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3B Specialties > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Describing an individual skin lesion

A

SCAM

S- size, shape
C- colour
A- associated secondary change
M- Morphology, Margin

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2
Q

Signs of melanoma within a skin lesion

A 
ABCD
A- asymmetry- lack of mirror image in any of the 4 quadrants)
B- irregular Border
C- two + colours within the lesion 
D- Diameter >6mm
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3
Q

Comedone

A

A plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris

  • can present as open (blackhead)
  • closed - whitehead
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4
Q

Functions of the skin

A
  1. Protective barrier against environmental insults
  2. Temperature regulation
  3. Sensation
  4. Vitamin D synthesis
  5. Immunosurveillace
  6. Appearance/Cosmesis
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5
Q

4 Major cell types of the epidermis

A

Keratinocytes- produce keratin
Langherhan’s cells - present antigens adn activate T-lymphocytes
Melanocytes- produce melanin
Merkel Cells - contain specialised nerve endings for sensation

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6
Q

4 layers of the epidermis

A

Stratum basale - actively dividing cells, deepest layer

Stratum spinosum (prickle cell layer)- differentiating cells

Stratum granulosum (granular cell layer) cells lose their nuclei and contain granules of keratohyaline- secrete lipid into the intercellular spaces

Stratum corneum - layers of keratin, most superficial layer (horny layer)

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7
Q

Pathology of the epidermis

A
  • changes in epidermal change over time (psoriasis)
  • changes in the surface of the skin or loss of the epidermis (scales, crusting, exudate, ulcers)
  • changes in pigmentation of the skin
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8
Q

What makes up the dermis

A

collagen, elastin and glycoaminoglycans (synthesised by fibroblasts) - provide strength and elasticity
Also contains immune cells, nerves, skin appendages and lymphatic and blood vessels

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9
Q

Pathology of the dermis

A

changes in the conout of the skin or loss of dermis e.g. papules, nodules, skin atrophy and ulcers

  • disorders of skin appendages e.g. disorders of hair, acne
  • Changes related to lymphatic and blood vessels e.g. erythema/urticaria
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10
Q

stages of wound healing

A

Haemostasis
Inflammation
Proliferation
Remodelling

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11
Q

Causes of urticaria, angioedema and anaphylaxis

A

idiopathic, food, drugs, morphine, ACE-i, insect bites, contact, viral or parasitic infections, autoimmune or herediatary

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12
Q

Description of urticaria

A

local increase in permeability of capilllaries and small veules
prostoglandins, leukotrienes and chemotactic release
main mediator = histamine released by skin mast cells

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13
Q

Presentation of urticaria

A

welling involving the superficial dermis, raising the epidermis
itchy wheals

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14
Q

Presentation of angioedema

A

deeper swelling involving the dermis and subcutaneous tissues
swelling of tounge and lips

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15
Q

Presentation of anaphylaxis

A

bronchospasm
facial and laryngeal oedema
hypotension
can present initially with angioedema and urticaria

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16
Q

Managment of urticaria, angioedmea and anaphylaxis

A

antihistamines for urticaria
corticosteroids for severe urticaria and angioedema
adrenaline, corticosteroids and antihistamines for anaphylaxis

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17
Q

Erythema nodosum

description

A

hypersensitivity reaction

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18
Q

Causes of erythema nodosum

A 
Group A B-haemolytic streptococcus
Primary TB 
Pregnancy
Malignancy 
Sarcoidosis
IBD
Chlamydia
Leprosy
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19
Q

Presentation of erythema nodosum

A

Discrete tender nodules which may become confluent
Lesions appear for 1-2 weeks and leave bruise like discolouration as they resolve
do not ulcerate and resolve without atrophy or scarring
Shins are the most common site

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20
Q

Description of Erythema multiforme

A

Acute self-limiting condition
Mainly precipitated by herpes simplex virus
Infections and drugs are other causes
Mucosal involvement absent or limited to only one mucosal surface

Discrete red annular lesions, with a paler ring and a red inner ring.

