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Dermatology Flashcards

1
Q

What are the 3 features you talk about when describing a rash

A

Distribution (where on the body)
Configuration (discoid, linear)
Morphology (pustule, plaque etc)

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2
Q

What is the function of the skin

A

1) Physical barrier
2) Temperature control
3) Prevent fluid loss
4) Immunosurveillance
5) Vitamin D synthesis
6) Sensation

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3
Q

What are the layers of the skin (basic)

A

Epidermis
Dermis
Subcutaneous tissue

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4
Q

What cells can be found in the epidermis (and their function)

A

Melanocytes - UV protection
Langerhans’ cells - produce T lymphocytes and antigens
Merkel cells - sensation
Keratinocytes - physical barrier

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5
Q

What are the layers of the epidermis

A 
Each layer represents a different layer of differentiation of keratinocytes 
Stratum basale 
Stratum spinosum 
Stratum granulosum 
(+ stratum lucidum in soles etc)
Stratum cornea
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6
Q

What cells can be found in the dermis and what is the dermis made of

A

The dermis contains
Collagen
Elastin
GAG (glycosaminoglycans)

In the dermis there are

  • T and B cells
  • Nerve endings
  • Blood vessels
  • Appendages (hair and glands etc)
  • Lymphatics
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7
Q

What are skin appendages

A 
Hair 
- Laguno 
- Vellus (body) 
- Terminal (eyelashes, scalp)
Nails 
Sebaceous glands 
Sweat glands - (apocrine and eccrine)
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8
Q

What are the phases of wound healing

A

1) Haemostasis - vasoconstriction and platelet aggregation
2) Inflammation- vasodilation and NP and MP migration - phagocytosis of debris
3) Proliferation - angiogenesis, granulation tissue formation(by fibroblasts)
4) Remodelling - scar tissue formation

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9
Q

Side effects of topical steroids

A

Striae
Skin atrophy
Acne
Telangiectasia

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10
Q

Side effects of systemic steroids

A 
Cushings 
HTN 
Immunosuppression 
Diabetes 
Osteoporosis 
Cataracts
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11
Q

Side effects of retinoids

A 
Depression 
Teratogenic 
Dry skin, eyes, lips 
Liver disorders 
Myalgia 
Arthralgia 
Hypercholesterolaemia
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12
Q

Side effects of ciclosporin

A

HTN
Renal dysfunction

Check BP and U+E when giving!!

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13
Q

Definition of eczema

A

Chronic, relapsing and remitting disorder characterised by:
itchy
erythematous
scaly patches

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14
Q

What is the distribution of eczema

A

Flexor surfaces for adults and children

Infants: extensor and face

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15
Q

Aetiology of eczema

A

Fam Hx

Hygiene hypothesis

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16
Q

Pathophysiology of eczema

A 
Defect in the barrier 
- increased pH --> increased protease 
- Increased fillagrin 
Defect in immune system 
- Lots of IL 4,5,13
- Th2 mediated response

IgE and eosinophilia!

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17
Q

Eczema triggers

A 
Heat 
Sweat 
Stress 
House dust mites 
Soaps 
Infection
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18
Q

Presentation of eczema

A

Remember distribution of:
Face and trunk - infants
Flexor surfaces - child + adult

Itchy 
DRY skin
Erythematous scaly patches
Hypopigmentation 
Vesicles + weeping if acute 
Chronic scratching - lichenification
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19
Q

Criteria for eczema (atopic)

A

ITCHY + 3 of the following

1) Hx of atopy
2) Dry skin in past year
3) Active flexor involvement
4) Flexor involvement in past year
5) Onset <2

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20
Q

Management of eczema

A

1) Emollients and avoid triggers
2) TCS or TCI
3) TCS or TCI high dose
4) Systemic therapy or UV therapy

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21
Q

Complication of eczema

A

1) Bacterial superinfection - Staph A (rx fluclox)
2) Eczema herpticum (emergency) - HSV
3) Psychological disturbance

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22
Q

Definition of psoriasis

A

Inflammatory condition in which there is hyperproliferation of keratinocytes + parakeratosis

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23
Q

Presentation of psoriasis (types)

A

ITCHY erythematous scales in extensor surfaces:

