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Old Y3 Sofia Notes > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Define basal cell carcinoma

A

Commonest form of skin malignancy, also known as rodent ulcer

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2
Q

Explain the aetiology/risk factors of basal cell carcinoma

A
  • MAIN RISK FACTOR: prolonged sun exposure or UV radiation
  • Seen in Gorlin’s syndrome
  • Other risk factors:

o Photosensitising pitch

o Tar

o Arsenic

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3
Q

Summarise the epidemiology of basal cell carcinoma

A
  • COMMON in those with FAIR SKIN
  • Common in areas of high sunlight exposure
  • Common in the elderly
  • Rare before the age of 40 yrs
  • Lifetime risk in Caucasians = 1 in 3
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4
Q

Recognise the presenting symptoms of basal cell carcinoma

A
  • A chronic slowly progressive skin lesion
  • Usually found on the:

o FACE

o Scalp

o Ears

o Trunk

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5
Q

Recognise the signs of basal cell carcinoma on physical examination

A
  • Nodulo-ulcerative (MOST COMMON)

o Small glistening translucent skin over a coloured papule

o Slowly enlarges

o Central ulcer with raised pearly edges

o Fine telangiectasia over the tumour surface

o Cystic change in larger lesions

  • Morphoeic

o Expanding

o Yellow/white waxy plaque with an ill-defined edge

o More aggressive than nodulo-ulcerative

  • Superficial

o Most often on trunk

o Multiple pink/brown scaly plaques with a fine edge expanding slowly

  • Pigmented

o Specks of brown or black pigment may be present in any BCC

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6
Q

Identify appropriate investigations for basal cell carcinoma

A
  • Biopsy is RARELY necessary

* Diagnosis is mainly on clinical suspicion

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7
Q

Define contact dermatitis

A

An inflammatory skin reaction in response to an external stimulus, acting either as an allergen or an irritant.

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8
Q

Explain the aetiology/risk factors of contact dermatitis

A
  • There are TWO main types of contact dermatitis that may co-exist:

o ALLERGIC - a delayed type IV hypersensitivity reaction, which occurs after sensitisation and subsequent re-exposure to the allergen

o IRRITANT - an inflammatory response that occurs after damage to the skin, usually by chemicals

  • Common ALLERGENS

o Cosmetics (e.g. fragrances)

o Metals

o Topical medications

o Textiles

  • Common IRRITANTS

o Detergents and soaps

o Solvents

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9
Q

Summarise the epidemiology of contact dermatitis

A
  • 4-7% of all dermatology consultations

* Hands are most commonly affected

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10
Q

Recognise the presenting symptoms and signs of contact dermatitis

A
  • HANDS are the most frequently affected
  • Contact dermatitis from clothing can occur in the axillae, groins and feet
  • Redness of skin
  • Vesicles and papules in the affected area
  • Crusting and scaling of skin
  • Itching of an affected area
  • Fissures
  • Hyperpigmentation
  • Pain or burning sensation
  • Make sure you do a thorough OCCUPATIONAL HISTORY
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11
Q

Identify appropriate investigations for contact dermatitis

A
  • NO investigations necessary most of the time

* Some may need patch testing

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12
Q

Define eczema

A

A pruritic papulovesicular skin reaction to endogenous and exogenous agents

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13
Q

Explain the aetiology/risk factors of eczema

A
  • There are lots of types because there are many different triggers
  • Exogenous

o Irritants (e.g. nappy rash)

o Contact (delayed type 4 hypersensitivity reaction to an allergen)

o Atopic

  • Endogenous

o Atopic

o Seborrhoeic

o Pompholyx (a type of eczema that affects the hands and feet)

o Varicose

o Lichen simplex

  • Varicose - due to increased venous pressure in lower limbs
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14
Q

Summarise the epidemiology of eczema

A
  • Contact - prevalence: 4%

* Atopic - onset in first year of life, childhood incidence: 10-20%

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15
Q

Recognise the presenting symptoms of eczema

A
  • Itching
  • Heat
  • Tenderness
  • Redness
  • Weeping
  • Crusting
  • Ask about occupational exposure to irritants 9eg.. Bleach)
  • Ask about personal/family history of atopy (e.g. asthma, hay fever)
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16
Q

