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Y3 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is basal cell carcinoma?

A

Skin neoplasm

AKA rodent ulcer

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2
Q

Summarise the epidemiology of basal cell carcinoma

A 
Commonest form of skin malignancy
Common in those with fair skin
Common in areas of high sunlight exposure
Common in elderly
Rare before age of 40
Lifetime risk in Caucasians = 1 in 3
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3
Q

Explain the aetiology of basal cell carcinoma

A

Prolonged sun exposure/UV radiation

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4
Q

What are the risk factors for basal cell carcinoma?

A 
Prolonged sun exposure/UV radiation
Fair skin
Gorlin's syndrome - hedgehog IC signalling cascade
Arsenic - contaminated well water
Xeroderma pigmentosum
Transplant patients
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5
Q

What are the presenting symptoms of basal cell carcinoma?

A

A chronic slowly progressive skin lesion

Usually on face, scalp, ears, trunk

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6
Q

What are the signs O/E of basal cell carcinoma?

A

Nodulo-ulcerative (most common):
Small gistening translucent skin over coloured papule, visible telangectasia, raised pearly edges

Morphoeic: yellow/white waxy plaque w ill-defined edge, more aggressive

Superficial: multiple pink/brown scaly plaques w fine edge on trunk

Pigmented:
Specks of brown/black pigment may be present in any BCC

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7
Q

How is basal cell carcinoma investigated?

A

Biopsy rarely necessary

Diagnosis mainly on clinical suspicion

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8
Q

What is erythema multiforme?

A

An acute hypersensitivity reaction of the skin and mucous membranes

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9
Q

Summarise the epidemiology of erythema multiforme

A

Any age group
Mainly in children and young adults
Twice as common in males

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10
Q

Explain the aetiology of erythema multiforme

A

Degeneration of basal epidermal cells
Development of vesicles between cells in basement membrane
Lymphocytic infiltrate around BVs and at dermo-epidermal junction

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11
Q

What are the presenting symptoms of erythema multiforme?

A

Non-specific prodromal symptoms of URTI
Sudden appearance of itching/burning/painful skin lesions
Skin lesions may fade leaving pigmentation

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12
Q

What are the signs O/E of erythema multiforme?

A

Classic target (bull’s eye) lesions w rim of erythema surrounding paler area
Vesicles/bullae
Urticarial plaques
Lesions often symmetrical and distributed over arms and legs, including palms, soles, and extensor surfaces

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13
Q

What are the risk factors for erythema multiforme?

A

Prior occurrence
Herpes simplex virus infection
Mycoplasma pneumonia

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14
Q

How is erythema multiforme investigated?

A
  1. Bloods
    FBC - abnormal WCC
    U+Es - elevated urea, nitrogen/creatinine due to volume depletion
  2. HSV serology
    +ve for HSV-1 or 2 IgM if HSV infection
  3. Rapid PCR
    +ve for varicella DNA
  4. Cold-haemagglutination serology
    +ve if M pneumoniae infection
  5. CXR:
    bronchial thickening
    interstitial infiltration
    Subsegmetnal atelectasis of lower lobe
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15
Q

What is erythema nodosum?

A

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

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16
Q

Summarise the epidemiology of erythema nodosum

A

Usually affects young adults

3x more common in females

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17
Q

Explain the aetiology of erythema nodosum

A

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

Commonly SARCOIDOSIS, drugs (sulphonamides, OCP, dapsone, penicillin) + streptococcal infection

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18
Q

How does erythema nodosum present?

A 
Tender red/violet nodules on both shins
Sarcoidosis - uveitis, red eyes, retinal nodules, candle-wax drippings
Joint pain
Fever
Signs of underlying cause
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19
Q

How is erythema nodosum investigated?

A

Determine underlying cause

  1. FBC - raised WCC
  2. Anti-streptolysin-O titre - raised in Strep infection
  3. ESR - raised
  4. CXR - bilateral hilar adenopathy in sarcoidosis, unilateral in TB, histoplasmosis etc
  5. PPD skin testing - +ve in TB
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20
Q

What are the risk factors for erythema nodosum?

