Dermatology Flashcards
1
Q
TF: skin conditions can be linked to increased risk of CVD
A
TRUE: psoriasis and eczema in particular
2
Q
what is the most common type of eczema? ____%
A
atopic- 80%
3
Q
what other type of eczema can be associated with atopic?
A
lichen- thick hardened skin from scratching
4
Q
why must you be careful using the word dermatitis?
A
means external cause which isn’t always the case
5
Q
eczema affects what ages?
A
any age but most common in children
6
Q
____% present in the first 6 months of life
A
50
7
Q
TF: eczema has variations between different genders and ethnicities?
A
false
8
Q
by the age of 7 ____% of eczema cases have cleared
A
65
9
Q
by the age of 16 ____% of cases have cleared
A
75
10
Q
1/___ have severe chronic eczema
A
20
11
Q
what are features of the skin barrier in eczema?
A
dysfunctional skin barrier- altered conversion of keratinocytes to protein/ lipid scales
12
Q
about 50% of cases have been traced back to a gene involved in…..
A
the conversion of keratinocytes to form scales
13
Q
if the conversion of keratinocytes to scales is altered what happens?
A
water is lost from the skin
hyper-reactivity to allergens
infections
14
Q
how is IgE related to eczema
A
Th cell dysregulation- IgE and mast cells create inflammation
15
Q
risk factors for worsening eczema
A
stress genetics pollen and pets clothes soaps extreme temperatures house mites foods infections hormones
16
Q
___% of children with eczema had parents with it
A
80
17
Q
what clothes help eczema?
A
cotton- rough clothes are bad
18
Q
why can soaps worsen eczema?
A
alters lipid barrier
dries skin
19
Q
winter is ____ than summer for eczema
A
worse
20
Q
what about house mites can worsen eczema?
A
faeces
21
Q
how would you know your eczema is infected?
A
weeping
22
Q
first line treatments for mild eczema?
A
emollients
mild topical steroids if the skin is inflamed- FTU’s
23
Q
what do emollients do?
A
restore skin integrity and hydrates
24
Q
effect of emollients on steroids?
A
steroid sparing effect- dont need as much
25
features of mild eczema?
some dry skin
some itching
some redness
26
features of moderate eczema?
dry skin
itching
redness
some thickening
27
treatment if eczema develops to moderate?
before: emollient and mild topical steroid
now: increase emollient use
increased to moderate potency steroid
non-sedating antihistamine if itchy
28
how long should the moderate potency steroid be used for in moderate eczema? what should be used on thin skin?
7-14 days
5 days if on sensitive skin
hydrocortisone on sensitive areas
29
in moderate eczema what can we use to treat the itch?
non-sedating antihistamine
30
when should the non-sedating antihistamine for moderate eczema be reviewed? why?
after 3 months as there's weak evidence for any benefit
31
what is advised for moderate eczema between flares?
low potency steroid intermittently (e.g. twice a week)
| second line: topical calineurin inhibitors (tacrolimus)
32
in children with moderate eczema what steroids would be used
only mild steroids
33
features of severe eczema?
widespread
skin thickening
bleeding
oozing
34
treatment for severe eczema?
increase emollient use
potent topical steroid- moderate on sensitive areas (same treatment timeline as moderate 7-14 days and 5 on sensitive)
ns antihistamine
can consider oral corticosteroid
35
what if severe eczema itch is effecting sleep?
sedating antihistamine
36
example of an oral corticosteroid that could be given in severe eczema?
oral prednisone
37
treatment between flares of severe eczema?
lower potency steroid
| 2nd line: topical calcineurin inhibitors (tacrolimus)
38
steroid use should try to be _____ between flares
avoided
39
how often must you be reviewed between flares?
