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Year 3 Special Senses > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Eczema definition

A

Papules and vesicles on an erythematous base occuring on flexor surfaces.

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2
Q

Eczema epidemiology

A
  • 20% prevalence <12 yo

- Atopic most common

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3
Q

Eczema aetiology

A
  • Primary genetic defect causing loss of function of filaggrin protein causing a defect in skin barrier function
  • Family history of atopy usually present
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4
Q

Eczema presentation

A
  • Itchy, erythematous, dry scaly patches on flexor surfaces (face and extensor surfaces in infants)
  • Acute lesions: erythematous vesicular and exudative if infected
  • Chronic scratching can lead to excoriation and lichenification
  • Pitting and ridging of nails
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5
Q

Eczema management

A
  • Avoid exacerbating agents
  • Emolients

Topical steroids for flares:

  • dipnovate
  • dermovate
  • immunomodulators for steroid sparing agents

Oral:

  • antihistamines for symptomatic relief
  • antibiotics (flucloxacillin) for secondary bacterial infection
  • acyclovir for secondary herpetic infection

Severe non-responsive cases:
-Oral steroids –> phototherapy –> immunosuppressants (methotrexate, ciclosporin) –> biologics

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6
Q

Psoriasis definition

A

Chronic inflammatory skin disease caused by hyperproliferation of keratinocytes and inflammatory cell infiltration

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7
Q

Psoriasis aetiology

A

Variants:

  • Chronic plaque - most common
  • Guttate - raindrop lesions
  • Seborrheic
  • Flexural
  • Pustular (palmar-plantar)
  • Erythrodermic (total body redness)

Complex interaction between genetic, immunological and environmental factors

Precipitating factors: trauma, infection, drugs, stress, alcohol

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8
Q

Psoriasis presentation

A
  • Well demarcated erythematous scaly plaques
  • Lesions are itchy / burning / painful
  • common on extensor surfaces and scalp
  • Auspitz sign” scratch and removal of scales causes capillary bleeding
  • 50% have nail changes: pitting, onycholysis
  • 5% have psoriatic arthropathy: symmetrical polyarthritis, asymmetrical oligoarthritis, lone distal interphalangeal disease, psoriatic spondylosis, arthritis mutilans
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9
Q

Psoriasis management

A

General: avoid precipitating factors, emollients to reduce scales

Topical: localised and mild

  • vitamin D analogues
  • corticosteroids
  • coal tar preparations
  • dithranol
  • retinoids
  • keratolytics

Phototherapy: for extensive disease. UVB and photochemotherapy.

Oral: extensive and severe

  • Methotrexate
  • Retinoids
  • Ciclosproin
  • Biologicals: infliximab, etanercept, efazulimab
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10
Q

Acne defintion

A

Inflammatory disease of the pilosebaceous follicle

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11
Q

Acne aetiology

A

Hormonal: androgens
Contributing factors: increased sebum production, abnormal follicular keratinisation, bacterial colonisation (propionibacterium acnes), inflammation

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12
Q

Acne risk factors

A
  • Pressure / friction on skin
  • Oily lotions
  • Teenage
  • Stress
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13
Q

Acne presentation

A

Non-inflammatory lesions:

  • Open comedones: blackheads
  • Closed comedones: whiteheads

Inflammatory lesions:

  • papules
  • pustules
  • nodules
  • cysts

Commonly affects chest face and upper back

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14
Q

Acne management

A

Topical: benzoyl peroxide, antibiotics, retinoids

Oral: antibiotics, anti-androgens in females, retinoids

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15
Q

Rosacea definition

A

Chronic relapsing disease of facial skin characterised by recurrent episodes of facial flushing with persistent erythema, telangiectasia, papules and pustules.

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16
Q

Rosacea aetiology

A
  • Chronic acneiform disorder of facial pilosebaceous glands with increased reactivity of capillaries to head causing flushing and eventually telangiectasia
  • Full mechanism unknown but altered immune response involved
  • Medication associations: amiodarone, topical steroids, nasal steroids, vit B6/12
  • Flushing caused by heat / temp change, alcohol, caffeine, spicy food, stress, sun, vasodilators
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17
Q

Rosacea presentation

A

Symptoms:

  • long history flushing
  • progresses to constant flushing with obvious telangiectasia
  • gritty eyes and facial oedema

Signs:

  • skin not greasy, can be dry
  • erythema and telangiectasia over forehead and chees
  • nose / cheeks / forehead / chest / neck / ears affected
  • prominent sebaceous glands
  • nose may be enlarged / distorted - rhinphyma
  • peri-orbital oedema
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18
Q

Rosacea managment

A

General:

  • avoid precipitating factors: products containing sodium lauryl sulfate and topical steroids
  • facial massage to reduce oedema
  • daily suncream application

Pharmacological:

  • topical: metronidazole, azelaic acid, oral abx if papulopustular
  • isotretinoin used for resistant cases
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19
Q

Urticaria definition

A

Hives - itchy red rash resulting from swelling of superficial skin.

