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Primary Care > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Koebner Phenomenon

A

Isomorphic Phenomenon- Linear exposure or irritation, seen most often in psoriasis, eczema, lichen planus and vitiligo.

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2
Q

Topical Steroids should be applied how far in advance of emollients?

A

> 30mins

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3
Q

Emollients should be applied in which direction?

A

Direction of hair growth

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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

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5
Q

For perioral infalammatory lesions use?

A 
1% hydrocortisone <7days 
If infected (angular cheilitis) - hydrocortisone + miconazole cream
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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

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7
Q

1 fingertip unit is sufficient to cover?

A

2x the size of the flat adult palm

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8
Q

Topical Corticosteroid potencies?

A

Mild- Hydrocortisone
Moderate- Betnovate
Potent - Betamethasone
Severe- Dermovate

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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
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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
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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
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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

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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

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14
Q

Citatricial pemphigoid usually occurs where and may cause?

A

Mucous membranes in the eyes/mouth

May cause visual loss due to scarring

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15
Q

When is pemphigoid gestationis most likely to remit and recur?

A

Remit after pregnancy

Recur durning subsequent pregnancies

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16
Q

Management of pemphigoid?

A 
Oral streroids-prednisolone 
Self limiting -50% Tx stopped after 2yrs
Other: Antibiotics
Nicotinamide
Azathioprine
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17
Q

What is Pemphigus?

A

AI disorder affecting skin and mucous membranes in adults (30-70yrs). Ass. w/t Myasthenia Gravis

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18
Q

Pemphigus presentation?

A
  • Mucocutanous erosions/ Blisters- 50% oral lesions
  • Flaccid superficial blisters- scalp, face, back, chest + flexures
  • Blisters burst - crusted erosions
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19
Q

Before treatment of pemphigus with high dose systemic steroids what was the outcome?

A

75% of patients died <4yrs

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20
Q

Prevalence of dermatitis herpetiformis amongst coeliacs?

A

2-5%

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21
Q

Dermatitis Herpetiformis occurs where?

A

Extensor surfaces, buttocks and scalp

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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)

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23
Q

What is epidermolysis bullosa?

A

Inherited disease causing blistering on minimal trauma

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24
Q

Linear IgA disease

A

Rare
Blisters and urticarial lesions
Back and Extensor Surfaces
Tx: Dapsone

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25
Q

Erythroderma (Exfoliative dermatitis)

A

Patchy erythema becomes universal >90% in <48hrs
Fever, shivering + malaise
2-6d Scaling
Acute Medical Emergency

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26
Q

Causes of erythroderma?

A

Eczema (40%)
Psoriasis (25%)
Lymphoma (15%)
Drug Eruption (10%)

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27
Q

Flushing definition?

A

Generalized erythema fue to vasodilatation

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28
Q

Causes of Flushing?

A
  • 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
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29
Q

Palmar erythema is associated with?

A

Pregnancy
Liver Disease
Polycythaemia

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30
Q

Erythema Nodosum (tender erythematous nodules extensor surfaces) is asscoiated with?

A 
Idiopathic 20%
Streptococcal Infection
OCP, Sulfonamides
Acute sarcoidosis
IBD
Malignancy 
TB
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31
Q

Erytema Nodosum usually takes how long to resolve?

A

<8wk, non-scarring

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32
Q

Erythema multiforme is?

A

Immune-mediated disease,
Red rings with central pale/ purple area on hands and feet
Frequently oral, conjunctival and genital mucosa

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33
Q

Causes of erythema multiforme?

A

Idiopathic 50%
Infective: Streptococcaal, HSV, HBV, mycoplasma
Drugs: Penicillin, Sulfonamide, Barbiturate
SLE, Pregnancy, Malignancy

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34
Q

Stevens-Johnson Syndrome

A

Severe Erythema multiforme

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35
Q

Rosacea

A

Relapsing and Remitting chronic inflammatory facial dermatosis - erythema and pustules

Flushing, erythema, telangiectasia, papules, pustules +/- lymphoedema

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36
Q

Rhinophyma

A

Complication of rosacea
Bullous appearance of nose
Eye involvement: blepharitis, dry eye and conjunctivitis

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37
Q

Treatment of roscae

A

Antibiotics repeated treatment:
topical metronidazole or azelaic acid - 3-4mnths
or
topical lymecycline or tetracycline - 4mnths
rebound may occur if antibiotics suddenly stopped

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38
Q

Livedo Reticularis

A

marbled, patterned cyanosis caused by cold, SLE, hyperviscosity

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39
Q

severe chilblains (inflammed purple swellings) treated with

A

oral nifedipine

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40
Q

Erythema ab igne

A

Reticulate pigmented eyrthema due to heat unduced damage (common in elderly)

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41
Q

Lyme disease

A

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

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42
Q

Treatment of Lyme disease

A

2-3wk course of doxycycline before flu-like symptoms, lymphadenopathy +/- splenomagaly and arthralgia

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43
Q

Complications of Lyme Disease

A

Neuro abnormalities
aseptic meningitis
myocarditis
arthritis

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44
Q

Chloasma

A

Patterned macular symetrical facial pigmentation usually involving the forehean +/- cheeks

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45
Q

Risk Factors for developing chloasma

A

Pregnancy
CHC
Dark skins
cosmetic soaps

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46
Q

Prevalence of Albinism

A

1/20,000

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47
Q

Vitiligo affects what percentage of the population?

