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Dermatology Flashcards

1
Q

Define basal cell carcinoma.

A

Commonest form of skin malignancy, most commonly occurring on the face, that often invades surrounding tissue but seldom metastasizes.

  • Also known as a rodent ulcer
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2
Q

What is Gorlin’s syndrome?

A

A condition that affects many areas of the body and increases the risk of developing various cancerous and noncancerous tumors.

  • Strongly linked to basal cell carcinoma
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3
Q

What are the risk factors for basal cell carcinoma?

A

o Pprolonged sun exposure or UV radiation

o Photosensitising pitch

o Tar

o Arsenic

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4
Q

What are the presenting symptoms of basal cell carcinoma?

A

o A chronic slowly progressive skin lesion

o Usually found on the FACE but sometimes the scalp, ears or trunk

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5
Q

What are the types of basal cell carcinoma?

A

o Nodulo-ulcerative (most common)

o Morphoeic

o Superficial

o Pigmented

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6
Q

What are the signs of nodulo-ulcerative on examination?

A

o Small glistening translucent skin over a coloured papule

o Slowly enlarges

o Central ulcer with raised pearly edges

o Fine telangiectasia over the tumour surface

o Cystic change in larger lesions

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7
Q

What are the signs of morphoeic basal cell carcinoma on examination?

A

o Expanding, yellow/white waxy plaque with an ill-defined edge

o More aggressive than nodulo-ulcerative

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8
Q

What are the signs of superficial basal cell carcinoma on examination?

A

o Most often on trunk

o Multiple pink/brown scaly plaques with a fine edge expanding slowly

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9
Q

What are the signs of pigmented basal cell carcinoma on examination?

A

o Specks of brown or black pigment may be present in any BCC

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10
Q

What are the appropriate investigations for basal cell carcinoma?

A

o Diagnosis is mainly on clinical suspicion

o Biopsy is rarely necessary

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11
Q

Define contact dermatitis.

A

An inflammatory skin reaction in response to an external stimulus, acting either as an allergen or an irritant.

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12
Q

What are the two types of contact dermatitis?

A

o Allergic - a delayed type IV hypersensitivity reaction, which occurs after sensitisation and subsequent re-exposure to the allergen

  • cosmetics, metals, topical medications, textiles

o Irritant - an inflammatory response that occurs after damage to the skin, usually by chemicals

  • detergents/soaps, solvents, powders
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13
Q

What are the presenting symptoms of contact dermatitis?

A

o HANDS are the most frequently affected but can occur anywhere

o Redness of skin

o Vesicles and papules in the affected area

o Crusting and scaling of skin

o Itching of an affected area

o Fissures

o Hyperpigmentation

o Pain or burning sensation

o Make sure you do a thorough occupational history

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14
Q

What are the appropriate investigations for contact dermatitis?

A

o No investigations necessary most of the time

o Some may need patch testing

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15
Q

Define eczema.

A

A pruritic papulovesicular skin reaction to endogenous and exogenous agents.

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16
Q

What are the risk factors for eczema?

A

o Exogenous = irritants (e.g. nappy rash), contact (delayed type 4 hypersensitivity reaction to an allergen), atopic

o Endogenous = atopic, seborrhoeic, pompholyx (a type of eczema that affects the hands and feet), varicose veins, lichen simplex

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17
Q

What are the presenting symptoms of eczema?

A

Itching

Heat

Tenderness

Redness

Weeping

Crusting

Ask about occupational exposure to irritants (e.g. bleach)

Ask about personal/family history of atopy (e.g. asthma, hay fever)

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18
Q

What are the signs of acute eczema on examination?

A

Poorly demarcated erythematous oedematous dry scaling patches

Papules

Vesicles with exudation and crusting

Excoriation marks

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19
Q

What are the signs of chronic eczema on examination?

A

Thickened epidermis

Skin lichenification

Fissures

Change in pigmentation

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20
Q

What is the usually presentation of atopic eczema?

A
  • mainly affects face and flexures
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21
Q

What is the usually presentation of seborrhoeic eczema?

A

o Yellow greasy scales on erythematous plaques

o Commonly found on eyebrows, scalp, presternal area

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22
Q

What is the usually presentation of pompholyx eczema?

A

o Vesiculobullous eruption on palms and soles

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23
Q

What is the usually presentation of nummular eczema?

A

o Coin shaped on the legs and trunk

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24
Q

What is the usually presentation of asteatotic eczema?