3-6 months
40
why are infections common in eczema?
due to skin barrier being broken down
41
features of infected skin?
weeping
crusted
pustules
systemic symptoms sometimes
42
TF: for skin infections in eczema only topical antibiotics can be used?
no oral or topical
43
first and second line antibiotics for skin infections in eczema?
flucloxacillin
| clarithromycin
44
example of light emollient
E-45
| Diprobase
45
example of a moderate emollient
oilatum
| hydrous cream
46
example of a greasy emollient
50% white soft/ liquid
| epidermis
47
example of a low potency steroid?
hydrocortisone 0.1, 0.5, 1, 2.5%
48
examples of a moderate steroid?
clobetasone butyrate 0.05%
| betamethasone valerate 0.025%
49
examples of potent steroids?
betamethasone valerate 0.1%
| betamethasone dipropionate 0.05%
50
what is another treatment that could be considered in severe eczema?
phototherapy
51
patient advice for eczema?
use emollients a lot- every 2 hours in flares
avoid scratching
avoid triggers
how to recognise infection
discard old products
advise oily products at night even though not preferred
fire warning with emollients
52
when using steroids what should you advise?
continue 48 hours after inflammation has reduced
53
formulations which emollients come in?
```
creams
bath additives
ointments
gels
lotions
```
54
when should you take corticosteroids in relation to emollients?
30 minutes later- increases penetration
55
advise on emollient application?
don't rub, gently stroke in along the hair follicles
56
what is the most common type of psoriasis?
vulgaris- chronic plaques
57
80% of people with vulgarisms psoriasis get...
scalp psoriasis
58
psoriasis mainly effects?
knees and elbows
59
features of psoriasis?
chronic, inflammatory disorder or skin and joints
| relapsing
60
when are presentations of psoriasis most common?
15-25 years then 55-60
61
what ethnicity gets psoriasis most often?
caucasian
62
pathophysiology of psoriasis?
inflammatory cells in skin layers lead to epidermal hyper proliferation and vascular changes
cell turnoverr is rapid
63
how much more rapid is cell turn over in psoriasis than normal?
from 42 days in normal people to 7 in psoriasis
64
vascular changes of psoriasis?
vessels are closer to the skin= bleeding when layers shed
65
risk factors for psoriasis
```
obesity
smoking
alcohol
hormones- pregnancy, puberty, menopause
medications skin injury
stress
infection
```
66
what medications increase chance of psoriasis?
```
lithium
NSAIDs
BBs
tetracyclines
ACEI
```
67
what is acanthuses?
| psoriasis
thick skin
68
what is hyperkeratosis?
| psoriasis
scaly skin
69
complications of psoriasis?
psoriatic arthiritis
depression and anxiety
bleeding if scales come off
70
how to detect psoriatic arthritis
PEST tool
71
what is crucial in psoriasis treatment?
patient education and support
72
topical treatments for psoriasis?
emollients recommended
ointments
creams/ gels/ lotions
corticosteroids
73
TF: emollients are in the NICE guidelines for psoriasis treatment
false but are recommended
74
what are ointments good for in psoriasis?
thick scale
75
side effects of corticosteroids?
skin atrophy and stretch marks
76
why must corticosteroids be used correctly in psoriasis?
can make it worse
77
psoriasis treatment is in _______ blocks. why?
no more than 4 weeks- regular review must be stressed
| 2 weeks if on face, flexures and genitals
78
treatment of psoriasis on the trunk and limb?
potent corticosteroid
Vitamin D analogue (calcipotrol)
coal tar if above not effective
79
what effect does the potent corticosteroid have in treatment of psoriasis on the trunk and limb?
anti inflammatory effects and alleviates itch
80
effect of vitamin D analogue in psoriasis?
modifies gene transcription and modified hyper proliferation of skin cells
81
treatment of scalp psoriasis?
potent corticosteroid
82
if potent corticosteroid isn't effective in treating scalp psoriasis?
try different formulations and/or salicylic acid
combine steroid with calcipotrol (vitamin D analogue) alone if not effective
83
what does salicylic acid do in scalp psoriasis?
helps remove some of the scales which could stop treatment getting in
84
face, flexures and genital treatment time scale?
2 week
85
face, flexures and genital psoriasis treatment
mild/ moderate steroid
86
if face flexures and genital psoriasis treatment using mild/ moderate steroid isn't effective, what should be used?
calcineurin inhibitor- tacrolimus
87
how long can steroids and vitamin D analogues take to have effect?
1-2 weeks
88
how long does coal tar take to work?
3-4 weeks
89
psoriasis patient advice?