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20
Q

Urticaria aetiology

A

Activation of skin mast cells, resulting in histamine release This causes capillaries to leak leading to swelling. Angio-oedema can also occur when deeper tissues are involved.

Triggers can be:

  • allergies: foods, bites, stings, medication - NSAIDs / ACEi
  • viral infection
  • skin contact
  • physical stimuli: rubbing pressure, temperature
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21
Q

Urticaria presentation

A
  • Typical lesion: central itchy white papule / plaque surrounded by erythematous flare. Vary in size and shape, can be accompanied by angioedema.
  • Individual lesions transient - come and go within hours
  • Classified as acute (<48h), chronic (> 6 weeks)
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22
Q

Urticaria managment

A
  • Identify and treat cause
  • Non-sedating H1 antihistamines: cetirizine, loratadine, fexofenadine
  • If ineffective, increase dose x4 or add another antihistamine
  • Short course oral steroids may be indicated if severe
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23
Q

Basal cell carcinoma definition

A

Slow growing locally invasive malignant tumour of epidermal keratinocytes

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24
Q

Basal cell carcinoma aetiology

A
  • Tumour infiltrates local tissues though slow irregular growth
  • Morbidity from local tissue invasion and destruction
  • Chronic sun exposure
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25
Q

Basal cell carcinoma risk factors

A

UV exposure
Male
Xeroderma pigmentosa, albinism

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26
Q

Basal cell carcinoma presentation

A
  • Typical lesion: translucent / pearly papule with raised areas, telangiectasia, rolled edges and a central depression
  • Rodent ulcer: indurated and ulcerated centre. Slow growing but spreads deep and destroys tissue.
27
Q

Basal cell carcinoma investigation

A

Biopsy

28
Q

Basal cell carcinoma managment

A
  • Surgical excision + histological examination of tumour and margins
  • Micrographic surgery if high risk recurrent
  • Radiotherapy if surgery not appropriate
  • Cryotherapy, curettage and cautery
29
Q

Squamous cell carcinoma defintion

A

Locally invasive malignant tumour of epidermal keratinocytes with potential to metastasise.

30
Q

Squamous cell carcinoma aetiology

A

Dysplastic cells which span full thickness of epidermis and have spread into dermis.
Precursor’s:
-Actinic keratosis: diffuse dysplastic cells within epidermis
-Bowen’s disease: dysplasia spanning full thickness of epidermis

31
Q

Squamous cell carcinoma risk factors

A
  • UV light
  • Susceptibility to light: fair skin (FItzpatrick type I), blonde, red hair
  • Chemical carcinogens
  • HPV
  • Ionising radiation
  • Immunodeficiency
  • Chronic inflammation
  • Genetic conditions: xeroderma pigmentosum, albinism
32
Q

Squamous cell carcinoma presentation

A
  • Indurated nodular keratinising / crusted tumour that may ulcerte or present as an ulcer without evidence of keratinisation
  • Non-healng ulcer or growth in sun-exposed areas.
  • Clinical appearance: enlarging module with centre becoming nectroting and sloughing, developing into ulcer
  • Slow growing with reddish skin plaque - bleeding may occur
  • May give rise to local mets / spread to local lymph nodes
33
Q

Squamous cell carcinoma management

A
  • Complete surgical excision, send for histopathological examination
  • Other options: curettage and cautery, cryotherapy, topical, photodynamic therapy, radiotherapy
34
Q

Malignant melanoma definition

A

Malignant growth of melanocytes.

35
Q

Malignant melanoma aetiology

A
  • Damage to melanocytes found in basal layer of epidermis, by UV
  • Once melanoma spreads to dermis, can spread thorugh lymphatic system to local lymph nodes or via blood stream
  • Common mets: lung, brain, bone, liver, lymph
36
Q

Malignant melanoma risk factors

A
  • Naevi: 100+ 5-20x higher risk
  • Sun exposure
  • Type I skin
  • Actinic keratosis
  • High SES
37
Q

Malignant melanoma presentation

A 
A: asymmetry 
B: border irregular
C: colour irregular - brown and black
D: diameter > 7mm
E: evolving
38
Q

Malignant melanoma differentials

A

For any brown patch:

  • benign naevi
  • seborrheic keratosis
  • melanoma
39
Q

Malignant melanoma investigation

A
  • Visual inspection with dermatoscope and removal for histology
  • Diagnosis based on full-thickness biopsy
  • Breslow thickness measure to determine malignant potential
40
Q

Malignant melanoma management

A
  • Surgical excision definitive treatment
  • Radiotherapy useful
  • Chemo if metastatic
41
Q

Impetigo definition

A

Acute superficial bacterial infection most common in children

42
Q

Impetigo aetiology

A
  • Most commonly S. aureus, can be Strep pyogenes.

