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Revision Year 2 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Psoriasis + Systemic Treatment

A 
Emollients - Creams vs Ointments
Vitamin D3 analogues, Topical Steroid 
Salicylic acid (keratolytic)

UVB Phototherapy, Dithranol

Systemics: Retinoid - Acitretin
Immunosuppression - Ciclosporin
Biologic Therapies: Anti-TNF - Infliximab

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2
Q

Psoriasis Differential Diagnoses

A

Seborrhoeic dermatitis
Contact dermatitis
Bowens disease
Drug eruption, Infection

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3
Q

Eczema Pathology

A

Filaggrin gene, Atopic family history

Epidermal barrier dysfunction
Environmental factors

Immune system dysregulation
Spongiosis (intercellular oedema) within the epidermis.
Acanthosis (thickening of the epidermis).
Inflammation - Superficial perivascular infiltrate

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4
Q

Seborrhoeic eczema - adults

Chronic dermatitis

A

Red, Sharply marginated lesions
- covered with greasy looking scales

Distinctive distribution – areas rich in supply of sebaceous glands (scalp, face, upper trunk).

Treat with topical anti-yeast (ketoconazole)

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5
Q

Eczema

A

Allergic, itchy skin inflammation of flexural areas in the past 12 months with 3 of:
Onset < 2 years old
Flexural Involvement
Dry Skin History
Atopic Disease History (Asthma, Allergic Rhinitis)

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6
Q

Psoriasis

A

Silver, salmon coloured scaly lesions

Non contagious, chronic Inflammation

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7
Q

Pompholyx/vesicular eczema

Asteatotic eczema

A

Palms and soles
Intensely itchy

Very dry skin
Cracked scaly appearance
Heat and continuous washings

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8
Q

Eczema herpeticum

A

Herpes Simplex 1 and 2
Itchy clusters of blisters and erosions
Fever and often unwell
Swollen lymph glands

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9
Q

Eczema Treatment

A

Antihistamines, Antimicrobials

Intermittent topical steroids
Hydrocortisone (low)
Betamethasone (potent)

Calcineurin Inhibitors - Tacrolimus

When Severe: Ultraviolet light
Immunosuppression - Azathioprine

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10
Q

ACNE VULGARIS

A

Disease of the pilo-sebaceous unit – face, chest, back

“Sticky” keratinocytes + increased sebum viscosity

Blocked follicles = COMEDONES

Change in commensal bacterial behaviour

Papules, pustules, nodules, cysts, scars

Peak 15-18 years

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11
Q

ACNE Treatment

A

TOPICAL - Retinoids, Benzoyl peroxide (BPO)
Anti-biotics : Clindamycin, Tetracycline, Erythromycin

Anti-androgens : Oral contraceptives
Isotretinoin

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12
Q

ACNE ROSACEA

A

Disease of the pilo-sebaceous unit – face, chest, back

Chronic inflammmation
Cutaneous vasculature

Ace of clubs distribution

Age 30-50 years
Fair skinned/Celts
Flushing – alcohol, spices, emotion, heat

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13
Q

Non Melanoma Skin Cancers RF

BCC, SCC

A 
UV radiation
Photochemotherapy
Chemical carcinogens
X-ray and thermal radiation
Human papilloma virus
Immunosuppression
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14
Q

BCC

A

Slow growing

Nodular

  • Pearly rolled edge
  • Telangiectasia
  • Central ulceration
  • Arborising vessels - distinct treelike telangiectasias seen on DERMOSCOPY
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15
Q

Mohs Surgery Indications

Thin layers removed one by one

A 
Site (face)
Size (large)
Subtype
Poor clinical margin definition
Recurrent
Perineural or perivascular involvement
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16
Q

Vismodegib

A

Tx for locally advanced BCC

Inhibits abnormal signalling in the Hedgehog pathway

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17
Q

SCC

A

Keratinising squamous cells
Usually on sun exposed sites
Can metastasise

Faster growing, tender, scaly/crusted ill defined nodules that may ulcerate

Causes: UV, chronic inflammation (wound scars, ulcers), imunosupression, genetics, pre-malignant skin condition

Excision / Mohs micro-graphic surgery +/- Radiotherapy

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18
Q

Keratoacanthoma

A

Erupts from hair follicles in sun damaged skin

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19
Q

Melanoma RF

A

UV Radiation

Genetic susceptibility - skin type 1
Multiple Moles History

Familial melanoma and melanoma susceptibility genes

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20
Q

Clinical Diagnosis of Melanoma

A 
Asymmetry
Border
Colour
Diameter
Evolution
Change in size, shape, colour
Diameter > than 5 mm
Inflammation
Oozing or bleeding
Mild itch or altered sensation
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21
Q

Melanoma Tx

A

Wide local excision
Sentinel lymph node biopsy
Chemotherapy/Immunotherapy
Regular follow up

Ipilimumab - Inhibits CTLA-4 molecule
Vemurafenib - Blocks B-RAF protein
Pembrolizumab - Blocks activity of PD-1

22
Q

Cutaneous Lymphoma

Extracorporeal photophoresis

A

Patients blood is drawn and leucocytes collected

Collected white cells mixed with psoralen which makes the T-Cells sensitive to UVA radiation

Exposed to UVA radiation, damaging diseased cells

Treated cells re-infused back to patient

23
Q

Fever

A

Caused by endogenous pyrogens (IL-1, IL-6)

Local production of prostaglandins by cyclo-oxygenase in the hypothalamus

24
Q

Functions of skin cont.

