Dermatology Flashcards
1
Q
What are the 5 layers of the epidermis?
A
from top: Stratum corneum, Stratum lucidum, Stratum Granulosum, Stratum spinosum, Stratum basale
2
Q
What is the name of the area under the nail plate?
A
Hyponychium
3
Q
What are the 3 stages of the hair cycle?
A
Anagen, catagen, telogen
4
Q
What happens in the anagen stage of the hair cycle?
A
Growing, it is the active growing phase
5
Q
What happens in the catagen stage of the hair cycle?
A
2-3week phase of growth stops and follicle shrinks
6
Q
What happens in the telogen stage of the hair cycle?
A
Resting phase for 1-4 months
7
Q
Ehat are the main functions of skin?
A
Thermoregulation, skin immune system, barrier, sensation, vitamin D synthesis, interpersonal communication
8
Q
What are the main external causes of skin disease?
A
Temperature, UV, chemical (allergen or irritant), infection, trauma
9
Q
What are the main internal causes of skin disease?
A
Systemic disease, genetics, drugs, infection
10
Q
What is dermatitis artefacta?
A
Self induced injuries without ownership
11
Q
An example of an internal autoimmune skin disease?
A
Bullous pemphigoid
12
Q
What is the name of a small circumscribed area skin lesion
A
Macule
13
Q
What is the name of a large circumscribed area skin lesion
A
Patch
14
Q
What is the name of a small raised area skin lesion
A
Papule
15
Q
What is the name of a large raised area skin lesion
A
Plaque
16
Q
What is the name of a small fluid filled area skin lesion
A
Vesicles
17
Q
What is the name of a large fluid filled area skin lesion
A
Bulla
18
Q
What is the name of a small pus filled area skin lesion
A
Pustule
19
Q
What is the name of a large pus filled area skin lesion
A
Abscess
20
Q
What is the name of a skin lesion which has loss of epidermis?
A
Erosion
21
Q
What is the name of a skin lesion which has loss of epidermis and dermis?
A
Ulcer
22
Q
When would you see eruptive xanthoma?
A
In a patient with hyperlipidaemia as is deposits of lipids in the skin
23
Q
When would you see acanthosis nigricans?
A
Someone with insulin resistance, obesity, malignancy in flexural areas
24
Q
What does acanthosis nigricans look like?
A
Hyperkeratosis and hyperpigmentation, papules and a velvety appearance
25
What investigation would you use if a bacterial infection is suspected?
Charcoal swab, with MC&S- microscopy, culture, sensitivities
26
What investigation would you use if a virial infection is suspected?
Viral swab for PCR
27
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28
What is Psoriasis?
Chronic, genetically determined, immune-mediated, inflammatory skin condition, usually characterised by typical well defined, scaly, plaques
29
What causes Psoriasis?
Overactivity of the immune system
There is excesssive production of TH1 cytokines including TNF-alpha, this causes vascular proliferation (erythema) nd increased cell turnover (plaques and scaling)
30
What can cause Psoriasis?
Genetics, environment, infection (strep, candida), drugs (lithium, b-blockers, NSAIDs, steroid withdrawal), trauma, sunlight, stress, alcohol, smoking
31
What is happening at a histological view in Psoriasis?
Hyperkeratosis (thickening of stratum corneum)
Parakeratosis (keratinocytes with nuclei in stratum corneum)
Neutrophils in stratum corneum
Hypogranulosis (no granular layer)
Psoriasiform hyperplasia: Acanthosis (thickening of squamous cell layer) with elongated rete ridges
Dilated dermal capillaries
Perivascular lymphohistiocytic infiltrate
T cell infiltration
32
What are the 8 subtypes of Psoriasis?
Chronic plaque, guttate, scalp, nail, palmo-plantar, flexural/ inverse, pustular, erythrodermic
33
What is a common cause of guttate Psoriasis?
Post-viral
34
How do you treat guttate Psoriasis?