- Non-bullous, bullous or ulcerated

43
Q

Impetigo risk factors

A
  • Immunosuppressed
  • Summer
  • Atopic eczema
  • Scabies
  • Skin trauma
44
Q

Impetigo presentation

A
  • Primarily affects exposed areas: face, hands
  • Irregular crops or irritable superficial plaques with honey crusting
  • Extend when healing to form annular or arcuate lesions
  • Lymphadenopathy, fever, malaise
45
Q

Impetigo management

A
  • Wound hygiene
  • Antibiotics to carrier sites to prevent recurrence
  • Avoid contact with others
46
Q

Cellulitis definition

A

Common bacterial infection of lower dermis / subcutaneous tissue

47
Q

Cellulitis aetiology

A

S. pyogenes
S. aureus
P. aeruginosa

48
Q

Cellulitis presentation

A
  • Can affect any site but usually unilateral limb
  • Localised area of painful, red, swollen skin
  • Peau d’orange
  • Blistering, erosions, ulceration, purpura
  • Poorly demarcated borders
  • Red lines streaking away represent progression of infection into lymphatic system
  • Crepitus if anaerobic organism
  • Systemic signs of infection
49
Q

Cellulitis management

A

Uncomplicated: oral abx 5-10 days, symptomatic relief for pain and fluid loss

Complicated: systemic illness. Fluids, IV abx with oral switch when fever settles, cellulitis regresses and CRP reducces. O2.

Recurrent: avoid trauma, wear long sleeves, skin hygiene. Avoid blood tests in affected site. Keep swollen limbs elevated to aid lymphatic circulation.

50
Q

Molluscum Contagiosum definition

A

Common skin infection caused by pox virus, transmitted by direct contact.
Most common in children < 10

51
Q

Molluscum Contagiosum aetiology

A

Molluscum contagiosum mvirus. Spread by:

  • direct contact
  • indirect through contaminated objects
  • auto-inoculation into site by scratching
  • sexual

Incubation 2weeks - 6months

52
Q

Molluscum Contagiosum presentation

A
  • Clusters of small round papules 1-6mm, white / pink / brown. Umbilicated (central depression). Contains cheesy white material.
  • Located in warm moist areas: axilla, knees, groin
  • Papules in a row if from scratching
  • Induce surrounding dermatitis
53
Q

Molluscum Contagiosum management

A
  • Usually self-limiting
  • Physical: burst papules, cryotherapy, curettage and cautery, laser ablation
  • Medical: antiseptics e.g. h2o2 cream, salicylic acid, topical abx
54
Q

Seborrhoeic Keratosis definition

A

Common benign hyperkeratotic skin lesions associated with ageing.

55
Q

Seborrhoeic Keratosis aetiology

A

Degenerative condition with UV role in causation. Oncogenic mutations. Full aetiology poorly understood.

56
Q

Seborrhoeic Keratosis presentation

A
  • Flat-topped lesions, 1mm-several cm with well circumscribed border
  • Usually deeply pigmented - brown / black
  • Surface pitted and irregular with visible keratin dots
  • Multiple lesions may align along skin folds
  • Usually asymptomatic - may become irritated, itchy or inflamed
57
Q

Seborrhoeic Keratosis management

A 
Surgical removal
Curettage and cautery 
Laser
Shave biopsy 
Chemical peel
58
Q

Necrotising fasciitis

A

Life threatening infection involving any layer of deep soft tissue compartment - dermis, subcut, fascia, muscle

59
Q

Necrotising fasciitis aetiology

A
  • Wide spread necrosis
  • Organism spread from subcut tissue along superficial and deep fascial planes
  • Muscle usually spared
  • Multi-bacterial symbiosis and synergy
  • Common organisms: S. pyogenes, anaerobes + GN
60
Q

Necrotising fasciitis presentation

A
  • Patients systemically ill with disproportionately severe pain - only minor skin changes in initial stages
  • Can affect anywhere but usually extremities, perineum or trunk
  • Starts with localised pain swelling and oedema with infection poorly demarcated
  • Systemic illness
  • Develops into tense oedema, may be bullae, discoloured skin, crepitus due to subcut gas, pain may progress to anesthesia as nerves are destroyed, broad erythematous tract in skin
  • Hypotension and shock
  • Confusion, apathy
61
Q

Necrotising fasciitis investigation

A
  • Exploratory surgery: macroscopic features of grey necrotic tissue
  • Bloods: increased WCC / CRP / CK / urea, decreased sodium
  • Microbiology: cultures, wound swab, gram stain, fungal culture
62
Q

Necrotising fasciitis mangement

A
  • Early and aggressive wound debridement
  • Broad spec high dose abx
  • Close monitoring and supportive measures
  • Nutritional support due to high protein and fluid loss
63
Q

How does Lichen Planus normally present

A 
6 P's
Planar (flat-topped)
Purple
Polygonal
Pruritic
Papules
Plaques

Year 3 Special Senses (3 decks)

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