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Dermatology Flashcards

1
Q

3 things to describe a rash?

A

Distribution
Configuration
Morphology

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2
Q

Give 3 examples of distribution a rash can be

A

Skin folds
Flexural
Hands and feet

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3
Q

Give 4 examples of rash configuration

A

Linear
Annular (ring)
Discoid (coin)
Cluster

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4
Q

What is macule morphology?

A

<0.5cm flat (non-palpable) areas e.g. freckle

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5
Q

What is patch morphology?

A

> 0.5cm flat area e.g. port wine stain

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6
Q

What is papule morphology?

A

<0.5cm solid raised lesion

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7
Q

What is nodule morphology?

A

> 0.5cm solid raised lesion with deeper component i.e. granuloma

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8
Q

What is plaque morphology?

A

Well circumscribed, PALPABLE scaling lesion e.g. psoriasis

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9
Q

What is vesicle morphology?

A

<0.5cm raised, clear fluid filled lesion - HSV

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10
Q

What is bulla morphology?

A

> 0.5cm raised, clear fluid filled lesion

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11
Q

What is pustule morphology?

A

<0.5cm pus containing lesions - acne

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12
Q

What is abscess morphology?

A

Localised accumulation of pus in dermis or subcutaneous

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13
Q

What is a weal?

A

Transient raised lesion due to dermal oedema - urticaria

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14
Q

What is a boil?

A

Staphylococcus infection around or within hair follicle

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15
Q

What is excoriation?

A

Loss of epidermis after trauma e.g. eczema

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16
Q

What is lichenification?

A

Well defined roughening, thickening of skin with loss of skin markings

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17
Q

What is a scale?

A

Flakes of stratum corneum

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18
Q

What is a crust?

A

Rough surface of dried blood serum or pus

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19
Q

What is a scar?

A

New fibrous tissue occurring post wound healing

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20
Q

3 types of scars

A

Atrophic - thinning
Hypertrophic - hyperproliferation within boundary
Keloidal - hyperproliferation beyond boundary

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21
Q

What is an ulcer?

A

Loss of the epidermis and dermis

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22
Q

What is a fissure?

A

Epidermal crack due to excess dryness

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23
Q

6 functions of normal skin

A 
Protection
Temperature regulation
Sensation
Vitamin D synthesis
Immunosurveillance
Stop fluid loss
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24
Q