Normally self-limiting, responds well to phototherapy
35
What features can be seen in nail psoriasis?
Pitting, onycholysis
36
What is special about flexural/ inverse psoriasis?
It lacks scales
37
What is another name for erythrodermic Psoriasis?
“Red man” syndrome
38
What percentage of the body is involved in erythrodermic psoriasis?
>90% of the body surface area
39
What are common differential diagnosises for psoriasis?
Seborrhoeic dermatitis, lichen planus, mycosis fungoides
40
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41
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Spreadsheet
42
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43
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44
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45
Definition of atopic eczema?
```
An itchy skin condition in the last 12 months plus 3 of the following:
Onset before 2,
History of flexural involvement,
History of general dry skin,
History of other atopic disease
```
46
Which gene plays a key role in eczema?
Filaggrin gene
47
4 pathogensis of eczema?
Genetics, epidermal barrier dysfunction, environmental factros, immune system dust evils toon
48
What 3 things would a skin biopsy show of eczema?
Spongiosis (intercellular oedema), acanthodians (thickening of epidermis), inflammation
49
What the of reaction is allergic contact dermatitis?q
Type 4 hypersensitivity
50
What cells are involved in an allergic contact dermatitis reactions?
T cells
51
On second exposure to a hapten in allergic contact dermatitis what happens in the body?
The T cells cause mast cell degranulation, vasodilation and neutrophils
52
Name the different types of eczema?
Allergic contact dermatitis, irritant contact dermatitis, seborrhoeic dermatitis, discoid eczema, pompholyx/ vesicular eczema, asteatotic eczema, venous eczema, eczema herpeticum
53
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54
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55
What are some predisposing factors for impetigo?
Warm temp, high humidity, poor hygiene, skin trauma
56
What bacteria causes impetigo?
Staphylococcus aureus,
| Sometime streptococcus pyogenes
57
What is the development of impetigo?
Begins as a macule, then becomes a vesicule, pustule, erosion with a yellow crust
58
What is folliculitis?
Infection of the hair follicle
59
What bacteria is a common cause of folliculitis?
Staph aureus
60
What is the treatment of impetigo?
Local wound care, topical antibiotics
61
What are predisposing factors of folliculitis?
Occlusion, maceration and hyper hydration, shaving or waxing, topical corticosteroids and diabetes
62
Where are common sites of folliculitis?
Face, chest, back, axillae or buttocks
63
Treatment of folliculitis?
Antibacterial washes, antibacterial ointments
64
What is erysipelas?
An superficial infection of the dermis with lymphatic involvement, most commonly caused by group A streptococci
65
Symptom of erysipelas?
Erythema with well defined margins, the affected skin feels hot, tense and indurated
Most commonly affects the face and lower extremities
66
treatment for erysipelas?
10-14 day course of penicillin
67
What is cellulitis?
Infection of the deep dermis and subcutaneous tissue caused most commonly by strep pyogenes and staph aureus
68
What are the predisposing factors for cellulitis?
Lymphedema, alcoholism, DM, IV drug abuse and peripheral vascular disease
69
Symptoms of cellulitis?
Rubor, calor, dolor, tumor (erythema, warmth, pain, swelling)
The lesion will have ill-defined, non-palpable borders.
In children the head and neck and affected and extremities in adults
70
How is cellulitis treated?
Antibiotics
71
What is syphilis?
STI caused by bacteria treponema pallidum, has episodes of active disease and is then followed by latent periods
72
How does primary syphilis appear?
Painless ulcer where the infection entered (gentians, anus, mouth), this is known as a chancre
73
What is a chancre?
A single small firm red painless papule that quickly ulcerates, appears in primary syphilis
74
What is the sign of secondary symphilis?
Widespread rash that appears 3weeks-months after primary syphilis, the rash doesn’t;t itch and commonly Preston’s of the trunk and palms and soles
75
What is tertiary syphilis?
