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Dermatology Flashcards

1
Q

DCM for describing a rash

A

Distribution: E.g. skin folds, flexural, size

Configuration: Linear, annular (ring), discoid (coin like), cluster

Morphology: Purpuric, vesicular, maculopapular

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2
Q

Macula

Papule

Vesicle

A

Flat (non-palpable) area of altered colour <0.5cm e.g. freckle

Solid raised lesion

Raised, clear, fluid filled lesion

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3
Q

6 main skin functions

A

Protection against environment

Temperature regulation

Sensation

Vitamin D synthesis

Immunosurveillance

Stop fluid loss

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4
Q

Skin layers

A

Epidermis

Dermis

Subcut tissue

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5
Q

Main cell types of Epidermis

A

Karatinocytes
- Produce protective layer (keratin)

Langerhan’s cells
- Present antigens activate T-cells

Melanocytes
- Make melanin protect nuclei from UV DNA damage

Merkel cells
- Special sensation nerve endings

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6
Q

Epidermal layers

A

Come Get Sun Burned (from superficial to deep)

  • Stratum Corneum (Horny- keratin layer)
  • Stratum Granulosum
  • Spinosum (prickle - differentiating cells)
  • Basale (actively dividing cells
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7
Q

What is contained in Dermis

A

Mainly made of collagen, elastin, glycosaminoglycans

Immune cells, nerve cells, skin appendages, lymphatics. blood vessels

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8
Q

Types of skin appendages

A

Hair
Nails
Sebaceous glands
Sweat glands

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9
Q

Hair types and made of

A

3 types (lanugo - fine, vellus - body, terminal - coarse i.e. scalp, eyelash), made of modified keratin, divided into shaft (keratinised tube) and bulb (actively dividing cells and melanocytes)

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10
Q

Sebaceous gland function

A

Produce sebum via hair follicles (lubricates and waterproofs)

Stimulated by conversion of androgens to dihydrotestosterone

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11
Q

Sweat glands function and type

A

Regulate temperature, innervated by SNS.

2 types eccrine (skin) and apocrine (axilla, anus, genitalia - only function from puberty, bacteria - body odour).

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12
Q

4 stages of wound healing

A

Haemostasis: Vasoconstriction and Pt aggregation (clot formation)

Inflammation: Vasodilation, migration neutrophil and macrophage (key) to phagocytose debris

Proliferation: Granulaiton tissue (from fibroblasts), angiogenesis, re-epithelialisation

Remodelling: Collagen fibre reorganisation, scar maturation

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13
Q

Emoillients:

  • Use
  • Directions
  • SE
  • Examples
A

To rehydrate skin, re-establish surface lipid layer

Use Liberally

SE: Irritant (rash)

Diprobase (cream)
Double base
Dermol (antibacterial)

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14
Q

Topical corticosteroid strengths

1) mild
2) moderate
3) potent
4) V.potent

A

1) Hydrocortisone
2) Eumovate
3) Betnovate
4) Dermovate

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15
Q

Topical corticosteroid Indications

A

Anti-inflam and Anti-prolif

allergic/immune conditions, blistering, inflammatory skin conditions, CTDs, vaculitis

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16
Q

Topical corticosteroid SE

  • local
  • systemic
A

Skin atrophy, telangiectasia, striae, exacerbation skin conditions: acne, perioral dermatitis

HTN, Immunosuppression, Psychosis, Diabetes, Osteoporosis, Cataracts

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17
Q

Topical Abx and SE

A

Fusidic acid, mupirocin, neomycin

Local (irritation, allergy)
Systemic: GI upset, rash, anaphylaxis, candidiasis, ABX associated infections

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18
Q

Oral retinoids (similar to Vit A)

  • EG
  • Indications
  • SE
A

Isotretinoin, Acitretin

Acne, Psoriasis

Dry skin/lips/eyes, disordered LFTs, hypercholesterolaemia, Myalgia/arthralgia, Depression, Teratogenicity

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19
Q

Tacrolimus and Ciclosporin

How do they work (Think T&C)