3 layers of skin in order from top to bottom

A

Epidermis - top
Dermis
Subcutaneous tissue - bottom

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25
4 cell types in epidermis
Keratinocytes produce keratin Langerhan's cells activate T lymphocytes Melanocytes produce melanin Merkel cells for sensation
26
4 layers of the epidermis?
``` Stratum basale (dividing cells) Stratum spinosum (differentiating) Stratum granulosum (lose nuclei) Stratum corneum (keratin) ```
27
What is the dermis made from (4)
Collagen mainly Elastin Glycoaminoglycans Fibroblasts
28
4 stages of wound healing?
Haemostasis (vasoconstriction, platelet aggregation) Inflammation (vasodilation, migration of neutrophils) Proliferation (granulation tissue) Remodelling (scar)
29
SHIP DOC systemic corticosteroids side effects
``` Syndrome Hypertension Immunosuppression Psychosis Diabetes Osteoporosis Cataracts ```
30
What is eczema?
A chronic, relapsing inflammatory skin condition characterised by itchy erythematous scaly patches
31
Distribution of eczema?
``` Flexor surfaces (skin folds) in children/adults INFANTS - face and extensor surfaces ```
32
Cause of eczema?
Combination of genetic susceptibility and environment | Defect in skin barrier function and immune dysregulation after allergen exposure
33
What is the genetic defect in skin barrier function in eczema?
Mutation in filaggrin - epidermal barrier protein | Increased exposure and sensitivity
34
What is the immune dysregulation in eczema?
Th2 mediated immune response Over expression of Il-4, 5, 13 Leads to increased IgE and eosinophilia
35
6 exacerbating factors of eczema
``` Infection Soaps Dust mites Sweat Heat Stress ```
36
Risk factors for eczema (2)
Atopy | Family history
37
How is eczema diagnosed?
Itchy skin +3 of: Flexural involvement - historical or visible History of asthma, hayfever of family history if <4 Generally dry skin in last year Onsert before 2 years old
38
Symptoms of eczema (5)
``` Itchy skin (pruritis) Dry skin (xerosis) Erythematous scaly patches on flexor surfaces Acute lesions - weeping Lichenification/excoriation Hypopigmentation ```
39
Investigations for eczema?
Serum IgE levels | Allergy testing - specific IgEs skin prick or RAST (radioallergosorbant test)
40
2 complications of eczema
``` Bacterial superinfection (staph aureus) Eczema herpeticum - EMERGENCY ```
41
4 stages of eczema treatment
1 - emollients, avoid irritants/soaps, identify triggers 2 - low/mid potency topical corticosteroids (hydrocortisone) or topical calcineurin inhibitors (tacrolimus) 3 - mid/high potency topical corticosteroids and/or topical calcineurin inhibitors (tacrolimus) 4 - systemic corticosteroids (prednisolone), azathioprine or ciclosporin, or UV therapy
42
What is tacrolimus?
Calcineurin inhibitor - steroid sparing immunomodulator
43
How to treat bacterial infection of eczema
Flucloxacillin or erythromycin
44
How to treat eczema herpeticum
Aciclovir
45
What is contact dermatitis?
Hand eczema - history of contact with irritants/allergic reaction Localised burning, itching, blistering at site of contact
46
How to treat contact dermatitis
Irritant - emollients, topical corticosteroids, avoid irritant Allergic - topical corticosteroids, avoid allergen
47
What is seborrhoeic dermatitis?
Pruritic, erythematous, scaly patched on SCALP, NASOLABIAL FOLD OR FRONT CHEST Cradle cap in infants, dandruff adults or pityriasis capitis (fungal)
48
Treatment of seborrhoeic dermatitis?
Infants - emollients, topical corticosteroids Adults - topical shampoo, topical corticosteroids, topical antifungals (ketoconazole) Oral ketoconazole if persistent
49
What is psoriasis?
Inflammatory disease due to proliferation of keratinocytes and inflammatory cell infiltrate
50
What does psoriasis plaque look like?
Erythematous, well-circumscribed, scaly plaques at extensor surfaces and scalp
51
2 associated symptoms/conditions with psoriasis
Nail changes - pitting, Beau's lines, oncholysis | Psoriatic arthritis
52
Cause of psoriasis?
Interaction between genetic (TNF alpha), immunological, environmental (stress), infection
53
Pathology of psoriasis?
Hyperproliferation of keratinocytes. Silver scale is dead cells
54
6 types of psoriasis
``` Plaque - most common Guttate (post strep throat) Seborrheic - nose, ears Flexural Palmar-plantar pustular Erythrodermic ```
55
Management of psoriasis? (8)
``` Avoid triggers Emollients Vitamin D analogues Topical corticosteroids Coal tar preparations Phototherapy Oral methotrexate, retinoids, ciclosporin Biologics - etanecerpt, infliximab ```
56
How is plaque psoriasis treated?
Topical corticosteroid and/or vitamin D analogue | Phototherapy/methotrexate/retinoid/biologic
57
What is acne vulgaris?
Inflammatory disease of pilosebaceous follicles
58
What causes acne?
Hormones - androgens cause increased sebum, comedones form and become colonised with propionibacterium acnes, causes inflammation
59
Types of non inflammatory acne (2)
