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Year 4 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

What is a macule?

A

An area different in colour or consistency with no elevation

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2
Q

What is a papule?

A

Raised lesion <1cm diameter

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3
Q

What is a nodule?

A

Raised lesion >1cm

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4
Q

What is a plaque

A

Circumscribed, superficial, elevated plateau area

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5
Q

What is a vesicle?

A

Raised lesion containing fluid

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6
Q

What is a bulla

A

Large lesion containing fluid >0.5cm

Looks like a blister

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7
Q

What is a pustule?

A

Circumscribed lesion containing pus

May be white or yellow

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8
Q

What is an erosion?

A

Loss of epidermis that generally heels without scaring

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9
Q

What is an ulcer?

A

Deeper loss of epidermis/dermis

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10
Q

What is a patch?

A

Large area of colour change

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11
Q

What is the pathophysiology of eczema?

A

Immune response occurs due to exposure to irritants and allergens
This immune response leads to breaks the layers of the skin
Water leaks out and skin becomes dry and itchy

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12
Q

What factors can exacerbate eczema?

A 
Stress
Sweat
Climate 
Foods
House dust mite
Infection
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13
Q

If atopic eczema is present in a child, will it progress to adulthood?

A

10-20% of children have it
Only 1-2% adults have it
As some children grow older, their skin disease may improve or disappear altogether, although their skin often remains dry and easily irritated

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14
Q

Which protein is mutated in 50% of cases of severe eczema?

A

Filggrin (FLG)

This is a protein in the epidermis which helps the layers to stick - loss of protein leads to break in the epidermal layer making it easier for irritants and allergens to enter the skin with resultant inflammation

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15
Q

In which area of the body is eczema more common?

A

Flexor surfaces

Note in infancy the cheeks is the most common place

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16
Q

What is eczema Herpeticum?

A

Herpes simplex virus infection of eczema areas of skin

Severe complication of eczema and may be life threatening

May be caused by being in contact with someone who has a cold sore

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17
Q

How do you spot the signs of eczema Herpeticum?

A

Areas of rapidly worsening painful eczema
Clustered blisters - that look like early stage cold sores
Skin erosions (Any skin that has broken away)
Possible fever

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18
Q

What are the life threatening complications of eczema Herpeticum?

A

Hepatitis
Encephalitis
Pneumonia

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19
Q

What is contact dermatitis?

A

A type of eczema
Due to a type IV hypersensitivity immune reaction
Either to an allergen e.g, latex, perfumes
Or to an irritant e/g, bleach, acid, pepper spray

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20
Q

What is linchenified skin?

A

Thickened skin which can be seen in areas of chronic eczema

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21
Q

What is the clinical picture of eczema?

A 
Flexural surfaces 
Dry and cracked skin 
Red itchy scaly patches 
Can be weepy or blistered 
Skin can be linchenified (thickened) in chronic eczema
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22
Q

What is the management of eczema?

A

Conservative: Avoid triggers
Emollients: e.g, diprobase, epidermis
Steroid cream: mild hydrocortisone, moderate eumovate

For more severe eczema may consider phototherapy and systemic medication

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23
Q

What kind of emollients are available and where are they best used?

A

Creams - good for daytime use as they aren’t very greasy and absorbed quickly
Lotions - good for hairy or damaged areas of skin (weeping eczema) they are thin and spread easily
Sprays - for hard to reach areas
Ointments - these are more greasy, but good for very dry skin so good for night time use. Not to be used on weeping eczema
Soap substitutes - don’t foam like normal soap (remember to pat dry)

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24
Q

How often should emollients be applied in eczema?

A

As much as you like to keep skin moisturised

Ideally 3-4 times a day

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25
Q

How would you counsel someone on how to apply an emollient?

A

Apply generously
Use a clean spoon or spatula to remove from a pot or tub - this reduces risk of infections from contaminated pots
Be careful not to slip when using emollients in bath/shower or tiled floor - protect floor with a towel
Apply in a downwards motion
Apply after showering
Apply before steroids

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26
Q

What are calcineurin inhibitors?

Give some examples?