1) Plaques - most common - scaly plaque - plaque falls off –> Auspitz’s sign
2) Guttate - raindrop - trunk + limbs (post strep)
3) Flexor - women + elderly
4) Seborrhic (associated with parkinsons) - nasolabial folds, retro-auricular
5) Palmer/ plantar - yellow/brown pustules
6) Erythrodermic - redness all over

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24
Q

Extra-dermal features of psoriasis

A 
Psoriatic arthritis 
Nail changes 
- Pitting 
- Onychomycosis 
- Beau's lines
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25
Q

Aetiology of psoriasis

A 
Post strep (guttate) 
Trauma (koebner's phenomoenon) 
Genetics 
Environment 
Drugs 
- BB 
- Lithium 
- Antimalarials 
- NSAIDS 
- ACE i
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26
Q

Drugs which worsen psoriasis

A 
BB 
Lithium 
Antimalarials 
NSAIDS 
ACE i
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27
Q

Management for psoriasis (plaque)

A

Potent TCS OD + vit D analogue OD

After 8w:
^ vit D to bd

then

potent TCS BD orrr coal tar preparation

Other:
Phototherapy (UV-B)
Photochemotherapy
SE: SCC, skin ageing

Systemic:

  • Oral methotrexate (good if articular features too)
  • Infliximab
  • Ciclosporin (SE: HTN, renal dysfunction)
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28
Q

Contact dermatitis
Types
Investigation
Management

A

Irritant - local
Allergic - systemic - type IV hypersensitivity

Investigations - patch testing

Management -
Irritant - emollient/ TCS
Allergic - TCS

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29
Q

Seborrhoeic dermatitis

Pathophysiology

A

Inflammatory disorder due to overgrowth/proliferation of malassezia furfur (fungus)

//inflammatory response to a normal skin inhabitant malassezia furfur

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30
Q

Seborrhoeic dermatitis presentation

A

Red itchy greasy skin in the distribution of:

Adults

  • Nasolabial folds
  • Periauricular
  • Periorbital
  • Scalp
  • Anterior chest

Children

  • Cradle cap
  • Nappy area
  • Flexors (limbs)
  • Face
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31
Q

Conditions associated with seborrheoic dermatitis

A

HIV

Parkinson’s

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32
Q

Management of seborrhoeic dermatitis

A

Adults scalp - coal tar shampoo/ head and shoulders - or Tketoconazole/ TCS

Adult other TCS/ketoconazole - if >3m can have oral ketoconazole

Child - usually spontaneously resolves within 12m - can give emollients / TCS

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33
Q

Acne vulgaris definition

A

inflammatory skin condition of pilosebaceous follicles

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34
Q

Aetiopathophysiology of acne vulgaris

A

Excess androgens

  • Puberty
  • PCOS
  • Cushings
  • steroid use

Excess androgens –>
–> increase in sebum production –> comedone –> infection of comedone by propionibacterium acnes –> inflammation of the infection

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35
Q

Types of acne vulgaris + presentation

A

Non-inflammatory
Open comedone - blackhead
Closed comedone - whitehead

Inflammatory

  • Papules/ pustules
  • Nodules
  • Cysts
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36
Q

Management of acne

A

Step wise

Single -
- keratinolytic - salicylic
acid/benzol peroxide/ topical retinoid

2nd combined topical

Oral abx and topical retinoid

  • Oral retinoid
  • Anti-androgens - COCP
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37
Q

Complications of acne vulgaris

A
  • Psychological
  • Hyperpigmentation (post-inflammatory)
  • Scarring
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38
Q

SCC of the skin

Definition and RFs

A

Definition: malignant disease of the keratinocytes and their skin appendages (its fast growing, high recurrence rate, low met rate)

RFs

  • UV
  • Previous SCC (big RF)
  • Immunosuppression
  • Chronic inflammation
  • Smoking
  • Actinic keratosis (pre-malig)
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39
Q

Presentation of SCC of the skin

A

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

Other

  • lymphadenopathy
  • hepatomegaly
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40
Q

Spread of SCC of the skin

A

RNL, Lung, liver, brain, bone

41
Q

Pre-malignant conditions of SCC

A

Pre-malignant - actinic keratosis

In situ - bowen’s (has not invaded the basement membrane)