```
emollient advice
skin irritation and photosensitivity with vitamin D analogues
several weeks till effects are seen
avoid scratching
report joint symptoms immediately
importance of review after 4 weeks
```
90
if a patient experiences joint problems in psoriasis what should they do?
report it immediately
91
why is review at 4 weeks so important in psoriasis?
toxicity
adherance
effectiveness
side effects
92
a _____ of steroid and calcipotiol is ______ than them alone
combination
| better
93
what could be used as treatment between psoriasis flares?
vitamine D
94
treatment in mild psoriasis?
emollients
topical corticosteroid alone or with Vitamin D
calcineurin inhibitor
coal tar
95
treatment of moderate psoriasis
if mild treatment isn't working
phototherapy plus topical treatments
oral methotrexate or ciclosporin
oral acitretin
96
treatment of severe psoriasis?
add a biological agent
apremilast
dimethyl fumarate
97
4 different types of acne?
vulgaris
rosacea
conglobata
fulminans
98
vulgaris acne effects what parts of the body?
mainly face
60% back
10% chest
99
which gender does acne effect more?
more men than women in the early years
| but when older its more common in women
100
1 in __ cases are severe and difficult to treat
5
101
what follicles does acne involve?
pilosebaceous follicles
102
pathophysiology of acne?
increased number of cells which produce sebum/
altered sebum composition
keratinocyte proliferation which blocks follicles and inflames
growth of cutibacterium acnes in the sebum in the hair follicles
103
TF: the increased volume of sebum production is what causes acne?
false
| its the altered composition
104
what is a hallmark feature of acne?
comedogenesis and hypercornification
105
what is comedogenesis and hypercornification?
hardening of the skin
106
what are open comecones?
black heads- close to the skin
| melanin interacts with the atmosphere and turns black
107
what are closed comedones?
white heads
108
what are closed comedones more likely to turn into?
acne legions
109
risk factors for acne?
```
family- 80%
high glycaemic index food
medications which cause populates= acne like response
PCOS
smoking
stress
cosmetics
```
110
TF: smoking can help acne
true
111
why does high glaecemic foods increase acne?
increased amount of androgens
112
why does PCOS increase acne?
linked to increased androgens
| 30% of people with PCOS get acne
113
what do you want your cosmetics to state if you have acne?
'non comedogenic' if not they block the PSF
114
if acne is <5mm in diameter?
papules- small and red
| pastures- yellow or white fluid
115
if acne is >5mm in diameter?
nodules, hard and deep- usually painful
cysts
116
if a large area of skin is effected by acne what isn't practical?
topical treatments
117
treatment for mild-moderate acne?
```
topical retinoid od/bd
BENZOYL peroxide
azelaic acid- milder
topical antibiotic
combination of above
emollients (OIL FREE)
```
118
effects of topical retinoid in acne?
disrupt comedones and prevent their formation , anti inflammatory
119
examples of topical retinoid
adapaline 0.1% gel/ cream
| isotretinoin
120
benzoyl peroxide effect on acne?
similar to topical retinoid: disrupt comedones and prevent their formation , anti inflammatory
but also an antibacterial effect
121
example of a topical antibiotic?
clindamycin 1%
122
what is a topical antibiotic always used with?
BPO
123
treatment for acne should be continued for how long?
| if see no improvement?
6-8 weeks
| refer to GP
124
what can be used as maintenance in acne?
retinoid or bpo
125
patient advice for acne?
```
dont over clean skin- irritation
dont pick or squeeze
non-comedogenic and oil products
skin irritation- if severe reduce frequency
photosensitivity- suncream is important
apply to whole area not just legions
```
126
how can you avoid irritation when using gels to treat acbe?
apply after washing and then remove a few hours later
127
how to use washes when treating acne?
apply and leave on for a few minutes then rinse off
128
advice for applying retinoids to treat acne?
pea sized amount to the entire effected area
| wash off after 30-60 minutes
129
can you use retinoids and oral antibiotics in pregnancy?
should be avoided
130
which acne drugs can cause increases photosensitivity?
BPO
retinoids
oral ABs
131
what should you be screened for if you have any of these conditions?
cardiovascular screening
| mental health
132
why is adherence poor in treating these conditions
slow onset of action
incorrect application
not educated
