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GP Block > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are the causes of acne?

A
  • Propionibacterium acnes
  • Increased androgens (puberty, PCOS, congenital adrenal hyperplasia)
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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)
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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
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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
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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
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6
Q

What are the complications of acne?

A
  • Scars
  • Depression
  • Anxiety
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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
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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
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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)
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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
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11
Q

What investigations should be performed for eczema?

A
  • Clinical diagnosis
  • Skin biopsy
  • Patch testing (allergic contact dermatitis)
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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
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13
Q

How is the skin barrier impaired in eczema?

A
  • Genetic defects
  • Reduced antimicrobial pepetides production
  • Decreased sebaceous secrection
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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.
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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
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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
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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.
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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
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19
Q

There are five official types of psoriasis. List them

A
  • plaque.
  • guttate.
  • inverse.
  • pustular.
  • erythrodermic.
  • psoriatic arthritis
  • Scalp
  • Nail
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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.
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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
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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
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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
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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.
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25
Q

What is pustular psoriasis?

A
  • Small, non-infectious pus-filled blisters
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26
Q

What is erythrodermic psoriasis?

A
  • 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
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27
Q
A
28
Q

What are the sign and symptoms of psoriasis?

A
  • 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
Q

How should psoriasis be investigated?

A
  • Clinical diagnosis
  • Skin biopsy/scraping
30
Q

How is psoriasis best managed?

A
  • 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
Q

What are factors to assess in the management of Psoriasis?

A
  • 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
Q

What can cause Allergic rashes and urticaria?

A
  • -Food
  • Pollen and Plants
  • Insect Bites and Stings
  • Chemicals
  • Latex
  • Dust Mites
  • Heat
  • Sunlight
  • Exercise
  • Water,
  • Medicines
  • Infections
  • Emotional Stress
33
Q

What is the presentation of Allergic rashes and urticaria?

A
  • Itchy
  • Stinging or Burning
  • Red Spots or patches
34
Q

How do you manage allergic rashes and urticaria?

A
  • 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
Q

How is Chronic Urticaria classified?

A
  • For chronic urticaria use validated too Chronic Urticaria Quality of Life Questionnare (CU-Q2oL)
36
Q

What are the risk factors for basal carcinoma?

A
  • UV
  • Lighter skin
  • Radiation
  • Arsenic
  • Poor immune system
37
Q

What is more common, basal cell carcinomas or squamous cell carcinomas?

A
  • BCC - 75%
  • SCC - 20%
38
Q

What are the types of BBC?

A
  • Superficial
  • Infiltrative
  • Nodular
39
Q

How does BCC present?

A
  • 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
Q

How is BCC managed?

A
  • Surgical removal
  • Cryosurgery
  • Radiation
41
Q

What are the risk factors for sqaumous cell carcinoma?

A
  • Older age
  • Male
  • Fair-skinned
  • Exposure to UV
  • Arsenic
  • Bowen disease
  • HPV
  • HIV/AIDS
  • Radiation
42
Q

Outline the pathophysiology of SCC

A
  • Slow growing
  • Tends to rise to pre-malignant lesions
  • Can spread to tissue, bone, LNs (more malignant than BCC)
43
Q

What are the signs and symptoms of SCC?

A
  • 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
Q

How is SCC managed?

A
  • Surgical excision
  • Dermabrasion
  • Cryosurgery
  • Topical chemotherapy
  • Ablative and non-ablative lasers
45
Q

Outline the risk factors for melanoma

A
  • Family history
  • Many moles
  • Poor immune system
46
Q

Outline the pathophysiology of melanoma

A
  • Development from melanocytes that have out-of control growth
47
Q

What are the signs and symptoms of melanoma?

A
  • Mole that is increasing in size
  • It has irregular edges
  • Changes in colour
  • Itchiness
  • Skin breakdown
48
Q

How should melanoma be investigated?

A
  • Skin exam
  • Tissue biopsy
  • Sentinel node biopsy
  • ABCDE
    • Asymmetry
    • Border uneven
    • Colouring different shade of brown
    • Diameter >6mm
    • Evolves over time
49
Q

How should melanoma be managed?

A
  • Surgical removal
  • Spread = immunotherapy
  • Biological therapy
  • Radiation
  • Chemotherapy
50
Q

What are preventative steps for skin cancers?

A
  • 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
Q

What are investigations for Skin Cancer?

A
  • Biopsy
  • Fine needles aspiration in some cases
52
Q

What is referral for skin cancer based on?

A
  • Change in size
  • Irregular shape
  • Irregular colour
  • Largest diameter 7 mm or more
  • Inflammation
  • Oozing
  • Change in sensation
53
Q

What do cancerous lumps tend to present as?

A
  • Most cases, the cancerous lumps are red and firm and sometimes turn into ulcers
54
Q

What are risk factors for skin cancers?

A
  • 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
Q

What are causes of Skin cancer?

A
  • Sunlight: Ultraviolet A, Ultraviolet B, Ultraviolet C
  • Sunlamps and tanning beds
56
Q

What are the functions of the skin?

A
  • 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
Q

Label the structures of the skin

A
58
Q

What is the impact of skin disease? 5 Ds

A
  • Disfigurement
  • Discomfort
  • Disability
  • Depression
  • Death
59
Q

What is the DERMATOLOGY LIFE QUALITY INDEX (DLQI)?

A

A tool used to assess the quality of life in skin disease

60
Q

How is the quality of life in skin disease measured?

A

DERMATOLOGY LIFE QUALITY INDEX (DLQI)

Psoriasis area severity index

61
Q

What is Bowen’s disease?

A
  • 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
Q

How does Bowen’s disease present?

A
  • 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
Q

What are causes of Bower’s disease?

A
  • 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
Q

How is Bowen’s disease managed?

A
  • Cryotherapy
  • Chemotherapy cream
  • Curettage and cautery
  • Photodynamic therapy
  • Surgery
65
Q
A

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