42
Q

Management of SCC

A

In situ (Bowen’s) - cryotherapy/ topical chemotherapy (fluoracil)

<2cm - wide surgical excision
>2cm/cosmesis - mohs micrographic surgery

Mets - + radio

43
Q

BCC
Definition
RFs

A

Definition: locally invasive malignancy of epidermal keratinocytes airsing from hair appendages

RF

  • Age
  • Male
  • Immunosupp
  • UV
  • Previous
44
Q

Morphological types of BCC

A

Pearly flesh coloured lesion
May have telangiectasia
May have ulcerated –> central crater

Nodules - most common, necrotic centre 
Superficial - thread border, erythmatous 
Cystic - yellow 
Morphoeic - blue/grey/brown
Pigmented
45
Q

Investigations for BCC

A

Biopsy

CT

46
Q

Management of BCC

A 
Surgical excision
Curettage 
Cryotherapy 
Imiquimod 
Mohs
Radio
47
Q

Malignant melanoma
Definition
RFs
Distribution

A 
malignancy of melanocytes 
RF 
- UV 
- Fam Hx 
- Immunosupp
- Previous

Distribution:
Women - legs
Men - trunk

48
Q

How to describe a pigmented lesion

A 
ABCDE
Asymmetry
Border
Colour
Diameter
Evolution
49
Q

Types of malignant melanoma

A

Superficial (most common) - legs

Nodule - trunk - most aggressive - rapidly enlarging lump

Lentigo melanoma - face

Acral lentiginous - palms, soles, not related to UV, can get subungal pigmentation - hutchinson sign - black nail stripe

50
Q

Where does melanoma met to

A

LIVER

BONE

51
Q

Classification of malignant melanoma in biopsy

A

Breslow’s thickness and Clark’s level

52
Q

Management of melanoma

A

In situ - wide local excision
Melanoma - surgical excision + Sentinal node biopsy
Mets - + radio/chemp

53
Q

Complications of melanoma

A
  • Surgery to skin – infection, bleeding etc
  • Lymph surgery – lymphoedema
  • Recurrence – recurrence rate based on Breslow thickness
54
Q 
Cellulitis 
Causative organisms 
RFs
Presentation 
Investigations
Criteria 
Management
A

Staph A
Strep pyogenes

RFs

  • Immunocomp
  • Ulcers
  • Poor healing - eg poor nutrition, poor vasculature from DM etc

Erythematous, pain
Rule out
DVT
Nec Fasc

Investigations
- Blood cultures, skin swab yada yada

Eron classification - urgently admit to hospital someone with III or IV, OR
- v young, v old
- immunocomp
- Significant lymphoedema
- facial
- rapidly deteriorating
Criteria - who to give IV abx to? - class III and IV (II = a grey area and depends on local guidelines
I - no systemic upset/ co-morbs
II - systemic upset/ no S upset and co-morbs
III - systemic upset + co morbs
IV - sepsis

55
Q

Eron classification for cellulitis

A

Admit urgently to hospital for abx IF:

  • III or IV
  • Immunocompromised
  • Y young (<1 or v old
  • Facial cellulitis
  • Significant lymphoedema
  • Rapidly deteriorating
56
Q

Management of cellulitis

A

Oral Fluclox (clindamycin if allergic)

Severe - IVBenzyl and fluclox (unsure check this)

Orbital - co-amox

57
Q

Scalded skin syndrome
Organism
Presentation
Management

A

Staph - coag +ve - epidermolytic toxin

eryethema - desquamates on pressing it (Nickolsky’s sign) –> flaccid bullae (fluid filled blisters)
PAINFUL
cracked around the mouth

Where?
Face + neck
Axilla
Groin

Management

  • FLUIDS FLUIDS FLUIDS - these poor kiddos can get so DEHYDRATED
  • Fluclox
58
Q

Cause and management of warts

A

HPV - 6-11

Management

  • Cryotherapy
  • Silver nitrate
  • Salicylic acid
59
Q 
Molluscum contagiosum
Cause 
Spread
Presentation 
Management
A

Cause
- Molluscum contagiosum virus (MCV)

Spread
- skin skin contact/ sexually in adults

Presentation

  • FACE AND GROIN
  • pearly white smooth papule

Management - self limi

60
Q 
Scabies 
Cause 
Spread 
Presentation 
Investigations 
Management
A

Mites

Skin skin/ overcrowded conditions

Presentation:

  • Erythematous papules
  • Linear burrows
  • ITCHY AF
  • In between fingers!

