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Year 4 Family and Children ANNA > Dermatology > Flashcards

Dermatology Flashcards

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1
Q

Why do you often get scaling in psoriasis?

A

Time to the surface for keratinocytes is decreased - normally takes 23 days, in psoriasis only 2-3!

Rapid turnover means that keratinoctyes rapidly reach the skin and accumulate → thick

and dry → scales

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2
Q

What happens to the nucleus of keratinocytes in psoriasis?

A

Doesn’t have time to lose nucleus so still present in stratum corneum = parakeratosis

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3
Q

What is the sign called where you scrape a scale off and can see dilated blood vessel?

A

Auspitz sign

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4
Q

What are the psoriatic nail changes here?

A

+ oil spots

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5
Q

What are the features of guttate psoriasis?

A
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6
Q

What is inverse / flexural psoriasis?

A

psoriasis localised to the skin folds and genitals.

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7
Q

What is this?

A

Palmoplantar pustulosis

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8
Q

What are some common complications of psoriasis?

A

Complications

  1. psoriatic arthropathy (around 10%)
  2. increased incidence of metabolic syndrome
  3. increased incidence of cardiovascular disease
  4. increased incidence of venous thromboembolism
  5. increased risk of T2 diabetes
  6. psychological distress
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9
Q

What is erythrodermic psoriasis?

A
  • When it covers over 90% of the body surface it is described as erythroderma.
  • The skin is red, feels hot and even painful.
  • You no longer have the clearly defined plaques.
  • Patients can feel unwell and become hypotensive.
  • These patients should be admitted to hospital for treatment.
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10
Q

What is Generalised Pustular Psoriasis?

A

Rarely a patient’s psoriasis can flare, become red, hot, painful and develop pustules within the plaques. This type of psoriasis, though rarely seen, is an emergency requiring hospital admission.

The trigger is WITHDRAWAL of inappropriate use of superpotent topical steroid (used for several months over a large body surface area) or systemic corticosteroids therapy.

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11
Q

Which medications could trigger psoriasis?

A
  1. antimalarials
  2. NSAIDs
  3. beta-blockers (non selective)
  4. lithium
  5. terbinafine (oral antifungal)
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12
Q

How do you counsel for phototherapy?

A
  1. Description of process
  2. It’s 2-3 times weekly for up to 10 weeks. Treatment lasts 3-10 minutes.
  3. You have to do it regularly so may not fit busy schedule
  4. Can re-flare when discontinued
  5. Lifetime risk of skin cancer → max 100 or so uses
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13
Q

When would you qualify for biologic psoriasis treatment?

A
  1. If you had tried 2+ systemic tx and these have failed
  2. Severe psoriasis - score 10+ (DLQI / PASI)

(it’s very ££££)

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14
Q

What is the difference between a blackhead and a whitehead?

A

a blackhead is “open” - you can see the build up of melanin in the trapped oil, a whitehead is “closed”. Both are due to blocked sebaceous ducts (by either sebum/oil or keratin)

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15
Q

What Qs should you ask with acne history?

A
  1. the age of onset and duration of the problem
  2. exacerbating factors (e.g. menstruation in women, anabolic steroids use in muscular individuals)
  3. prior and current treatments
  4. other health problems (Polycystic Ovarian Syndrome)
  5. other medications (topical and systemic steroids can cause acne)
  6. effects on social interactions/ work/ life
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16
Q

What bug is found in acne?

A

Propionibacterium Acnes

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17
Q

What is this?

A

Actinitic keratosis

Benign skin changes in response to sun exposure. But can be a site for malignancy to grow - check for changes

18
Q

What 2 risk factors are present in SCC but not BCC?

A

Smoking and chronic ulcers

19
Q

What are the 4 common risk factors for SCC and BCC?

What is also important?

A
  1. Chronic Ultraviolet Light Exposure
  2. Fitzpatrick Skin Type 1 & 2
  3. Chemicals
  4. Immunosuppression

Family History

20
Q

What skin type is someone who can tan but burns a lot first?

A

Fitzpatrick 2

21
Q

In a suspected malignant lesions we should also examine what areas?

A
  1. Draining lymph nodes
  2. Hepatomegaly
22
Q

From the description what is this:

indurated nodular lesions. Commonly they have crusted or hyperkeratotic surfaces.
Occasionally, lesions are ulcerated and rarely there are verrucous forms which can be mistaken for viral warts. Lesions are often painful and grow rapidly (over a few weeks to a couple of months).

