Dermatology Flashcards by James Bateman

WHAT IS ECZEMA?

Papules and vesicles on an erythematous base.

ITCHY!!!

Reaction pattern to stimuli

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What are the two type of eczema?

What is the exogenous one precipitated by?

Endogenous (atopic)

or exogenous (contact dermatitis)

Contact dermatitis is a type of eczema precipitated by an exogenous agent e.g. chemicals, sweat, abrasives

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What is filaggrin?

Skin barrier protein

If damaged increases the risk of eczema

Genetic predisopsition

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What is the treatment of eczema?

Avoid triggers

Keep nails short in children

Topical therapies (emollients, steroids for flare ups)

Oral therapies
Anti-histamines
Flucloxacillin
Oral steroids
Ciclosporin

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WHAT IS ACNE?

Inflammatory disease of the pilosebaceous follicles

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What is the pathology of acne?

Increased sebum production (hormonal in adolescents)

Abnormal follicular keratinization

Pilosebaceous duct obstruction

Bacterial colonisation with Propionibacterium acne

Inflammation

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What is the presentation of acne?

Blackheads and whiteheads (open and closed comedomes), inflammatory lesions, papules, nodules, cysts.

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What is the management of acne?

Mild
Topical therapies e.g. benzylperoxide and topical antibiotics and topical retinoids

Moderate
Oral therapies e.g. oral antibiotics and anti-androgens in females (COCP or cyproteroneacetate)

Severe
Oral retinoids

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WHAT IS PSORIASIS?

Chronic, inflammatory skin disease due to hyper-proliferation of Keratinocytes + inflammatory cell infiltration

Well demarcated erythematous plaques topped with silvery scales

NOT ITCHY

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Where can psoriasis be seen?

Extensor surfaces

Associated nail changes: pitting, onycholysis

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What are the precipitating (flare up) factors for psoriasis?

Trauma, drugs (lithium, beta blockers), stress, smoking and alcohol

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What is the treatment for psoriasis?

Mild
Topical vitD analogues e.g. calcipotriol, topical corticosteroids, coal tar preparations, topical retinoids

Mod
Phototherapy

Severe
Oral methotrexate, retinoids, ciclosporin, infliximab

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WHAT ARE THE FEATURES OF A BCC?

What is it a tumour of?

Does it metastasise?

Slow growing

Locally invasive

Tumour of the epidermal keratinocytes

Rarely metastasises but locally destructive

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What are the risk factors for a BCC?

UV exposure

Skin type 1 (burns rather than tans)

Aging

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What is the presentation of a BCC?

Common on head and neck

Pearly appearance

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What is the treatment of a BCC?

Surgically excise

Radiotherapy if surgery is not appropriate

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What are the complications of a BCC?

Complications – local tissue destruction

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WHAT IS A SCC?

Locally invasive malignant tumour of keratinocytes

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What are the risk factors for a SCC?

UV exposure

Chronic inflammation
e.g. wound scars, immunosuppression

What is the presentation of a SCC?

Scaly and crusty, ill-defined edges, may ulcerate

What is the management of a SCC?

Surgical excision/ radiotherapy if non-resectable

WHAT IS A MELENOMA?

Invasive tumour of melanocytes

What are the risk factors for a melenoma

UV exposure

Skin type 1

Atypical moles

Multiple moles

Family history

What is the presentation of a melenoma?

A – asymmetrical shape

B – boarder irregularity

C – colour irregularity

D- diameter >5cm

E – evolution/change of lesion

SYMPTOMS e.g. bleeding, itching

What is the treatment of a melenoma?

Surgical, radiotherapy, chemotherapy if metastatic.

WHAT ARE THE RISK FACTORS FOR ARTERIAL SKIN ULCERS?

Arterial disease (atherosclerosis) Smoking Cholesterol DM

How does a arterial ulcer present? What does the ulcer look like?

Pain, worse when legs elevated Cold skin, absent peripheral pulses, shiny pale skin, loss of hair **_Ulcer_** Small, sharply defined, necrotic base

What are the investigations of an arterial ulcer?

ABPI \< 0.8 suggests arterial insufficiency Doppler studies

What is the treatment of a arterial ulcer?

Vascular reconstruction

WHAT ARE THE RISK FACTORS FOR VENOUS ULCERS?

Varicose veins, DVT

How does a venous ulcer present? What does the ulcer look like?

Pain (minimal) Warm skin Normal peripheral pulses, leg oedema, haemosiderin, lipodermatoosclerosis Large, shallow, irregular, exudative

What are the investigations of a venous ulcer?

ABPI normal (\>0.8 – 1)

What is the management of a venous ulcer?

Compression bandaging

WHERE ARE NEUROLOGICAL ULCERS FOUND?

DM, neurological disease

What are the symptoms of neurological ulcers? What does the ulcer look like?

Often painless Found at pressure sites (e.g. heel or toes) Warm skin and normal peripheral pulses Associated peripheral neuropathy Variable size, maybe surrounded by callus

What is the treatment for neurological ulcers?

Appropriate foot wear Control DM Podiatary

WHAT IS CELLULITIS?

Bacterial infection of the deep subcutaneous tissue

What are the causes of cellulitis?

S. pyogenes, S. aureus

What are the risk factors for cellulitis?

Immunosuppression Wounds Leg ulcers Trauma Athletes foot

What is the presentation of cellulitis?

Local inflammation, systemically unwell

What is the treatment of cellulitis?

fluclox or benpen

WHAT IS NECROTISING FASCITIS?

Bacterial infection of the deep fascia + tissue necrosis

What are the causes of NF?

Group A haemolytic strep

What are the risk factors for NF?

abdo. Surgery, immunosuppression

What are the symptoms of NF?

Severe pain out of proportion, necrotic skin, systemically unwell, soft tissue gas seen on Xray

What is the treatment of NF?

Surgical debridement, IV Abx