A 
Streptococcal infection
Sarcoidosis
Tuberculosis
Coccidiodomycosis
Histoplasmosis
Blastmycosis
Behcet's disease
OCPs
Leprosy
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21
Q

What is a lipoma?

A

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

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22
Q

Summarise the epidemiology of lipomas?

A

Seen at any age
More common between 40-60 years
Relatively common

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23
Q

Explain the aetiology of lipomas

A

Benign tumours of adipocytes

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24
Q

What are the risk factors for lipomas?

A

Genetic predisposition - familial multiple lipomatosis, Gardner’s syndrome

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25
Q

How do lipomas present?

A 
Anywhere, often upper arms
<5cm
Lobulated
Non-tender, painless
Slowly enlarging
Soft, compressible, mobile
Do not fluctuate or transilluminate
Normal overlying skin
Local LN not palpable

Only painful on nerve compression/fat necrosis due to trauma

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26
Q

How is a lipoma investigated?

A

Clinical diagnosis usually

US/MRI/CT used if in doubt

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27
Q

What is molluscum contagiosum?

A

A common skin infection caused by a pox virus that affects children and adults

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28
Q

Summarise the epidemiology of molluscum contagiosum

A

Common

90% of patients < 15 years

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29
Q

Explain the aetiology of molluscum contagiosum

A

Viral skin infection caused by molluscum contagiosum virus (MCV)
Type of pox virus
Transmission by direct skin contact

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30
Q

What are the risk factors for molluscum contagiosum?

A

Close contact with infected individual - towels, sex, clothes
Kids
Immunodeficient - HIV
Swimming

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31
Q

What are the presenting symptoms of molluscum contagiosum?

A

Incubation period: 2-8 weeks
Usually asymptomatic
Tenderness, pruritus and eczema around lesion
Lesions last for around 8 months

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32
Q

What are the signs O/E of molluscum contagiosum?

A

Firm, smooth, umbilicated papules
2-5mm in diameter
Children - trunk, extremities
Adults - lower abdo, genital area, inner thighs (sexual contact)

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33
Q

How is molluscum contagiosum investigated?

A

Clinical diagnosis

Dermatoscopy if doubt

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34
Q

What are pressure sores?

A

Damage to the skin, usually over a bony prominence, as a result of pressure

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35
Q

Summarise the epidemiology of pressure sores

A

Very common in hospitals

Most commonly occurs in elderly

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36
Q

Explain the aetiology of pressure sores

A

Constant pressure limits blood flow to the skin leading to tissure damage

Occur as a result of pressure, friction and shear

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37
Q

What are the risk factors for pressure sores?

A

Immobility
Alzheimer’s disease
Diabetes

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38
Q

What are the presenting symptoms and signs of pressure sores?

A

Occur over bony prominence - sacrum, heel
Very tender
If infected - fever, erythema, foul smell

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39
Q

How are pressure sores investigated?

A

No investigations necessary

Clinical diagnosis

40
Q

What score is used to predict risk of pressure sores in patients?

A

Waterlow Score

41
Q

What is psoriasis?

A

Chronic inflammatory skin disease, which has characteristic lesions and may be complicated by arthritis

42
Q

Summarise the epidemiology of psoriasis

A

1-2% of population

Peak age of onset = 20 years

43
Q

Explain the aetiology of psoriasis

A

Unknown

Genetic, environmental factors and drugs implicated

44
Q

What are the risk factors for psoriasis?

A

Genes - IL23R, IL12B, TNF-a
Strep throat - guttate psoriasis
Flares - viral infection, immunisations
Local trauma - trauma/injection/scar (Koebner phenomenon)

45
Q

What are the presenting symptoms of psoriasis?

A

Itching and occasionally tender skin

Pinpoint bleeding with removing scales (Auspitz phenomenon)

46
Q

What are the signs O/E of psoriasis?