A

Immunosupressors

Inhibit Calcineurin which inhibits T-cell activation

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20
Q

Azathioprine

physiology

SE

A

Immunosuppress

Inhibits enzymes required for DNA synthesis of T & B cell

SE: hepato/myelotoxicity

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21
Q 
Atopic eczema
(atopy = IgE)

Definition
Aetiology
Distribution

A

Chronic inflammatory skin disorder. Itch, erythema, Scaly patches

genetic susceptible and env factors (hygiene hypoth) result in defect in skin barrier function and dysregulation post allergen exposure

Flexor surfaces (skin folds)
Also face in infants
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22
Q

Atopic eczema pathophys

A

1) defect skin barrier function
- genetic defect in barrier protein = inc desquamation = barrier defect.
- increased exposure/sensitisation to cutaneous antigens

2) immune function disorder
- Th2 response post acute phase sensitisation = IL4/5/13 over express
- Results in increased IgE and peripheral eosinophils

3) Exacerbating factors: infection, soap (inc pH), dust, sweat, heat, stress

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23
Q

Atopic eczema Dx

A

Itchy skin + 3 of:

History of flexural involvement

Visible flexural dermatitis

Personal history asthma, hayfever (or family if <4)

Generally dry skin in last year

Onset at <2

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24
Q

Complications of Atopic eczema

A

Bacterial superinfection (S.aureus)

Eczema herpeticum (HSV)- emergency

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25
Q

Other tests to consider in Atopic eczema

A

Serum IgE

Allergy testing (skin prick or RAST - radio allergen blood test to see specific IgE and determine allergen)

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26
Q

Steps in Atopic Eczema Tx

A

1) emollient, avoid trigger
2) Low/mild topical steroid ( Hydrocortisone, Euvate)
3) Mild/high potency
4) Systemic therapy or UV therapy

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27
Q

Atopic aczema presents with

A

RFs: atopy, family history eczema

Pruritus

Xerosis (dry skin) - hallmark

Erythematous scaly patches @ flexor surfaces

Acute lesions
(Vesicles and weeping)

Consequences of chronic scratching/rubbing
(Lichenification and excoriation)

Hypopigmentation

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28
Q

Contact dermatitis

  • Hx and pres
  • Types
  • Diagnosis
  • Tx
A

History of contact with irritants / Occupational exposure

Localised burning, stinging, itching, blistering, redness, swelling at area of contact

Irritant - direct toxicity without prior sensitisation

Allergic - delayed hypersensitivity (history of atopy)

History/Patch testing to help identify agent

Irritant: emollients/topical corticosteroids + alergen/irritant avoidance (gloves)

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29
Q

Seborrhoeic dermatitis

  • what
  • flares
  • Tx
A

Itchy, erythematous patches on chest, nasolabial folds, scalp

Flares with stress, fungal infection

corticosteroids ± anti fungal (non-scalp)

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30
Q

Psoriasis

  • Definition
  • Characteristics
  • Other features
A

Inflammatory disease due to hyperproliferation of keratinocytes and inflammatory cell infiltrate

Extensive erythematous, well-circumscribed, scaly plaques at extensor surfaces and scalp ( can be seen following abrasion)

50% nail changes (pitting), 10% arthritis (symmetrical poly, asymmetrical oligo)

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31
Q

Psoriasis

  • Definition
  • Aetiology
A

hypreproliferation of keratinocytes with increase basal proliferation and migration to corner

Complex interaction of genetics (THfa, FH) and env (triggers: beta block, trauma, stress), infection (guttate normally follows strep pharyngitis

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32
Q

Koebner Phenomenon

A

New Psoriatic skin lesions on areas of cutaneous injury in otherwise healthy skin

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33
Q

Types of psoriatic rashes

ALL ARE ITCHY

A

Plaque: most common (80-905), silver scaling and bleed on removal

Guttate: raindrop shaped on trunk, arms and legs. post strep tonsillitis

Seborrhoeic: nasolabial, retroauricular

Palmar, plantar

Flexural

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34
Q

Psoriasis therapies (cant be cured so manage)

  • General
  • Topical
  • Oral
  • Biological
  • Photo
A

Educate, avoid precipitants (drugs, stress, alcohol),

Emollients, Vit D analogues, topical corticosteroids.

