Dermatology Flashcards
1
Q
What are the causes of acne?
A
- Propionibacterium acnes
- Increased androgens (puberty, PCOS, congenital adrenal hyperplasia)
2
Q
Outline the pathophysiology of acne
A
- Dead follicles are clogged with dead skin cells and oil from the skin
- Androgens increase production of sebum
- Excessive growth or propionbacterium acnes (normally present on the skin)
3
Q
How can acne be classified?
A
- Mild - clogged skin follicles limited to the face
- Moderate - papules and pustules on the face and trunk
- Severe - nodule are the characteristic facial lesion with extensive trunk involvement
4
Q
What are the signs and symptoms of acne?
A
- Primarily affects face, upper cheek and back
- Blackheads
- Whiteheads
- Pimples
- Oily skin
- Scarring
- Secondary
- Anxiety
- Reduced self esteem
- Depresion
- Post inflammatory hyperpigmentation
5
Q
How is acne best managed?
A
- Lifestyle - eat less carbs
- Medication
- Benzoyl peroxide - kills bacteria and reduces inflammation
- Azelaic acid - reduces skin cell accumulation in follicle, antibacterial and anti-inflammatory
- Salicyclic acid - stops bacterial reproduction, opens obstructed skin pores
- Antibiotics - clindamycin, erythromycin, metronidazole
- OCP - decrease androgen production
- Isotretinoin (roaccutane) - severe acne
- Reduces inflammation
- Normalise the follicle cells life cylce
- Reduce sebum production
- Medical procedure
- Exraction
- Light therapy
6
Q
What are the complications of acne?
A
- Scars
- Depression
- Anxiety
7
Q
What are the causes of eczema?
A
- Hygiene hypothesis
- Suppresses the natural development of Th1 predominant immune response
- Promotes a Th2 dominant or allergic response
- Genetics
8
Q
Outline the pathophysiology of eczema
A
- Two hypotheses
- Inside-out immunological distubance causes IgE mediated sensitisation, epithelial barrier dysfunction is secondary
- Outside in = epidermal barrier dysfucntion allows irritants and allergens into the skin, with immunological disturbance secondary
- These lead to immune dysfunction –> itch –>scratch–>leaky skin barrier—> inflamation–> immune dysfunction
9
Q
What are the types of eczema?
A
- Atopic dermatitis
- allergic rash that is found on head, scalp, neck, inside of elbows, behind knees and buttocks
- Contact dermatitis
- Allergic hypersensitivity reaction to the skin
- Irritant contact dermatitis - direct reaction to something that has been touched
- Seborrhoeic dermatitis
- Dry or greasy peeling of the scalp, eyebrows and face and sometimes the trunk
- in the newborn is it a crusty yellow rash called a cradle cap
- Dyshidrosis - the palms and soles and sides of fingers and toes are affected and this is worse in warm weather
- Discoid - round spots of oozing or dry rash with clear boundaries, often on lower legs (worse in winter)
10
Q
What are the signs and symptoms of eczema?
A
- Small lesions - entire body
- itchiness
- thickened skin
- Rough texture
- Red skin
- Dry skin
- Rash
- Swelling
- Blisters
- Oozing
- Scarring
11
Q
What investigations should be performed for eczema?
A
- Clinical diagnosis
- Skin biopsy
- Patch testing (allergic contact dermatitis)
12
Q
How is eczema correctly managed? (7)
A
- Lifestyle
- Bathing once or more a day in warm water, no soap
- Avoid allergen/irritant
- Moisturisers - oil based, not water (zerobase)
- Topical corticosteroids
- Immunosuppressents
- These require regular blood test monitoring
- Antihistamine to reduce nighttime scratching
- Antibiotics
13
Q
How is the skin barrier impaired in eczema?
A
- Genetic defects
- Reduced antimicrobial pepetides production
- Decreased sebaceous secrection
14
Q
What is psoriasis?
A
- Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales.
- These patches normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body.
- Most people are only affected with small patches.
- In some cases, the patches can be itchy or sore.
15
Q
What are the causes of psoriasis?
A
- Autoimmune
- Problems with the immune system – T cells attacking the healthy skin cells by mistake
- Genetics
16
Q
Can anything trigger psoriasis?
A
- Injury to the skin - koebner phenomenon
- Drinking excessive amounts of alcohol
- Smoking
- Stress
- Hormonal changes
- Certain medicine
- Throat infections
- Immune disorders such as HIV
17
Q
What is koebner phenonmenon?
A
- The Koebner phenomenon is an aspect of psoriasis that’s well-known but not completely understood.