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21
Q

Description of Steven-Johnson syndrome

A

mucocutaneous necrosis with at least 2 mucosal sites involved
drugs/infections main associations
epithelial necrosis with few inflammatory cells involved on histopathology

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22
Q

Description of Toxic Epidermal Necrolysis

A

usually drug induced
acute severe disease characterised by extensive skin and mucosal necrosis accompanied by systemic toxicity
full thickness epidermal necrosis with subepidermal detachment

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23
Q

Management of Erythema Multiforme, Steven-Johnson syndrome and Toxic Epidermal necrolysis

A

Early recognition and call for help

Full supportive care to maintain haemodynamic equilibrium

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24
Q

Complications of Erythema Multiforme, Steven-Johnson syndrome and Toxic Epidermal necrolysis

A

Sepsis
electrolyte imbalance
multisystem organ failure

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25
Q

Description of acute meningococcaemia

A

Serious communicable infection transmitted by respiratory secretions
bacterial in circulating blood

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26
Q

Causes of acute meningococcaemia

A

gram negative diplococcus Neisseria meningitides

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27
Q

Presentation of acute meningococcaemia

A

meningitis- headache, fever, neck stiffness
septicaemia - hypotension, fever, myalgia
non-blanching purpuric rash on the trunk and extremities (may be preceded by a blanching maculopapular rash )
may progress to ecchymoses, haemorrhagic bullae and tissue necrosis

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28
Q

Ecchymoses

A

a discolouration of the skin resulting from bleeding underneath, typically caused by bruising

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29
Q

Management of acute meningococcaemia

A

Antibiotics

prophylactic abx for close contacts

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30
Q

Complications of acute meningococcaemia

A

septic shock
DIC
multi-organ failure
death

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31
Q

Erythryoderma

Description

A

exfoliative dermatitis involving at least 90% of the skin surface

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32
Q

Causes of Erythryoderma

A

previous skin disease (eczema, psoriasis)
lymphoma
drugs (sulphonamides, gold, sulphonylureas, penicillin, allopurinol)
idiopathic

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33
Q

Presentation of Erythryoderma

A

Skin appears inflamed, oedematous and scaly

Systemically unwell with lymphadenopathy and malaise

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34
Q

Management of Erythryoderma

A

treat underlying cause where known
emollients and wet wraps to maintain skin moisture
topical steroids to help relieve inflammation

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35
Q

Complications of Erythryoderma

A 
Secondary infection 
fluid loss and electrolyte imbalance 
hypothermia
high out-put cardiac failure and capillary leak syndrome (most severe)
overall mortality 20-40%
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36
Q

Eczema herpeticum (Kaposi’s varicelliform eruption)

Description

A

widespread eruption

serious complication of atopic eczema or other skin conditions

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37
Q

Causes of Eczema herpeticum (Kaposi’s varicelliform eruption)

A

herpes simplex virus

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38
Q

Presentation of Eczema herpeticum (Kaposi’s varicelliform eruption)

A

extensive crusted papules, blisters and erosions

systemically unwell with fever and malaise

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39
Q

Management of Eczema herpeticum (Kaposi’s varicelliform eruption)

A

anti-virals e.g. aciclovir

antibiotics for secondary bacterial infection

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40
Q

Complications of Eczema herpeticum (Kaposi’s varicelliform eruption)

A

Herpes hepatitis
encephalitis
disseminated intravascular coagulation
rarely - death

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41
Q

Necrotising fasciitis

Description

A

rapidly spreading infection of the deep fascia with secondary tissue necrosis

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42
Q

Causes of Necrotising fasciitis

A

Group A haemolytic streptococcus
or
Mixtures of aerobic and anaerobic bacteria

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43
Q

Risk factors for necrotising fasciitis

A

abdominal surgery
medical co-morbidities - DM, malignancy
50% of cases in previously healthy individuals

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44
Q

Presentation of necrotising fasciitis

A

severe pain
erythematous, blistering and necrotic skin
systemically unwell with fever and tachycardia
prescence of crepitus (subcutaneous emphysema)
XR may show soft tissue gas

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45
Q

Management of necrotising fasciitis

A

urgent referral for extensive surgical debridement
IV abx
mortality up to 70%

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46
Q

Erysipelas and cellulitis

description

A

spreading bacterial infection of the skin
erysipelas- acute superficial form of cellulitis and involves the dermis and upper subcutaneous tissue
cellulitis - involves deep subcutaneous tissue

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47
Q

Causes of Erysipelas and cellulitis

A

staphylococcus aureus and streptococcus pyrogenes

RF- immunosuppression, wounds, leg ulcers, toeweb intertrigo and minor skin injury

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48
Q

Presentation of Erysipelas and cellulitis

A

most common in the lower limbs
local signs of inflammation - tumour, rubor, calor and dolor
may be associated with lymphangitis
systemically unwell with fever, malaise or rigors esp. erysipelas
Erysipelas differentiated from cellulitis by well-defined, red raised border