A

o Dry, crazy paring pattern

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25
Q

What are the appropriate investigation for eczema?

A

o Contact Eczema = skin patch testing - a disc containing allergens is diluted and applied on the skin for 48 hrs -> is positive if it causes a red raised lesion

o Atopic Eczema = lab testing e.g. IgE levels

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26
Q

Define erythema multiforme.

A

An acute hypersensitivity reaction of the skin and mucous membranes.

  • Stevens-Johnson syndrome is a severe form with bullous lesions and necrotic ulcers.
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27
Q

What are precipitating factors for erythema multiforme?

A

o Drugs - e.g. sulphonamides, penicillin, phenytoin

o Infection - e.g. HSV, EBV, adenovirus, chlamydia, histoplasmosis

o Inflammatory - e.g. rheumatoid arthritis, SLE, sarcoidosis, ulcerative colitis

o Malignancy - e.g. lymphomas, leukaemia, myeloma

o Radiotherapy

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28
Q

What are the presenting symptoms of erythema multiforme?

A

Non-specific prodromal symptoms of upper respiratory tract infection

Sudden appearance of itching/burning/painful skin lesions

Skin lesions may fade leaving pigmentation

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29
Q

What are the signs of erythema multiforme on examination?

A

Classic target (bull’s eye) lesions with a rim of erythema surrounding a paler area

Vesicles/bullae

Urticarial plaques

Lesions are often symmetrical and distributed over the arms and legs including the palms, soles and extensor surfaces

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30
Q

How Stevens-Johnson syndrome characterised?

A

o Affecting > 2 mucous membranes - conjunctiva, cornea, lips, mouth, genitalia

o Systemic symptoms - sore throat, cough, fever, headache, myalgia, arthralgia, diarrhoea, vomiting

o Shock (hypotension and tachycardia)

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31
Q

What are the appropriate investigations for erythema multiforme?

A

o Usually unnecessary - erythema multiforme is very much a clinical diagnosis

o Bloods = high WC, eosinophils, ESR/CRP

o Imaging - excludes sarcoidosis and atypical pneumonia

o Skin biopsy - histology and direct immunofluorescence if in doubt about diagnosis

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32
Q

Define erythema nodosum.

A

Panniculitis (inflammation of subcutaneous fat tissue) presenting as red or violet subcutaneous nodules.

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33
Q

What are the presenting symptoms of erythema nodosum?

A

Tender red or violet nodules bilaterally on both shins

Occasionally on thighs or forearms

Fatigue

Fever

Anorexia

Weight loss

Arthralgia

Symptoms of underlying cause

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34
Q

What are the signs of erythema nodosum on examination?

A

Crops of red or violet dome-shaped nodules usually present on both shins

Occasionally appear on the thighs and forearms

Nodules are tender to palpation

Low-grade pyrexia

Joints may be tender and painful on movement

Signs of underlying CAUSE

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35
Q

What are the appropriate investigations for erythema nodosum?

A

o Determine underlying CAUSE

o Bloods = anti-streptolysin-O titres to check for streptococcal infection, FBC/CRP/ESR, U&Es, serum ACE (raised in sarcoidosis)

o Throat swab and cultures

o Mantoux/Head skin testing - for TB

o CXR - check for bilateral hilar lymphadenopathy or other evidence of TB, sarcoidosis or fungal infections

36
Q

Define lipoma.

A

Slow-growing, benign adipose tumours that are most often found in the subcutaneous tissues.

37
Q

What are the presenting symptoms and signs of lipoma?

A

Most are asymptomatic

Compression of nerves can cause pain

Soft or firm nodule

Smooth normal surface

Skin coloured

Most are < 5 cm in diameter

Mobile

Soft/doughy feel

38
Q

What are the appropriate investigations for lipoma?

A

o Usually CLINICAL diagnosis

o US/MRI/CT used if there is doubt about the diagnosis

39
Q

Define melanoma.

A

Malignancy arising from neoplastic transformation of melanocytes, the pigment-forming skin cells.

  • Leading cause of death from skin disease.
40
Q

What are the types of melanoma?

A

o Superficial spreading (70%)

o Nodular (15%)

o Lentigo maligna (10%)

o Acral lentiginous (5%)

41
Q

Describe superficial spreading melanoma.

A

Usually arises in a pre-existing naevus, expands in a radial fashion before a vertical growth phase

42
Q

Describe nodular melanoma.

A

Arises de novo

AGGRESSIVE

No radial growth phase

43
Q

Describe lentigo malinga melanoma.