- It describes the formation of psoriatic skin lesions on parts of the body that aren’t typically where a person with psoriasis experiences lesions.
- This is also known as an isomorphic response.
18
Q
Outline the pathophysiology of psoriasis
A
- Thought be be genetic that is triggered by envrionmental factors
- Abnormal excessive/rapid growth of the epidermal layer, every 3-5 days, rather than 28-30
- Premature maturation of keratinocytes
- Symptoms worse in winter with certain medication (beta blockers, NSAIDs), infection, stress
19
Q
There are five official types of psoriasis. List them
A
- plaque.
- guttate.
- inverse.
- pustular.
- erythrodermic.
- psoriatic arthritis
- Scalp
- Nail
20
Q
What is plaque psoriasis?
A
- Dry red skin lesions covered in silver or white scales on top
- Normally appear on your elbows, knees, scalp and lower back.
- Can be itchy, sore or both.
- In severe cases skin around joints may crack and bleed.
21
Q
What is scalp psoriasis?
A
- Red patches of skin in thick, silvery scales.
- Extremely itchy while in others, there is no discomfort.
- Can cause hair loss
22
Q
What is nail psoriasis?
A
- Tiny pits in nails
- May become discolored or grow abnormally.
- Can often become loose and separate from nail bed and may crumble in severe cases
23
Q
What is guttate psoriasis?
A
- Small drop-shaped sores on your chest, arms, legs and scalp.
- Can be caused by strep infections
- Lasts few weeks
24
Q
What is inverse psoriasis?
A
- Large smooth red pathes in skin folds
- Skin folds in armpits, groin, between the buttocks and under the breast.
25
What is pustular psoriasis?
* Small, non-infectious pus-filled blisters
26
What is erythrodermic psoriasis?
* Widespread
* Rare form of psoriasis that affects nearly all skin on the body.
* Can cause intense itching or burning.
* Can cause body to lose proteins and fluid leading to further problems such as infection, dehydration, heart failure, hypothermia and malnutrition
27
28
What are the sign and symptoms of psoriasis?
* Skin varies from small to complete coverage
* Red
* Dry
* Itchy
* Scaly
* Nail
* Pitting
* Whitening
* Bleeding under the nails
* Psoriatic arthritis
* Painful joints
* Inflmaed
* Dactylitis
29
How should psoriasis be investigated?
* Clinical diagnosis
* Skin biopsy/scraping
30
How is psoriasis best managed?
* Lifestyle
* Smoking cessation
* Stopping Alcohol Consumption
* Weight Loss
* Assess for associated stress, distress, anxiety, and/or depression and manage appropriately
* Topical corticosteroid
* Vitamin D3 cream
* UV light
* Methotrexate
* Infliximab
31
What are factors to assess in the management of Psoriasis?
* Follow-Ups: Assess for joints, Assess for Cardiovascular Disease, Review four weeks after treatment.
* Assess for anxiety, depression or any associated stress
* Nail Psoriasis: keep nails short, avoid manicure of the cuticle.
32
What can cause Allergic rashes and urticaria?
* -Food
- Pollen and Plants
- Insect Bites and Stings
- Chemicals
- Latex
- Dust Mites
- Heat
- Sunlight
- Exercise
- Water,
- Medicines
- Infections
- Emotional Stress
33
What is the presentation of Allergic rashes and urticaria?
* Itchy
* Stinging or Burning
* Red Spots or patches
34
How do you manage allergic rashes and urticaria?
* Avoid Triggers
* Offer non-sedating antihistamine for up to 6 weeks. If it carried on precribe antihistamine daily
* Severe symptoms:
* Short course of oral corticosteroids and non-sedating oral antihistamine
* Arrange referral to the dermatologist or immunologist for people that have painful and persistent urticaria, people who can’t be controlled, urticaria due to food or latex allergy
35
How is Chronic Urticaria classified?
* For chronic urticaria use validated too Chronic Urticaria Quality of Life Questionnare (CU-Q2oL)
36
What are the risk factors for basal carcinoma?
* UV
* Lighter skin
* Radiation
* Arsenic
* Poor immune system
37
What is more common, basal cell carcinomas or squamous cell carcinomas?
* BCC - 75%
* SCC - 20%
38
What are the types of BBC?
* Superficial
* Infiltrative
* Nodular
39
How does BCC present?
* Usually appears as a small, shiny pink or pearly -white lump with a translucent or waxy appearance.
* Can also look like a red, scaly patch.
* Sometimes brown or black pigment within the patch
* Can develop to painless ulcer. Slowly gets bigger and may become crusty, bleed.