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49
Q

Management of Erysipelas and cellulitis

A

Abx- flucloxacillin or benzylpenicillin

supportive care- rest, leg elevation, sterile dressings and analgesia

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50
Q

Complications of Erysipelas and cellulitis

A

local necrosis, abscess and septicaemia

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51
Q

Staphylococcal scalded skin syndrome description

A

commonly seen in infancy and early childhood

52
Q

Causes of Staphylococcal scalded skin syndrome

A

production of circulating epidermolytic toxin from phage group II, benzylpenicillin resistant (coagulase positive) staphylococci

53
Q

Presentation of Staphylococcal scalded skin syndrome

A 
develops over hours to days
worse over face, neck, axillae or groin
scald like skin appearance followed by large flaccid bulla
typical perioral crusting 
intraepidermal blistering
lesions are painful
recovery usually 5-7 days
54
Q

Management of Staphylococcal scalded skin syndrome

A

antibiotics - systemic penicillinase-resistant penicillin, fusidic acid, erythromycin or appropriate cephalosporin
analgesia

55
Q

Causes of superficial fungal infections

A
  • dermatophytes (tinea/ringworm)
  • yeasts (candidiasis, malassezia)
  • moulds (aspergillus)
56
Q

Presentation of fungal infections

A

usually unilateral and itchy

57
Q

Management of fungal infections

A

establish diagnosis from skin scrapings/ hair/ nail clippings
(dermatophytes)
skin swabs for yeasts
general measures- treat known precipitating factors (underlying immunosuppression, moist environment)
- topical antifungals (terbinafine cream)
- oral anti-fungal agents - itracpnaozole
- avoid topical steroids

58
Q

Description of BCC

A

slow growing, locally invasive malignant tumour of the epidermal keratinocytes
rarely metastasises
most common malignant skin tumour

59
Q

Causes of BCC

A 
UV exposure 
history of frequent or severe sunburn in childhood 
skin type I (frequently burns, never tans)
increasing age 
male 
immunosuppression 
previous history of skin cancer 
genetic predisposition
60
Q

Presentation of BCC

A

various morphological types

  • nodular (most common)
  • superficial (plaque like)
  • cystic
  • morphoeic (sclerosing)
  • keratotic
  • pigmented

Nodular BCC = small skin coloured papule or nodule with surface telangiectasia and pearly rolled edge
may have a necrotic or ulcerated centre (rodent ulcer)

61
Q

Management of BCC

A

surgical excision
mohs micrographic surgery for high risk recurrent tumours
radiotherapy where surgery isn’t appropriate
cryotherapy, curettage and cautery, topical photodynamic therapy and topical treatment (imiquimod cream)

62
Q

Complications of BCC

A

local tissue invasion and destruction

63
Q

Description of SCC

A

locally invasive malignant tumour of the epidermal keratinocytes or it’s appendages
potential to metastatise

64
Q

Causes of SCC

A

UV exposure
pre-malignant skin conditions (actinic keratoses)
chronic inflammation (leg ulcers, wound scars)
immunosuppression
genetic predisposition

65
Q

Presentation of SCC

A

keratotic (scaly/crusty) ill defined nodule which may ulcerate

66
Q

Management of SCC

A

surgical excision
moh’s micrographic surgery
radiotherapy for non-resectable tumours

67
Q

Description of malignant melanoma

A

invasive malignant tumour of the epidermal melanocytes

potential to metastatise

68
Q

Causes of malignant melanoma

A 
excessive UV exposure
skin type I
history of multiple moles/atypical moles
family history 
previous history of melanoma
69
Q

Presentation of malignant melanoma

A 
ABCDE symptoms 
A- asymmetry
B- border irregularity 
C- colour irregularity 
D- Diameter >6mm
E- Evolution of lesion (changes in size/shape)
Symptoms- bleeding/itching
  • more common on the legs in women and the trunk in men
70
Q

Types of malignant melanoma

A

superficial/ nodular –> common on the lower limbs/trunk in young and middle aged adults, related to intermittent high intensity UV
lentigo –> common on the face in the elderly
acral lentiginous melanoma - common on palms, soles and nail beds in the elderly

71
Q

management of malignant melanoma

A

surgical excision
radiotherapy
chemotherapy for malignant disease

72
Q

Description of eczema

A

papules and vesicles on an erythematous base

most commonly atopic - develops early childhood and resolves during teenage years

