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Phase 3B > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What are the different layers forming the skin?

A
  • Stratum corneum
  • Stratum lucidum
  • Stratum granulosum
  • Stratum spinosum
  • Stratum basale
  • Dermis
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2
Q

What cells give skin it’s pigmentation and which layer do they lay in?

A

-Melanocytes in the basal layer

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3
Q

When describing skin lesions how is it best to describe them?

A
  • Distribution
  • Configuration
  • Morphology
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4
Q

What are some distribution factors of skin lesions to consider?

A 
-Where on the body it is?
>Flexures ie eczema
>Extensors ie psoriasis
>On the face ie seborrhoeic
>Dermatomoal ie shingles
>Intertriginous ie in moist areas such as under the breast
-Pattern
>Symmetrical ie vitilgo
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5
Q

What are some configuration factors of skin lesions?

A
  • Linear
  • Targetoid (3 concnetric rings ie erythema multiforme)
  • Annular (ring shaped) ie tinea, ring worm, lupus
  • Discoid ie discoid lupus
  • Reticular ie livedo reticularis
  • Clusters
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6
Q

How can the morphology of a skin lesion be described?

A
  • Macular (flat)
  • Papule (raised)
  • Plaque (elevated, well circumscribed raised area) ie psoriasis
  • Nodule (big papule)
  • Vesicle (small blister - if >5mm = bulla)
  • Crust (dry blood/serum)
  • Scale (hyperkeratosis)
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7
Q

What is the most important diagnosis to consider with a skin lesion?

A

-Skin cancer

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8
Q

What are the Fitzpatrick skin types

A

I: never tans, always burns (red hair, freckles, blue eyes
II: usually tans, always burns
III: always tans, sometimes burns (dark hair, brown eyes)
IV: always tans, rarely burns (olive skin)
V: Sunburn and tan after extreme UV exposure (brown skin)
VI: Black skin, never tans, never burns

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9
Q

What is the most common type of skin cancer?

A

-Basal cell carcinoma

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10
Q

What are the risk factors for basal cell carcinoma?

A
  • UV exposure in the elderly (long time exposure)
  • Fair skin
  • Immune suppression
  • Genetic factors
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11
Q

What are the features of basal cell carcinomas?

A
  • Shiny ‘pearly surface’
  • Telangiectasia (branch line capilarries)
  • Central nodule/’rodent ulcer’
  • Surface ulceration
  • Rolled edge
  • Locally invasive (won’t met)
  • Slow growing over 1+ year
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12
Q

How are superficial BCCs managed?

A
  • Creams if stay superficial
  • Excision by Moh’s micrographic surgery >for ill-defined and large BCC on risky sites
  • Radiotherapy
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13
Q

What are risk factors/causes for malignant melanoma

A
  • UV light exposure
  • Fair skin (Fitzpatrick I or II)
  • Red hair
  • > 100 Naevi on body
  • > 5 atypical naevi on body
  • Family history
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14
Q

What are features of malignant melanoma?

A
  • Asymmetry
  • Border irregularity
  • Colour irregularity
  • Diameter >6mm
  • Evolving
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15
Q

What is the most common type of melanoma?

A

-Superficial spreading

> others: nodular, lentigo maligna, melanoma of the nails

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16
Q

What is the most important prognostic indicator for malignant melanoma?

A

-Breslow thickness

> Thickness of the melanoma. thicker = worse prognosis

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17
Q

How is malignant melanoma treated?

A
  • Excision

- Chemo, radio and immunlogical therapy for palliative pts with mets disease

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18
Q

Where do malignant melanomas commonly metastasis to?

A
  • Lungs

- Brain

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19
Q

Which skin cancer is most likely to be keratotic and faster growing?

A

-Squamous cell carcinomas

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20
Q

What are risk factors/causes for squamous cell carcinomas?

A
  • UV light exposure over long time frame
  • Immune suppression
  • Actinic keratoses and Bowen’s disease
  • Smoking
  • Long standing leg ulcers
  • Genetic conditions ie albinism, xeroderma pigmentosum
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21
Q

What are features of squamous cell carcinoma?

A
  • Potential to metastasise
  • High risk sites: lips and ears
  • Keratotic appearance
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22
Q

How are SSCs treated?

A
  • Surgical excision

- Moh’s micrographic surgery for high risk pts/cosmetic areas

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23
Q

What are 3 types of ulcers seen on skin?

A
  • Venous
  • Arterial
  • Neuropathic
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24
Q

What are features of venous ulcers?