A

More common in elderly with sun damage

Large flat lesions

Progresses slowly

Usually on the face

44
Q

Describe acral lentiginous melanoma.

A

Arise on palms, soles and subungual areas

Most common type in non-white populations

45
Q

What are the presenting symptoms of melanoma?

A

Change in size, shape or colour of a pigmented skin lesion

Redness

Bleeding

Crusting

Ulceration

46
Q

What are the signs of melanoma on examination?

A
47
Q

What are the appropriate investigations for melanoma?

A

o Excisional Biopsy - histological diagnosis and determination of Clark’s Levels and Breslow Thickness

o Lymphoscintigraphy - a radioactive compound is injected into the lesion and images are taken over 30 mins to trace the lymph drainage and identify the sentinel nodes

o Sentinel Lymph Node Biopsy - check for metastatic involvement

o Staging - using ultrasound, CT or MRI, CXR

o Bloods - LFTs (because the liver is a common site of metastasis)

48
Q

Define molluscum contagiosum.

A

A common skin infection caused by a pox virus that affects children and adults. Transmission is usually by direct skin contact.

49
Q

What is the cause and what are the risk factors for molluscum contagiosum?

A

o Viral skin infection caused by molluscum contagiosum virus (MCV) - a type of pox virus

o Risk Factors = being a child, immunocompromised, atopic eczema

50
Q

What are the presenting symptoms of molluscum contagiosum?

A

o Incubation period: 2-8 weeks

o Usually Asymptomatic barring the papules

o May be tenderness, pruritus and eczema around the lesion

o Lesions last for around 8 months

51
Q

What are the signs of molluscum contagiosum on examination?

A

o Firm, smooth, umbilicated papules

o Usually 2-5 mm in diameter

o In children - tends to occur on the trunk and the extremities

o In adults - tends to occur on the lower abdomen, genital area and inner thighs (suggesting sexual contact)

52
Q

What are the appropriate investigations for molluscum contagiosum?

A

Usually a CLINICAL diagnosis

Dermatoscopy may be useful if there is doubt

53
Q

Define pressure sore.

A

Damage to the skin, usually over a bony prominence, as a result of pressure.

54
Q

What are the risk factors for pressure sores?

A

Immobility

Hospitalisation

Alzheimer’s disease

Diabetes

55
Q

What are the presenting symptoms and signs for pressure sores?

A

o Occurs over bony prominences - most commonly the sacrum and heel

o Pressure scores can be staged from Stage 1-4

o Are very TENDER

o May become infected leading to fevers, erythema and foul smell

56
Q

What are the appropriate investigations for pressure sores?

A

o Clinical diagnosis - no investigations necessary

o Waterlow Score is used to predict risk of pressure sores in patients

57
Q

Define psoriasis.

A

A chronic inflammatory skin disease, which has characteristic lesions and may be complicated by arthritis.

58
Q

What are the general risk factors for psoriasis?

A

o genetics

o environment

o drugs

59
Q

What are the risk factors for guttate psoriasis?

A

o Streptococcal sore throat

60
Q

What are the risk factors for palmoplantar psoriasis?

A

o Smoking

o Middle-aged women

o Autoimmune thyroid disease

61
Q

What are the risk factors for generalised pustular psoriasis?

A

o Hypoparathyroidism

62
Q

What are the presenting symptoms of psoriasis?

A

o Itching and occasionally tender skin

o Pinpoint bleeding with removing scales (Auspitz phenomenon)

o Skin lesions may develop at sites of trauma/scars (Koebner phenomenon)

63
Q

What are the signs of nummular/discoid psoriasis on examination?

A

o symmetrical, well-demarcated erythematous plaques with silvery scales over extensor surfaces (knee, elbows, scalp, sacrum)

64
Q

What are the signs of flexural psoriasis on examination?

A

o Less scaly plaques in axilla, groins, perianal and genital skin

65
Q

What are the signs of guttate psoriasis on examination?

A

o Small drop-like lesions over the trunk and limbs

66
Q

What are the signs of palmoplantar psoriasis on examination?

A

Erythematous plaques with pustules on palms and soles

67
Q

What are the signs of generalised pustular psoriasis on examination?

A

o Pustules distributed over limbs and torso - very widespread

68
Q

What are the general signs of psoriasis on examination?