73
Q

Causes of eczema

A

primary genetic defect in skin barrier function (filaggrin)

exacerbated by infections, allergens, sweating, heat, severe stress

74
Q

Presentation of eczema

A

itchy erythematous dry, scaly pathces
more common on the face and extensor aspects of limbs in infants
flexor aspects in children and adults
acute lesions are erythematous, vesicular and weepy
chronic scratching/ rubbing can lead to excoriations and lichenification
may show nail pitting and ridging

75
Q

Management of eczema

A
  • avoid exacerbating features
  • frequent emoillients ± bandages and bath/ soap substitutes
  • topical steroids for flare ups
  • topical immunmdulators (tacrolimus)
  • oral therapies - antihistamines, antibiotics and antivirals
  • phototherapies
  • immunosuppression - oral prednisolone, azathioprine, ciclosporin
76
Q

Complications of eczema

A

secondary bacterial infection

secondary viral infection - molluscum contagiosum, viral warts and eczema herpeticum

77
Q

Acne vulgaris description

A

inflammatory disease of pilosebaceous follicle

78
Q

Causes of acne vulgaris

A 
hormonal (androgens)
increased sebum production 
abnormal follicular keratinisation 
bacterial colonisation (propionibacterium acnes)
inflammation
79
Q

Presentation of acne

A

non-inflammatory lesions - open and closed comedones

inflammatory lesions - papules, pustules, nodules and cysts

80
Q

management of acne vulgaris

A

topical therapies - benzoyl peroxide and topical antibiotics, topical retinoids
oral therapies - oral antibiotics, antiandrogens (females)
oral retinoids for severe acne

81
Q

Complications of acne vulgaris

A

post-inflammatory hyperpigmentation/scarring/deformity

psychological and social effects

82
Q

Description of psoriasis

A

chronic inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration

83
Q

Types of psoriasis

A 
chronic plaque psoriasis 
guttate (raindrop lesions)
seborrhoeic (nasolabial and retroauricular)
flexural 
pustular (palmar-plantar)
erythrodermic (total body redness)
84
Q

Causes of psoriasis

A

complex interaction between genetic, immunological and environmental factors
precipitating factors include trauma, infection, drugs, stress and alcohol

85
Q

Presentation of psoriasis

A

well demarcated erythematous scaly plaques
lesions can be itchy, burning or painful
common on extensor surfaces and scalp
auspitz sign (scratch and gentle removal of scales causes capillary bleeding
50% associated nail changes
arthropathy

86
Q

Management of psoriasis

A

avoid precipitating factors
emollients
topical therapies - vit D analogues, topical corticosteroids, coal tar preparations, topical retinoids, keratolytics
phototherapy
oral therapies - methotrexate, retinoids, ciclosporin, mycophenolate mofetil, fumaric acid esters
biologics- infliximab, etanercept, efalizumab

87
Q

Bullus pemphigoid

description

A

blistering skin disorder that usually affects the elderly

88
Q

Causes of bullus pemphigoid

A

autoantibodies against antigens between the epidermis and dermis
causes a sub-dermal split in the skin

89
Q

Presentation of bullus pemphigoid

A

tense, fluid filled blisters on an erythematous base
lesions are often itchy
may be preceeded by a non-specific itchy rash
- usually affects trunk and limbs (mucosal involvement less common)

90
Q

Management of bullus pemphigiod

A

wound dressings, monitor for infection
topical steroids
oral steroids, tetracyline with nicotinamide, immunosuppression (azathioprine, mycophenolate mofetil and methotrexate)

91
Q

Description of pemphigus vulgaris

A

blistering skin disorder which usually affects the middle-aged

92
Q

Causes of pemphigus vulgaris

A

autoantibodies against antigens in the epidermis

cause an intra-epidermal split in the skin

93
Q

Presentation of pemphigus vulgaris

A

flaccid easily ruptured blisters forming erosions and crusts
lesions are often painful
usually effects mucosal areas

94
Q

Management of pemphigus vulgaris

A

wound dressings, monitor for infection, good oral hygiene
oral therapies- high dose steroids, immunosuppressive agents- methotrexate, azathioprine, cyclophosphamide, mycophenolate mofetil