A

Discoid/nummular - symmetrical, well-demarcated erythematous plaques w silvery scales over extensor surfaces (knee, elbow, scalp, sacrum)

Flexural - less scaly plaques in axilla, groins, perianal and genital skin

Guttate - small, drop-like lesions on trunk and limbs

Palmoplantar - erythematous plaques w pustules on palms and soles

Generalised pustular - pustules over limbs and torso

Joint signs

47
Q

How is psoriasis investigated?

A

Most patients don’t need investigations

Guttate - anti-streptolysin-O titre, throat swab

Flexural - skin swabs to exclude candidiasis

Nail clipping analysis for onychomycosis (fungal infection)

Joint involvement analysed by checking for RF and radiographs

48
Q

What is urticaria?

A

Itchy, red, blotchy rash resulting from swelling of the superficial part of the skin

AKA hives

49
Q

Summarise the epidemiology of urticaria

A

15% get at some point

Acute > chronic

50
Q

Explain the aetiology of urticaria

A

Mast cell activation in the skin, resulting in histamine release

Cytokine release –> capillary leakage –> skin swelling and vasodilation –> erythematous appearance

51
Q

What are the possible triggers for urticaria?

A

Acute:

  • Allergies (foods, bites, stings)
  • Viral infections
  • Skin contact with chemicals
  • Physical stimuli

Chronic:

  • Chronic spontaneous urticaria - meds, stress, infections
  • Autoimmune
52
Q

What are the presenting symptoms of urticaria?

A

Central itchy white papule or plaque surrounded by erythematous flare

Lesions vary in size and shape

May be associated w swelling of soft tissues of eyelids, lips and tongue (angiooedema)

Individual lesions usually transient

53
Q

How do the timescales of acute and chronic urticaria differ?

A

Acute - symptoms develop quickly but normally resolve within 48h

Chronic - rash persists for > 6 weeks

54
Q

How is urticaria investigated?

A

Usually clinical

Tests may be required for chronic - FBC, ESR/CRP, patch testing, IgE tests

55
Q

What is eczema?

A

An inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course

56
Q

Summarise the epidemiology of eczema

A

All age groups
Most commonly diagnosed before 5 years of age
Childhood prevalence = 10-20%

57
Q

Explain the aetiology of eczema

A

Genes + environment

Defects in barrier function + immune dysregulation following allergen exposure

Common loss-of-function variants of epidermal barrier protein FILAGGRIN = major predisposing factor –> leads to lower levels of natural moisturising factor in stratum corneum

Skin also deficient in extra-cellular lipids including ceramides

Breaks in epidermal barrier allow increased exposure and sensitisation to antigens

58
Q

What are the presenting symptoms of eczema?

A 
Itchy, dry skin
Heat
Tenderness
Redness
Weeping
Crusting
59
Q

What are the signs O/E of eczema?

A 
Acute:
Poorly demarcated erythematous oedematous dry scaling plaques
Papules
Vesicles w exudation and crusting
Excoriation marks
Chronic:
Thickened epidermis
Skin lichenification
Fissures
Change in pigmentation
60
Q

Where does atopic eczema mainly affect?

A

Face and flexures

61
Q

What is sebhorrheic dermatitis?

A

Appears where there are lots of sebaceous glands - upper back, nose and scalp

Not a result of allergy (like other types of eczema)

Any age

Yellow greasy scales on erythematous plaques
Greasy, swollen skin

62
Q

Where is seborrhoeic dermatitis mainly affect?

A 
Eyebrows
Scalp
Presternal area
Upper back
Nose
63
Q

What are the risk factors for eczema?

A 
Age < 5
FHx
Allergic rhinitis
Asthma
Anthelmintic treatment in utero
64
Q

What is atopic dermatitis?

A

Type of eczema
Chronic and inflammatory
Exact cause unknown - happens when immune system goes into overdrive in response to exo/endogenous allergen
Usually begins in childhood (first 6 months)

Dry, scaly skin
Erythema
Itching
Cracks behind ears
Rash on cheeks, arms, and legs
Open, crusted or weepy sores
65
Q

What is contact dermatitis?