Recognise the signs of eczema on physical examination

A
  • Acute

o Poorly demarcated erythematous oedematous dry scaling patches

o Papules

o Vesicles with exudation and crusting

o Excoriation marks

  • Chronic

o Thickened epidermis

o Skin lichenification

o Fissures

o Change in pigmentation

  • Based on type of eczema

o Atopic - mainly affects face and flexures

o Seborrhoeic - yellow greasy scales on erythematous plaques. Commonly found on eyebrows, scalp, presternal area

o Pompholyx - vesiculobullous eruption on palms and soles

o Varicose - associated with marked varicose veins

o Nummular - coin shaped, on legs and trunk

o Asteatotic - dry, crazy paring pattern

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17
Q

Identify appropriate investigations for eczema

A
  • Contact Eczema

o Skin patch testing - a disc containing allergens is diluted and applied on the skin for 48 hrs. It is positive if it causes a red raised lesion

  • Atopic Eczema

o Lab testing e.g. IgE levels

18
Q

Define erythema multiforme

A

An acute hypersensitivity reaction of the skin and mucous membranes. Stevens-Johnson syndrome is a severe form with bullous lesions and necrotic ulcers

19
Q

Explain the aetiology/risk factors of erythema multiforme

A
  • Degeneration of basal epidermal cells
  • Development of vesicles between cells in the basement membrane
  • Lymphocytic infiltrate around the blood vessels and at the dermo-epidermal junction
  • A precipitating factor is only identified 50% of the time
  • Precipitating Factors:

o Drugs - e.g. sulphonamides, penicillin, phenytoin

o Infection - e.g. HSV, EBV, adenovirus, chlamydia, histoplasmosis

o Inflammatory - e.g. rheumatoid arthritis, SLE, sarcoidosis, ulcerative colitis

o Malignancy - e.g. lymphomas, leukaemia, myeloma

o Radiotherapy

20
Q

Summarise the epidemiology of erythema multiforme

A
  • Any age group
  • Mainly in CHILDREN and YOUNG ADULTS
  • TWICE as common in MALES
21
Q

Recognise the presenting symptoms of erythema multiforme

A
  • Non-specific prodromal symptoms of upper respiratory tract infection
  • Sudden appearance of itching/burning/painful skin lesions
  • Skin lesions may fade leaving pigmentation
22
Q

Recognise the signs of erythema multiforme on physical examination

A
  • Classic target (bull’s eye) lesions with a rim of erythema surrounding a paler area
  • Vesicles/bullae
  • Urticarial plaques
  • Lesions are often symmetrical and distributed over the arms and legs including the palms, soles

and extensor surfaces

  • Stevens-Johnson syndrome is characterised by:

o Affecting > 2 mucous membranes (e.g. conjunctiva, cornea, lips, mouth, genitalia)

o Systemic symptoms (e.g. sore throat, cough, fever, headache, myalgia, arthralgia, diarrhoea/vomiting)

o Shock (hypotension and tachycardia)

23
Q

Identify appropriate investigations for erythema multiforme

A
  • Usually unnecessary - erythema multiforme is very much a clinical diagnosis
  • Bloods

o High WC, eosinophils, ESR/CRP

  • Imaging - exclude sarcoidosis and atypical pneumonia
  • Skin biopsy - histology and direct immunofluorescence if in doubt about diagnosis
24
Q

Define erythema nodosum

A

Panniculitis (inflammation of subcutaneous fat tissue) presenting as red or violet subcutaneous nodules

25
Q

Explain the aetiology/risk factors of erythema nodosum

A
  • Delayed hypersensitivity reaction to antigens associated with various infectious agents, drugs and diseases
  • Infection

o Bacterial - e.g. streptococcus

o Viral - e.g. EBV

o Fungal - e.g. histoplasmosis

  • Systemic Disease

o Sarcoidosis

o IBD

o Behcet’s disease

  • Malignancy

o Leukaemia

o Hodgkin’s disease

  • Drugs

o Sulphonamides

o Penicillin

o Oral contraceptive pills

  • Pregnancy
  • 25% of cases have no identifiable cause
26
Q

Summarise the epidemiology of erythema nodosum

A
  • Usually affects YOUNG ADULTS

* THREE times more common in FEMALES

27
Q

Recognise the presenting symptoms of erythema nodosum

A
  • Tender red or violet nodules bilaterally on both shins
  • Occasionally on thighs or forearms
  • Fatigue
  • Fever
  • Anorexia
  • Weight loss
  • Arthralgia
  • Symptoms of underlying CAUSE
28
Q