Investigations
Clinical diagnosis but can confirm by skin scrapings

Management
- Permethrin - to ALL household contacts + wash clothes and bedding at 60 degrees

61
Q 
Bullous pemphigoid 
What is it 
Presentation 
Investigations 
Management
A

Autoimmune disease in which the body creates antibodies against hemidesmosal (in dermis and epidermis)

Presentation 
ITCHY erythematous tense blisters 
- Trunk 
- Limb flexures 
(mouth usually spared) 
Preceded by a rash

Investigations
Immunofluoresc
Skin biopsy (refer to derm)

Management

  • Oral Steroids
  • Immunosupressants
  • Abx
62
Q

Pemphigoid vulgaris
What is it
Presentation
Management

A

Autoimmune conditions in which there are antibodies against desmoglein 3

Presentation
Mouth ulcers - then months later can get –>
Flaccid blisters that are easily broken
PAINFUL not itchy

Management
Steroids
Immunosup

63
Q 
Impetigo
Cause
Presentation 
Investigations 
Management
A 
Cause
staph A (can be strep pyogenes)

Presentation
Golden crusted lesions around the mouth - common in kiddos

RF

  • Post-trauma
  • Eczema
Management 
Limited disease 
- Topical fusicid acid 
- Topical retampulin 
- Topical murpirocin - if MRSA

Extensive disease
- Oral fluclox

64
Q

School exclusion in impetigo

A

when lesions have crusted or 48hrs after abx commenced

65
Q

Pathophysiology of venous ulcers

A

incompetent valves + chronic venous insufficiency –> stasis of blood flow/ blood flows into the superficial veins rather than to the heart –> oedema, venous eczema, varicose veins

66
Q

Signs and symptoms of venous ulcer + RFs

A

Site - medial and lateral malleolus, (+ between the knee and ankle)

Edge -shallow, irregular border, sloping edges

Base - moist, granulomatous base

PAINLESS (or pain relieved by elevation)

RFs

  • Age
  • Smoking
  • Fam Hx
  • Orthostatic occupation
67
Q

Signs and symptoms of venous insufficiency

A

Ankle oedema
Heavy legs

Dry scaly skin 
Itching 
Ulcers/ varicose veins 
Lipodermatosclerosis 
Hyperpigmentation
68
Q

Venous ulcer investigation

A

Measure SA
ABPI
swab + culture
Doppler studies

69
Q

Management of venous ulcer

A

debridement +/- abx if infection
compression (if ABPI >0.9)
Occlusive hydrocolloidal dressing

70
Q

Appearance of arterial ulcers

A

Site - dorsal foot, toe, heel

Edge - punched out - cold shiny surrounding skin

Base - grey granulomatous

PAINFUL
Does not bleed on probing

71
Q

Investigations for arterial ulcers

A

ABPI <0.9
DO NOT FUCKING USE COMPRESSION
Doppler studies

Angio +/- stent

72
Q

Appearance

Management of neuropathic ulcers

A

Site - plantar surface of metatarsal and hallux

Edge - punched out - surrounded by chronic inflammatory tissue

Base - sloughy/ necrotic

Management - diabetic foot care eg footwear

73
Q

Complications of psoriasis

A 
Psychological
Psoriatic arthritis 
Increased risk of: 
VTE 
CVA 
Metabolic syndrome
74
Q

Complications cellulitis

A

Sepsis
Gangrene
Osteomyelitis

75
Q

Necrotising fasciitis

Cause
RF
Pres
Rx

A 
Cause 
Strep progenies (group A strep)

RF

  • Diabetes
  • Abdominal surgery

Pres

  • SEVERE PAIN - Especially out of proportion to the physical signs (v key info)
  • Systemic upset
  • Erythematous, necrotic skin
  • Haemorrhagic bullae
  • Subcutaneous emphysema

