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Dermatology Flashcards

1
Q

What is pemphigus vulgaris?

A

Autoimmune condition characterised by IgG antibodies against desmoglein 3

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2
Q

When does pemphigus vulgaris normally occur?

A

Middle age

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3
Q

What are risk factors for pemphigus vulgaris?

A

Jewish descent, drugs (NSAIDs, ACEis)

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4
Q

How does pemphigus vulgaris present?

A

Flaccid blisters that are easily ruptured to form shallow erosions. Not itchy. Seen in face, scalp, axilla, mucosa

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5
Q

Is pemphigus vulgaris Nikolsky sign +ve or -ve?

A

Positive

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6
Q

What does immunofluorescence of Pemphigus Vulgaris show?

A

Intracellular IgG deposits

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7
Q

‘Crazy paving/chicken wire appearance on immunofluorescence’

A

Pemphigus vulgaris

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8
Q

What is the treatment of pemphigus vulgaris?

A

Topical steroids and pain relief

Prednisolone +/- azaithioprine, dapsone, ciclosporin

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9
Q

What is the prognosis of pemphigus vulgaris?

A

Remits in 3-6 years, mortality rate of 10-20%

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10
Q

What is bullous pemphigoid?

A

Autoimmune condition characterised by antibodies against the BM

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11
Q

What age group commonly get bullous pemphigoid?

A

Elderly

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12
Q

How does bullous pemphigoid present?

A

Itchy tense bullae, around flexures, on an urticarial base. Usually without scarring, mouth spared

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13
Q

Is bullous pemphigoid Nikolsky sign +ve or -ve?

A

Negative

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14
Q

What is seen on immunofluorescence in bullous pemphigoid?

A

IgG and c3 deposits at dermoepidermal junction

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15
Q

How is bullous pemphigoid managed?

A

Topical steroids

Oral prednisolone, tetracyclines, azaithioprine, dapsone

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16
Q

What is the prognosis of bullous pemphigoid?

A

Chronic self limiting course, most achieve remission in 3-6 months

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17
Q

What is dermatitis herpetiformis?

A

Autoimmune blistering skin condition caused by IgA deposition in the dermis

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18
Q

What is dermatitis herpetiformis associated with?

A

Coeliac disease

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19
Q

How does dermatitis herpetiformis present?

A

Itchy, vesicular skin lesions on extensor surfaces, buttocks, face and scalp. On erythematous bases

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20
Q

What is seen on histology in dermatitis herpetiformis?

A

Papillary dermal microabscesses

IgA deposits in dermal papillae

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21
Q

How is dermatitis herpetiformis treated?

A

Gluten free diet

Dapsone, tetracyclines

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22
Q

What is acne vulgaris?

A

Common chronic inflammatory condition of the pilosebaceous unit

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23
Q

What percentage of teenagers does acne vulgaris affect?

A

80-90%

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24
Q

What are the 4 main pathogenesis’ of acne vulgaris?

