/feet (or elecon if hasnt worked)
eumivate (clobetasone): face
elecon (mometasone): body
68
Discoid eczema
Late onset elderly
Could get discoid in atopic eczema
69
Adult seborrhoeic dermatitis
Older patients
Red, scaly rash
Affect scalp, eyebrows, nasolabial folds and cheeks
70
Cause of adult seborrhoeic dermatitis
eg overgrowth of skin yeasts (malassezia)
71
Risk with Actinic keratosis
Aka solar keratosis
pre malignant (SSC)
yellow-white scaly crust on sun exposed skin
72
Mx of actinic keratosis
1. diclofenac gel
2. fluorouracil cream (5FU)
3. Imiquimod
4. cryotherapy
5. curettage
73
Describe Bowens disease natural history
premalignant (SSC)
well defined
slow enlarging
red scaly plaque w/ flat edges
74
Causes of Bowens disease
uv exposure
radiation
immunosuppression
arsenic
hpv infection
75
Management of Bowens disease
1. fluorouracil cream (5FU)
2. Imiquimod
3. cryotherapy
4. curettage
76
RFs for malenoma
Hx of SCC or BCC or malenoma
Sun exposure/sunburn in childhood
Fair skin
FHx
Large number of moles or abnomal moles (atypical or dysplastic naevi)
77
How diagnose malenoma
ABCD
Asymmetry - in colour or shape
Border - irregular or sharp cut off
Colour- 3 or more colours
Diameter - \>7 mm
Evolution - change in size/shape/etc
Funny looking- out of ordinary
78
Types of melanoma
superficial spreading melanoma 70%
nodular melanoma 15%
acral lentiginous melanoma 10%
lentigo maligna melanoma 5%
79
Superficial spreading melanoma description
slowly enlarging pigmented lesion
colour variation
irregular border
80
Where superficial spreading melanoma mostly occur
trunks of men
legs of women
81
Superficial spreading melanoma natural progression
starts growing in radial plane (thin)
but may also grow vertical
very slow growth
82
Nodular malenoma natural hx
no radial growth
grows rapidly
invades deeply and mets early
most aggressive
83
Acral lentiginous melanoma most common in
common in black and asians
84
Acral lentiginous melanoma distribution
palms
soles
sunburn areas
hutchinsons nail sign
85
Prognosis of melanoma
Berlows thickness (histological measurement of tumour depth)
If \>75 mm, then 5 % survival 5 yrs
If \<4mm, then 45% survival 5 yrs
86
genetics of psoriasis
Multiple genes ass with
if both parents have it, 50% risk of getting it
87
Triggers for psoriasis
Environmental: Stress, infection, climate, skin trauma (kobner phenomenon)
Modifiable: alcohol, smoking, meds, obesity
88
Which meds trigger psoriasis
NSAIDS
B blockers
antimalarials
lithium
89
Types of psoriasis
Chronic plaque
Flexural
Guttate
Postular
Generalised (erythrodermic or postular)
90
Chronic plaque psoriasis
symmetrical well defined red plaques with sliver scale
on extensor surfaces
91
Flexural psoriasis
In moist areas: axilla, elbow, groin, submammary, umbilicus
92
Guttate psoriasis
large number of small plaques \<1cm over trunk and limbs
often in young, post strep infection
93
Postular(palmoplantar) psoriasis
yellow-brown postules within plaques affecting palms/soles
94
Generalised erythrodermic psoriasis
May cause systemic sx (high temp, WCC, dehydration)
Medical emergency
95
Generalised postular psoriasis
May cause systemic sx (high temp, WCC, dehydration)
Medical emergency
96
Nail changes in psoriasis
pitting
onycholysis
thickening and subungal keratosis
97
What is this
onycholysis( separation from nail-bed)
98
What is this
subungal keratosis
99
Topical treatment of plaque psoriasis
Corticosteroid (eg betnovate) OD
AND
vit D (affects cell division, eg dovonex) ON
If widespread: Coal tar lotion (Exorex)
Dithranol cream (slows cell division) if resistant to Rx
-
100
How long can steroids be used for plaques
8 weeks followed by 4 week break
Vit D could continue
101
Scalp psoriasis mx
potent topical steroids
OR
vit D prep
or
Coal tar shampoo
102
Flexural psoriasis mx
2 weeks topical steroids and 4 week break
+/- antifungal/antibiotic
103
When to consider biologics for psoriasis
If PASI \>10 or DLQI \>10 for over 6 months and one of:
- resistant/ SE from treatment
- CI to other systemic agents
- severe life threatening disease
104
Biologics mechanism of action
inhibit T cell activation and function or neutralise cytokines
105
Phototherapy use in psoriasis
UVB- for guttate - wide spread
PUVA- psoralen + UVA : large plaque psoriasis )
106
Problem with PUVA
increased risk of SCC of skin
107
Overview of psoriasis mx
Topical steroid/vit D
Coal tar lotion
Dithranol
UVB/PUVA
Non-biologics (methotrexate, ciclosporin, acitreitin)
Biologics (infliximab, adalimumab, enteracpet)
108
What is utricaria
Wheals (hives) +/- angio-oedema
109
what is this
Wheal
lasts mins to 24hrs
causes pruritis (itch)
affects deep dermal, raising the epidermis
110
What is this
angio-oedema
lasts up to 72 hrs
Deep dermal/subcutaneous tissue
111
Types of urticaria
acute \<6 wks, mostly paeds
chronic \>6wks mostly adults
112
Causes of urticaria
Idopathic
infection
meds- IgE
autoimmune
113
physical urticaria
induced by an external trigger
eg dermographism (rubbing/itching)
or sun exposure
Rx with anti histamine
114
Urticaria Rx?