A
  • Commonly over the medial malleolus
  • May have varicose veins
  • Haemosiderin patches/deposits in the skin
  • Lipodermatosclerosis
  • Venous eczema (dry/shiny)
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25
Q

How are venous ulcers managed?

A
  • Compression bandages as 1st line

- Refer to vascular surgery if not effective

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26
Q

What is the most important investigation to perform for skin ulcers?

A

-ABPI
>Normal: 0.9-1.2
»Compression bandages should not be used if <0.9 as could lead to criticla limb ischaemia

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27
Q

What are features of arterial ulcers?

A
  • Peripherally located at distal points, pressure sites
  • Deep, punched out and necrotic
  • Painful
  • Shiny skin
  • Increased cap refill time
  • Absent pedal pulses
  • Hypoperfusion signs ie lack of hair
  • Risk factors for ateial disease
  • Abnormal ABPI
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28
Q

How are arterial ulcers managed?

A
  • Referral to vascular surgeons
  • Exercise
  • Modify CV Risk factors
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29
Q

What are the features of neuropathic ulcers?

A
  • Most commonly seen in diabetes
  • Commonly over plantar surface of the metatarsal head and hallux
  • Occur on pressure sites
  • Punched out/necrotic
  • Caused by sensory impairment to the area
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30
Q

How are neuropathic ulcers treated?

A
  • Education of diabetic foot health

- Cushioned shoes and appropriate dressings to relieve pressure and reduce callous formation

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31
Q

What is the most common form of eczema/dermatitis?

A

-Atopic eczema

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32
Q

What are some triggers/causes of eczema?

A
  • Dry skin
  • Hot/cold temperatures
  • Irritants
  • Allergy
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33
Q

What are features of eczema?

A
  • Patches of dry red itchy skin
  • Adults/older children: flexor surfaces
  • Babies: face and trunk
  • Contact dermatitis: in distribution to exposure
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34
Q

How is eczema managed?

A
  • Emollients daily
  • Topical steroids for acute flares: when not responding to treatment
  • Steroid sparing agents
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35
Q

What are some examples of steroid sparing agents?

A
  • Topical calcineuin inhibitors: tacrolimus
  • Antihistamines (fotr itch)
  • 2nd line systemic treatments: azathioprine, MTX
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36
Q

What life threatening emergency caused by herpes simplex virus 1 or 2?

A
  • Eczema herpeticum

- Usually occurs in children with pre-existing eczema

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37
Q

What is the management for eczema herpeticum?

A
  • Admit to hospital

- IV acyclovir

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38
Q

What is psoriasis?

A
  • Chronic skin condition which squaly plaques form on the extensor surfaces of the body
  • Can affect scalp and nails
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39
Q

What are the different types of psoriasis?

A
  • Chronic plaque psoriasis
  • Flexure psoriasis
  • Scalp
  • Guttate
  • Palmar-plantar
  • Nail
  • Generalised pustular
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40
Q

What are the features of nail psoriasis?

A
  • Pitting
  • Oncholysis
  • Thick/hyperkeratotic nails
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41
Q

What are some possible triggers of psoriasis?

A
  • Stress
  • Alcohol
  • Smoking
  • Trauma
  • Steroid withdrawal
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42
Q

Which medications trigger psoriasis?

A
  • Beta blockers
  • Lithium
  • NSAIDs
  • ACEi
  • TNF inhibitors
  • Anti-malarials
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43
Q

What is Koebner phenomenon?

A

-Psoriasis that spreads to an area of skin that has been broken
ie will move down the track line a scratch

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44
Q

How is psoriasis managed?

A
  1. Emollients
  2. Topical steroids and vit D analogues ie Dovobet
  3. Vit D analogues
  4. UV light therapy
  5. Traditional systemic therapies ie retinoids, MTX, ciclosporin
  6. Biologics ie anti-TNF (infliximab, adalamumab)
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45
Q

What other factors need to be considered/looked for with someone who has psoriasis?

A
  • Psoriatic arthritis

- Adults with psoriasis are at increased risk of CV disease

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46
Q

What triggers guttate psoriasis and what is it?

A
  • Triggered by strep throat (strep group A)
  • Raindrop shaped plaques
  • Silver scale
  • Trunk
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47
Q

How is guttate psoriasis investigated and treated?

A

-Throat swab for anti-streptolysin O titre
-RX:
>Most self resolve within 2-3 months
>Topical agents as per psoriasis
>UVB phototherapy

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48
Q

What is acne vulgaris?

A

-Common skin condition affecting adolescents usually affecting the face, neck and trunk

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49
Q

What’s the pathology behind acne?