MTX (IM weekly) + folic acid
Acitretin (retinoid - regulate epithelial cell growth)

Anti-TNF: Adalimumab, etanercept, infliximab

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35
Q

Psoriasis 1st line

  • Mild plaque
  • Mod/sev plaque
  • Guttate
A

Topical corticosteroid ± Vit D analogue

Phototherapy or MTX or Oral Retinoid or Biologic

Phototherapy

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36
Q

Acne Vulgaris

  • Def
  • Who
  • Cause (typically)
  • Other cause
A

Inflammatory disease of pilosebaceous follicles

80% teens

Hormonal: excess androgens inc sebum prod, hypercornification = comedone formation, bacterial colonisation causes inflammatory reaction

PCOS, Cushing’s, Steroid use, Puberty

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37
Q

Acne Vulgaris Presentation

A

Open (blackhead) and closed (white) comedones

Papules nodules and cysts if inflammatory (mod/sev)

On face, upper back, chest.

Depression, low confidence

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38
Q

Acne complications

A

Hyperpigmentation, scarring, deformity, psychological

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39
Q

Therapies for Acne Vulgaris

A

Topical (for mild)

  • Salicylic acid - thins skin
  • Retinoids - isotretinoin (Vit A derivative - modulates epithelial prolif)

Oral therapy (mod/sev)

  • Topical retinoid + oral abx (doxy, tetracycline)
  • antiandrogens (female) COCP
  • Oral retinoids (Isotretinoin - has SE: Depression, LFT disorder, dry skin, teratogen)
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40
Q

Types of skin cancer

A

Melonoma (10%)

Non-melanoma (90%)
- BCC (70%) tumour of hair follicle, METs rare, low recurrence)

-SCC (20%) keratinocyte, METs common an 20% recurrence
Pre-malig = Actinic Keratosis, In-situ = Bowen’s

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41
Q

SCC Def

A

Locally invasive malignant tumour of epidermal keratinocytes and its appendages. Potential to metastasise.

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42
Q

SCC RF

A 
UV
Premalig lesions (AK, Bowen's)
Chronic inflam (leg ulcer)
Immunosuppression
Previous SCC
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43
Q

SCC Pres

A

Keratotic (scaly, crusty)
Ill-defined nodule
Ulceration, bleeding

Invasive disease: Lymphadenopathy, Neural (e.g. CNVII) invasion symptoms

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44
Q

SCC spread

A

Quick growing, Local mets/spread to Local LN

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45
Q

SCC investigations

A

Biopsy

  • Keratonicyte atypia
  • For invasive = penetrate to dermis

CT/MRI

  • For mets
  • Regional LNs , lung, liver, brain, bone
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46
Q

SCC Tx

  • In situ
  • Invasive
  • Mets
  • Follow up
A

Topical chemo (Efudix - 5FU)

Wide local excision (4mm) or Mohs (ill defined/recurrent)

Excision + radiotherapy

3-6 month follow up, sun avoidance

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47
Q

BCC

  • Other name
  • Def
  • RF
A

Rodent ulcer

slow growing, locally invasive malignant tumour arising from hair follicle

UV exposure, sunburn as child, Type 1 skin, White, age

48
Q

Typical appearance BCC

  • Nodular
  • Superficial
  • Morphoeic
A

Head & neck. small nodule, surface telangiectasia, pearly rolled eye, ulcerated centre

Trunk/shoulder, erythematous plaque

Resembles melanoma, more aggressive, poorly defined borders (Mohs surgery)

49
Q

Investigtion BCC

A

Excisions biopsy

50
Q

Treatment BCC

A

surgical excision and histology

higher risk (morphoeic) get Mohs

Radiotherapy sometimes given

Low risk = Efudix

51
Q

Describing a pigmented lesion

A

ABCDE

Asymmetry
Border
Colour
Diameter
EVOLUTION
52
Q

Malignant melanoma, why important?

