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4th Year > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Types of emolient?

A

Moisturising creams, ointments, gels and sprays
Shower/bath products
Soap substitutes

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2
Q

Criteria for atopic eczema?

A

History of a flexural involvement

Visible flexural dermatitis

Personal history of asthma or hay fever

History of a generally dry skin in the last year

Itchy skin

Onset <2 y/o

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3
Q

List of topical steroids (4) from weakest to strongest?

A
  1. Hydrocortisone
  2. Clobetasone (Eumovate)
  3. Betametasone
  4. Clobetasol (dermovate)
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4
Q

Areas affected in psoriasis?

A

Extensor aspect of elbows and knees, the lower back and the scalp

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5
Q

Nail changes in psoriasis?

A
  1. Nail Pitting – Loss of parakeratotic cells from surface of nail plate
  2. Oncholysis – Nail plate separates from its underlying attachment to nail bed due to excessive proliferation of the nail bed and hyponychium
  3. Oil drop / Salmon Patch – Translucent yellow-red discolouration in the nail bed
  4. Beau’s Lines – Transverse lines in nails due to intermitten inflammation.
  5. Leukonychia - Areas of white nail plate due to foci of parakeratosis within the body of the nail plate
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6
Q

Treatment for chronic plaque psoriasis?

A
  1. General measures - Emollients to reduce scale and discomfort

Topical therapies (for localised and mild psoriasis) - vitamin D analogues, topical corticosteroids, coal tar preparations.

Phototherapy

Oral therapies (for extensive and severe psoriasis, or psoriasis with systemic involvement) - methotrexate, ciclosporin, etc.

Biological agents (e.g. infliximab)

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7
Q

Rosacea treatment?

A

Topical

  • Metronidazole (1st line treatment), which acts as an anti-inflammatory and antioxidant.
  • azelaic acid

Oral

  • Tetracycline (e.g. Lymecycline, Oxytetracycline)
  • Erythromycin. This is an alternative if tetracyclines are contraindicated (e.g. pregnancy, reactions to sunlight)
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8
Q

Treatment for seborrhoeic dermatitis?

A

Scalp:

Prescribe ketoconazole 2% shampoo. Selenium sulphide shampoo may be used as an alternative.

Face:

Prescribe ketoconazole 2% cream or another imidazole cream

always give steroid

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9
Q

Features of bullous pemphigoid?

A

Blisters - tense

Mouth - uncommon

Trunk, limbs, groin

Subepidermal bullae

Linear C3 igG BMZ deposits

> 60

Outlook is good (1-5 years of disease), 6-41% mortality.

Treatment - wound care & topical steroids/oral

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10
Q

Features of Pemphigus Vulgaris

A

Flaccid blisters

Mouth involvement common

mucosa - nase, mouth, larynx, vagina

Intraepidermal bullae

intracellular IgG. dsg3, dsg1

> 50

prognosis is worse, 1 in 10 die.

Treatment - wound care, ORAL corticosteroid

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11
Q

Dermatitis herpeteformis is associated with what autoimmune disease?

A

Coeliac disease

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12
Q

What is erythroderma? Causes?

A

Skin is red and varying degrees of scale.

Psoriasis

Dermatitis especially atopic dermatitis

Drug eruptions

Cutaneous T-cell lymphoma (Sezary syndrome)

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13
Q

Treatment for eczema herpetiform?

A

Antiviral medication – Aciclovir, intravenously or orally.

Antibiotics – for secondary bacterial skin infection

Emollients

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14
Q

Toxic Epidermal Necrolysis features?

A

Age affected:
- Any age groups

Cause
- Drug-induced

Histological level of split
- Full thickness epidermal necrosis with sub-epidermal detachment.

Mortality
- >30%

First-line treatment
- Early withdrawal of culprit drugs

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15
Q

Staph scalded skin syndrome features?

A

Age affected
- Usually in infancy and early childhood

Cause
- Production of a circulating epidermolytic toxin from phage group II

Histological level of split
- Intra-epidermal blistering

Mortality
- Low

First-line treatment
- IV Antibiotics (e.g. a systemic penicillinase-resistant penicillin, fusidic acid, erythromycin or appropriate cephalosporin)

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16
Q

Impetigo/cellulitis causative organisms?

