Dermatology Flashcards
1
Q
What are the types of tumours of the epidermis?
A
- Actinic keratosis
- Bowen’s disease
- SCC
2
Q
Key features of Actinic Keratosis
A
- Sun exposed areas- hands, nose etc
- Yellow scaly plaque with irreg. edges
- Tx- topical chemo, cyro, curettage, photodynamic therapy
3
Q
Key features of Bowen’s Disease
A
- Full thickeness dysplasia
- Causes- sun, carcinogens, radio. ++immunosuppressed
- Ix- biopsy
- Tx- Cryo, curettage, excision, topical chemo, photodynamic therapy
4
Q
Key features of SCC
A
- Cause- sun, radio, carcinogens, mercury, progression from prev ulcer
- Scaly/cruty raised area of skin with red inflamed base
- Common in sun exposed areas
- Ix- biopsy
- Excition +/- radio
5
Q
Types of basal cell skin tumours and Key features of BCC
A
- Seborrheoic keratosis= wart. brown. middle aged.
- Basal cell carincoma:
- Cause= cumulative sun exposure
- Pearly, rolled edges, telangectasia. Can form ulcer.
- Invade local structure. don’t met.
- Tx- excision, radio, curettage, cryo
6
Q
Types of melanocytic lesions and key features of melanoma
A
- Ephelis- freckle
- Melanocytic naevus= benign pigmented macule
- Lentigo= liver spot. Flat pigmented area.
- Malignant melanoma:
- Cause= BURN (UV B). trunk/ legs. pale people.
- Presentation- asymmetrical, variable pigmentation, irregular edge, bleeding, itching, at least 6mm diameter
- Met early and unpredictably
- Ix= biopsy –> Breslow thickness
- Tx= excision, chemo, radio
7
Q
2 week wait referral criteria for melanoma
A
- Dermatoscopy suggesting melanoma
- OR 3 points from:
- Major (2 points each): Change in size, irregular colour, irregular size
- Minor (1 point each): >6mm, inflammation, oozing, change in sensation
8
Q
What is cellulitis, what are common organisms and RF?
A
- = Acute infection of lower dermis and SC tissue
- Organisms: Strep. pyogenes (2/3), Staph. Aureus
- RF:
- Immunocompromise- steroids, DM, HIV, chemo
- Entry point- wound, skin fissures, ulcer
- CKD
- Chronic liver disease
- Alcoholism
- PMH cellulitis
9
Q
Presentation of cellulitis
A
- Presentation:
- Local- redness, hot, swelling, erythema, blisterds, erosions, abscess, purpura, purulent
- Unilateral
- Streaking away from lesion
- Systemic- tachycardia, tachypnoea, malaise, fevers/chills, rigors, sepsis
- Entry site? Wound, cannula, ulcer, bite
- Lymphadenopathy
10
Q
Complications of cellulitis
A
- Necrotising fasciitis
- Gas gangrene
- Sepsis
- Infections to other organs eg endocarditis, osteomyelitis
11
Q
Ix and Tx of cellulitis
A
- Ix:
- Bedside- swabs (inc MRSA), obs
- Bloods- WCC, CRP, cultures
- Imaging- USS ?DVT, X-ray ?osteomyelitis
- Tx:
- Cons- rest, elevate, mobilise, fluids, draw margins.
- Medical:
- Analgesia
- Antipyretics
- ABx- 1. Fluclox (erythromicin). 2.Clindamicin. Co-amox if facial/ systemic.
- MRSA- doxycycline
- Surgical- debridement
12
Q
Key features of necrotising fasciitis
A
- = Rapidly progressive infection of deep fascia –> necrosis of SC tissue.
- Presentation:
- ++pain out of proportion
- Rapidly spreading erythema, blistering, oedema
- Systemic Sx- sepsis, fever, sweating, N+V, anorexia, diarrhoea
- Ix- obs, swabs, bloods, x-ray
- Tx:
- ABCDE. Senior help ASAP!
- ABx- micro. IV BenPen, gentamicin, clindamicin, metronidazole
- Surgical debridement ASAP!
13
Q
Presentation of eczema
A
- Dry red and scaly patches
- Itchy
- Poorly demarcated rash. Acute= oozing papules + vesicles. Subacute= red + scaly.
- Chronic –> lichenification. Skin thickening + exaggeration of skin markings.