Rx
- URGENT Surgical debridement
- Broad spec abx
VANC + TAZ

76
Q

Pres Nec fasciitis

A
  • SEVERE PAIN - Especially out of proportion to the physical signs (v key info)
  • Systemic upset
  • Erythematous, necrotic skin
  • Haemorrhagic bullae
  • Subcutaneous emphysema
77
Q

Symptom to distinguish from arterial v venous ulcers

A

Arterial are PAINFUL

78
Q

Acne rosacea

Presentation

A 
Flushing – first symptom 
Dilated telangiectasia 
Later --> Inflammatory papules + pustules 
Rhinophyma 
Occular – blephartiris 
SYMMETRY
79
Q

Good way to differentiate acne v from R

A

Obvs flushing etc in acne R but also is SYMMETRICAL

80
Q

Triggers of acne rosacea

A

Sunshine
Alcohol
Stress
Hot bath/drinks

81
Q

Acne rosacea Rx

A

Topic abx - metronidazole
Oral abx - tetracycline

Telangiectasia - laser therapy

Other

  • Wear sunscreen
  • Anti-inflammatory like azelaic acid
82
Q

Seborrhoeic keratosis

Definition
Presentation
Association
Rx

A

Definition
Common multiple benign skin lesions

Presentation 
Face and trunk 
STUCK ON lesions 
May be warty 
Grey/brown/black 
PAINLESS

Association
UV sun damage

Rx
TCS if itchy
Flat – Cyrotherapy
Raised – curettage

83
Q

Lichen planus

Definition
Presentation
Rx

A

Definition
Inflammatory skin condition

Presentation
The Ps
Pruritis, Purple, Papule, polygonal rash

INTENSE ITCHING 
Flat shiny white papules 
Wickham striae - white lacy network 
MUCOSAL INVOLVEMENT 
nail thinning 
Rx 
Cutaneous 
- TCS + antihistamine 
Oral 
- TCS/ oral steroid 
Genital 
- TCS/ TCI/ ?imiquimod

Triggers

  • Gold
  • Thiazides
  • Quinine
84
Q

SCC that has not invaded the basement membrane is called a what

A

BOWEN’S

Carcinoma in situ

85
Q

68 y/o male has been told by his GP he has a pre-malignant condition due to chronic UV exposure
What does the GP mean by this

A

Actinic keratosis (pre-malignant to SCC)

86
Q

Most important prognostic factor in malignant melanoma

A

depth (breslow’s thickness)

87
Q

Mets of malignant melanoma

A

LIVER

BONE

88
Q

Erythema nodosum

definition

A

inflammation of the subcutaneous fat

89
Q

Erythema nodosum

Presentation

A

Tender
Erythematous nodules
Typically on shins

90
Q

Erythema nodosum

Causes

A 
NODOSUM 
NO - idiopathic 
Drugs - penicillin, sulphasalazine
OCP/ pregnancy 
Sarcoidosis/ TB 
UC/crohn's 
Micro - strep
91
Q

Erythema nodosum

Rx

A

Rx cause

Resolves in 6w

92
Q

What investigation could you do in someone with erythema nodosum

A

CXR - rule out TB and sarcoidosis

93
Q

Erythroderma

Definition
Aetiology
Rx
Complications

A

Definition
When >95% body is a rash

Aetiology

  • Eczema
  • Psoriasis

Rx

  • Replace fluids
  • Emollients
  • Wet wraps
Complications 
DEHYDRATION 
High output cardiac failure (SOB!) 
Electrolyte ∆ 
Hypothermia
94
Q

Erythroderma complications

A

DEHYDRATION
High output cardiac failure (SOB!)
Electrolyte ∆
Hypothermia

95
Q

Erythema multiforme

A

Hypersensitivity reaction

Usually HSV

TARGET LESION - back of hands + feet and then –> body

Rx
Rx cause

96
Q

TARGET LESION - multiple on back of hards

A

Erythema multiforme

97
Q

Pyoderma gangrenousum

Aetiology
Presentation
Rx

A

Aetiology
IBD
RA/ SLE

Presentation
Small red papule –> later –> deep red necrotic ulcer

Rx
Oral steroids
Immunosuppression

98
Q

Skin lesions in IBD

A

Pyoderma gangrenosum

Specialties (3 decks)

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