A

Staph/Strep

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17
Q

Impetigo Tx?

A

First line:
- Fusidic acid

Oral flucloxacillin (or erythromicin)

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18
Q

Warts treatment?

A

Cryo

Topical salicylic acid

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19
Q

Acne treatment?

A

First Line Treatment – Topical Retinoid, Benzoyl Peroxide, topical antibiotics

Second Line Treatment:

  • Oral antibiotics (at least 3 months)
  • Oral Antibiotic combined with topical retinoid or benzoyl peroxide
  • Dianette (COCP + Cyproterone Acetate (Anti-androgen)

Severe
- isotretinoin (teratogenic)

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20
Q

Layers of skin

A

Epidermis & Dermis

Stratum corneum (superficial)
Granular layer
Suprabasal layer.
Basal layer

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21
Q

What is epidermolysis bullosa simplex?

A

Gentic disorder affecting the basal layer keratins (K5 or K15)

Minor trauma results in bullae formation.

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22
Q

What is epidermolysis bullosa dystrophica?

A

Genetic skin disorder with a defect in type VII collagen (upper dermis)

minor trauma causes sub-epidermal blistering

80% die of SCCs

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23
Q

Stratum corneum make-up?

A

Made up of dead cells

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24
Q

What does filaggarin do?

A

Mediates the aggregation of keratin filament to forms a strong barrier in the stratum cornea (epidermis)

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25
Q

What do langerhans cells do?

A

come in to contact with pathogen and then migrate out of the epidermis to prime the immune system

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26
Q

Pathogenesis of contact allergic dermatitis?

A

Skin recognises a benign substance as foreign and mounts an immune response - and becomes allergic to substance. (dyes, softener e.t.c.)

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27
Q

Effect of UVR of Langerhans cells?

A

Downregulates them (less immune activity = immunosuppression = cancer)

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28
Q

Pathogenesis of irritant hand dermatitis?

A

Irritant substance (acid, alkali, hard water, detergents) damage stratum corneum. Results in skin inflammation at that sight.

Treatment is avoid irritants (and emolients?)

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29
Q

Subtypes of psoriasis?

A

Chronic plaque (most common)

Guttate (water splashes) - post infective

Flexural (white patches)

Erythrodermic

Pustular (although not actually infected)

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30
Q

Conditions associated with psoriasis?

A

Obesity
Diabetes
Crohns

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31
Q

Patho-aetiology of psoriasis?

A

Polygenic

Infection (strep), Drugs (Lithium/beta-blockers)

Stress

Results in dysfuntion to immune system Cytokine alterations), Epidermis (hyperkeratosis) and vessels (Inc. VEGF).

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32
Q

Assessments of extent of psoriasis?

A

PASI - area

DLQI - life quality index

BSA - body surface area

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33
Q

Is a halo-naevus harmful?

A

nope

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34
Q

Pyogenic granuloma typical history? When should you remove?

A

Overgrowth of blood vessels following minor trauma

Remove if fast growing and profusely bleeding

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35
Q

What is a dermatofibroma?

A

Benign, firm nodule, can be pigmented.

Dimple test - will go in

36
Q

Three pre malignant skin lesions?

A

Actinic keratosis

Bowens disease lesions

Lentigo maligna

37
Q

What are the lesions in bowens disease?

A

Intradermal squamous neoplasia (CIS)

a red scaly plaque, normally found on the legs in women and the hands in men. Can have a large cutaneous horn.

38
Q

Management of bowens disease?

A

Topical therapy (efudix- 5-FU)

PDT

Surgery

39
Q

Causes of a cutaneous keratin horn (what’s under it)?

A 
Actinic keratoses
Seborrhoiec keratosis
Squamous papilloma
Bowens disease
SCC
40
Q

Types of BCC?

A

Superficial
Nodular
Infiltrative
Pigmented

41
Q

New, keratinised fleshy nodule back of the hand?

A

SCC until proven otherwise

42
Q

If the cancer is on the ear is it likely to be a BCC or a SCC?

A

SCC

43
Q

Typical history of a keratocanthoma?