- Atopy= Eczema, hayfever, asthma. PMH/ FHx?
- Triggers- fabrics, inhaled allergens, stress, heat, hormones, skin infections, dietary etc
14
Q
Ix and Tx of eczema
A
- Ix- usually none. IgE, RAST (specific Ab), patch testing
- Tx:
- Cons- avoid triggers and scratching. Soap substitutes eg dermol. Emollients- epaderm, diprobase
- Medical= topical steroids. 1% hydrocortisone –> eumovate –> betnovate –> dermovate
- 2nd line therapies- topical tacrolimus, phototherapy, ciclosporin, azathioprine
15
Q
What are the eczema variants and their features?
A
- Discoid- circular, oozing and crusting patches
- Contact dermatitis to irritants eg soaps
- Varicose eczema- varicose veins. Red/itchy. Borwn scars. Lipodermatosclerosis. –>?ulcer
- Seborrhoeic dermatitis- red and scaly. Overgrowth of skin yeast. In eyebrows, scalp, cheeks, nasolabial folds. Tx= daktacort (miconazole + hydrocortisone)
- Dyshydrotic eczema- blisters on soles of feet and hands. Related to stress and allergies
16
Q
What is psoriasis? + RF/ aggravating factors
A
- = AI disorer. Inflammation of dermis with epidermal hyperproliferation.
- RF/ aggravating factors:
- FHx
- Stress
- Smoking/ alcohol
- Obesity
- Infections (esp strep), skin injury
- Hormonal
- Meds- beta blockers, lithium, antimalarials
17
Q
Presentation of chronic plaque psoriasis
A
- Itchy, dry patches +/- bleeding
- Plaques- pink/red, scaly. Esp extensors (elbows, knees), lower back, scalp. Well demarcated and symmetrical.
- Nail changes- pitting, onycholysis
- 10-40% –> seronegative arthritis (mono/polyarthritis). Asymmetrical. DIPs.
18
Q
Variants of psoriasis and their presentation
A
- Pustular- palms and soles
- Guttate- Sudden. 2-3w post strep throat. Papules on trunk.
- Flexural- older people. No scale. Groin, nasal cleft, submammary
19
Q
Tx of psoriasis
A
- Cons- avoid triggers, soap substitutes eg aqueous cream. Emollients eg epaderm/dermol/diprobase.
- Topical therapy- steroids, Vit D3 analogue (calciprotriol), tar, retinoids (eg tazarotene).
- UVB phototherapy
- Systemic:
- Biological- anti-TNFalpha eg infliximab
- Non-biological- methotrexate, ciclosporin
20
Q
What is Tinea and its types? + Tx
A
- Tinea= superficial mycosis caused by dermatophytes (fungi)
- Presentation= Round, scaly, itchy lesions with central clearing. Slightly raised. Well demarcated. Scaly edge.
- Types:
- Tinea corporis= symmetrical. spreading. on body.
- Tinea faciei= face.
- Tinea cruris= Groin. More red and plaque-like.
- Tinea pedis= athlete’s foot. ++ itchy. Fissured and macerated skin.
- Tx= topical antifingals eg clotrimazole. PO if widespread.
21
Q
What is scabies? Presentation, Ix and Tx
A
- = Skin infection with saropptoes scabiei
- Rash- ++ itchy, papular. Site- interdigital, ankles, wrist, axillae, umbilicus
- Linear skin burrows= pathopneumonic.
- Ix- skin scraping
- Tx- wash clothes/ sheets. Scabicide to whole body eg malathion.
- ++ Contagious
22
Q
What is candida albicans? Presentation + Tx
A
- = Yeast infection.
- Thrives in warm moist areas- nappies, body fold, interdigital space.
- Rash- Erythematous, ragged, peeling edge +/- small pustules
- Mouth + genital- white plaques/ discharge
- Tx:
- Cons- clean and dry skin
- Topical antifugal- cream eg clotrimazole, drops eg nystatin, pessaries eg clotrimazole.
- PO Fluconazole if resistant
23
Q
What are the key features of acne vulgaris?
A
- Keratinocyte proliferation
- ++ Sebum
- Bacteria colonisation
- Inflammatiion
- White and black heads
24
Q
Tx of acne vulgaris
A
- Cons- screen for mental health
- Med:
- Topical ABx + bezoyl peroxide
- PO ABx 4-6m + bezoyl peroxide. Eg doxycycline.