A

SCC

23
Q

What are the 2 pre-cursors to SCC?

A

AK/SK (acitinic/solar keratosis) → Bowen’s disease → SCC

24
Q

What are the clinical features of SCC that suggest poorer prognosis?

A
  • Tumours > 2 cm in size are twice as likely to metastasise
  • Lesions on the lip or ear
  • Immunosuppression (tumours histologgically more aggressive)
25
Q

What are the histological features that give SCC poorer prognosis?

A
  • Invasion > 4mm
  • Perineural invasion
  • Nuclear atypia (poorly differentiated cells) have a poorer prognosis with increased risk of mestastasis
26
Q

What is the management for a high risk SCC?

A

Surgical excision with clear margins

27
Q

How do you counsel for UV exposure?

A
  • SPF 30+ and UVA (star rating 3-4) and B
  • Apply sun cream half an hour before to all exposed areas
  • Reapply every 2 hrs
  • Don’t rub
  • Never burn
  • Avoid sun between 11-3pm
  • Appropriate clothing - hold against light, darker
  • Hats!
28
Q

What is this lesion?

A

BCC

29
Q

What is the unifying feature of someone needing 2ww for ?melanoma?

A

any CHANGES

30
Q

What is the treatment for a suspected malignant melanoma?

A

The ONLY treatment for a lesion suspected to represent malignant melanoma is excision with a narrow margin (with a small number of exceptions). This is an urgent procedure and the dermatologist will try to arrange for this to happen the same day or within the same week.

31
Q

What is the scientific name for moles?

A

Melanocytic naevi

32
Q

Is horizontal or vertical melanoma growth more worrying?

What scale is used?

A

Vertical

BRESLOW THICKNESS of a melanoma measures the distance in mm from the granular layer in the epidermis to the deepest level on invasion in the dermis.

33
Q

What should you tell high risk patients to look for regarding melanomas?

A

“ugly duckling sign” - look for a mole that’s doing its own thing

34
Q

What is the scientific word for scratching?

A

excoriation

35
Q

What are the non-derm causes of widespread itch?

A

Neurological

  • Peripheral neuropathy
  • Post-herpetic neuropathy
  • Multiple sclerosis

Psychogenic

  • Parasitophobia
  • Obsessive-compulsive disorder
  • Depression/Anxiety

Metabolic

  • Hyperthyroidism
  • Chronic kidney disease
  • Secondary hyperparathyroidism
  • Uraemic pruritus
  • Diabetes

Gastrointestinal

  • Cholestasis

Malignancy

  • Hodgkin’s lymphoma (often causes paraneoplastic pruritus)
  • Myeloid and lymphatic leukaemia
  • Solid malignant tumours (paraneoplastic manifestation)

Haematological

  • Polycythaemia rubra vera
  • Myeloid dysplasia

Inflammatory

  • Dermatomyositis
  • Scleroderma

Infectious/infestations

  • HIV
  • Hepatitis C

Also DRUGS are a potential cause for widespread itch.

36
Q

What is the weighted 7 point checklist for suspected melanoma?

A

A NICE tool for weighing up whether referral is necessary. Score of 3 or more → refer 2ww

37
Q

What is in the weighted 7 point checklist for suspected melanoma?

A

Major features of the lesions (scoring 2 points each):

  1. change in size
  2. irregular shape
  3. irregular colour.

Minor features of the lesions (scoring 1 point each):

  1. largest diameter 7 mm or more
  2. inflammation
  3. oozing
  4. change in sensation
38
Q

What is this condition:

a superficial, contagious, blistering infection of the skin caused by the bacteria Staphylococcus aureus and Streptococcus pyogenes. It has two forms: non-bullous and bullous.

A

Impetigo

39
Q

What is the main symptoms of behcets?

A

genital and mouth ulcers

40
Q

What is DRESS syndrome?

A

Drug Rash with Eosinophilia and Systemic Symptoms

is an adverse reaction term that is currently used to describe a hypersensitivity reaction with an estimated mortality of up to 10%

MANAGE IN ICU / BURNS unit!

Patients routinely develop fever early on in the disease process, followed by the development of rashes. These may vary from a very mild exanthem to extensive blistering and skin loss, but is more often a pruritic, macular erythema which may contain papules, pustules or vesicles. Systemic involvement commonly manifests as lymphadenopathy, hepatitis, pericarditis, interstitial nephritis or pneumonitis.

Year 4 Family and Children ANNA (23 decks)

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