A

Immunemodulators used as an alternative to steroid therapy for eczema
They suppress the T lymphocyte response
Used as 2nd line treatments when you want to avoid the side effects of prolonged steroid use
Examples: tacrolmius, pimecrolimus

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27
Q

What is Dupilimab?

A

Immuneregulator
Antibody which inhibits the Th2 immune response

Approved for moderate to severe eczema

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28
Q

What is the pathophysiology of psoriasis?

A

Autoimmune skin condition
Where there is rapid turnover of skin cells (keratinocytes)
Cells only take 3-5 days to migrate to surface (normal cells take 23)
This causes hyperkeratosis - thickened skin and scaling
Leads to immature skin cells at the surface

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29
Q

What is the auspitz sign?

A

When the skin of psoriasis is scraped off it reveals dilating blood vessels underneath

This accounts for much of the erythema in psoriatic plaques

30
Q

What is the clinical presentation of psoriasis?

A

Silver plaques - usually found on extensor surfaces
Scaling
Waxy appearance
Erythema

31
Q

What are the psoriatic nail changes?

A

Nail pitting - small depressions in the nail
Subungal hyperkeratosis- chalky looking material under nail
Onycholysis - lifting of nail bed
Splinter haemorrhages - due to leaking of blood from capillaries

32
Q

What are the different types of psoriasis?

A

Chronic plaques psoriasis (most common) - extensor surfaces
Flexural Psoriasis - seen in axilla, groin, and other skin folds
Pallmar plantar - lesions on palms and soles
Gluttate Psoriasis - plaques on trunk and limbs
Erythrodermic psoriasis - serious condition with confluence eczema effecting 90% of skin

33
Q

What is the most common type of psoriasis?

A

Chronic plaque psoriasis

34
Q

What infection usually precedes gluttate Psoriasis?

A

Sore throat - with associated group B strep

35
Q

What age group does gluttate Psoriasis usually effect?

A

Adolescents

36
Q

What are the triggers for Psoriasis?

A 
Illness 
Stress
Alcohol 
Smoking 
Infection - e.g, group B strep
Certain drugs - lithium, beta blockers, antimalarials
37
Q

What is the major risk factor for palmar planter psoriasis?

A

Smoking

38
Q

What is the genetic basis for Psoriasis?

A

Inherited Th1 cell mediated disease

39
Q

What is psoriatic arthopathy?

A

When patients with psoriasis also have arthritis in their joints due to the immune response

40
Q

How is mild/moderate psoriasis managed?

A

Emollients
Coal tar (only to be used on stable Psoriasis) - can normalise keratinocyte growth patterns)
Calcipotrol - vit D analogues
Corticosteroids - to reduce inflammation

41
Q

How is severe psoriasis managed?

A

Phototherapy - 2-3 times a week for 10 weeks (UV rays slow growth of keritonocytes)

Systemic treatment - methotrexate (immune modulator)
Give folic acid along side it

Biological agents - e.g, infliximab

42
Q

What is the presentation of acne?

A

Papules
Pustules
Whiteheads (close comedomes)
Blackheads (open comodomes)

43
Q

What is the pathophysiology of acne?

A

Inside hair follicles there is sebaceous glands (oil producing)
In acne an abnormal amount of oil is produced which can block the hair follicle
Blocked hair follicle becomes inflamed
Any harmless germs that live on skin surface can get trapped and exacerbate the situation

44
Q

How can hormones effect acne?

A

Androgens can increase the size of sebaceous glands which increases the amount of oil produced

45
Q

What are the different types of acne?

A

Acne vulgaris (most common)
Acne excoriee - where patient picks at skin and produces erosions
Infantile acne - seen in first few months of life
Acne fulminans - severe form seen in tropical climates

46
Q

How is acne graded?

A

Mild - no scaring, a few small comedones
Moderate - no scaring, large close comedones
Moderately severe - some scaring, papular and pustular acne
Severe acne - severe scaring, nodules and cyst

47
Q

What is the conservative lifestyle management for acne?