A

Variant of SCC that grows fast and then ‘self-destructs’.

44
Q

EFG rule in melanomas/cancer?

A

Elevated, firm and growing (more selective than ABCDE)

45
Q

Pink lumps that are growing and bleeding are potentially what?

A

Amelanotic melanomas

46
Q

What do melanomas look like under dermatoscope?

A

Chaotic - multiple colours

47
Q

What is hutchinsons sign?

A

Dark pigment in skin adjacent to the nail

48
Q

What is tinea corporis? Where may it affect

A

fungal infection of body, anywhere but often arms, legs.

49
Q

Tinea capitus?

A

Fungal infection of scalp

50
Q

Types of eczema?

A

Discoid - usually following skin injury w/ staph involvement.

Asteatotoic eczema - Elderly, lower legs

Venous eczema - Due to venous insufficiency get leg oedema, usually bilateral.

Contact dermatitis

  • Irritant: friction, soap, detergent) - can happen to anyone
  • Allergic: Metal, fragrance, adhesive - they have a specific allergy.

Atopic eczema

51
Q

What is lichen planus?

A

T cell mediated autoimmune, adults >40

Polygonal, purple, papules

52
Q

What is lichen simplex?

A

Mainly affects adults, who have a pre0existing skin disease, it is a patch of thickened skin, often solitary but may be bilateral or widespread.

53
Q

What is erythroderma?

A

Basically no skin barrier

Full body redness

Problems with:

  • Temperature
  • fluid balance
54
Q

Treatment of seborrhoaic dermatitis?

A

Ketoconazole cream

55
Q

Atopic eczema treatment?

A

Moisturise!

  • bath emollient
  • soap substitute
  • moisturisers

Topical steroids

Bandages sometimes

Occasionally systemic - cyclosporin

Phototherapy

56
Q

Erythroderma treatment?

A

Emollients frequently (e.g. 50/50 WSP/LP every 2 hours)

Look for 2ndary infection - swab

Potent steroids

Fluid balance

57
Q

What is Impetiginsed eczema? Tx?

A

Eczema complication due to bacterial invasion

Isolation if inpatient admission required
Swab skin
Emollients
Flucloxacillin (oral/IV)
Potent topical steroids
Pain relief
58
Q

Emergency complications of psoriasis? Tx?

A

Erythrodermic or pustular psoriasis

Inpatient admission
Careful fluid balance
Watch renal function, markers of infection, albumin
Temperature control
Emollients frequently (eg. 50/50 WSP/LP every 2 hours)
Refer urgently to dermatologist

59
Q

Acne vulgaris lesions?

A

Comedones – always present

  • Open (blackheads)
  • Closed (whiteheads)

Moderate:

  • Papules
  • Pustules

Severe

  • Nodules
  • Cysts (Scars)
60
Q

Rosacea features?

A

Adults

Flushing, erythema, telangiectasia, papules, pustules, rhinophym.

61
Q

What is urticaria/angioedema usually? Tx?

A

Chronic spontaneous urticaria
- individual weals/swellings lasting <24 hrs

treat with longterm daily non-sedative antihistamine
reassure patient

62
Q

When should you be concerned regarding urticaria?

A

If airway symptoms or other systemic symptoms

If definite and immediate association with food, drug or latex

If weals last longer than 24 hours and leave bruising – urticarial vasculitis

If strongly associated with pressure, water, cold, sun

If angioedema without urticaria, and presence of autosomal dominant family history – very rare (hereditary C1 esterase deficiency)

63
Q

Classic description of psoriatic lesion?

A

Salmon pink scaly plaques

64
Q

3 main blistering autoimmune diseases?

A
  1. Bullous pemphigoid
  2. Pemphigus
    - Pemphigus vulgaris
    - Pemphigus foliaceous
  3. Dermatitis herpetiformis
65
Q

Complications of impetigo, and their respective tx?

A

SSSS - Staphylococcus Scalded Skin Syndrome
- Treat with flucloxacillin

Bullous impetigo
- Admit, pain relief, careful nursing, emollients, IV fluclox

66
Q

Features of impetigo?