Solitary granulomatous lesions (gummas) may be found on the skin, mouth and throat or in bones
Can affect brain, spinal cord, heart, liver, eyes
76
Investigations for syphilis?
Serological tests turn positive about 5-6 weeks after infection
Use Non-specific non-treponemal tests (VDRL) or Specfic anti-treponemal antibody tests (TTPA)
77
How is sypholis treated?
Penicillin by injection
78
What is the herpes simples virus
Orolabial and genital infection
79
How does herpes simples virus present?
Sore areas with erythematous base with vesicles followed by pustules and ulcerations
80
What virus causes chickenpox?
Varicella-zoster virus
81
How does chicken pox develop?
Red macules- vesicules- pustules-crusts
82
What is shingles?
Localised, blistering and painful rash caused by reactivation of varicella-zoster virus, it is characterised by dermatomal distribution
83
What are complications of shingles?
Infection, post-herpetic neuralgia
84
What is treatment of shingles?
Area clean to prevent infection, pain relief and rest
85
What virus causes viral warts?
Human papillomavirus
86
How do viral warts present?
Hyperkeratotic papules, thick hyperkeratotic plaques
87
Treatment of viral warts?
Salicylic acid, cryotherapy
88
When should you refer someone with viral warts?
When diagnosic uncertainty exists, eg if patients are immunocompromised or warts are large or extensive
89
What os molluscum contagiosum?
Common viral skin infection caused by a pox virus, mainly affects children under 10, it is more common in warm climates and in obvercrowding
90
What do molluscum contagiosum lesions look like?
Lesions are firm, umbilicated perly papules with waxy surface, most common in skin folds and genital region
91
What is the treatment for molluscum contagiosum?
Curettage, liquid nitrogen, chemovesicants
92
What is dermatophytoses?
```
Usually affects postpuberal hosts, normally has refer edges, different types:
Tinea corporis ringworm,
Tinea crusis, ringworm of groin,
Tinea capitis, ringworm of scalp,
Tinea pedis, ringworm of foot,
Tinea unguium, rigneworm of nail
```
93
What are predisposing factors of mucocutaneous candida infections?
DM, occlusion, hyperidrosis, broad spectrum antibiotics, immunosuppresion
94
What causes mucocutaenous canfdida infections?
Candida albicans
95
What does mucoocutaneous candida infection look like?
Erythematous patches that are often accompanied by satellites pustules, if affects intertriginous zones and diaper areas
96
Treatment for mucocutaenous candida infections?
Remove predisposing factors, topical antifungals, oral antifungals
97
What is pityriasis versicolor?
Multiple oval to round patches with mild scale, caused by the malassezia, increased chance in high temperatures and humidity, oily skin and in excessive sweating
98
Treatment for pityriasis versicolor?
Topical antimycotic (shampoos, creams)
99
What causes scabies?
Sarcoptes scabiei
100
How can you diagnose scabies?
Very itchy,
| Use skin scraping, visualise burrows
101
What do scabies burrows appear as?
0.5-1.5cm grey irregular tracts in the web spaces between the fingers, on the palms and wrists
Appears on the trunk and limbs
102
Treatment for scabies?
Antiscabietic topical treatment in the patient and close contacts, repeat after 1 week
103
Treatment for head lice?
2 applications of insecticide and/or physical methods
104
Describe a Seborrhoeic ketatoses?
Benign lesion, warty growths that look stuck on, patients often have multiple +/- cherry agiomas
105
Treatment of seborrhoeic keratoses?
Only treated if troublesome, with cryotherapy and curettage
106
What is Leser-Trelat?
Abrupt onset of widespread seborrhoeic keratosis, could indicate an underlying solid malignancy eg GI adenocarcinoma
107
What are cysts?
Encapsulated lesion containing fluid or semi-fluid material, they are usually firm and fluctuant
108
Wha are the different types of cysts?
```
Epidermoid cyst,
Pilar cyst (hair follicle),
Steatocystoma,
Dermoid cyst,
Hidrocystoma,
Ganglion cyst
```
109
How would you treat a cyst?