H1 antihistamines:
Sedating: Hydroxyzine, Chlorpheniramine
Non-sedating: Loratidine, Cetirizine, Fexofenadine
H2 antihistamines:
Ranitidine
115
Mx of urticaria if refractory to primary mx
if acure : pred for 5 days
if chronic: ciclosporin or omalizumab
116
Endogenous causes of dermatitis
Seborrhoeic
Discoid
Pompholyx
Gravitational
117
Venous causes of dermatitis
Asteatotic
Lichen simplex
118
Napkin dermatitis causes
Faecal enzymes
Alkalinity
Heat
Humidity
119
Pompholyx
pruritic vesicular rash on hands and feet
120
Graviational eczema
Ass with venous HTN
Haemosiderin staining common
121
Asteatotic eczema
Crazy paving appearance of cracks in skin surface
Shins most common site
122
Asteatotic eczema causes
Central heating
low humidity
overwashing
diruetics
hypothyroid
123
Lichen simplex cause
due to repeated rubbing /scratching
124
common sites for lichen simplex
Men lower leg
women neck
both anogenital
125
Lichen planus features
on flexor aspects of wrist forearms ankles and legs + white lacy markings
Itchy
126
Rx for lichen planus
topical steroids
127
Pyogenic granuloma
vascular lesion arises from minor trauma
mainly on fingers
grows rapidly and bleeds
128
Alopecia types
Scarring (irreversible)
- Inflammatory : lichen planus, discoid lupus
- Trauma
- Tumour : BCC, SCC
Non-scarring (may be reversible):
- areata
- totalis
- universalis
129
How to treat androgenic alopecia
Minoxidil
130
Nutritional causes of alopecia
Fe and Zn deficiency
131
Alopecia areata
well definded round patches of hair loss on scalp
exclamation mark hair
Spontaneous regrowth in 3 months in 80%
132
alopecia totalis
complete loss of scalp hair
133
alopecia universalis
total body hair loss
134
Bullous pemphigoid
autoimmune IgG against basement membrane
blistering disorder
relapse remitting over 5-10 yrs
135
Bollous pemphigoid Rx?
Clobetasol (steroid) topical
Prednisolone PO
136
Pemphigus description
affects young \<40 yrs
IgG against desmosomal component
flaccid superficial blister, rupture easily to leave widespread erosions
137
Pemphigus Rx
prednisolone PO
Rituximab + iv immunoglobulin if resistant
138
Venous leg ulcer risk factors
varicose vein
dvt
venous insufficiency
fracture
139
Commonest place for venous leg ulcers
medial malleolus
140
Venous leg ulcer management
Graded compression bandages (40mmHg -ankle, 15-20 mmHg- calf)
Occlusive dressing
Pentoxyphylline 400mg TDS PO up to 6/12
141
pressure ulcer common places
sacrum
heel
greater trochanter
142
Stages of pressure ulcer
Stage I non blanching erythema over intact skin
Stage II partial thickness skin loss
Stage III full thickness skin loss extending to fat
Stage VI Destruction of bone, muscle, tendons
143
Rx of pressure ulcers
Debride dead or necrotic
Pressure-relieving mattress/cusion
Turning chart
Dress
144
Dermatophyte infections
tinea (ringworm) fungal infections,
grow and invade dead keratin
145
Different species of dermatophytes
Human only (anthropophilic) eg Trichophyton rubrum
+animals (zoophilic) eg Microsporum canis
+ soil (geohilic) eg Micosporum gypseum
146
Tinea rash description
round scaly
itchy
more inflammed edge than centre
147
Tinea pedis
dermatophyte infection of foot
148
tinea cruris
dermatophyte infection of groins
149
tinea capitis
dermatophyte infection of scalp
150
tinea unguium
dermatophyte infection of nails
151
tinea corporis
dermatophyte infection of body
152
Diagnosis of dermatophyte infections
skin scrappings
scalp brushings
nail clippings
hair plucking
153
Topical antifungals
Imidazoles e.g Clotrimazole (Canesten cream)
Terbinafine e.g (Lamisil cream)
Amorolfine e.g (Loceryl Nail lacquer)
154
Systemic antifungals
Itraconazole
Terbinafine
Griseofulvin
155
Yeast skin infections
candida albicans
pityriasis vesicolor
156
Candida albicans affects which areas
mouth
vagina/ glans of penis
skin fold
toe web and nail
157
Description of candida albicans leisions
pink and moist
+/- satellite leisions
158
Skin candida albicans rx
imidazole cream
159
Mouth candida albican rx
nystatin oral suspension
or miconazole oral gel
160
vaginal canida albicans rx
imidazole cream +/- pessary
161
Pityriasis vesicolor species
Malassezia (eg M urfur)
162
Pityriasis vesicolor lesion description
multiple hypopigmented scaly macules on the upper trunk and back
(they produce azelaic acid which prevents tanning of skin)