95
Q

History of venous ulcers

A

often painful, worse on standing

history of venous disease

96
Q

Common sites of venous ulcers

A

malleolar area

more commonly medial than lateral

97
Q

Lesion of venous ulcers

A

large, shallow, irregular ulcer

exudative and granulating base

98
Q

Features associated with venous ulcers

A

warm skin
normal peripheral pulses
leg oedma, haemosiderin and melanin deposition
lipodermatosclerosis
atrophie blanche (white scarring with dilated capillaries)

99
Q

Possible investigations in venous ulcers

A

normal ABPI

100
Q

Management of venous ulcers

A

compression bandaging (After excluding arterial insufficiency)

101
Q

History in arterial ulcers

A

painful esp at night
worse when legs are elevated
history of arterial disease

102
Q

common sites of arterial ulcers

A

pressure and trauma sites (pretibial, lateral supramalleolar, distal points (toes) )

103
Q

Lesion of arterial ulcers

A

small, sharply defined deep ulcer

necrotic base

104
Q

Associated features of arterial ulcers

A

cold skin
weak or absent peripheral pulses
shiny, pale skin
loss of hair

105
Q

Possible investigations of arterial ulcers

A

ABPI <0.8 = prescence of arterial insufficiency

- Doppler studies and angiography

106
Q

Management of arterial ulcers

A

vascular reconstruction

compression bandaging is contraindicated

107
Q

History of neuropathic ulcers

A

often painless
abnormal sensation
history of diabetes or neurological disease

108
Q

Common sites of neuropathic ulcers

A

pressure sites - soles, heels, toes, metatarsal heads

109
Q

Lesion in neuropathic ulcers

A

variable size and depth
granulating base
maybe surrounded by or underneath a hyperkeratotic lesion

110
Q

Associated features of neuropathic ulcers

A

warm skin
normal peripheral pulsese (cold, weak or absent pulses in neuroischaemic ulcers)
peripheral neuropathy

111
Q

Possible investigations in neuropathic ulcers

A

ABPI <0.8 implies neuroischaemia

XRay to exclude osteomyelitis

112
Q

Management of neuropathic ulcers

A

wound debridement

regular repositioning, appropriate footwear and good nutrition

113
Q

History of lichen planus

A

family history

may be drug induced

114
Q

Common sites of lichen planus

A

forearms, wrists and legs

always examine oral mucosa

115
Q

lesion in lichen planus

A

violaceous (lilac) flat-topped papules

symmetrical distribution

116
Q

Associated features

lichen planus

A

nail changes and hair loss

lacy white streacks on the oral mucosa and skin lesions (Wickham’s striae)

117
Q

Possible investigations lichen planus

A

skin biopsy

118
Q

Management of lichen planus

A

corticosteroids

anti-histamines

119
Q

Actinic keratoses

A

pre-malignant crumbly yellow-white scaly crusts on sun-exposed skin fro dysplastic intra-epidermal proliferation
may regress/recur
treat with - diclofenac gel, fluorouracil, imiqimod, cryotherapy, surgical excision

120
Q

Bowen’s disease

A

SCC in situ
well defined, slowly enlarging red scaly plaque with a flat edge
full thickness dysplasia/carcinoma in situ
treat with cryotherapy, fluorouracil or imiquimod, photodynamic therapy or surgical excision

121
Q

Paget’s disease of the nipple

A

itchy red scaly or crusted nupple

from direct extension of intraductal adenocarcinoma

122
Q

non-scarring alopecia

A

alopecia areata - smooth well defined round patches of hair loss on scalp. spontaneous regrowth in 3/12
consider sterpods

123
Q

scarring alopecia

A

inflammatory diseases damage follicular stem cells or follicles are damaged by trauma or tumour

124
Q

Pressure ulcers

pathology

A

uninterrupted pressure on the skin leads to ulcers and extensive painful subcutaneous dectruction
shearing forces, friction and moisture and implicating factors

125
Q

risk factors for pressure ulcers

A

extremes of age

reduced mobility and sensation, vascular disease, chronic or terminal illness

126
Q

Staging of pressure ulcers

A
  1. non-blanching erythema over intact skin
  2. partial thickness skin loss
  3. full thickness skin loss extending into fat
  4. destruction of muscle, bone or tendons
127
Q

Scabies

A

mites burrow and lay eggs which hatch as larvae
very itchy papules, vesicles, pustules and nodules affecting finfger webs, wrist flexure, axillae, abdomen, buttocks and groin
Treat with permethrin

3B Specialties (7 decks)

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