A

Happens when skin touches irritating substances or allergens
These make skin inflamed, causing it to burn, itch and become red
Usually on hands

Most common irritants: solvents, industrial chemicals, detergents, fumes, tobacco smoke, paints, bleach, wool, acidic foods, astringents, alcohol in skin products

Redness and rash
Burning or swelling
Blisters that weep or crust over

66
Q

What is dyshidrotic eczema?

A

A condition that produces small, itchy blisters on edges of the fingers, toes, palms and soles of the feet

Triggers = stress, allergies (hayfever), moist hands and feet, or exposure to nickel, cobalt, or chromium salts

2x in women

Small fluid-filled blisters (vesicles)
Itching
Redness
Flaking
Scaly, cracked skin
Pain
67
Q

What is discoid eczema?

A

AKA nummular

Common type of eczema that can occur at any age

Symptoms =
Round, coin-shaped spots
Itching
Dry, scaly skin
Wet, open sores

Triggers = insect bites, reactions to skin inflammation, dry skin in winter

68
Q

What is eczema herpeticum?

A

Rare but serious complication, which can happen when skin affected by eczema comes into contact with herpes virus

Most often caused by contact w cold sore (HSV-1)

Usually occurs on head, neck, or trunk

Rash that causes blisters
Malaise, swollen LNs, fever, chills, fatigue

Medical EMERGENCY

69
Q

How is eczema investigated?

A

Usually clinical diagnosis

Contact dermatitis - skin patch allergy testing

Atopic eczema - lab testing, eg elevated IgE levels

Skin biopsy - exclude mycosis fungoides

70
Q

What are epidermoid and pilar cysts?

A

Used to be known as sebaceous cysts

But contain KERATIN, not sebum, and neither originates from sebaceous glands

Epidermoid cysts originate from epidermis
Pilar cysts from hair follices

Cyst = closed sac with a lining (epidermis or hair root cells) + contents that are liquid or semi-solid (keratin)

71
Q

Summarise the epidemiology of epidermoid and pilar cysts

A

Epidermoid - young and middle-aged adults

Pilar - women more than men, middle-aged

72
Q

Explain the aetiology of epidermoid and pilar cysts

A

High tesosterone and use of androgenic anabolic steroids

Epidermoid - Gardner’s syndrome / implantation of epidermis into dermis during trauma, surgery / blocked pore next to piercing / nevoid BCC syndrome on head and neck

Pilar - inflamed hair follicle

73
Q

What are the risk factors for epidermoid and pilar cysts?

A

Acne
FHx - pilar (autosomal dominant)
Gardner’s syndrome

74
Q

What are the presenting symptoms of epidermoid and pilar cysts?

A 
Grow slowly
Some become infected (red and sore)
Cheesy foul-smelling pus discharge
Often multiple
Common in hair-bearing regions
75
Q

What are the signs O/E of epidermoid and pilar cysts?

A

Round, smooth, tethered lump just under skin surface

Overlying skin punctum

May discharge granular creamy foul-smelling material

Pilar = scalp
Epidermoid = face, neck, genital skin, upper trunk
76
Q

How are epidermoid and pilar cysts investigated?

A

Clinical diagnosis
None needed

Skin biopsy/FNA to rule out differentials

77
Q

What is squamous cell carcinoma?

A

Malignancy of epidermal keratinocytes of the skin

78
Q

Summarise the epidemiology of squamous cell carcinoma

A

2nd most common cutaneous malignancy - 20% of all skin cancers
Middle-aged and elderly
Light-skinned at higher risk
2-3x more common in males

79
Q

Explain the aetiology of squamous cell carcinoma

A

UV radiation

Sun exposure can lead to actinic keratosis (sun-induced precancerous lesion)

80
Q

What are the risk factors for squamous cell carcinoma?

A

UV radiation
Radiation
Carcinogens (eg tar derivatives, cigarette smoke)
Chronic skin disease (eg SLE)
HPV
Long-term immunosuppression
Defects in DNA repair (eg xeroderma pigmentosum)

81
Q

What are the presenting symptoms of squamous cell carcinoma?