A

Melanoma is the most common cause of death from skin cancer. Metastasis can occur early

53
Q

Malignant melanoma definition

A

Invasive malignant tumour of epidermal melanocytes (in basal layer)

54
Q

Non-cancerous melanocytes growth

A

Naevi (mole)

55
Q

Malignant melanoma RFs

A

Excess UV, type I skin (burns), atypical moles, FH, immunosuppression

56
Q

Types of Malignant melanoma

A 
Superficial spreading (70%) 
- grow lateral before going deep

Nodular (20%)
- Aggressive, rapidly growing

Lentigo maligna

Acral - palms, soles, nails. not related to UV

57
Q

Malignant melanoma investigations

A

Dermatoscope (ABCDE)

Biopsy: abnormal melanocytes proliferation in epidermis/dermis (invasive if in dermis)

Assess mets: sentinel LN biopsy, CXR & Liver USS, CT chest/abdo/pelvis

58
Q

Breslow’s thickness

A

Depth of invasion, determines margin of excision

1) thin: 1mm = 1cm margin
2) Intemediate: 1-4mm = 2cm margin
3) Thick: over 4mm 2-3cm margin

59
Q

Malignant melanoma Treatment

A

Wide local excision and SLN biopsy if intermediate/thick

Im mets: Lymphadenectomy, radio, chemo (pembrolizumab - anti programmed death receptor

60
Q

Impetigo:

  • Who
  • Appearance
  • When
  • Organism
  • Tx
A

Highly contagious, common in children

Goldencrust/vesicles/bullae (in bullous impetigo)

Post trauma / skin breaks e.g. eczema

Staph aureus

Abx:

  • Topical fusidic acid (narrow spect abx against Staph aureus)
  • Oral Fluclox
61
Q

Herpes simplex

  • types
  • Tx
A

Type 1 = oral herpes

Type 2 = Genital herpes

Aciclovir oral ± topical

62
Q

Cellulitis

  • Def
  • RF
  • Organism
A

Spreading of bacterial infection in deep sub cut layers with overlying skin inflammation (erythema, oedema, warm, tender)

Immunosuppression, wounds, ulcers, poor hygiene, poor vascularisation (e.g. DM)

Staph aureus, Strep pyogenes/other strep

63
Q

Ddx cellulitis

A 
Thrombophlebitis
DVT
Gout
Necrotising fasciitis
Abscess
64
Q

Cellulitis investigations

A

FBC (raised WCC), Blood culture, culture purulent foci (s.aureus), If orbital cellulitis CT/MRI to check abscess)

65
Q

Complications in cellulitis

A

Local tissue damage
Sepsis
Orbital cellulitis: blindness, abscess formation - intracranial

66
Q

Abx for cellulitis

A

General:
-Flucloxacillin (oral)

Severe:
- MRSA cover: vancomycin/tazocin

Orbital:

  • 3rd gen cephalosporin + MRSA cover
  • IV Ceftriaxone +Vancomycin

Bite related:
- IV co-amoxiclav (Pasteurella cover)

67
Q

Scalded skin syndrome

A

Condition seen in children due to epidermolytic endotoxin from Staph aureus

Develops over hours

worse in face, neck, axilla, groin

painful blistering lesions, fever

68
Q

Scalded skin syndrome Tx

A

Analgesia
Antibiotics (IV the oral fluclox) fluids (beware dehydration)

Recover 5-7 days

69
Q

Fungal infections

A

Common and mild

Usually superficial and itchy

70
Q

Tinea capitis

A

Scalp ringworm: Patches broken hair, scaling and inflammation

71
Q

Dermal candida

A

White plaques on mucosal areas (mouth, genitalia), erythema with satellite lesions in flexures

Itchy

72
Q

Management of fungal infections

  • Diagnosis
  • Treatment
A

Skin scraping, swabs, hair/nail clipping

Topical anti fungal (terbinafine cream)

Oral (itraconazole, fluconazole)

73
Q

Verrucae cause mimics Tx

A

HPV6-11

SCC
Cryotherapy, silver nitrate, debridement

74
Q

Scabies

- Cause, transmission, where seen

A

Infection with mites, transmission via skin to skin contact. Often seen in overcrowded living conditions

75
Q

Scabies

  • Pres
  • Diagnosis
A

Pruritus, erythematous papules, linear burrows in interdigital web space

Microscopic visualisation of mites, eggs in skin scraping

76
Q

Scabies

- Tx protocol

A 
Treat the whole family + wash clothes >60 degrees
Topical permethrin (5%) + antihistamines: apply from neck down and wash after 8 hours
77
Q

