Dermatology Flashcards
1
Q
Koebner Phenomenon
A
Isomorphic Phenomenon- Linear exposure or irritation, seen most often in psoriasis, eczema, lichen planus and vitiligo.
2
Q
Topical Steroids should be applied how far in advance of emollients?
A
> 30mins
3
Q
Emollients should be applied in which direction?
A
Direction of hair growth
4
Q
Topical Steroids-Contraindications
A
C/I Urticaria
C/I Rosacea
Not recommended for acne
May worsen - ulcerated or secondarily infected lesions
Should only be used in pruritis if inflammation is caused itch
Should not be used on the face long term >7-14days
5
Q
For perioral infalammatory lesions use?
A
1% hydrocortisone <7days If infected (angular cheilitis) - hydrocortisone + miconazole cream
6
Q
Rebound Relapse is be caused by
A
Def: Generalized, pustular psoriasis +/- local and systemic toxicity
Caused by potent topical or sytemic steroids used to treat psoriasis
7
Q
1 fingertip unit is sufficient to cover?
A
2x the size of the flat adult palm
8
Q
Topical Corticosteroid potencies?
A
Mild- Hydrocortisone
Moderate- Betnovate
Potent - Betamethasone
Severe- Dermovate
9
Q
Referral of Patients with Purpura
A
- unwell patients with new purpura/petechia (E)
- well children/ young adults w/t unexplained petechiae (I)
- Well older adults with unexpplained bruising, bleeding or purpura- check FBC, blood film, clotting screen, ESR/viscosity/CRP
10
Q
Causes of Itching + Skin Lesions?
A
Urticaria Contact Dermatitis + Allergies Prickly Heat Skin Infestations- Scabies, Pediculosis, Insect Bites Infections - Viral-chickenpox, Fungal Dermatitis Herpetiformis Lichen Planus Senile Atrophy Psyhcological
11
Q
Causes of itching in the abscence of skin lesions?
A
- Obstructive jaundice, pregnancy
- DM, thyrotoxicosis, hypothyroidism, hyperparathyroidism
- Chronic Renal Failure
- Polycythaemia Vera, Iron def, leukaemia,Hodgkin’s disease
- Malignancy
- Drug Allergies
- Schizophrenia, Obsessive states
- Diabetes Insipidus, Ringworm Infection
12
Q
Causes of Blisters
A
Subcorneal: Pustular Psoriasis, Bullous Impetigo
Intraepidermal: Eczema, HSV, VZ-chickenpox or shingles, pemphigus, friction
Subepidermal: Burns, Pemphigoid, Dermatitis Herpetiformis, linear IgA disease
Other: Insect bites
13
Q
An elderly patient has blisters on the limbs, trunk and flexures. Preceeded by urticarial reaction. The patient most likely has?
A
Bullous Pemphigoid
14
Q
Citatricial pemphigoid usually occurs where and may cause?
A
Mucous membranes in the eyes/mouth
May cause visual loss due to scarring
15
Q
When is pemphigoid gestationis most likely to remit and recur?
A
Remit after pregnancy
Recur durning subsequent pregnancies
16
Q
Management of pemphigoid?
A
Oral streroids-prednisolone Self limiting -50% Tx stopped after 2yrs Other: Antibiotics Nicotinamide Azathioprine
17
Q
What is Pemphigus?
A
AI disorder affecting skin and mucous membranes in adults (30-70yrs). Ass. w/t Myasthenia Gravis
18
Q
Pemphigus presentation?
A
- Mucocutanous erosions/ Blisters- 50% oral lesions
- Flaccid superficial blisters- scalp, face, back, chest + flexures
- Blisters burst - crusted erosions
19
Q
Before treatment of pemphigus with high dose systemic steroids what was the outcome?
A
75% of patients died <4yrs
20
Q
Prevalence of dermatitis herpetiformis amongst coeliacs?
A
2-5%
21
Q
Dermatitis Herpetiformis occurs where?
A
Extensor surfaces, buttocks and scalp
22
Q
How long does it take for dermatitis herpetiformis to clear up and what should be used as treatment in the meantime?
A
Dapsoneor sulfapyridine (antibiotics)
23
Q
What is epidermolysis bullosa?
A
Inherited disease causing blistering on minimal trauma
24
Q
Linear IgA disease
A
Rare
Blisters and urticarial lesions
Back and Extensor Surfaces
Tx: Dapsone
25
Erythroderma (Exfoliative dermatitis)
Patchy erythema becomes universal >90% in <48hrs
Fever, shivering + malaise
2-6d Scaling
Acute Medical Emergency
26
Causes of erythroderma?
