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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
Bullous Pemphigoid
Autoimmune rxn against the basement membrane Epidermis detachment after erethymatous and eczematous areas on trunk Ix shows IgG + C3 at basement membrane
26
Macule | Patch
Small circumscribed area | Larger circumscribed area
27
Papule | Plaque
Small raised area | Larger Raised area
28
Vesicle | Bulla
Small Fluid filled | Large Fluid filled
29
Pustule | Abscess
Small Pus filled | Large Pus filled
30
Erosion | Ulcer
Loss of Epidermis | Loss of Epidermis and dermis
31
Systemic Treatments in Dermatology
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
Retinoids in Acne Psoriasis Cutaneous T cell lymphoma Hand eczema
Isotretinoin Acitretin Bexarotene Alitretinoin
33
Biologists in Chronic spontaneous urticaria Eczema
Omalizumab | Dupilumab
34
GI Genetic GI Inflammatory / Autoimmune Vitamin Deficiency
Hereditary haemorrhagic telangiectasia Erythema nodosum Pyoderma gangrenosum > IBD Scurvy / Beriberi
35
Diabetes
``` Acanthosis nigricans Diabetic bullae Diabetic dermopathy Eruptive xanthomas Necrobiosis lipoidica ```
36
Cutaneous Lupus
Butterfly rash /Plaques with clear margins /Photosensitivity /Negative antibodies
37
Autoimmunity
Cutaneous lupus Cutaneous vasculitis - vessels seen as erethyma Alopecia T-lymphocyte, cytokine rejection of hair Vitiligo
38
Carcinoid Syndrome
Episodic flushing, mins -hours No sweating Facial telangiectasia
39
Ectopic ACTH syndrome
Tumour production of ACTH leads to generalised hyperpigmentation ACTH -> Inc. MSH -> release of melanin from melanocytes
40
Seborrhoeic Keratoses
Benign, Warty growths (Elies) Cryotherapy Curettage Abrupt and widespread can suggest GI adenocarcinoma
41
Viral Warts
Human Papilloma Virus | Rough hyperkeratotic surface
42
Cysts
``` Treated with excision If inflammed/infected Antibiotics Intralesional steroid Incision & Drainage ```
43
Dermatofibroma
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
Lipoma
Benign tumour consisting of fat cells Smooth and rubbery subcutaneous mass If tender can be angiolipoma / Liposarcoma – rare malignancy
45
Vascular Lesions
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
Actinic Keratoses
Rough scaly patches on sun damaged skin | Low risk of transformation to SCC
47
Bowen’s Disease
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
Thermal Balance
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
Response to heat stress Heat loss from the body is increased by:
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
Heat exhaustion (heat illness)
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
Heat stroke (heat injury)
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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