- ?OCP
- –> Specialist. Isotretanoin. SE= dryness, depression, teratogenic
25
Q
What is acne rosacea and how does it present?
A
- = Chronic relapsing remitting disorder of BVs adn pilosebaceous units
- Presentation:
- More in fair skinned
- Pre-rosacea- flushing in repsone to stress etc
- Central rash- symmetrical, erythema, telangectasia, papules, pustules, inflamm nodules
26
Q
Tx of acne rosacea
A
- Cons- soap substitutes. Sun cream.
- Med:
- Topical metronidazole
- PO doxycycline
- Isotretanoin
27
Q
What is erythema multiforme? Presentation + Tx
A
- = Hypersensitivity. Mostly to HSV
- Rash- Erythematous, round, well defined ‘target lesions’. Extensor surfaces. Lesions at different stages (multiforme)
- Major= severe mucosal involvement, systemic upset.
- Tx= usually none. ?Steroids ?aciclovir
28
Q
What is Steven-Johnson Syndrome- causes, presentation
A
- = Serious disease of skin and mucous membranes. Hypersensitivity reaction to drugs/ infection
- Drugs- NSAIDs, penicillins, anti-epileptics, sulfonamides
- Presentation- Starat drug –> vague URTI Sx for 2-3w –> painful erythematous macules –> severe mucosal ulcerations
29
Q
Erythroderma - What is it? Presentation, complications, Tx
A
- = Intense widespread reddening of skin due to inflammatory skin diseases. ‘Red man syndrome’
- Causes/ RF: Drug eruption, dermatitis, psoriasis, infection, systemic disease (HIV, GVHD, malignancy).
- Presentation:
- Often preceded by eruptions, plaques, dermatitis.
- Generalised erythema (>90% skin surface). Warm.
- Oedema
- Systemic- lymphadenopathy, hepatosplenomegaly
- Complications- hypothermia, dehydration, electrolyte imbalance, HF, secondary skin inf, hypoalbuminaemia (–> oedema)
- Tx- Regulate body temp, fluid status and electrolytes. Wet wraps, emollients (thick white paraffin), topical steroids.
30
Q
What are the types of malignant melanoma?
A
- Superficial spreading
- Nodular
- Lentigo maligna melanoma (face. prev. lentigo maligna)
- Acral lentigenous melanoma (nails)
- Amelanotic melanoma
31
Q
Types of severe cutaneous drug reaction and presentation
A
- Widespread macular papular rash.
- Features of severe:
- Temp >40
- Hypotension
- Lymphadenopathy
- SOB/ wheeze
- Erythroderma
- Swelling of face/ tongue
- Pain/ burning
- Erosions/ shearing
- Blistering/ bullae
- SJS= <10% surface areas with blisters
- TEN= >30%. Toxic epidermal necrolysis.
32
Q
Presentation of eczema herpeticum + Ix and Tx
A
- Sudden deterioration of stable eczema:
- ++ pain
- Unwell +/- fever
- Small punched out ulcers (can merge)
- Dissemination
- Ix- viral swabs
- Tx- PO aciclovir +/- flucloxicillin
33
Q
What is staphylococcal scaled skin syndrome?
A
- Esp infants, elderly, immunocompromised.
- Infection of Staph (may not be skin) –> release epidermolytic toxins
- Mucosal surface never involved, no necrosis
- Look for local focus eg nasopharynx
- Ix- blood culture and swabs
- Tx= fluclox
34
Q
Types of Bullous skin disorders + key features
A
- Bullous pemphigoid- Elderly w/ neuro disease. Itchy skin with large tense bullae. Risk of infection. Tx= steroids
- Pemphigoid vulgaris- younger, more severe. Flaccid superficial blisters. Tx- systemic steroids/ immunosuppression
- Dermatitis herpetiformis- Esp in coeliac. Sysmmetrical ++ itchy blisters. +/- GI Sx. Tx= gluten free
35
Q
Categories of skin lesion morphology
A
- Flat: Macule <0.5cm, patch >0.5cm
- Raised: Papule <0.5cm, nodule >0.5cm
- Plaque= large, plateau, superficial
- Fluid filled: vesicle= <0.5cm, bulla= >0.5cm, pustule= pus filled
- Abscess= fluid filled lesion