Eczema (40%)
Psoriasis (25%)
Lymphoma (15%)
Drug Eruption (10%)
27
Flushing definition?
Generalized erythema fue to vasodilatation
28
Causes of Flushing?
- Physiological
- Emotion
- Foods- Spices, Alcohol
- Menopause, Cushings
- Opioids, Tamoxifen, Danazol, GnRH analogues,Clomifene, Nitrates, CCB
- Rosacea, Contact dermatitis
- SLE, dermatomyositits
- Infection - slapped cheeck syndrome (5th disease), cellulitis/erysipelas
- Pancreatic tumour, medullary thyroid ca, carcinoid, phaeochromocytoma
29
Palmar erythema is associated with?
Pregnancy
Liver Disease
Polycythaemia
30
Erythema Nodosum (tender erythematous nodules extensor surfaces) is asscoiated with?
```
Idiopathic 20%
Streptococcal Infection
OCP, Sulfonamides
Acute sarcoidosis
IBD
Malignancy
TB
```
31
Erytema Nodosum usually takes how long to resolve?
<8wk, non-scarring
32
Erythema multiforme is?
Immune-mediated disease,
Red rings with central pale/ purple area on hands and feet
Frequently oral, conjunctival and genital mucosa
33
Causes of erythema multiforme?
Idiopathic 50%
Infective: Streptococcaal, HSV, HBV, mycoplasma
Drugs: Penicillin, Sulfonamide, Barbiturate
SLE, Pregnancy, Malignancy
34
Stevens-Johnson Syndrome
Severe Erythema multiforme
35
Rosacea
Relapsing and Remitting chronic inflammatory facial dermatosis - erythema and pustules
Flushing, erythema, telangiectasia, papules, pustules +/- lymphoedema
36
Rhinophyma
Complication of rosacea
Bullous appearance of nose
Eye involvement: blepharitis, dry eye and conjunctivitis
37
Treatment of roscae
Antibiotics repeated treatment:
topical metronidazole or azelaic acid - 3-4mnths
or
topical lymecycline or tetracycline - 4mnths
rebound may occur if antibiotics suddenly stopped
38
Livedo Reticularis
marbled, patterned cyanosis caused by cold, SLE, hyperviscosity
39
severe chilblains (inflammed purple swellings) treated with
oral nifedipine
40
Erythema ab igne
Reticulate pigmented eyrthema due to heat unduced damage (common in elderly)
41
Lyme disease
Borrelia Burgdorferi
Erythema migrans- a red macule/papule on the upper arm, leg or trunk 7-10days after tick bite
Expands to form ring w/t central clearing
42
Treatment of Lyme disease
2-3wk course of doxycycline before flu-like symptoms, lymphadenopathy +/- splenomagaly and arthralgia
43
Complications of Lyme Disease
Neuro abnormalities
aseptic meningitis
myocarditis
arthritis
44
Chloasma
Patterned macular symetrical facial pigmentation usually involving the forehean +/- cheeks
45
Risk Factors for developing chloasma
Pregnancy
CHC
Dark skins
cosmetic soaps
46
Prevalence of Albinism
1/20,000
47
Vitiligo affects what percentage of the population?
1%
48
Vitiligo is associated with?
Pernicious anaemia
Addisson'd disease
Thyroid disease
49
Morphoea (localized scleroderma) presentation?
Round, oval plaques of induration and erythema which become smooth, shiny and white with violet borders
Leaves atrophic, hairless pigmented patches
50
Causes of diffuse non-scarring alopecia? (alopecia tortalis)
```
Male pattern baldness (tx:topical minoxidil)
hypothyroidism
iron deficiency
malnutrition
hypopituitarism
hypoadrenalism
drug-induced
```
51
Causes of localized non scarring alopecia?
Alopecia areata- AI (tx. injected/systemic steroids)
Ringworm (fungal -red or silvery ring-like rash)
Trauma
SLE
secondary syphilis
52
Causes of Hypertrichosis (Excess hair in non androgenic distribution on face and trunk)
```
Drugs: Phenytoin, ciclosporin, minoxidil
malnutrition
Anorexia nervosa
Porphyria cutanea tarda
malignancy
```
53
Local Hypertrichosis is caused by?