With excision,
| If inflamed: antibiotics, intralesional steroid and incision and drainage
110
What are dermatofibromas?
Benign fibrous nodules often found on limbs,
They are a fun nodule, tethered to skin but mobile over fat, dimple sign positive
Pale pink/brown colour
111
What is a lipoma?
Benign tumour consisting of fat cells, looks like a smooth and rubbery subcutaneous mass
112
What is the risk of a lipoma if tender?
Could be angiolipoma or liposarcoma
113
What is an angioma?
Overgrowth of blood vessels in the skin due to proliferating endothelial cells
114
What are the types of angiomas?
Cherry angiomas, spider naevi, venous lakes
115
What is a pyogenic granuloma?
Rapidly enlarging red/raw growth, often at site of trauma,
| Common on head and hands
116
Treatment of pyogenic granuloma?
Curettage and cautery
117
Name some pre-malignant lesions
Actinic keratoses,
Bowen’s disease,
Melanoma in situ
118
What is actinic keratoses?
Rough scaly patches on sun damaged skin, has a low risk of transformation to SCC
119
Treatment of actinic keratoses?
Cryotherapy, curettage, diclofenac gel, imiquimod
120
What is Bowen’s disease
Squamous cell carcinoma in situ- characterised by full thickness dysplasia, contained within the epidermis, looks like an irregular, scaly, erythematous plaque
121
Treatment of Bowens
Cryotherapy, curettage, photodynamic therapy, imiquimod
122
What is photo-dynamic therapy?
Photochemical reaction to selectively destroy cancer cells.
Topical photsensitising agent is applied, this concentrates in the cancerous cells and red light is applied, creating the photodynamic reaction to occur
123
What is imiquimod?
Aldara cream
| Is an immune response modifier, it stimulates cytokines release causing inflammation and destruction of the lesion
124
Risk factors of non-melanoma skin cancer?
```
UV radiation,
Photochemotherapy- PUVA,
Chemical carcinogens,
X-ray and thermal radiation,
Human papilloma virus,
Familial cancer syndromes,
Immunosuppresion
```
125
Types of basal cell carcinoma?
Modular, superficial, pigmented, morphoeic
126
How do nodular basal cell carcinomas look?
Pearly rolled edge, telangiectasia, central ulcearation, arborising vessels on dermoscopy
127
Treatment of basal cell carcinoma?
Excision- ellipse with rim of unaffected skin,
| Sometimes curettage
128
Indications for MOHs surgery for basal cell carcinoma?
```
Site,
Size,
Subtype,
Poor clinical margin definition,
Recurrent,
Perineural or perivascular involvement
```
129
Indications for vismodegib use in basal cell carcinoma?
Locally advanced BCC that isn’t suitable for surgery or radiotherapy,
Metastatic BCC
130
What is vismodegib?
Selectively inhibits abnormal signalling in the hedgehog pathway, which is a molecular driver in BCC,
Can shrink BCC
131
Side effects of Vismodegib?
Hair loss, weight loss, altered taste, muscle spasms, nausea, fatigue
132
Describe squamous cell carcinoma?
Derived from keratinising squamous cells, usually on sun exposed sites, is a fast growing, tender, scaly/crusted of fleshy growth and can ulcerated
133
Treatment of SCC?
Excision +/- radiotherapy
134
What would class SCC as high risk and need a follow up after treatment?
```
Immunosuppressed,
>20mm diameter,
>4mm depth,
Ear, nose, lip, eyelid where the SCC locations,
Perineural invasion,
Poorly differentiated
```
135
What is keratoacanthoma?
A variant of squamous cell carcinoma, it erupts from hair follicles in sun damaged skin
136
Treatment of keratoacanthoma?
Surgical excision
137
Risk factors of melanoma skin cancer?
UV radiation,
Genetic susceptibility- fair skin, red hair, blue eye and tendency to burn easily,
Familial melanoma and melanoma susceptibility genes
138
What is the ABCDE rule for melanoma skin cancers?