A

1%

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48
Q

Vitiligo is associated with?

A

Pernicious anaemia
Addisson’d disease
Thyroid disease

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49
Q

Morphoea (localized scleroderma) presentation?

A

Round, oval plaques of induration and erythema which become smooth, shiny and white with violet borders
Leaves atrophic, hairless pigmented patches

50
Q

Causes of diffuse non-scarring alopecia? (alopecia tortalis)

A 
Male pattern baldness (tx:topical minoxidil)
hypothyroidism
iron deficiency
malnutrition
hypopituitarism
hypoadrenalism
drug-induced
51
Q

Causes of localized non scarring alopecia?

A

Alopecia areata- AI (tx. injected/systemic steroids)
Ringworm (fungal -red or silvery ring-like rash)
Trauma
SLE
secondary syphilis

52
Q

Causes of Hypertrichosis (Excess hair in non androgenic distribution on face and trunk)

A 
Drugs: Phenytoin, ciclosporin, minoxidil
malnutrition
Anorexia nervosa 
Porphyria cutanea tarda 
malignancy
53
Q

Local Hypertrichosis is caused by?

A

Topical steroid usage - melanocytic naevus, spina bifida occulta

54
Q

Hidradenitis suppuritiva

A

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
Q

Onset of atopic eczema (waxing and waning itchy)

A

<6mnths usually resolves in 60% by 1yr

56
Q

Diagnosis of atopic eczema?

A

Itch + >/= 3 of;

  • Itching in skin creases
  • Hx asthma or hayfever
  • Onset <2yr
  • Generally dry skin
  • Visible flexural eczema
57
Q

Compications of atopic eczema?

A
  • 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
Q

Referral of Eczema?

A
  • 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
Q

Hx of atopy with Prurigo Nodularis (intensely itchy firm lumps)

A

80%

60
Q

Contact Dermatitis

A

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
Q

Discoid (nummular) Eczema

A

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
Q

Venous (stasis, varicose) eczema

A

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
Q

Asteatotic Eczema (dry,itchy eczema w/t fine, crazy-paving pattern of fissuring and cracking of skin) Risk Factors ?

A 
Increasing age
overwashing
dry climate
hypothyroidim
diuretics
64
Q

Traetment of Asteatotic Eczema (dry,itchy eczema w/t fine, crazy-paving pattern of fissuring and cracking of skin)?

A

Emollients

Mild topical steroid

65
Q

Pompholyx

A

Sago-like intensely itchy vesicles
sides of fingers +/- palms/soles
Young adults
Not ass. w/t eczema or contact dermatitis

66
Q

Lichen Simplex Chronicus

A

Area of llichenified eczema due to repeated rubbing/scratching

67
Q

List the 5 patterns of seborrhoeic dermatitis (chronic scaly eruption affecting scalp, face +/- chest)?

A
  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
Q

Seborrhoeic Dermatitis treatment?

A

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
Q

Severe or resistant seborrhoeic dermatitis is an indicator of?

A

HIV

70
Q

Pyoderma Gangrenosum Presentation

A

Pustule/inflammed nodule breaks down to form a painful ulcer, expands rapidly
Purplish margin, erythema
Trunk, Lower limbs

71
Q

Causes of Pyoderma Gangrenosum?

A 
UC 50% of pyoderma gangrenosum
Crohns Disease
RA
Behcet's Syndrome
Multiple Myeloma and Monoclonal Gammopathy
Leakaemia
72
Q

Urticaria

A

Hives or nettle rash
Superficil, itchy swellings of the skin or weal
shifting rash

73
Q

Management of urticaria

A

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
Q

Management of angio-oedema?

A

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
Q

Angio-oedema

A

Deeper, longer lasting swellings, painful rather than itchy. Commonly affect eyes, lips, genitalia, hands, feet
May affect bowel or airway

76
Q

Urticaria Pigmentosa (cutaneous mastocytosis)

A

<2wks old
Dark freckle-like lesions - face, limbs or trunk
Become urticarial when the skin is rubbed
Clears spontaneously

77
Q

Ordinary/idiopathic Urticaria or angio-oedema weals last how long?

A

Individual weals last 2-24hrs

78
Q

Which type of physical urticaria lasts longer than 1hr?

A

(Mechanical) Delayed pressure urticaria

Weals appear in 2-6hrs and last over 48hrs

79
Q

Contact Urticaria is caused by?

A

Allergens or chemicals

weals last <2hr

80
Q

Urticarial Vasculitis?

A

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
Q

Drug-induced lone angio-oedema is caused by?