Topical steroid usage - melanocytic naevus, spina bifida occulta
54
Hidradenitis suppuritiva
Chronic inflammatory condition of sweat glands in axilla, groinand perineum
Nodules, abscesses, cysts and sinuses form which lead to scarring
Tx: topical chlorhexidine, systemic antibiotics (tetracycline) and drainage
55
Onset of atopic eczema (waxing and waning itchy)
<6mnths usually resolves in 60% by 1yr
56
Diagnosis of atopic eczema?
Itch + >/= 3 of;
- Itching in skin creases
- Hx asthma or hayfever
- Onset <2yr
- Generally dry skin
- Visible flexural eczema
57
Compications of atopic eczema?
- Skin thickening and scaling
- Bacterial Infection: secondary , S.aures, Tx: topical Steroid + fucidic acid or systemic AB: flucloxacillin or erythromycin
- Viral Infection:
- Catracts
- Growth Retardation
58
Referral of Eczema?
- Infection with diseminated HSV
- Severe eczema resistant to treatment
- Infection which cannot be cleared
- Severe social/psychological problems
- Tx req excessive amounts of topical steroids
- Failure to control symptoms
- Patch teting required if contact dermatitis
- Dietary Factors are suspected
59
Hx of atopy with Prurigo Nodularis (intensely itchy firm lumps)
80%
60
Contact Dermatitis
is precipitated by an exogenous agent (irritant or allergen)
Acute: itchy erythema and skin oedema +/- papules, vesicles or blisters
Chronic: lichenification, scaling and fissuring
Tx: Emolients and topical steroids
61
Discoid (nummular) Eczema
Elderly Patients
Intensely itchy, coin shapeed lesions on limbs - symmetrical
Vesicular or chronic and lichenified
Tx: tends to remit
-moderate or potent steroid
-Fusidine( steroid + fusidic acid) or tetracycline
-hydroxyzine - antihistamine
62
Venous (stasis, varicose) eczema
Elderly Patients
Ass. w/t underlying venous disease
Early signs: capillary veins and haemosiderin deposition around the ankles and over the prominent varicose veins
Late signs: eczema + lipodermatosclerosos + ulceration
Tx: Emollients, Mild/Moderate steroids
63
Asteatotic Eczema (dry,itchy eczema w/t fine, crazy-paving pattern of fissuring and cracking of skin) Risk Factors ?
```
Increasing age
overwashing
dry climate
hypothyroidim
diuretics
```
64
Traetment of Asteatotic Eczema (dry,itchy eczema w/t fine, crazy-paving pattern of fissuring and cracking of skin)?
Emollients
| Mild topical steroid
65
Pompholyx
Sago-like intensely itchy vesicles
sides of fingers +/- palms/soles
Young adults
Not ass. w/t eczema or contact dermatitis
66
Lichen Simplex Chronicus
Area of llichenified eczema due to repeated rubbing/scratching
67
List the 5 patterns of seborrhoeic dermatitis (chronic scaly eruption affecting scalp, face +/- chest)?
1. Scalp and facial: Young men, ass. blepharitis
2. Petaloid: pre-sternal area
3. Pityrosporum Folliculitis:Papules/pustules over the back
4. Flexural: Elderly, ass w/t candida infection
5. Infantile
68
Seborrhoeic Dermatitis treatment?
Facial, Truncal, Flexural:
Imidazole + hydrocortisone
Pityrosporum Folliculitis: Itraconazole 7d or Fluconazole 2wks
Scalp Lesons: Ketoconazole
Coal tar shampoo
Resistant cases apply 2%sulphur +2% salicylic acid cream before shampooing
Recurrence:maintenance tx w/t antifungal
69
Severe or resistant seborrhoeic dermatitis is an indicator of?
HIV
70
Pyoderma Gangrenosum Presentation
Pustule/inflammed nodule breaks down to form a painful ulcer, expands rapidly
Purplish margin, erythema
Trunk, Lower limbs
71
Causes of Pyoderma Gangrenosum?
```
UC 50% of pyoderma gangrenosum
Crohns Disease
RA
Behcet's Syndrome
Multiple Myeloma and Monoclonal Gammopathy
Leakaemia
```
72
Urticaria
Hives or nettle rash
Superficil, itchy swellings of the skin or weal
shifting rash
73
Management of urticaria
Acute <6wks :
- Cetirizine, Fexofenadine (Non-sedating antihistamine)
- chlorphenamine, hydroxyzine (if affects sleep)
- Topical menthol 1% cream - alternative to antihistamines
- If severe, prednisolone 3-5days
```
Chronic >6wks :
Check FBC, TFTs, ESR, potential causes?