```
Asymmetry,
Border,
Colour,
Diameter,
Evolution
```
139
7 point checklist for melanoma skin cancer?
Change in size,
Change in shape,
Change in colour
(Major features)
```
Diameter more than 5mm,
Inflammation,
Oozing or bleeding,
Mild itch or altered sensation
(Mini features)
```
140
What is the biological progression of melanoma?
```
Benign nevus,
Dysplastic nevus,
Radial-growth phase,
Vertical growth phase,
Metastatic melanoma
```
141
Name the different types of melanoma
Superficial spreading malignant melanoma,
Lentigo maligna melanoma,
Nodular melanoma,
Acral lentiginous melanoma/ subungal melanoma,
Ocular melanoma
142
What is superficial spreading malignant melanoma?
Most commonest melanoma, about 10mm
143
What is lentigo maligna melanoma?
Melanoma evolved from lentigo maligna, commonly found on chronically sun damaged skin ,
Greater than 20mm
144
What is nodular melanoma?
Most aggressive melanoma, tends to grow in thickness more than diameter, but can be 1cm
145
What is acral lentigninous melanoma/ subungal melanoma?
Melanoma that appears on palms of hands/ soles of feet/ under nails
146
What is ocular melanoma?
Melanoma of the eye
147
Treatment of melanoma?
Urgent surgical excision (depends on subtype and Breslow thickness),
Wide local excision,
Sentinel lymph node biopsy,
Chemotherapy/ immunotherapy
148
Treatment of metastasis melanoma?
Ipilimumab,
Pembrolizumab,
Vemurafenib and dabrafenib
149
How does ipilimimab work against metastatic melanoma?
It inhibits CTLA-4 molecules
150
How does pembrolizumab work against metastatic melanoma?
Blocks activity of PD-1
151
How does vemurafenib and dabrafenib work against metastatic melanoma?
Blocks B-RAF protein
152
Types of cutaneous lymphoma
Secondary cutaneous disease from systemic/nodal involvement,
Primary cutaneous disease (abnormal neoplastic proliferation of lymphocytes in the skin):
Cutaneous T cell lymphoma,
Cutaneous B cell lymphoma
153
Types of cutaneous T cell lymphoma?
Mycosis fungoides,
| Sezary syndrome
154
Types of cutaneous B cell lymphoma?
Cutaneous folllicle centre lymphoma,
Cutaneous marginal zone lymphoma,
Cutaneous diffuse large B cell lymphoma
155
Stages of mycosis fungoides?
Patch (flat, red dry, oval lesions),
Plaque,
Tumour (large irregular lumps, can ulcerate),
Metastatic (infiltration of neoplastic cells in lymph nodes, blood and solid organs)
156
What is Sezary Syndrome?
“Red man syndrome”
A Cutanteous T cell lymphoma which causes skin thickened, scaly, red and itchy skin.
There is lymph node involvement and sezary cells in peripheral blood
157
What are sezary cells?
Atypical T cells, found in Sezary syndrome
158
Treatment of cutaneous lymphoma?
```
Topical steroids,
PUVA or UVB,
Localised radiotherapy,
Interferon,
Bexarotene,
Low dose methotrexate,
Chemotherapy,
Total skin electron beam therapy,
Extracorporeal photophoresis,
Bone marrow transplant
```
159
What is total skin electron beam therapy?
A type of radiotherapy consisting of very small electrically charged particles
160
What is extracorporeal photophoresis?
Step 1: patients blood is drawn and leucocytes collected
Step 2: collected white cells mixed with psoralen which makes the T-cells sensitive to UVA radiation
Step 3: exposed to UVA radiation, damaging diseased cells
Step 4: treated cells re-infused back to patient
161
Common causes of cutaneous metastasises?
Breast, colon, lung
162
Management of cutaneous metastases?
Treat underlying malignancy, local excision, localised radiotherapy, symptomatic