A

Duct occlusion
Increased sebum production
Bacterial colonisation
Inflammation

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25
What bacteria commonly colonise in acne vulgaris?
P. Acnes, staph epidermidis
26
What are aggravating factors for acne vulgaris?
Diet, premenstrual, sweating, UV radiation, job (Steam/oil), stress
27
What atrophic scarring is seen in acne vulgaris?
'Ice pick lesions'
28
What hypertrophic scarring is seen in acne vulgaris?
Keloid
29
What is mild acne?
Scattered papules and pustules
30
What is moderate acne?
Numerous papules, pustules, atrophic scarring
31
What is severe acne?
Papules, pustules, nodules, significant scarring
32
What is the first line management of acne?
Single topical treatment
33
What topical treatments are there?
Topical antibiotics Topical retinoids Benzoyl Peroxide
34
What is second line management of acne?
Combined topical treatment
35
What is 3rd line management of acne?
Oral antibiotics or OCP
36
What oral antibiotics are used for management of acne vulgaris?
Erythromycin, oxytetracycle, lymecycline, doxycycline
37
What are side effects of oral antibiotics?
Gi upset, thrush, photosensivity
38
What type of COCP is used for acne vulgaris?
Dianette, triphasic pills
39
How will progesterone only contraception affect acne vulgaris?
May exacerbate it
40
What is 4th line acne treatment?
Oral retinoids
41
How doe oral isotretinoin (roaccutane) work?
Reduces sebaceous gland activity
42
What are side effects of roaccutane?
Dry skin, lips, eyes, skin fragility, hyperlipidaemia, abnormal LFTs, teratogenic, mood alteration, hair thinning,
43
What is acne rosacea?
Chronic skin condition of unknown aetiology
44
How does acne rosacea present?
papules, pustules and erythema, prominent facial flushing (worsened by spicy food/alcohol)
45
What is acne rosacea associated with?
Blepharitis
46
How is acne rosacea managed?
Avoid dietary triggers Topical metronidazole Telangactasia - laser therapy Rhinophyma - surgery/laser shaving
47
What is eczema?
Inflammatory skin condition often starting in early infancy
48
What are causes of eczema?
Multifactorial - genetics, allergens, diet, overwashing, poor barrier, filaggrin deficiency, dryness, heat, cold, stress, infection
49
Which social class is there a higher incidence of eczema in?
Higher social classes
50
How does eczema present?
Itchy, red, flexural rash. Chronic scratching causes lichenification, scarring, infection
51
How is eczema diagnosed?
Itching PLUS 3 OF | visible flexural rash, history of flexural rash, personal/family history of atopy, dry skin, onset before 2
52
What is step 1 in eczema management?
Emollients
53
What is step 2 in eczema management?
Emollients + mild steroid
54
What is step 3 in eczema management?
Emollients + mild steroid + calcineurin inhibitor
55
What is step 4 in eczema management?
Emollients + potent/very potent steroid
56
How should emollients be used?
Liberally (500g/week), also bath and shower emollients
57
What are the effects of topical steroids?
Anti-inflammatory Vasoconstrictive Antiproliferative
58
What are side effects of topical steroids?
Skin thinning, increased infections, telangastasia, cushings
59
How much steroid does one finger tip unit cover?
Two hands
60
What is an example of a mild topical steroid?
Hydrocortisone
61
What is an example of a moderate topical steroid?
Eumovate
62
What is an example of a potent topical steroid?
Betnovate
63
What is an example of a very potent topical steroid?
Dermovate
64
What are examples of calcineurin inhibitors?
Tacrolimus, pimecromilus
65
What can be used if eczema is severe and does not respond to topical treatments?
Phototherapy, systemic agents (e.g. azaithioprine, methotrexate, mycopentolate)
66
What organism is the cause of infected eczema?
Staph Aureus
67
How is infected eczema treated?
Fusidic acid
68
What is eczema herpeticum?
Herpes simplex infection of eczema
69
How does eczema herpeticum present and how is it treated?
Monomorphic rash with circular blisters | EMERGENCY - admit for IV aciclovir
70
What is psoriasis?
Chronic relapsing remitting condition
71
When is the peak incidence of psoriasis?
20s-50s
72
What is the underlying pathophysiology of psoriasis?
Hyperproliferation of epidermal cells
73
What is the normal skin turnover?
25 days ish
74
What is the skin turnover in psoriasis?
5 days
75
What does histology show in psoriasis?
Parakeratotic statum corneum Absence of granular layer Extended prickle cell layer
76
How does chronic plaque psoriasis present?
Erythematous, scaly plaques on extensor aspects of skin. Palpable and shiny with silvery scale. Koebner phenomenon
77
What is the Koebner phenomenon?
Skin lesions arising in areas of trauma
78
How does guttate psoriasis present?
Usually occurs 2-4 weeks post strep infection. 'Tear drop' scaly patches. Resolves spontaneously in 2-4 months
79
How does flexural psoriasis present?
Shiny red well demarcated plaques in flexural surfaces
80
How does erythrodermic psoriasis present?
90% of skin surface goes red. Usually occurs in patients with psoriasis and is due to UV burns/withdrawal of steroids
81
What nail changes may be seen in psoriasis?
Pitting, onycholysis, oil drop lesions, sublingual hyperkeratosis, deformity
82