A

Thermoregulation - Insulation, Heat transfer

Skin immune system

Barrier - Protects against Mechanical, Chemical, UV, microorganisms

Sensation - Temperature, touch and pain

Vitamin D Synthesis
- UV converts 7-dehydrocholesterol to cholecalciferol

Interpersonal Communication
- Physical appearance, smell, self -identity

25
Q

Bullous Pemphigoid

A

Autoimmune rxn against the basement membrane

Epidermis detachment after erethymatous and eczematous areas on trunk

Ix shows IgG + C3 at basement membrane

26
Q

Macule

Patch

A

Small circumscribed area

Larger circumscribed area

27
Q

Papule

Plaque

A

Small raised area

Larger Raised area

28
Q

Vesicle

Bulla

A

Small Fluid filled

Large Fluid filled

29
Q

Pustule

Abscess

A

Small Pus filled

Large Pus filled

30
Q

Erosion

Ulcer

A

Loss of Epidermis

Loss of Epidermis and dermis

31
Q

Systemic Treatments in Dermatology

A

1) Retinoids
- Vitamin A analogues
Normalise keratinocyte function
Anti inflammatory and anti cancer effects

SE: Teratogenic
Cheilitis (dry lips) and xerosis (dry skin)
↑transaminases, ↑triglycerides

2) Traditional immunosuppressants
Oral steroids 
Azathioprine FBC monitoring, 
Methotrexate FBC and Liver monitoring
Ciclosporin Renal function monitoring

3) Biologics (also immunosuppressive)
- Genetically engineered proteins derived from human genes

32
Q

Retinoids in

Acne
Psoriasis
Cutaneous T cell lymphoma
Hand eczema

A

Isotretinoin
Acitretin
Bexarotene
Alitretinoin

33
Q

Biologists in

Chronic spontaneous urticaria
Eczema

A

Omalizumab

Dupilumab

34
Q

GI Genetic

GI Inflammatory / Autoimmune

Vitamin Deficiency

A

Hereditary haemorrhagic telangiectasia

Erythema nodosum
Pyoderma gangrenosum > IBD

Scurvy / Beriberi

35
Q

Diabetes

A 
Acanthosis nigricans
Diabetic bullae
Diabetic dermopathy
Eruptive xanthomas
Necrobiosis lipoidica
36
Q

Cutaneous Lupus

A

Butterfly rash
/Plaques with clear margins
/Photosensitivity
/Negative antibodies

37
Q

Autoimmunity

A

Cutaneous lupus
Cutaneous vasculitis - vessels seen as erethyma
Alopecia T-lymphocyte, cytokine rejection of hair
Vitiligo

38
Q

Carcinoid Syndrome

A

Episodic flushing, mins -hours
No sweating
Facial telangiectasia

39
Q

Ectopic ACTH syndrome

A

Tumour production of ACTH leads to generalised hyperpigmentation
ACTH -> Inc. MSH -> release of melanin from melanocytes

40
Q

Seborrhoeic Keratoses

A

Benign,
Warty growths (Elies)
Cryotherapy
Curettage

Abrupt and widespread can suggest GI adenocarcinoma

41
Q

Viral Warts

A

Human Papilloma Virus

Rough hyperkeratotic surface

42
Q

Cysts

A 
Treated with excision
If inflammed/infected
Antibiotics
Intralesional steroid
Incision &amp; Drainage
43
Q

Dermatofibroma

A

Benign fibrous nodule often on limbs
sometimes attributed to an area of trauma

Firm nodule, tethered to skin but mobile over fat. Pale pink/brown. Often paler in centre

Dimple sign positive

Usually asymptomatic. Can be itchy or tender

44
Q

Lipoma

A

Benign tumour consisting of fat cells

Smooth and rubbery subcutaneous mass

If tender can be angiolipoma /
Liposarcoma – rare malignancy

45
Q

Vascular Lesions

A

Angioma - Overgrowth of blood vessels in the skin due to proliferating endothelial cells

Pregnancy & liver disease
Excision or laser

Cherry angiomas, Spider naevi, Venous lakes

Pyogenic Granuloma - head and hands
- Removed by curettage & cautery

46
Q

Actinic Keratoses

A

Rough scaly patches on sun damaged skin

Low risk of transformation to SCC

47
Q

Bowen’s Disease

A

Squamous cell carcinoma in situ
Full thickness dysplasia, entirely contained within the epidermis

Irregular, scaly erythematous plaque

Cryotherapy
Curettage
Photodynamic therapy
Imiquimod - Stimulates cytokine release

48
Q

Thermal Balance

A

Convection = air or a liquid, is heated and travels away

Conduction = heat transfer direct bw touching objects

Evaporation = respiration + sweating

Radiation - heat loss / heat gain

49
Q

Response to heat stress

Heat loss from the body is increased by:

A

Vasomotor control

  • Arteriolar dilation
  • Increases delivery of blood to the skin

Sweating - sympathetic cholinergic fibres increase evaporative heat loss

Behavioural responses - increasing surface area, removing clothing, moving to shaded area

50
Q

Heat exhaustion (heat illness)

A

Vasodilation and drop in central blood volume
caused by a disturbance of the body’s fluid/salt balance due to excessive sweating
symptoms include headache, confusion, nausea, profuse sweating, clammy skin, tachycardia, hypotension, weak pulse, fainting & collapse

51
Q

Heat stroke (heat injury)

A

body temperature raised above 40ºC

body’s temperature control mechanisms fail
symptoms include hot dry skin (sweating ceased) & circulatory collapse

Revision Year 2 (14 decks)

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