A

-Obstruction of the pilosebacious follicles with keratin plugs causing:
>Comedones
>Inflammation
>Pustules

50
Q

What is the causative organism responsible for acne vulgaris?

A

-Propionibacterium acnes

51
Q

What are the features of acne vulgaris?

A
  • Comedones: dilated sebaceous follicles (closed top: white heads, open top: blackheads)
  • Papules
  • Pustules
  • Nodules
  • Cysts
  • Scarring
52
Q

How is acne vulgaris managed?

A
  • Single topical therapy ie topical retinoids or benzylperoxide
  • Topical combination ie tetracycline and a stage 1 topical therapy
  • Oral antibiotics (oxytetracycline or doxycyline) may need to wait 3-4 months
  • Oral isotretinoin
53
Q

What are some side effects of isotretinoin?

A
  • Dry skin
  • Depression
  • Liver function derangement
  • Increase in serum triglyceride
  • Teratogenic
  • Hair thinning
  • Nose bleeds
  • IIH
  • Photosensitivity
54
Q

What is Wallace’s rule of 9s for burns?

A
  • Arm 9%
  • Front of leg 9%
  • Back of leg 9%
  • Front of torso 9%
  • Back of torso 9%
  • Front of abdomen 9%
  • Back of abdomen 9%
  • Head and neck 9%
55
Q

What are different gradings for burns?

A
  • Superficial epidermal: red, painful
  • Superficial dermal: red, painful, blistered
  • Deep dermal: decreased sensation, white
  • Full thickness: white, no pain, no blisters, muscle and bone involvement
56
Q

What is the Parkland formula for burns?

A

-Calculates how much fluid replacement someone needs following a burn

57
Q

What is the calculation for the Parkland formula?

A
  • Fluid requirement (mls) = TSBA burn (%) x body weight (kg) x 4
  • over 24 hours
58
Q

What is the management of burns?

A
  • ABCDE
  • Stop the burning
  • Clingfilm
  • Monitor U&Es
  • Superficial burns: use emollients
  • If circumferential: escharotomy
  • Analgesia
  • Non-adherent dressing
59
Q

What are the indications for referral to secondary care

A
  • Any burn affecting the face, neck, hands, feet and genitals
  • Any deep dermal or full thickness burns
  • Smoke inhalation injury
  • Chemical or electrical burns
  • NAI
60
Q

What are the features of acne roasacea?

A
  • Affects the nose, cheeks and forehead
  • Flushing (can be alcohol related)
  • Telangiectasia
  • Later: develops into persistent erythema with papules and pustules
  • Rhinophyma
  • Blepharitis, keratitis, conjunctivitis
61
Q

How is acne rosacea managed?

A
  • topical metronidazole
  • Systemic antibiotics: oxytetracycline
  • high SPF suncream
  • Camouflage creams to conceal redness
  • Laser treatment for telangectasia
  • surgical repair of rhinophyma
62
Q

What is bullous phemigoid?

A
  • An autoimmune condition causing sub-epidermal blistering of the skin
  • Causes itchy tense blisters around the flexures
63
Q

Who is commonly affected by bullous phemigoid?

A

-Elderly patients

64
Q

What does a biopsy of bullous phemigoid contain?

A

-IgG and C3

65
Q

How is bullous phemigoid managed?

A
  • Refer to dermatology

- Oral corticosteroids

66
Q

What is vitilgo?

A
  • An autoimmune disease causing a loss of melanocytes = depigmentation
  • Commonly presents in 20s-30s
67
Q

Management of vitiligo?

A
  • Sunscreen for affected areas
  • Camouflage make up
  • Topical corticosteroids
  • ?Tacrolimus and phototherapy
68
Q

What diseases are associated with vitiligo?

A
  • T1DM
  • Addison’s disease
  • Pernicious anaemia
  • Autoimmune thyroid disease
  • Alopecia areata
69
Q

What is alopecial areata?

A
  • An autoimmune cause of localised hair loss

- Occurs in well demarcated patches

70
Q

Management of alopecia areata?

A
  • Usually regrows back itself
  • Education
  • Topical steroids
  • Topical minoxidil (restores blood supply to area)
  • Phototherapy
  • Contact immunotherapy
  • Wigs
71
Q

What is erythema nodosum?

A

-Inflammation of the subcutaneous fat

72
Q

What are the features of erythema nodosum?

A
  • Tender
  • Erythematous
  • Nodular lesions
  • Usually over the shins
73
Q

What are the causes of erythema nodosum?