A

o Nail signs = pitting, onycholysis, subungual hyperkeratosis

o Joint Signs = FIVE presentations of psoriatic arthritis

  • Asymmetrical oligoarthritis
  • Symmetrical polyarthritis
  • Distal interphalangeal joint predominance
  • Arthritis mutilans
  • Psoriatic spondylitis
69
Q

What are the appropriate investigations for psoriasis?

A

o Most patients don’t need investigations

o Guttate psoriasis - anti-streptolysin-O titre, throat swab

o Flexural psoriasis - skin swabs to exclude candidiasis

o Nail clipping analysis for onychomycosis (fungal infection)

o Joint involvement analysed by checking for rheumatoid factor and radiographs

70
Q

Define sebaceous cysts.

A

Epithelium-lined, keratinous, debris-filled cyst arising from a blocked hair follicle.

  • Also known as an epidermal cyst.
71
Q

What are the risk factors for sebaceous cysts?

A

o Gardner’s Syndrome = autosomal dominant condition characterised by the presence of multiple polyps in the colon and in extra-colonic sites (e.g. sebaceous cyst, thyroid cancer, fibroma)

72
Q

What are the presenting symptoms of sebaceous cysts?

A

Non-tender slow-growing skin swelling

There are often multiple

Common on hair-bearing regions of the body (e.g. face, scalp, trunk or scrotum)

May become red, hot and tender if there is superimposed infection or inflammation

73
Q

What are the signs of sebaceous cysts on examination?

A

Smooth tethered lump

Overlying skin punctum

May discharge granular creamy material that smells bad

74
Q

What are the appropriate investigations for sebaceous cysts?

A

o None needed

o Skin biopsy or FNA may be used to rule out other differentials

75
Q

What is the treatment for sebaceous cysts?

A

o Conservative = may be left alone if its not causing the patient any distress

o Surgical = excision of the cyst under local anaesthesia

o Medical = antibiotics if there is an infection

76
Q

What are the possible complications of sebaceous cysts?

A

o Infection

o Abscess formation

o Recurrence (if incomplete excision)

o May ulcerate

77
Q

Define squamous cell carcinoma.

A

Malignancy of epidermal keratinocytes of the skin.

78
Q

Define Marjolin’s ulcer.

A

Squamous cell carcinoma that arises in an area of chronically inflamed skin.

79
Q

What are the risk factors for squamous cell carcinoma?

A

o Main risk factor = UV RADIATION - sun exposure can lead to actinic keratosis (sun-induced precancerous lesion)

o Radiation

o Carcinogens (e.g. tar derivatives, cigarette smoke)

o Chronic skin disease (e.g. lupus)

o HPV

o Long-term immunosuppression

o Defects in DNA repair (xeroderma pigmentosum)

80
Q

What are the presenting symptoms of squamous cell carcinoma?

A

Skin lesion

Ulcerated

Recurrent bleeding

Non-healing

81
Q

What are the signs of squamous cell carcinoma on examination?

A

o Variable appearance - may be ulcerated, hyperkeratotic, crusted or scaly, non-healing

o Often on sun-exposed areas

o Palpate for local lymphadenopathy

82
Q

What are the appropriate investigations of squamous cell carcinoma?

A

o Skin biopsy - confirm malignancy and specific type

o Fine-needle aspiration or lymph node biopsy - if metastasis is suspected

o Staging - using CT, MRI or PET

83
Q

Define urticaria.

A

Itchy, red, blotchy rash resulting from swelling of the superficial part of the skin.

84
Q

What occurs in deep tissues are involved in urticaria?

A
  • Angiooedema occurs when the deep tissues, the lower dermis and subcutaneous tissues are involved and become swollen
85
Q

What are the triggers of urticaria?

A

o Acute urticaria

  • allergies (foods, bites, stings)
  • viral infections
  • skin contact with chemicals
  • physical stimuli

o Chronic urticaria

  • chronic spontaneous urticaria - medication, stress, infections
  • autoimmune
86
Q

What are the presenting symptoms and signs for urticaria?

A

o Central itchy white papule or plaque surrounded by erythematous flare

o Lesions vary in size and shape

o May be associated with swelling of the soft-tissues of the eyelids, lips and tongue (angiooedema)

o Individual lesions are usually transient

o Timescales: acute = symptoms develop quickly but normally resolve within 48 hrs but chronic = rash persists for > 6 weeks

87
Q

What are the appropriate investigations for urticaria?

A

o Usually clinical

  • Tests may be required for chronic urticaria (e.g. FBC, ESR/CRP, patch testing, IgE tests)

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