How is psoriasis managed 1st line?
Topical treatment
83
What topical treatments are available for psoriasis?
Emollients, tar, vitamin D analogues, salicylic acid, dithranol, steroids
84
How does coal tar work?
Reduces DNA synthesis and epidermal proliferation
85
What is an example of a vitamin D analogue?
Calcitriol
86
What does salicyic acid do in psoriasis?
Removes hyperkeratosis
87
How does dithranol cream work?
Anti-mitotic - used in short regimes as can burn skin
88
What is second line treatment for psoriasis after topical agents?
Phototherapy
89
What are the options of phototherapy?
UVB treatment or PUVA (psoralen topical.oral and UVA)
90
What is the 3rd line treatment for psoriasis after phototherapy?
Systemic treatment
91
What systemic treatments are available for psoriasis?
Methotrexate, ciclosporin, retinoids, biologics
92
What are causes of venous ulcers?
Venous hypertension secondary to venous insufficiency
93
What is the pathogenesis of venous ulcers?
Ulcers form due to capillary fibrin cuff or leucocyte sequestration
94
What are features of venous insufficiency?
Oedema, brown pigmentation, lipatodermatosclerosis, eczema
95
What are features of venous ulcers?
Superficial, above ankle (Gaiter area), painless
96
What investigations should be done for venous ulcers?
Doppler USS | ABPI
97
How are venous ulcers managed?
4 layer compression bandaging
98
What should the pressure of a bandage be for venous ulcer at the ankle?
Around 40mmHg
99
What should the pressure of a bandage be fore venous ulcers at the knee?
Around 25mmHg
100
How long should you aim to heal a venous ulcer in?
12 weeks
101
What should the ABPI be to be suitable for compression bandaging?
Over 0.8
102
What are causes of arterial ulcers?
Hypertension, atherosclerosis
103
What are the features of arterial insufficiency?
Hairless, pale, cold, unable to palpate pulses
104
What are features of arterial ulcers?
Deep, punched out, may see tendon, over heels/toes, painful
105
What investigations are done for an arterial ulcer?
Doppler USS | ABPI
106
What is the management of an arterial ulcer?
Pain relief, lifestyle changes, aspirin, treat infections, Soffban + crepe bandages to reduce oedema. Vascular surgery if needed
107
What does ABPI measure?
Ratio of systolic blood in the lower leg compared to the arms
108
What does a decreased pressure in the legs indicate?
Peripheral arterial disease
109
What is a normal ABPI?
1-1.2
110
What does an ABPI of 0.8-0.9 indicate?
Mild peripheral arterial disease
111
What does an ABPI of 0.5-0.79 indicate?
Moderate PAD
112
What does an ABPI less than 0.5 indicate?
Severe PAD
113
What does an ABPI above 1.2 indicated?
Calcification of artery
114
What is a Marjolins ulcer?
SCC occuring at a site of chronic inflammation
115
Who and where do neuropathic ulcers occur?
In diabetics. commonly on points on pressure (e.g. metatarsal head)
116
What is pyoderma gangrenosum?
Erythematous nodules than can ulcerate, associated with IBD, RA. may occur at stoma sites
117
What are symptoms of venous eczema?
Red, scaly rash that is intensely itchy. Often misdiagnosed as cellulitis
118
What are the causative organisms of impetigo?
Staph aureus, strep pyogenes
119
How does impetigo present?
Well defined lesions with a honey coloured crust and erythematous base
120
How is impetigo treated?
Topical fusidic acid | If sevre - oral flucloxicillin
121
What are complications of impetigo?
Bullous impetigo | Staphylococcal scolded skin syndrome
122
What is staphylococcal scaled skin syndrome?
Loss of epidermis secondary to exotoxin release
123
What is folliculitis?
Superficial infection of hair follicle
124
What is a boil?
Deep infection of a single hair follicle
125
What is a carbuncle?
Deep infection of multiple hair follicles
126
How does folliculitis/boils/carbuncles present?
Discrete erythematous papules/pustules on hair bearing sites, itch
127
How are boils and carbuncles treated?
Oral flucloxacillin
128
What is cellulitis?
Acute infection of skin and soft tissues
129
What are causes of cellulitis?
Strep pyogenes, staph aureus
130
How does cellulitis present?
Usually in legs, macular hot erythema with ill defined margins that is often spreading. Associated fever, malaise, leg pain, swelling, local lymphadenopathy
131
How is cellulitis managed?
Flucloxacillin orally
132
If a patient gets recurrent cellulitis, what should you consider swabbing for?
Panton-Valentine-Leucocidin
133
What is erysipelas?
Superficial form of cellulitis
134
What is erysipelas caused by?
Strep Pyogenes
135
How does erysipelas present?
Spreading rash, commonly on face. Well demarcated, erythematous plaque, systemic upset
136
How is erysipelas treated?
IV flucloxacillin
137
What is necrotising fasciitis?
Infection of soft tissue and fascia
138
What causes type 1 necrotising fasciitis?
Mixed aerobe/anaerobe
139
What causes type 2 necrotising fasciitis?
Strep pyogenes
140
What causes type 3 necrotising fasciitis?
Clostridia
141
How does necrotising fasciitis present?
Acute onset, painful, erythematous lesions, extremely tender over tissue
142
How is necrotising fasciitis managed?
Surgical debridement, IV antibiotics
143
What causes skin warts?
HPV types 1-4
144
How do warts present?
Raised papules with firm, rough surface, cauliflower appearance