A
  • Infection ie TB, strep
  • Systemic disease ie IBD, sarcoidosis, Bechets
  • Malignancy ie lymphoma
  • Pregnancy
  • Drugs ie penicillin, cocp, sulphonamides
74
Q

How is erythema nodosum managed?

A
  • Usually self resolves within 6 weeks
  • Lesions heal without scarring
  • Treat pain with analgesia
75
Q

What is pellagra?

A
  • A disease caused by deficiency of nicotinic acid (Vit B3)
  • Common in alcoholics
  • Can occur as consequence of isoniazid therapy
76
Q

What are the features of pellagra?

A 
-4 Ds
>Diarrhoea
>Dementia/depression
>Dermatitis - brown and scaly skin on sun exposed areas
>Death (if not treated)
77
Q

How is pellagra managed?

A

-Vitamin B3 supplementation

78
Q

What is keratocanthoma?

A

-Benign epithelial tumour filled with keratin
>looks like a volcano/crater
>SCC needs to be excluded

79
Q

How are keratocanthomas managed?

A

-Usually regress within 3 months. (often scars)
-Should be excised
>5% progress to SCC

80
Q

What is seborrhoeic dermatitis?

A

-Chronic inflammation reaction to a normal skin inhabitant - Malassezia furfur

81
Q

What are some associations with seborrhoeic dermatitis?

A
  • HIV

- Parkinson’s disease

82
Q

Which parts of the body does seborrhoeic dermatitis affect?

A
  • Scalp
  • Periorbital
  • Auricular
  • Nasolabial folds
  • Cheeks
83
Q

How is face and body seborrhoeic dermatitis managed?

A
  • Topical antifungals ie ketoconazole

- Topical steroids (for short term use for acute flares)

84
Q

How is scalp seborrhoeic dermatitis treated?

A
  • Head and shoulders shampoo (contains zinc pyrithione)
  • 2nd line: ketoconazole
  • Selenium as topical steroid
85
Q

What are seborrhoiec keratoses?

A

-Seborrhoeic warts
>benign, epidermal lesions
-Commonly affects older people

86
Q

What are the features of seborrhoiec keratosis?

A
  • Vary in colour: pink fleshy, light brown, dark brown, black
  • ‘Stuck on’ appearance
  • Keratotic plugs on surface
87
Q

Management of seborrhoeic keratoses?

A
  • Reassure as benign

- Removal if irritating: curettage, cryosurgery

88
Q

What is actinic keratosis?

A

-Premalignant condition associated with chronic skin exposure

89
Q

What is the spectrum of disease associated with actinic keratosis?

A
  1. Photodamage
  2. Actinic keratosis
  3. SCC in situ (Bowen’s disease)
  4. Invasive SCC
90
Q

What are the features of actinic keratosis?

A
  • Small crusty lesions
  • Pink, red, brown or skin colour
  • Typically on skin exposed areas
  • Multiple lesions can be present
91
Q

How are actinic keratoses managed?

A
  • Reduce further risk with sun avoidance/sunscreen
  • Flurouracil cream
  • Topical diclofenac
  • Cyrotherapy
  • Curretage and cautery
92
Q

What is erythema abigne?

A

-Rash caused by heat exposure
ie old lady using hot water bottle to treat back pain for hours
-Risk factor for SSC
-Needs to treat the reason why they are using the heat ie the back pain

93
Q

What is acanthosis nigricans?

A

-Brown/black poorly defined velvety hyperpigmentation
-Found in the body folds
>neck
>axilla
>groin
>umbilicus
>forehead

94
Q

What conditions are associated with acanthosis nigricans?

A

-Insulin resistance
-Paraneoplastic
>pancreatic and gastric malignancies
>involvement of mucous membranes suggests malignancy

95
Q

What are the features of pyoderma gangrenosum?

A
  • A lesion which initially starts as a small red papule and later develops into a deep red necrotic ulcer with a purple border
  • Typically affects lower limbs
96
Q

What causes pyoderma gangrenosum?

A
  • 50% idiopathic
  • IBD
  • Connective tissue disorders: RA, SLE
  • Myeloproliferative disorders
  • Lymphoma, myeloid leukaemia
  • Monoclonal gammopathy
  • Primary billiary cirrhosis
97
Q

How is pyoderma gangrenosum treated?

A
  • Oral steroids

- If not responsive: ciclosporin, infliximab

98
Q

What are features of lichen sclerosus?