Blackheads - open comedones | Whiteheads - closed comedones
60
Types of inflammatory acne (3)
Papules Nodules Cysts
61
Topical therapies for acne (3)
Topical keratolytic - salicyclic acid Topical retinoids - isotrenoin Topical antibiotics - erythromycin
62
Oral therapies for acne (3)
Oral antibiotics - doxycycline Anti-androgens - COCP Oral retinoids - isotrenoin
63
What are the types of skin cancer
10% melanoma 20% squamous cell carcinoma METS COMMON (premalignant = actinic keratosis, in situ = Bowen's) 70% basal cell carcinoma METS RARE
64
What is squamous cell carcinoma?
Locally invasive malignant tumour of epidermal keratinocytes, potential to metastasise
65
Risk factors for squamous cell carcinoma? (4)
``` UV exposure Chronic inflammation Immunosuppression Fair skin Outdoor occupation ```
66
Presentation of squamous cell carcinoma? (3)
Keratotic (crusty/scaly) ill defined nodule Possible ulceration or bleeding Possible lymphadenopathy or hepatomegaly if spread
67
Investigations of squamous cell carcinoma?
Biopsy - keratinocyte atypia | CT/MRI for mets
68
Management of squamous cell carcinoma? (3)
In situ - cryotherapy or topical chemotherapy Invasive - wide surgical excision Metastatic - excision plus radiotherapy
69
What is basal cell carcinoma?
Slow growing, locally invasive, malignant tumour of epidermal keratinocytes arising from hair follicle
70
Risk factors for basal cell carcinoma
``` UV exposure Fair skin Age Male Immunosuppression ```
71
Presentation of basal cell carcinoma?
Rodent ulcer - small papule/nodule with surface telangectasia, pearly rolled edge and necrotic or ulcerated centre
72
Investigation of basal cell carcinoma?
Biopsy for histopathology - small dark staining basal cells invading the dermisM
73
Management of basal cell carcinoma? (3)
Surgical excision Radiotherapy If low risk - cryotherapy, photodynamic therapy, topical chemotherapy
74
How to describe a pigmented lesion?
``` Asymmetry Border Colour Diameter Evolution ```
75
What is malignant melanoma?
Invasive malignant tumour of the epidermal melanocytes
76
Risk factors for malignant melanoma?
``` UV exposure Fair skin Lots of moles/atypical Family history Immunosuppression ```
77
Presentation of melanoma?
Asymmetrical, jagged border, non uniform colour >6mm diameter Evolving colour shape or size
78
Investigations of melanoma? (3)
Dermatoscopy for ABCDE Skin biopsy - abnormal melanocytic proliferation Assess mets - lymph node biopsy, CXR, liver USS, CT
79
Management of melanoma (3)
In situ - wide local excision Invasive - wide local excision with sentinel lymph node biopsy Mets - lymphadenectomy, radiotherapy, chemotherapy
80
What is impetigo?
Staphylococcus aureus infection common in children | Golden crusts or vesicles in bullous impetigo
81
What causes impetigo
Staph aureus infection in skin susceptible post trauma, in eczema
82
How is impetigo treated?
Topical fusidic acid | Oral flucloxacillin
83
Types of herpes simplex?
1 - oral 2 - genital Treat with aciclovir
84
What is cellulitis?
Spreading bacterial infection of deep subcutaneous tissue causing overlying skin inflammation (red, oedema, warm, tender)
85
What is erysipelas
Acute superficial cellulitis
86
Organism in cellulitis
Staph aureus (or strep pyogenes)
87
Risk factors for cellulitis
``` Immunosuppression Wounds Leg ulcers Poor hygiene Poor vascularisation ```
88
Investigations for cellulitis
Bloods - raised WCC on FBC, blood culture, swab
89
Management of cellulitis
Flucloxacillin 250mg 6hrly | If very ill, IV vancomycin or tazocin to cover MRSA
90
Give some examples of fungal infections
Tinea corporis Tinea pedis - moist fissures between toes Tinea capitis - scalp ringworm - broken hair, scaling Tinea unguium - yellow crumbly nails Candidiasis - white plaques on mucosa
91
Treatment of fungal infections?
``` Swabs for organism Treat triggers - moisture, immunoosuppressives Topical antifungals - ketoconazole Oral antifungals - fluconazole AVOID TOPICAL STEROIDS ```
92
What is a wart and what causes it
Elevated round, hyperkeratotic skin papules with rough grey brown surface HPV 6-11
93
Treatment of warts
Cryotherapy Salicyclic acid Silver nitrate Debridement
94
What is molloscum contagiosum?
Viral, acquired skin to skin Pearly smooth papule with central umbilication, face and groin Treated with cryotherapy
95
What is scabies?
Infection with mites, transmissed skin to skin | Itchy red papules, linear burrows between fingers
96
Investigation of scabies?
Microscopic confirmation of mites eggs or faeces in skin scrapings
97
Treatment of scabies
Treat whole family, hot wash clothes | Topical permethrin
98
What is an ulcer?
Abnormal break in the epithelial surface, commonly venous
99
Causes of venous ulcers?
Chronic venous insufficiency Incompetent valves, blood squeezed into superficial veins causing dilatation, raised pressure causes oedema and fibrin deposition, poor oxygenation of skin and ulcration
100