Specialist req-
cimetidine, ranitidine (H2 receptor antagonists)
montelukast (anti-leukotrienes)
```
74
Management of angio-oedema?
If anaphylaxis suspected - adrenaline
Admit if airway compromised
Otherwise;
Acute:
-Cetirizine, Fexofenadine (Non-sedating antihistamine)
-chlorphenamine, hydroxyzine (if affects sleep)
-Topical menthol 1% cream - alternative to antihistamines
-If severe, prednisolone 3-5days
75
Angio-oedema
Deeper, longer lasting swellings, painful rather than itchy. Commonly affect eyes, lips, genitalia, hands, feet
May affect bowel or airway
76
Urticaria Pigmentosa (cutaneous mastocytosis)
<2wks old
Dark freckle-like lesions - face, limbs or trunk
Become urticarial when the skin is rubbed
Clears spontaneously
77
Ordinary/idiopathic Urticaria or angio-oedema weals last how long?
Individual weals last 2-24hrs
78
Which type of physical urticaria lasts longer than 1hr?
(Mechanical) Delayed pressure urticaria
| Weals appear in 2-6hrs and last over 48hrs
79
Contact Urticaria is caused by?
Allergens or chemicals
| weals last <2hr
80
Urticarial Vasculitis?
Lesions are burning/painful rather than itchy
Lesions leave scaling, bruising, purpura/petechial haemorrhages
Suspect if relentless rather than self limiting
Weals last >24hrs
Ass. w/t arthralgia, fever +/- malaise
81
Drug-induced lone angio-oedema is caused by?
ACEi, ARBs, NSAIDs
82
C1 esterase inhibitor deficiency (hereditary angio-oedema)
Presnts in puberty
Angio-oedema alone
Dx: Decreased C4 levels
83
Which patients with hereditary angio-oedema should have maintenance treatment?
Anabolic steroids(testosterone) or tranexamic acid(prevents excess blood loss)
Patients with symptomatic, recurring angio-oedema
Related abdominal pain
84
Inflammatory acne arises from he host response to which pathogen?
Propionibacterium acnes
85
Acne
Chronic inflammatory condition characterized by comodones (dilated pores with black plug of keratin), papules (cream coloures, red), pustules +/- cysts.
Scarring from old lesions
Severe: Burrowing abscesses and sinuses w/t conglobate acne (scarring)
86
Mild Acne definition and treatment ?
Open and Closed comodones and some papules
Tx:
Topical to entire area
-Benzoyl peroxide bd build up
-Topical Retinoids (Isotretinoin) Low strength prearation every 2-3nights, build up strength and frequency
-Clindamycin (topical AB) in conjuction with benzoyl peroxide or if failed
87
Moderate Acne definition and treatment?
More frequent papules and pustules with mild scarring
Tx:
Try topical tx for 4-8wks (may be used with systemic tx)
-Long term oral antibiotic tetracycline 8wk min.
-OCP cyproterone, co-cyprindiol >6mnths
88
Severe Acne definitionand treatment?
Nodular abscesses more widespread scarring
Tx:
Try tx for moderate, if failed
Oral retinoids
89
Acne referral to dermatology?
- Acne Fulminans (adolescdent males, severe acne, fever, arthritis + vasculitis)
- Severe acne or painful, deep nodules or cysts
- Severe social/psychologicla sequelae
- At risk of developing scarring
- Poor tx response
- Suspected underlying cause for acne
90
Psoriasis definition?
Chronic, non-infectious, inflammatory skin condition. Epidermal cell proliferation is increased 20x
Turnover time is decreased from 28 to 4d
91
Psoriasis is associated with?
IBD
| Crohn's > UC
92
Patients with psoriasis have increased risk of? and you should check?
CVS Risk
| Check BP, Lipids, exclude DM
93
Causes of psoriasis?
```
Genetic (25% chance child will have if 1 parent has)
Trauma - Koebner Phenomenon
Infection
Drugs: B Blockers, NSAIDs, Lithium
Alcohol
Sunlight
Psychological Stress
```
94
Treatment of Psoriasis?
- Emollient
- Salicylic Acid (decreases surface scale)
- Coal Tar (anti-inflammatory + anti-scaling)
- Vit D analogue (calcipotriol, tacalcitol)
- Dithranol (plaque psoriasis)
- Topical Retinoids (tazarotene)-mild/mod plaque psoriasis
- Topical steroids: dovobet = calcipotriol + betamethasone
95
Psoriasis Referral?