163
Rx of pityriasis vesicolor
Imidazole cream
Ketaconazole shampoo if more generalised
164
Erythrasma description
superficial skin infection that causes brown, scaly skin patches
165
Erythrasma organism
corynobacteria
166
Pitted keratolysis decription
a superficial bacterial skin infection that affects the soles of the feet
167
Pitted keratolysis organism
corynobactor
168
Erythrasma/pitted keratolysis rx
topical clindamycin or oral erythromycin
169
Impetigo description
contagious superficial infection
start around nose and face honey coloured crust at base
170
Impetigo pathogens
staph aureus +/- staph phyogenes
171
Impetigo Rx
fusidic acid for local infection
flucloxacillin QDS 7 days
172
Erysipelas
sharply defined superficial infection
173
Erysipelas pathogen
S pyogenes
174
Erysipelas affects where
face unilaterally + fever
175
Difference between cellulits and erysipelas
cellulites less well defined and is deeper
176
Pathogens causing cellulites
B haemolytics strep + staphs
177
Rx of cellulites and erysipelas
elevate affected part
benzylpenicillin 600mg/6hr IV + flucloxacillin 500mg/6hr PO
178
chancre
Painless inoculation ulcer
From direct sexual contact
Primary Syphillis
179
Syphillis progression
Primary: chancre from direct sexual contact
Secondary: rash or multitude of other sx
latent
Tertiary: gummatous,cardio,neuro
180
Rx of syphillis
Penicillin G - 1 dose
181
Lyme disease
tick borne
182
Lyme disease rx
doxycycline/penicillin
183
Lupus vulgaris
red brown scarring plaque
## Footnote
Primary inoculation in person with some immunity
caused by TB
184
Mycobacterium marinum
contact with topical fish tank or swimming pool
aka fish tank granuloma
185
Leprosy features
tubercloid ( anaesthetic patch)
lepromatous (thickened areas)
186
what is this
herpes simplex
187
what is this
chicken pox
188
Shingles pathology
VZV becomes dorment in root ganglia after chicken pox infection subsided
affects one or more dermatomes
189
what is it
shingles
190
HSV rx
Nothing for oral
Genital: aciclovir for 200mg 5/daily 1wk + avoid sex until lesions clear (you dont have to worry about this one TOM)
191
What is this
filiform (common viral wart)
192
What is this
planar wart
flat skin coloured or brown
resist treatment
193
what is this
verrucous (viral wart)
aka plantar wart
194
what is this
genital wart
195
Which malignancies is HPV associated with
CIN, VIN, PIN
(penile,cervical,vulvar intraepithelial neoplasia)
196
Rx for genital warts
Cryotherapy every 3wks, up to 4 times
Topical salicytic acid gel (keratolytic) 12 wks
Padophyllin or imiquimod cream
197
What is this
molluscom contagiosum
198
Molluscum contagiosum pathogen
pox virus
199
molluscum contagiosum rx
nil
may takes months to go aways
Squeeze in bath
200
Scabies spread
direct person to person eg by holding hands, sharing a bed
201
What causes scabies
female mite digs a hole and lay eggs
itch and subsequent rash due to hypersensitivity reaction
202
Scabies rx
topical permethrine 5% :
- left on for 24 hours , applied to neck down , reapplied to hands after washing
- repeated after 1 week
- Contacts must be treated to prevent reinfestation
203
Headlice spread
head to head contact
204
Headlice rx
Topical permethrin or malathion
repeat after 1 week
205
Furuncle def
aka boil
deep folliculitis- infection of hair follicle
206
Carbuncle
cluster of furuncles together
207
Skin sensitivity to ultraviolet (UV) light (Fitzpatrick classification)
208
Rosacea description
relapsing remitting disorder of blood vessels and pilosubaceous units
symmetrical facial rash
209
Rosacea vs acne
both may papules/postules
rosacea doesnt have comedones
210
Rosacea mx
Topical or oral abx
211
Erythema ab igne
Painful
RF: heat exposure
may lead to SSC
212
trichotillomania
Pulling out your own hair
213
Pityriasis rosea
Solitary "Herald" patch
Days later more lesions on trunk
214
Mx of pityriasis rosea
Self limiting
May use topical steroids for itch
215
Mx Hyperhidrosis
Aluminium chloride
2nd line: Botux or topical glycopyrrolate
216
Skin conditon ass with coeliac
dermatitis herpetiformis
217
Pyoderma gangrenosum ass condtions
IBD
Rheumatoid
Autoimmune (SLE)
218
Lupus pernio
Sarcoid
219
Erythema chronicum migrans
lyme disease
220
Keloid vs hypertrophic scar
keloid: within the boundary of scar
hypertrophic: beyond the boundary of scar