Signs of chronic venous insufficiency? (5)
``` Ankle swelling Hyperpigmentation Heavy legs Dry scaly skin Varicosities ```
101
Risk factors for venous ulcers? (4)
Age Family history Smoking DVT
102
Presentation of venous ulcers (5)
Medial/lateral malleolus between knee and ankle | Large, shallow, painless/mild pain, irregular border, moist granulating base
103
Investigation of venous ulcers
ABPI and doppler to exclude arterial Swabs for microbiology Biopsy if atypical
104
Management of venous ulcers (4)
Graduated compression and leg elevation Debridement and cleaning Occlusive hydrocolloid dressing ABX if infected
105
Cause of arterial ulcers?
Atherosclerosis, tissue hypoxia
106
Risk factors for arterial ulcers
CV RFs - smoking, diabetes Absent pulses Ischaemia - pain, pulseless, perishingly cold, paraesthesia, paralysis
107
Site of arterial ulcers
more distal than venous - dorsum of foot or toes
108
Presentation of arterial ulcers (4)
``` Painful Irregular edge initially Grey granulating base No bleeding on debridement Punched out, cold shiny surrounding skin ```
109
Investigations of arterial ulcers
ABPI (cuff above ankle) and doppler (on dorsum of feet) | Divide systolic at ankle by that at arm - <0.9 indicates peripheral arterial disease
110
Management of arterial ulcers
Management of peripheral vascular disease - analgesia, refer to surgeons
111
What are neuropathic ulcers?
Ulcer formed due to paraesthesia and peripheral neuropathy - painless skin breakdown
112
Site of neuropathic ulcers
under callouses, pressure points | plantar aspect of 1st and 5th metatarsopharangeal joint
113
Presentation of neuropathic ulcers (4)
``` Punched out, deep Surrounded by chronic inflammatory tissue Bleeding on debridement Painless May be necrotic ```
114
Treatment of neuropathic ulcers
Seek cause - often diabetes | Diabetic foot management - socks, shoes, hygiene, check sensation
115
What is urticara?
Itchy wheals - transient central swellling with peripheral oedema
116
Pathophysiology of urticaria
Local increase in permeability of capillaries and venules mediated by histamine derived from skin mast cells, IgE response
117
Treatment of urticaria
antihistamines - chlorphenamine, loratidine
118
3 Signs of anaphylaxis
Bronchospasm - stridor Facial and laryngeal oedema Hypotension
119
Causes of urticaria/anaphylaxis (4)
``` Food allergy - nuts, shellfish Drugs - penicillin Contact - latex Bites - bees Autoimmune ```
120
What is erythema nodosum?
Erythematous lumps on shins due to inflammation of subcutaneous fat
121
Causes of erythema nodosum (4)
IBD TB Strep throat Sarcoidosis
122
Treatment of erythema nodosum
Treat cause | Prednisolone
123
What is erythema multiforme
Hypersensitivity reaction triggered by infection Acute, self limiting inflammation, HSV, SLE Lesions spreading from back hands/top feet to body
124
What is steven-johnson syndrome?
Mucocutaneous necrosis with at least 2 mucosal sites | Preceding use of medication use or infection - anticonvulsants, ABX, NSAIDs
125
What is toxic epidermal necrolysis?
Mucocutaneous necrosis with at least 2 mucosal sites involved with SYSTEMIC TOXICITY 25% mortality
126
Signs of SJS/TEN?
Maculopapular rash Bullae Sloughing under pressure
127
Management of SJS/TEN
``` Escalate Withdraw causative agent Dressings, topical emollients IV fluids Analgesia ```
128
What is necrotising fasciitis?
Rapidly spreading infection of deep fascia with secondary tissue necrosis
129
Cause of nec fas
Group a haemolytic strep - pyogenes RFs - abdo surgery, diabetes, comorbidities
130
Presentation of nec fas
Severe pain Erythematous, blistering necrotic skin Systemically unwell - fever, tachycardi Crepitus - asubcutaneous emphysema
131
management of nec fas
Surgical debridement Haemodynamic support Empirical broad spec ABX - i.e. vancomycin, tazocin
132
What is seborrheic keratosis and how treated?
Common multiple benign lesions affecting over 50s Well circumsribed plaques or papules, warty, brown Painless Steroids or cryotherapy
133
What is lichen planus?
Self limiting inflammatory disease affecting skin and genitals, nails, hair Common in middle ages women Intense pruritus, scarring
134
How does lichen planus present
Itchy, shiny, flat topped papules Extremities, mucosal Overlying white lacy network
135
Management of lichen planus
Topical corticosterois and antihistamine Oral corticosteroid if on mouth
136
5 causes of systemic itch
Renal failure - urea mediated Cholestatic pruritus - bile salt mediated Haematological - polycythaemia vera = increased basophils and mast cells Endocrine - hyper/hypothyroid, diabetes Malignant - hodgkins lymphoma
137
What is alopecia areata?
Autoimmune disease - inflammatory t cells target hair follicles preventing growth Associated with HLA
138
Treatment for alopecia
Limited. Topical corticosteroid, cosmetic camouflage Topical immunotherapy Often spontaneous regrowth

3B Revision (3 decks)

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