-Generalized pustular or erythrodermic psoriasis
-Acutely unstable
-widespread guttate psoriasis
Symptoms are troublesome
-Severe social/occupational/psychological sequlae
-Management of associated arthropathy
-Failure to respond to tx
96
Generalized pustular psoriasis?
Unwell with fever and malaise
Sheets of small sterile yellowish pustules develop on erythematous background and spread rapidly
ADMIT
97
Plaque Psoriasis?
Most common
Well-defined disc shaped plaques
Knees, elbows scalp, hair margin or sacrum
Red plaques covered with waxy white scales
Bleeding points if detached
98
Guttate Psoriasis
Acute symmetrical raindrop lesions
Trunk, Limbs
Adolescents/ Young Children
May follow strep throat infection
99
Flexural Psoriasis
Elderly Patients
Axillae, Submammary areas, natal cleft
Plaques are smooth and glazed
100
Nail Psoriasis
Thimble pitting onycholysis and oily patches
Ass. w/t arthropathy
Tx is difficult
101
Palmoplantar Pustulosos Psoriasis
Yellow/brown coloured sterile pustules on palms or soles
102
Napkin Psoriasis
Well defined
| Nappy area of infants
103
Psoriatic Arthropathy affects what percentage of patients with skin changes (psoriasis)
40%
104
Lichen Planus
Very itchy, ponygonal, flat-topped papular lesions
Flexor surfaces, palm/soles, mucous membranes and genitalia
Koebner Phenomenon
Wickham's striae - surface network of white lines
Initially papules are red but become violaceous
Papules flatten leaving pigmentation
105
Types of lichen planus?
```
Annular 10% - glans penis
Atrophic
Bullous
Follicular
Hypertrophic
Mucous membrane
```
106
Complications of lichen planus?
Nails- Longitudinal pitting and grooving
Scalp - Scarring alopecia
Malignant change
107
Treatment of lichen planus?
Emolients
Moderate/potent topical steroids : betnovate/betamethasone
Sedating antihistamines: chlorphenamine,hydroxyzine
108
Lichen planus-liked drug reactions?
```
Thiazide Diuretics
ACE inhibitors
Tolbutamide
Penicillamine
Phenothiazides
Streptomycin
Tetracycline
Isoniazid
Gold
Quinine
Chloroquine
```
109
Treatment for callosities (painless, localized thickenings of the keratin layer)
Keratolytics
5-10% salicylic acid
10% urea cream
110
Keratosis pilaris is associated with which other skin condition?
Ichthyosis Pilaris (Prevalence 1 in 300)
111
Diffuse Keratoderma (hyperkeratosis of palms and soles) is called?
Tylosis
112
Aqcuired Keratoderma is caused by?
Menopause
| Lichen Planus
113
Pityriasis Rosea
Herald Patch- Single, large oval lesion consisting of Generalized eruption many smaller lesions-oval, pink and scale
Trunk, upper arms and thighs
Christmas tree Pattern
Fades spontaneously in 4-8wks
114
Pityriasis (tinea) Versicolor is caused by which pathogen?
Pityrosporum orbiculare
115
Pityriasis (tinea) Versicolor presentation?
Pinkish-brown oval/round patches w/t fine scale
Hypopigmenation in tanned patients
Trunk and proximal limbs
116
Treatment of tinea?
Topical imidazole antifungal - clotrimazole
or Topical selenium sulfide shampoo 2x weekly
Resistant cases - systemeic antifungal - itraconazole 1wk
117
Pityriasis alba
Finely scaled white patches on face and arms
Children/ Young adults
Ass. w/t atopy
118
Typical dermoscopic features of seborrhoeic warts?
```
Fat Fingers
Irregular Crypts
Light brown fingerprint-like parallel structures
Milia-like cysts 2types;
-tiny, white starry
-large, yellowish, cloudy
Fissures/ridges
Blue-grey globules
```
119
Seborrhoeic warts (Senile wart, Basal cell papilloma) presentation?
```
>60yrs
multiple
trunk
pigmented
"stuck-on" appearance
Pieces of wart can be picked off
```
120
Tx for seborrrhoeic warts/senile warts/ basl cell papilloma?
Reassurance
```
Removal:
cryotherapy
curettage
shave biopsy
excision biopsy
```