A
  • An inflammatory condition affecting the vulva
  • White plaques caused by atrophy of the epidermis and itch
  • Biopsy is diagnostic
99
Q

How is lichen sclerosus managed?

A
  • Topical steroids
  • Emollients
  • Careful follow up due it increased risk of vulval cancer
100
Q

What are the features of lichen planus?

A

-All the Ps:
>Purple
>Pruritic
>Papular
>Polygonal
-Most common on palms, soles and genitals
-White lace pattern on the surface ‘Wickham’s striae’
-Nail signs: thinning of nail plate, longitudinal ridging

101
Q

What are some causes of lichenoid drug eruptions?

A
  • Gold
  • Quinine
  • Thiazides
102
Q

How is lichen planus managed?

A
  • Topical steroids
  • Oral disease: benzylamine mouthwash
  • Oral steroids/Immune suppression for extensive disease
103
Q

What is molluscum contagiosum?

A

-Raised papules caused by molluscum contagiosum virus

104
Q

What is molluscum transmitted?

A
  • Close personal contact

- Contaminated surfaces such as shared towels and flannels

105
Q

What are features of molluscum?

A
  • Pinkish/pearly white papules
  • Central umbilication
  • Up to 5mm diameter
  • Lesions appear in clusters
  • Spares palms and soles
  • Children: trunk and flexures
  • Adults: sexual contact can lead to lesions on the genitalia, pubis, thighs, lower abdomen
106
Q

Self care advice for molluscum?

A
  • Advise patients this is a self limiting condition, lasts <18 months
  • Contagious towel sharing
  • Don’t scratch
107
Q

What are treatment options for molluscum?

A
  • Squeeze after a bath
  • Cyrotherapy
  • Steroids if itchy
  • Antibiotics if crusted/infective looking
108
Q

When should someone with molluscum be referred for specialist input?

A
  • HIV positive
  • Eyelid/ocular margin lesions
  • Anogenital lesions: refer to GUM
109
Q

What is scabies?

A
  • A sarcopetes scabeii bite
  • Commonly affects children and young adults (shared houses)
  • Eggs laid in stratum corneum
110
Q

What are the features of scabies?

A
  • Widespread pruritus
  • Linear burrows (side of fingers, web spaces, flex of wrist
  • Excoriations
  • Infants: face and scalp
  • Complicated in immunosuppressed: crusted scabies
111
Q

How long will the pruritus from scabies persist for following successful treatment?

A

-4-6 weeks

112
Q

How is scabies treated?

A
  • Permethrin 5%
  • Ensure whole household treated
  • Clean all clothes, bedding, towels etc on 1st day of treatment
113
Q

WHat is hyperhidrosis?

A

-Excesive sweating

114
Q

How is hyperhidrosis managed?

A
  • Topical aluminium chloride
  • Electric current: iontophoresis
  • Botox of axilla
  • Surgery
115
Q

What is hereditary haemorrhagic telengectasia?

A

-An autosomal dominant condition characterised by multiple telangiectasia over the skin and mucus membranes

116
Q

What are the diagnostic criteria for hereditary haemorrhagic telengiectasia?

A
  1. Epistaxis: Spon. nose bleeds for >3/7
  2. Telangiectasia: Multiple at lips, oral cavity, fingers, nose
  3. Visceral lesions: Gi telangiectasia (on colonscopy), Atriovenous malformations - pulmonary, hepatic, cerebral, spinal
  4. Family history
117
Q

What are the features of pityriasis rosea?

A
  • Acute self-limiting rash (resolves after 4-12 weeks)
  • Young adults
  • Associated with HHV-7
  • Herald patch (early lesion) - appears on trunk
  • Followed by erythematous oval scaly patches
  • URTI prodrome
118
Q

What skin condition is a medical emergency?

A

-Erythroderma!

>when >95% of skin is involved in a rash of any kind

119
Q

What are some causes of erythroderma?

A
  • Idiopathic
  • Eczema
  • Psoriasis
  • Lymphoma
  • Leukaemia
  • Drugs: Gold
120
Q

What are features of erythroderma?

A
  • Dry mucous membranes
  • Pain/discomfort
  • Hypothermia
  • Electrolyte imbalances
121
Q

What parameters need monitoring for a pt with erythroderma?

A
  • Dehydration
  • Infection
  • High output cardiac failure (SOB)
  • Hypothermia
122
Q

How is erythromderma managed?

A
  • Admit to hospital urgently
  • IV fluids
  • Analgesia
  • Emollients
  • Cool wet dressings
  • Bed rest in warm room
  • Nutritional support

Phase 3B (14 decks)

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