145
How are warts managed?
Salicylic acid, cryotherapy, imiquimod
146
What causes molluscum contagiosum?
Pox virus
147
How does molluscum contagiosum present?
Itchy, solid, pearly pink papules with umbilicated centre
148
How is molluscum contagiosum managed?
Self limiting
149
What causes coldsores?
Herpes Simplex Virus 1
150
How does herpes simplex virus (coldsores) present?
Single or grouped painful itchy vesicles on erythematous base that burst without scarring
151
What is herpetic whitlow?
HSV lesion on finger
152
How is HSV managed?
Analgesia | Topical/oral aciclovir
153
What causes chicken pox?
Varicella Zoster virus
154
How does chicken pox present?
Macules -> papules -> vesicles that crust over and recover. Intensely itchy
155
What is the cause of shingles?
Herpes Zoster - reactivation of VZV in dorsal root ganglion
156
How does shingles present?
Erythematous macules, burning and tingling pain, dermatomal distribution
157
How is shingles managed?
Oral aciclovir + analgesia
158
How does a dermatophyte infection present?
Erythematous, scaly itchy ring shaped lesion with expanding edge and resolving centre. Named by body site.
159
How is a dermatophyte infection treated?
Topical/oral antifungals
160
What causes thrush?
Candida albicans
161
How does thrush present?
Itchy scale, ragged peeling edges. In mouth - white lesion that can be scraped off.
162
How is thrush treated?
``` Oral = miconazole Skin = topical clotrimazole or oral antifungal ```
163
What causes pityriasis vesicular?
Melassezia yeast
164
How does pityriasis vesicular present?
Well defined macular lesions with fine scale that are hypo or hyperpigmented. Often noticed after being on holiday
165
How is pityriasis vesicular treated?
Topical ketoconazole
166
What is the most common skin cancer?
BCC
167
What are risk factors for BCC?
Fair skin, UV exposure, intermittant sun damage
168
How does a nodular BCC present?
Raised lesion with pearly shiny papule, rolled edge, central ulceration, telangactasia
169
'Rodent ulcer'
BCC
170
How is BCC diagnosed?
Clinical suspicion and biopsy
171
How is BCC managed?
Leave and monitor Topical imiquimod Cryotherapy Surgery/MOHS
172
What is actinic keratosis?
Premalignant lesion, develops as a consequence of sun exposure
173
How does an actinic keratosis present?
Small crusty or scaly lesion. May be pink/brown/red/same colour as skin. Typically on sun exposed sites
174
How is actinic keratosis' managed?
``` Prevention of further risk Fluorauricil cream Topical diclofenac Topical imiquimod Cryotherapy/Currettage/Cautery ```
175
What is Bowens disease?
Intraepidermal SCC
176
How does Bowens disease present?
Slow growing red scaly plaque, typically on shin
177
How is Bowens disease managed?
Topical fluoracil Topical Imiquimod Cryotherapy Excision
178
What is the commonest skin cancer post transplant?
SCC
179
What are risk factors for SCC?
Excessive sunlight exposure, PUVA, actinic keratosis, Bowens disease, immunosuppression, smoking, long standing ulcers
180
How does an SCC present?
Grows slowly over months, firm erythematous plaque over sun exposed site. Associated scale, crust bleeding, tenderness, itch
181
How is SCC managed?
Surgical excision
182
What is a malignant melanoma?
Tumour derived from melanocytes
183
What are risk factors for malignant melanoma?
Personal/family history, large number of moles, excess sun exposure, sunbed use, immunosuppression
184
What are the two growth phases of melanomas?
Radial and vertical
185
What is the radial growth phase of a melanoma?
Grows horizontally within the epidermis
186
What is the vertical growth phase of a melanoma?
Lesion becomes elevated and invades dermis
187
What is the commonest type of melanoma?
Superficial spreading
188
How does superficial spreading melanoma present?
Growing, changing mole
189
How does a nodular melanoma present?
Red/black lump that oozes and bleeds
190
Who do lentigo malignas occur in?
Elderly sun exposed skin
191
What is an acral lenitgo?
A melanoma arising on the palms, nails or soles of feet
192
How is assessment of a melanoma done?
Asymmetry, Border, Colour, Diameter >6mm, evolving
193
How is a melanoma managed?
Surgical excision with 2mm margins +/- sentinel node biopsy | If advanced can do chemo/radio/immunotherapy
194
What is a prognostic indicator in melanoma?
Breslow thickness
195
What is breslow thickness?
Measure of tumour thickness/depth, measured from basal layer of epidermis
196
'Herald patch'
Pityriasis rosea
197
How is scabies treated?
Malathion lotion/permethrin cream
198
What is the cause of sebhorroeic dermatitis?
Malassezia
199
'Hypersensitity reaction triggered by infections'
Erythema multiforme
200
What is ertythema ab igne caused by?
Infra-red exposure
201
'Itchy white spots on vulva of elderly woman'
Lichen scleorsis
202
'Pruritic purple pustular rash on flexors. Itchy'
Lichen planus
203
'Wickhams striae'
Lichen planus
204
How is lichen planus treated?
Topical steroids
205
How is erythrasma treated?
Erythromycin
206
'Exclamation mark hairs'
Alopecia areata
207
What drugs can commonly trigger psoriasis?
Betablockers and lithium
208
Lupus pernio
Sarcoidosis

Finals Revision (22 decks)

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