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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
What do langerhans cells do?
come in to contact with pathogen and then migrate out of the epidermis to prime the immune system
26
Pathogenesis of contact allergic dermatitis?
Skin recognises a benign substance as foreign and mounts an immune response - and becomes allergic to substance. (dyes, softener e.t.c.)
27
Effect of UVR of Langerhans cells?
Downregulates them (less immune activity = immunosuppression = cancer)
28
Pathogenesis of irritant hand dermatitis?
Irritant substance (acid, alkali, hard water, detergents) damage stratum corneum. Results in skin inflammation at that sight. Treatment is avoid irritants (and emolients?)
29
Subtypes of psoriasis?
Chronic plaque (most common) Guttate (water splashes) - post infective Flexural (white patches) Erythrodermic Pustular (although not actually infected)
30
Conditions associated with psoriasis?
Obesity Diabetes Crohns
31
Patho-aetiology of psoriasis?
Polygenic Infection (strep), Drugs (Lithium/beta-blockers) Stress Results in dysfuntion to immune system Cytokine alterations), Epidermis (hyperkeratosis) and vessels (Inc. VEGF).
32
Assessments of extent of psoriasis?
PASI - area DLQI - life quality index BSA - body surface area
33
Is a halo-naevus harmful?
nope
34
Pyogenic granuloma typical history? When should you remove?
Overgrowth of blood vessels following minor trauma Remove if fast growing and profusely bleeding
35
What is a dermatofibroma?
Benign, firm nodule, can be pigmented. Dimple test - will go in
36
Three pre malignant skin lesions?
Actinic keratosis Bowens disease lesions Lentigo maligna
37
What are the lesions in bowens disease?
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
Management of bowens disease?
Topical therapy (efudix- 5-FU) PDT Surgery
39
Causes of a cutaneous keratin horn (what's under it)?
``` Actinic keratoses Seborrhoiec keratosis Squamous papilloma Bowens disease SCC ```
40
Types of BCC?
Superficial Nodular Infiltrative Pigmented
41
New, keratinised fleshy nodule back of the hand?
SCC until proven otherwise
42
If the cancer is on the ear is it likely to be a BCC or a SCC?
SCC
43
Typical history of a keratocanthoma?
Variant of SCC that grows fast and then 'self-destructs'.
44
EFG rule in melanomas/cancer?
Elevated, firm and growing (more selective than ABCDE)
45
Pink lumps that are growing and bleeding are potentially what?
Amelanotic melanomas
46
What do melanomas look like under dermatoscope?
Chaotic - multiple colours
47
What is hutchinsons sign?
Dark pigment in skin adjacent to the nail
48
What is tinea corporis? Where may it affect
fungal infection of body, anywhere but often arms, legs.
49
Tinea capitus?
Fungal infection of scalp
50
Types of eczema?
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
What is lichen planus?
T cell mediated autoimmune, adults >40 Polygonal, purple, papules
52
What is lichen simplex?
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
What is erythroderma?
Basically no skin barrier Full body redness Problems with: - Temperature - fluid balance
54
Treatment of seborrhoaic dermatitis?
Ketoconazole cream
55
Atopic eczema treatment?
Moisturise! - bath emollient - soap substitute - moisturisers Topical steroids Bandages sometimes Occasionally systemic - cyclosporin Phototherapy
56
Erythroderma treatment?
Emollients frequently (e.g. 50/50 WSP/LP every 2 hours) Look for 2ndary infection - swab Potent steroids Fluid balance
57
What is Impetiginsed eczema? Tx?
Eczema complication due to bacterial invasion ``` Isolation if inpatient admission required Swab skin Emollients Flucloxacillin (oral/IV) Potent topical steroids Pain relief ```
58
Emergency complications of psoriasis? Tx?
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
Acne vulgaris lesions?
Comedones – always present - Open (blackheads) - Closed (whiteheads) Moderate: - Papules - Pustules Severe - Nodules - Cysts (Scars)
60
Rosacea features?
Adults Flushing, erythema, telangiectasia, papules, pustules, rhinophym.
61
What is urticaria/angioedema usually? Tx?
Chronic spontaneous urticaria - individual weals/swellings lasting <24 hrs treat with longterm daily non-sedative antihistamine reassure patient
62
When should you be concerned regarding urticaria?
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
Classic description of psoriatic lesion?
Salmon pink scaly plaques
64
3 main blistering autoimmune diseases?
1. Bullous pemphigoid 2. Pemphigus - Pemphigus vulgaris - Pemphigus foliaceous 3. Dermatitis herpetiformis
65
Complications of impetigo, and their respective tx?
SSSS - Staphylococcus Scalded Skin Syndrome - Treat with flucloxacillin Bullous impetigo - Admit, pain relief, careful nursing, emollients, IV fluclox
66
Features of impetigo?
Usually children Usually mild Usually Staphyloccus aureus Erythema with golden crusting Always take a swab Contagious
67
Big complication of cellulitis? Tx?
Necrotising fasciitis | - Urgent surgical debridement along with IV antibiotics
68
Palmar and plantar warts Tx?
Normally can just leave alone will resolve without scarring - Topical salicylic acid - Cryotherapy
69
Fungal infection management?
Take scrapings and/or pull hairs for mycology Treatments: topical or oral azoles/terbinafine, also oral griseofulvin
70
What is Malassezia furfur, what might it cause?
Yeast infection - Pityriasis versicolor - Seborrheoic dermatitis
71
General causes of TEN and SJS?
Mainly drug reactions Antibiotics, anti-epileptics Minority are Viral-induced
72
Management of TEN and SJS?
1. Stop drugs 2. Supportive management in intensive care for TEN (potentially fatal) 3. ?IV immunoglobulin
73
How does erythema multiforme to TEN present>
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
ABCDE rule for melanoma
Asymmetrical Borders are undefined Colour is dark and several of them? Diameter is large (>6mm) ntation Evolving over time
75
BCC presentation?
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
SCC presentation?
Keratotic ill defined nodule that may ulcerate, grows quicker than BCC
77
Risk factors for skin cancer in general, and specifics?
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
Types of melanoma?
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
What is erythema nodosum? Causes? Presentation?
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
Most common cause of erythema multiforme?
HSV
81
Abx in meningiococcaemia?
Benzylpenicillin
82
Causative organism of necrotising faciitis?
Group A strep commonly
83
What is the difference in cellulitis and erysipelas
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
Causative organisms in cellulitis and erysipelas?
Staph and strep
85
Presentation of SSSS?
Scald like appearance followoed by flaccid bullae, perioral crusting, usual recovery with 5-7 days with fluclox

4th Year (15 decks)

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