A

Usually children

Usually mild

Usually Staphyloccus aureus

Erythema with golden crusting

Always take a swab

Contagious

67
Q

Big complication of cellulitis? Tx?

A

Necrotising fasciitis

- Urgent surgical debridement along with IV antibiotics

68
Q

Palmar and plantar warts Tx?

A

Normally can just leave alone will resolve without scarring

  • Topical salicylic acid
  • Cryotherapy
69
Q

Fungal infection management?

A

Take scrapings and/or pull hairs for mycology

Treatments: topical or oral azoles/terbinafine, also oral griseofulvin

70
Q

What is Malassezia furfur, what might it cause?

A

Yeast infection

  • Pityriasis versicolor
  • Seborrheoic dermatitis
71
Q

General causes of TEN and SJS?

A

Mainly drug reactions

Antibiotics, anti-epileptics
Minority are Viral-induced

72
Q

Management of TEN and SJS?

A
  1. Stop drugs
  2. Supportive management in intensive care for TEN (potentially fatal)
  3. ?IV immunoglobulin
73
Q

How does erythema multiforme to TEN present>

A

Erythema multiforme - SJS - TEN (worst)

Eythema multform
- There may be either no prodrome or a mild upper respiratory tract infection. The rash starts abruptly, usually within three days. It starts on the extremities, being symmetrical and spreading centrally.

  • Lesions appear first on the extensor surfaces of the periphery and extend centrally.
  • Mild/limited mucosal involvement

TEN
- There is a prodromal phase usually lasting 2-3 days with fever, symptoms similar to upper respiratory tract infection, conjunctivitis, pharyngitis, pruritus, malaise, arthralgia and myalgia.

Mucous membrane involvement occurs early in 90% of cases and commonly precedes other symptoms

ill-defined red ‘burning/painful’ macular or papular rash, spreads from face or upper trunk

Then bullae that caolesce

Hypotension and tachycardia can develop secondary to dehydration and hypovolaemia

74
Q

ABCDE rule for melanoma

A

Asymmetrical

Borders are undefined

Colour is dark and several of them?

Diameter is large (>6mm)
ntation
Evolving over time

75
Q

BCC presentation?

A

Most common over head and neck

Nodular is most common type, small skin coloured papule or nodule with surface telangiectasia and pearly rolled edge, may have necrotic or ulcerated centre

76
Q

SCC presentation?

A

Keratotic ill defined nodule that may ulcerate, grows quicker than BCC

77
Q

Risk factors for skin cancer in general, and specifics?

A

General

  • UV exposure
  • Genetic
  • Type 1 skin
  • Immunosuppression
  • Hx of skin cancer

BCC:

  • Sunburn in childhood
  • Male
  • Older

SCC
- Pre-malignant skin lesions such as actinic keratoses

Melanoma
- Atypical moles, lots of moles

78
Q

Types of melanoma?

A

Superficial spreading

  • Lower limbs
  • Young and middle aged
  • Intermittent high UV exposure

Nodular melanoma

  • Common on trunk, in young middle aged adults
  • Intermittent high UV exposure

Lentigo maligna

  • Face
  • Elderly
  • Long term cumulative UV

Acral lentiginous melanoma

  • Palms, soles and nail beds in elderly
  • Not related to UV
79
Q

What is erythema nodosum? Causes? Presentation?

A

Hypersensitivity reaction to a variety of stimuli

Group A strep, TB, malignancy, sarcoidosis, IBD

Discrete tender nodules, may become confluent

1-2 weeks then leave bruise

80
Q

Most common cause of erythema multiforme?

A

HSV

81
Q

Abx in meningiococcaemia?

A

Benzylpenicillin

82
Q

Causative organism of necrotising faciitis?

A

Group A strep commonly

83
Q

What is the difference in cellulitis and erysipelas

A

Celulitis involves the deep subcut tissue, erysipelas is the superficial form only involving dermis and upper subcut

Erysipelas has also got a well-defined raised border

84
Q

Causative organisms in cellulitis and erysipelas?

A

Staph and strep

85
Q

Presentation of SSSS?

A

Scald like appearance followoed by flaccid bullae, perioral crusting, usual recovery with 5-7 days with fluclox

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