A

Skin lesion
Ulcerated
Recurrent bleeding
Non-healing

82
Q

What are the signs O/E of squamous cell carcinoma?

A

Variable appearance - may be ulcerated, hyperkeratotic, crusted or scaly, non-healing
Often on sun-exposed areas
Palpate for local lymphadenopathy

83
Q

How is squamous cell carcinoma investigated?

A

Skin biopsy - confirm malignancy and type
FNA/LN biopsy - if metastasis suspected
Staging - using CT, MRI, PET

84
Q

What is herpes simplex infection?

A

Infection with HSV-1 or HSV-2 causing oral, genital, and ocular ulcers

85
Q

Explain the aetiology of herpes simplex infection

A

HSV-1 –> herpes labialis (cold sores)
But also causes 50% of initial episodes of genital herpes
Also associated w HSV encephalitis

HSV-2 –> genital herpes

Large, enveloped dsDNA viruses

Latent and lytic state

Lytic infection = viral replication + transport of virus to skin, infects skin and mucosal surfaces

86
Q

What are the presenting symptoms of herpes simplex infection?

A

Dysuria (in women)
Tingling prodrome
Genital/oral painful ulcer

87
Q

What are the signs O/E of herpes simplex infection?

A

Lymphadenopathy (rare in oral)

Genital ulcer - multiple, painful ulcers start as vesicular lesions –> ulceration –> crusted lesions

Oral ulcer - single, recurrent, painful, self-limited ulcer along vermilion border

88
Q

How is herpes simplex infection investigated?

A

Viral culture: +ve
HSV PCR: +ve
Type-specific serological IgG assay: +ve antibody to HSV-1 or HSV-2

89
Q

What is melanoma?

A

Malignancy arising from neoplastic transformation of melanocytes, the pigment-forming skin cells

90
Q

Summarise the epidemiology of melanoma

A

Leading cause of death from skin disease

Steadily increasing incidence

White races have 20x increased risk

91
Q

Explain the aetiology of melanoma

A

DNA damage caused by UV radiation leads to neoplastic transformation

50% arise in existing naevi
50% arise in previously normal skin

92
Q

What are the 4 histopathological types of melanoma

A

Superficial spreading (70%):

  • arises in pre-existing naevus
  • expands in radial fashion before vertical growth phase

Nodular (15%):

  • arises de novo
  • aggressive
  • no radial growth phase

Lentigo maligna (10%):

  • more common in elderly w sun damage
  • large flat lesions
  • progresses slowly
  • usually on face

Acral lentiginous (5%):

  • palms, soles, subungual areas
  • most common type in non-white populations
93
Q

What are the presenting symptoms of melanoma?

A 
Change in size, shape, or colour of a pigmented skin lesion
Redness
Bleeding
Crusting
Ulceration
94
Q

What are the signs O/E of melanoma?

A 
ABCDE for examining moles:
Asymmetrical
Borders uneven
Two or more colours
Diameter > 6mm
Evolving size, shape, colour
95
Q

How can melanoma be investigated?

A

Excisional biopsy - histological diagnosis and determination of Clark’s Levels and Breslow Thickness (both determine depth of penetration of melanoma)

Lymphoscintigraphy - radioactive compound injected into lesion and images taken over 30m to trace lymph draining - identify sentinel nodes

Sentinel LN biopsy - check for metastatic involvement

Staging - US, CT, MRI, CXR

Bloods - LFTs (common site of mets)

96
Q

What are the risk factors for melanoma?

A 
FHx of melanoma
Personal Hx of melanoma/skin cancer
Hx of atypical naevi
Pale skin
Red or blonde hair
Sun exposure/sun bed use
Immunosuppression
Xeroderma pigmentosum
97
Q

What are the nail signs in psoriasis?

A

Pitting
Onycholysis
Subungual hyperkeratosis

Y3 (20 decks)

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