Ulcers

  • Def
  • Cause
A

Break in epithelial surface

Venous 80%
Arterial 20%

78
Q

Venous ulcers pathophys

A

Venous insufficiency

Incompetent valves in veins of lower leg

Blood is squeezed into superficial veins rather than to heart = dilation (varicosities) and raised pressure

Raised pressure causes oedema and poor oxygenation of surrounding skin

Ulceration

79
Q

Signs of venous insufficiency

A

Ankle swelling, hyperpigmentation (haemosiderin), heavy legs, dry/scaly skin, telangiectasias, varicose veins, itching

80
Q

Venous ulcers RF

A

Age, family history, smoking, DVT, orthostatic occupation (sitting)

81
Q

Venous ulcers site and appearance

A

Medial/Lateral malleolus

Between knee and ankle

Large, shallow, painless, irregular boded, moist granulating base

82
Q

Venous ulcers investigations

A

ABPI using doppler for pulses (exclude arterial)

Swabs & microbiology

Biopsy if fail to heal in 12 weeks

83
Q

Venous ulcers Treatment

A

Graduated compression (max pressure at ankle, decreases going up)

Debride/Clean

Dression: hydrocolloid

Abx if cellulitis

84
Q

Arterial ulcers

  • Cause
  • Pres
  • site
  • Appearance
A

Atherosclerosis/tissue hypoxia

CV RFs (smoking, DM), absent pulses, 6Ps (pale, pulseless, perishingly cold, paresthesia, pain, paralysis)

More distal: dorm of foot/toes

Painful, great/granulating base, no bleeding on decried, punched out, cold/shiny/hairless skin surrounding

85
Q

Arterial ulcers investigation and treatment

A

ABPI: BP cuff on lower calf, doppler probe dorsals pedis
- less than 0.0 = peripheral arterial disease

Vasc surgery and analgesia may be needed
DO NOT USE COMPRESSION!

86
Q

Neuropathic ulcers:

  • Who
  • Site
  • Appearance
  • Tx
A

Diabetics (commonest)

Under callouses, over pressure points (plantar aspect 1st - 5th metatarsaophalangeal joint)

Punched out, deep sinus, brisk to bleed, painless, necrotic base

Diabetic foot management

87
Q

Urticaria

  • Pathophys & Pres
  • Tx
A

Histamine (from skin mast cells - antigen IgE cross link) and other cytokine (PG, Leukotrienes) = inc permeability of Blood vessels
Exposure to allergen/toxin

Itchy Wheals (swelling and erythema)

swelling of superficial dermisfor 30m-24hr)

Antihistamines

88
Q

Angioedema

  • Pres
  • Description
  • Complications
A

Swelling of tongue, eyelids, lips

Dermis/subcut swelling. Lasts up to 24 hrs

Asphyxia (due to suffocation), cardiac arrest, death

89
Q

Anaphylaxis triad of presentation

A

1) Bronchospasm (stridor = severe)
2) Facial, Laryngeal swelling
3) Hypotension

90
Q

Anaphylaxis common causes

A

Food
Nuts, sesame seeds, shellfish, dairy

Drugs
Mainly penicillin
Contrast media, NSAIDs, morphine, ACE-I

Contact
Latex

Bites
Insect

Autoimmune

91
Q

Anaphylaxis acute management

A

IM adrenaline 500 micrograms (0.5ml 1 in 1000 - mid anterolateral thigh)
Airway protection
IV antihistamines (chlorphenamine/dipenhydramine = 2nd generation)
IV corticosteroids (hydrocortisone)
Trigger identification + avoidance

92
Q

Erythema nodosum

  • What is it
  • Causes
  • Tx
A

Erythematous lumps on shins from inflammation of subcut fat

Inflam bowel (UC/CD)
TB
Strep throat
Sarcoidosis (Seen with mediastinal LNs)