Recognise the signs of erythema nodosum on clinical examination

A
  • Crops of red or violet do
  • Occasionally appear on the thighs and forearms
  • Nodules are tender to palpation
  • Low-grade pyrexia
  • Joints may be tender and painful on movement
  • Signs of underlying CAUSE
29
Q

Identify appropriate investigations for erythema nodosum

A
  • Determine underlying CAUSE
  • Bloods

o Anti-streptolysin-O titres (check for streptococcal infection)

o FBC/CRP/ESR - check for signs of infection/inflammation

o U&Es

o Serum ACE (raised in sarcoidosis)

  • Throat swab and cultures
  • Mantoux/Head skin testing - for TB
  • CXR - check for bilateral hilar lymphadenopathy or other evidence of TB, sarcoidosis or fungal infections
30
Q

Define lipoma

A

Slow-growing, benign adipose tumours that are most often found in the subcutaneous tissues.

31
Q

Explain the aetiology/risk factors of lipoma

A
  • Benign tumours of adipocytes
  • Conditions associated with lipomas

o Familial multiple lipomatosis

o Gardner’s syndrome

o Dercum’s disease

o Madelung’s disease

  • Liposarcoma - rare malignant tumour of adipose tissue
32
Q

Summarise the epidemiology of lipomas

A
  • Can be seen at any age but more common between 40-60 yrs

* Relatively COMMON

33
Q

Recognise the presenting symptoms and signs of lipoma

A
  • Most are ASYMPTOMATIC
  • Compression of nerves can cause pain
  • Soft or firm nodule
  • Smooth normal surface
  • Skin coloured
  • Most are < 5 cm in diameter
  • Mobile
  • Soft/doughy feel
34
Q

Identify appropriate investigations for lipoma

A
  • Usually CLINICAL diagnosis

* US/MRI/CT used if there is doubt about the diagnosis

35
Q

Define melanoma

A

Malignancy arising from neoplastic transformation of melanocytes, the pigment-forming skin cells. The leading cause of death from skin disease.

36
Q

Explain the aetiology/risk factors of melanoma

A
  • DNA damage caused by ultraviolet radiation leads to neoplastic transformation
  • 50% arise in existing naevi
  • 50% arise in previously normal skin
  • FOUR histopathological types

o Superficial Spreading (70%)

  • Arises in a pre-existing naevus, expands in a radial fashion before a vertical growth phase

o Nodular (15%)

  • Arises de novo
  • AGGRESSIVE
  • NO radial growth phase

o Lentigo Maligna (10%)

  • More common in ELDERLY with sun damage
  • Large flat lesions
  • Progresses slowly
  • Usually on the face

o Acral Lentiginous (5%)

  • Arise on palms, soles and subungual areas
  • Most common type in NON-WHITE populations
37
Q

Summarise the epidemiology of melanoma

A
  • Steadily increasing in incidence

* WHITE races have 20 x increased risk compared to non-whites

38
Q

Recognise the presenting symptoms of melanoma

A
  • Change in size, shape or colour of a pigmented skin lesion
  • Redness
  • Bleeding
  • Crusting
  • Ulceration
39
Q

Recognise the signs of melanoma on physical examination

A

ABCDE criteria for examining moles:

  • A - asymmetry
  • B - border irregularity
  • C - colour variation
  • D - diameter > 6 mm
  • E - elevation/evolution
40
Q

Identify appropriate investigations for melanoma

A
  • Excisional Biopsy - histological diagnosis and determination of Clark’s Levels and Breslow Thickness (two methods of determining the depth of penetration of a melanoma)
  • Lymphoscintigraphy - a radioactive compound is injected into the lesion and images are taken over 30 mins to trace the lymph drainage and identify the sentinel nodes
  • Sentinel Lymph Node Biopsy - check for metastatic involvement
  • Staging - using ultrasound, CT or MRI, CXR
  • Bloods - LFTs (because the liver is a common site of metastasis)

Old Y3 Sofia Notes (9 decks)

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