A

ACEi, ARBs, NSAIDs

82
Q

C1 esterase inhibitor deficiency (hereditary angio-oedema)

A

Presnts in puberty
Angio-oedema alone
Dx: Decreased C4 levels

83
Q

Which patients with hereditary angio-oedema should have maintenance treatment?

A

Anabolic steroids(testosterone) or tranexamic acid(prevents excess blood loss)

Patients with symptomatic, recurring angio-oedema
Related abdominal pain

84
Q

Inflammatory acne arises from he host response to which pathogen?

A

Propionibacterium acnes

85
Q

Acne

A

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
Q

Mild Acne definition and treatment ?

A

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
Q

Moderate Acne definition and treatment?

A

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
Q

Severe Acne definitionand treatment?

A

Nodular abscesses more widespread scarring

Tx:
Try tx for moderate, if failed
Oral retinoids

89
Q

Acne referral to dermatology?

A
  • 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
Q

Psoriasis definition?

A

Chronic, non-infectious, inflammatory skin condition. Epidermal cell proliferation is increased 20x
Turnover time is decreased from 28 to 4d

91
Q

Psoriasis is associated with?

A

IBD

Crohn’s > UC

92
Q

Patients with psoriasis have increased risk of? and you should check?

A

CVS Risk

Check BP, Lipids, exclude DM

93
Q

Causes of psoriasis?

A 
Genetic (25% chance child will have if 1 parent has)
Trauma - Koebner Phenomenon
Infection
Drugs: B Blockers, NSAIDs, Lithium 
Alcohol
Sunlight
Psychological Stress
94
Q

Treatment of Psoriasis?

A
  • 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
Q

Psoriasis Referral?

A

-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
Q

Generalized pustular psoriasis?

A

Unwell with fever and malaise
Sheets of small sterile yellowish pustules develop on erythematous background and spread rapidly
ADMIT

97
Q

Plaque Psoriasis?

A

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
Q

Guttate Psoriasis

A

Acute symmetrical raindrop lesions
Trunk, Limbs
Adolescents/ Young Children
May follow strep throat infection

99
Q

Flexural Psoriasis

A

Elderly Patients
Axillae, Submammary areas, natal cleft
Plaques are smooth and glazed

100
Q

Nail Psoriasis

A

Thimble pitting onycholysis and oily patches
Ass. w/t arthropathy
Tx is difficult

101
Q

Palmoplantar Pustulosos Psoriasis

A

Yellow/brown coloured sterile pustules on palms or soles

102
Q

Napkin Psoriasis

A

Well defined

Nappy area of infants

103
Q

Psoriatic Arthropathy affects what percentage of patients with skin changes (psoriasis)

A

40%

104
Q

Lichen Planus

A

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
Q

Types of lichen planus?

A 
Annular 10% - glans penis
Atrophic
Bullous
Follicular
Hypertrophic
Mucous membrane
106
Q

Complications of lichen planus?

A

Nails- Longitudinal pitting and grooving
Scalp - Scarring alopecia
Malignant change

107
Q

Treatment of lichen planus?

A

Emolients
Moderate/potent topical steroids : betnovate/betamethasone
Sedating antihistamines: chlorphenamine,hydroxyzine

108
Q

Lichen planus-liked drug reactions?

A 
Thiazide Diuretics
ACE inhibitors
Tolbutamide
Penicillamine 
Phenothiazides 
Streptomycin
Tetracycline
Isoniazid 
Gold 
Quinine
Chloroquine
109
Q

Treatment for callosities (painless, localized thickenings of the keratin layer)

A

Keratolytics
5-10% salicylic acid
10% urea cream

110
Q

Keratosis pilaris is associated with which other skin condition?

A

Ichthyosis Pilaris (Prevalence 1 in 300)

111
Q

Diffuse Keratoderma (hyperkeratosis of palms and soles) is called?

A

Tylosis

112
Q

Aqcuired Keratoderma is caused by?

A

Menopause

Lichen Planus

113
Q

Pityriasis Rosea

A

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
Q

Pityriasis (tinea) Versicolor is caused by which pathogen?

A

Pityrosporum orbiculare

115
Q

Pityriasis (tinea) Versicolor presentation?

A

Pinkish-brown oval/round patches w/t fine scale
Hypopigmenation in tanned patients
Trunk and proximal limbs

116
Q

Treatment of tinea?

A

Topical imidazole antifungal - clotrimazole
or Topical selenium sulfide shampoo 2x weekly
Resistant cases - systemeic antifungal - itraconazole 1wk

117
Q

Pityriasis alba

A

Finely scaled white patches on face and arms
Children/ Young adults
Ass. w/t atopy

118
Q

Typical dermoscopic features of seborrhoeic warts?

A 
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
Q

Seborrhoeic warts (Senile wart, Basal cell papilloma) presentation?

A 
>60yrs
multiple
trunk
pigmented
"stuck-on" appearance 
Pieces of wart can be picked off
120
Q

Tx for seborrrhoeic warts/senile warts/ basl cell papilloma?

A

Reassurance

Removal:
cryotherapy
curettage
shave biopsy
excision biopsy

Primary Care (9 decks)

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