Treat cause, if pyoderma gangrenous = prednisolone

93
Q

Stevens-Johnson syndrome

Vs

Toxic epidermal necrolysis

A

Mucocutaneous necrosis covering less than 10%. 5% mortality

TEN is over 30%. has a 25% mortality

Both involve at least two mucosal sites and occur following Anticovulsants, ABx, NSAIDs

94
Q

Stevens-Johnson syndrome and toxic epidermal necrolysis

Pathophys
Diagnosis

A

Detachement of epidermis from dermis

Skin biopsy and histopathology (necrosis and inflammatory cells)

95
Q

Stevens-Johnson syndrome and toxic epidermal necrolysis

Tx

A

Call for helpQ

Withdraw causative agent
Dressing, topical antibacterial and emollients

IV fluids

Analgesia

96
Q

Stevens-Johnson syndrome and toxic epidermal necrolysis

Complications

A

Dehydration, infection and sepsis, multi-organ failure

97
Q

Necrotising fasciitis

  • Definition
  • Organism commonly
  • RF
  • Presentation
A

infection of deep fascia - rapidly spreading

Group A strep (pyogenes)

Abdo surgery, DM, Malig
50% in healthy individuals

SEVERE PAIN, erythematous necrotic skin, systemically unwell (fever, tachycardia), subcutaneous emphysema

98
Q

Necrotising fasciitis management

A

Rapid surgical debridement and haemodynamic support

Empirical broad spectrum ABx
- Vancomycin and Tazocin

99
Q

Rosacea

  • What is it
  • Tx
A

Skin flushing and erythema

Topical antibiotic/anti-inflam ± oral Abx

Metronidazole topical
Doxy oral

100
Q

Seborrhoeic keratosis

  • Visual desc
  • Cause
  • Tx
A

Common benign skin lesions (look stuck on) due to UV sun damage

Tx: steroids if itchy, Cryotherapy if flat

101
Q

Lichen Planes

A
  • inflammatory disease with itchy affecting skin + genitals

Tx: topical corticosteroids

102
Q

Systemic causes of pruritus

A

Renal: chronic renal failure (urea mediated)

Cholestatic (Bile salt mediated)

Haematological (Polycythemia vera)

Endocrine (Hypothyroid, DM)

Malignant: Hodgkin lymphoma (Bradykinin), Carcinoid (serotonin)

103
Q

Vasulitic skin changes
- Small vessels

  • Medium vessels
A

Purpura, petechiae, ulcers

Nodules, Livedo reticularis (lace/purple discolourations on skin)

104
Q

Alopecia areata

  • Cause
  • Pres
  • Tx
  • Prog
A

Autoimmune (t-cell) target hair follicles

Patchy hair loss, exclamation mark hairs

Topical corticosteroid and cosmetic camouflage

Relapses occur. spontaneous regrowth in 2 years

105
Q

Androgen alopecia

A

Male pattern baldness

Androgen mediated follicular miniaturisation (seen in women with PCOS and onset of menopause, TFT as can be seen in hypothyroid)

106
Q

Dermatitis herpetiformis

  • Assoc with
  • Pathophys
  • Pres
  • Tx
A

Coeliac disease

IgA deposits in the dermis

Itchy vesicular rash on extensors and buttocks

Low gluten diet

107
Q

Severe, widespread rash including mucosa assoc with recent infection …

A

Stevens-Johnson syndrome

108
Q

Acanthosis Nigricans Causes

A

Diabetes mellitus

Gastric adenocarcinoma

109
Q

Red ulcerating lump associated with IBD

A

Pyoderma gangrenosum

110
Q

One trunk patch and then several round erythematous scaly patches follow

A

Pityriasis Rosea

111
Q

Vitiligo assoc diseases

A

Autoimmune
(Tx with topical steroids- reverse if early, sunblock, camouflage, tacrolimus)
Also get koebner phenomenon here

112
Q

What heart medication can worsen psoriasis

A

Beta blockers

113
Q

Premalignant sun damage

A

Actinic Keratosis

114
Q

4 D’s of Pellagra (Caused by Vit B3 def e.g. due to Isoniazid)

A

Diarrhoea
Dermatitis
Dementia
Death

115
Q

White patches in a smoker

A

Leukoplakia

Risk of malignant transformation

Final (26 decks)

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