* Does not require urgent referral and see specialist within 18 weeks
40
How is BCC managed?
* Surgical removal
* Cryosurgery
* Radiation
41
What are the risk factors for sqaumous cell carcinoma?
* Older age
* Male
* Fair-skinned
* Exposure to UV
* Arsenic
* Bowen disease
* HPV
* HIV/AIDS
* Radiation
42
Outline the pathophysiology of SCC
* Slow growing
* Tends to rise to pre-malignant lesions
* Can spread to tissue, bone, LNs (more malignant than BCC)
43
What are the signs and symptoms of SCC?
* Appears as a firm pink lump with a rough or crusted surface
* Lot of surface scale and sometimes even **spiky horn** spiking up from the surface
* Lump is often tender to touch, bleeds easily and may develop into an ulcer
* Requires an urgent referral
44
How is SCC managed?
* Surgical excision
* Dermabrasion
* Cryosurgery
* Topical chemotherapy
* Ablative and non-ablative lasers
45
Outline the risk factors for melanoma
* Family history
* Many moles
* Poor immune system
46
Outline the pathophysiology of melanoma
* Development from melanocytes that have out-of control growth
47
What are the signs and symptoms of melanoma?
* Mole that is increasing in size
* It has irregular edges
* Changes in colour
* Itchiness
* Skin breakdown
48
How should melanoma be investigated?
* Skin exam
* Tissue biopsy
* Sentinel node biopsy
* ABCDE
* Asymmetry
* Border uneven
* Colouring different shade of brown
* Diameter \>6mm
* Evolves over time
49
How should melanoma be managed?
* Surgical removal
* Spread = immunotherapy
* Biological therapy
* Radiation
* Chemotherapy
50
What are preventative steps for skin cancers?
* Avoid overexposure to UV light
* Protect yourself from sunburn by using high factor sunscreen,
* Dress sensibly in the sun and limiting the amount of time you spend in the sun on the hottest part of the day
51
What are investigations for Skin Cancer?
* Biopsy
* Fine needles aspiration in some cases
52
What is referral for skin cancer based on?
* Change in size
* Irregular shape
* Irregular colour
* Largest diameter 7 mm or more
* Inflammation
* Oozing
* Change in sensation
53
What do cancerous lumps tend to present as?
* Most cases, the cancerous lumps are red and firm and sometimes turn into ulcers
54
What are risk factors for skin cancers?
* Having pale skin that doesn’t tan easily
* Have blonde or red hair
* Having blue eyes, older age
* Having large number of moles
* Having a large number of freckles
* Having an area of skin previously damage by burning or radiotherapy treatment,
* Suppression of immune system
* Exposure to certain chemicals such as arsenic
* Having been previously diagnosed with skin cancer
55
What are causes of Skin cancer?
* Sunlight: Ultraviolet A, Ultraviolet B, Ultraviolet C
* Sunlamps and tanning beds
56
What are the functions of the skin?
* External barrier to microbes, chemicals, UV radiation and antigens
* Temperature regulationvia sweat glands and blood flow
* Protection of internal structures
* Sensation
* Biochemistry - Vitamin D synthesis + androgens
* Immune suveillance
57
Label the structures of the skin
58
What is the impact of skin disease? 5 Ds
* Disfigurement
* Discomfort
* Disability
* Depression
* Death
59
What is the DERMATOLOGY LIFE QUALITY INDEX (DLQI)?
A tool used to assess the quality of life in skin disease
60
How is the quality of life in skin disease measured?
DERMATOLOGY LIFE QUALITY INDEX (DLQI)
Psoriasis area severity index
61
What is Bowen's disease?
* Is a precancerous form of SCC referred to as squamous cell carcinoma in situ.
* It develops slowly and is easily treated.
* Although not classed as non-melanoma skin cancer, Bowen's disease can sometimes develop into squamous cell carcinoma if left untreated.
62
How does Bowen's disease present?
* Red or pink
* Scaly or crusty
* Flat or raised
* Up to a few centimetres across
* Itchy but isn’t always
* Can appear on any area of skin.
* Most commonly affects elderly women and often found on lower leg
63
What are causes of Bower's disease?
* Long term exposure to the sun or use of sunbeds especially in people with fair skin
* Having a weak immune system
* Previously having radiotherapy treatment
* HPV which often affects the genital area and can cause genital warts
64
How is Bowen's disease managed?
* Cryotherapy
* Chemotherapy cream
* Curettage and cautery
* Photodynamic therapy
* Surgery
65