A

Avoid humid conditions
Diet - low sugar, low protein, low dairy. Lots of fruit and veg
Stop smoking - as nicotine increases sebum retention
Minimise face products - as oils and cosmetics can alter skin
Don’t scratch or pick lesions
Exposure to sunlight helps

48
Q

How is mild acne managed?

A

Benzoyl peroxide face wash
Topical antibitoics - e.g, erythromycin solution or gel
Topical retinoids - eg, isotretinoin

49
Q

How is moderate acne managed?

A 
Benzylperoxide face wash 
Topical retinoids 
Antibiotics - e.g, tetracycline or doxyclicine 6-8 week course 
Oral contraception - can help with girls
NSAIDs - short term use my help
50
Q

What is the management for severe acne?

A

Oral isotretanoin

51
Q

What must you counsel a girl on before starting oral isotretanoin

A

Works in 90% of cases - see improvement with 4-6 months
It is teratogenic
So make sure she is not pregnant and is using contraception
Must wait 3 months after finishing course to get pregnant

52
Q

What is acne rosacea?

A

Characterised by facial flushing, persistent erythema, talangiestasia, inflammatory pustules and oedema

53
Q

How is acne rosacea managed?

A

Avoid triggers - heat, hot food/drink, spicy food, alcohol, sunlight
Topical metronidazole
Oral antibiotics

54
Q

What is actinic keratoses?

A

Rough scaly keratotic lesions on areas of exposed skin
Usually occur in patients who have worked outdoors
They are a precursor for skin cancer

55
Q

How are actinic keratoses managed?

A

Liquid nitrogen - for individual lesions

5-FU cream - useful for large or multiple AKs, applied OD for 4-6 weeks

56
Q

What is bowens disease?

A

Type of squamous cell carcinoma in situ
Only in epidermis with no dermis invasion
Seen on trunks or limbs
Well defined erythematous macule with slight crusting
Lesions enlarge slowly
Risk of developing SCC is 3-5%

57
Q

How is bowens disease managed?

A

Excision, curettage and cautery

Cryotherapy

58
Q

What is the appearance of a basal cell carcinoma?

A

Small papules that slowly grow
Lesions have pearly, shiny, translucent quality
Characteristic rolled edge
Have telangiectasia - dilated blood vessels near the surface of skin

59
Q

What is the most common type of skin cancer?

A

Basal cell carcinoma

60
Q

Where are the majority of squamous cell carcinomas found?

A

Head and neck

61
Q

How can you tell the difference between a BCC and a SCC?

A

BCC - slow growing

SCC - rapidly growing, painful, markedly hyperkaratoic

62
Q

What is the appearance of SCC?

A

Usually nodular with surface changes - crusting, ulceration, formation of cutaneous horn
Hyperkeratosis surfaces

63
Q

What risk factors are specific for SCC?

A

Smoking
Chronic ulcers
Xederma pigemntosum - autosomal recessive condition that causes extreme sun sensitivity

64
Q

Which types of SCC have poor prognosis?

A

> 2cm in size
Lesions on lip or ear
Invasion >4mm deep
Poorly differentiated cells

65
Q

What is the medical name for a mole?

A

Melanocytic naevus

66
Q

What is the ABCDEF for lesions?

A

A - asymmetrical
B - borders (regular or irregular)
C - colour (any variation, is it hyperpigmented)
D - diameter (>6mm (pencil rubber) is atypical)
E - evolution - has it changed, over what time period
F - family and friends (do others look similar)

67
Q

What is a melanoma?

A

An invasive malignant tumour or melanocytes in the skin

68
Q

What is breslow thickness?

A

Measures the distance in mm from the epidermis to the deepest layer of invasion in the dermis

69
Q

How is eczema Herpeticum managed?

A

Admit to hospital

IV aciclovir

70
Q

Which drugs can exacerbate psoriasis?

A 
Lithium 
Beta blockers
NSAIDs
ACEi
Anti-materials
71
Q

What is the difference between a petechiae and a purpuric rash?

A

Petechiae - blanching macular <3mm

Purpura - raised blanching 3-10mm

Year 4 (16 decks)

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