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Year 5 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Risk factors/triggers/exacerbating factors for psoriasis

A
  • Ethnicity - lower rates in Africans, Norwegians and some Asians
  • Age - peaks in teenage/young adults and 50-60s
  • Strep throat infection
  • Other infections e.g. HIV
  • Drugs e.g. lithium, beta-blockers, interferon-alpha, chloroquine
  • Bone marrow transplant
  • Obesity
  • Smoking
  • Alcohol
  • Koebner phenomenon
  • Psychogenic factors e.g. stress
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2
Q

Two cardinal histological features of psoriasis

A

1) Epidermal hyper proliferation

2) Pronounced inflammatory infiltrate

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3
Q

Clinical features of stable chronic plaque psoriasis

A
  • Scaly, red well demarcated plaques
  • Most commonly seen on extensor surfaces
  • Remitting and relapsing course
  • May be associated with psoriatic arthritis
  • Increased risk of metabolic syndrome and CVD
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4
Q

Clinical features of guttate psoriasis

A
  • Several hundred small lesions
  • Most common on the trunk
  • Most common in children and young adults
  • 2-3 weeks after strep throat
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5
Q

Psoriatic nail signs

A
  • Nail plate pitting
  • Onycholysis
  • Oily spots
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6
Q

How would you diagnose psoriasis

A
  • Clinical diagnosis
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7
Q

Management of psoriasis

A

1) Avoidance of precipitants e.g. smoking cessation, reduce alcohol intake
2) Topical emollients
3) Topical corticosteroids (particularly in flexure and scalp psoriasis)
4) Topical vitamin D analogues
5) Phototherapy
5a) Narrow band UVB phototherapy (works best for small plaque psoriasis)
5b) PUVA therapy
6) Methotrexate
7) Ciclosporin
8) Retinoids (vitamin A analogues)
9) Biologics e.g. TNFa inhibitors or cytokine pathway inhibitor

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8
Q

Side effects of topical corticosteroids

A
  • Skin thinning
  • Telangiectasia
  • Striae
  • Systemic steroid effects with prolonged use
  • May loss efficacy over time
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9
Q

Side effects of UBV phototherapy

A
  • Small risk of sunburn

- Potential long-term increased risk of non-melanoma skin cancer

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10
Q

Side effects of PUVA therapy

A
  • Tan

- Increased risk of non-melanoma and melanoma skin cancers

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11
Q

Side effects of methotrexate

A
  • Hepatic fibrosis
  • Bone marrow inhibition
  • Immunosuppression
  • Nausea
  • Teratogenic - wait 3 months after stopping treatment two conceive
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12
Q

Monitoring required for patients on methotrexate

A
  • Regular FBC, LFTs and U&Es
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13
Q

Side effects of ciclosporin

A
  • Excessive hair growth
  • Gingival hyperplasia
  • Immunsuppression
  • Nephrotoxicity
  • Hypertension
  • Increased risk of virally-associated cancers e.g. EBV-lymphoma, HPV-cervical cancer
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14
Q

Side effects of retinoids

A
  • Teratogenic - women should not conceive for 3 years after treatment with acitretin
  • Triglyceride elevation
  • Increased CVD risk
  • Mucosal and cutaneous dryness
  • MSK pain
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15
Q

Side effects of biologics

A
  • Immunosuppression
  • Virus reactivation
  • Worsening of inflammatory disease
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16
Q

3 pathogenic features of acne vulgaris

A

1) Abnormal keratinisation of the follicular epithelium
2) Increased sebum excretion
3) Infection with gram-positive rod Propionibacterium Acnes

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17
Q

Risk factors for acne

A
  • Male sex
  • PCOS
  • Congenital adrenal hyperplasia
  • Androgen secreting tumour
  • Exogenous androgens e.g. steroids
  • Family history
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18
Q

Clinical features of acne

A
  • Typically affects the face and upper torso/back
  • Includes: comedones, inflammatory papules, pustules, scars
  • May have features of hyper-androgenism e.g. hirsutism, androgenic alopecia
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19
Q

Investigations to consider in a patient with acne

A
  • Menstrual history
  • Total and free testosterone
  • DHEAS
  • 17-hydroprogesterone
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20
Q

Management options for acne

A

1) Topical retinoids (best for comedonal acne)
2) Topical benzoyl peroxide
3) Topical or systemic antibiotics (tetracyclines, erythromycin, clindamycin)
4) Hormonal methods in women e.g. COCP
5) Systemic retinoids (4 month course, dose depends on weight)

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21
Q

Side effects of topical retinoids

A
  • Mild inflammatory reaction e.g. erythema, dryness, scaling

- Teratogenic

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22
Q

Side effects of topical/systemic antibiotics in acne treatment

A
  • Need to be tried for 2 months before considered ineffective
  • Tetracyclines CI in <12s - stain teeth and absorbed by bone
  • Teratogenic
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23
Q

What tests need to be done before starting a patient on isoretinoin?

A
  • FBC
  • Lipid profile
  • TFTs
  • Pregnancy test
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24
Q

Monitoring required whilst on isoretinoin

A
  • Pregnancy test every month

- Pregnancy test 5 weeks after stopping

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25
Q

Side effects of isoretinoin

A
  • May precipitate acne fulminas/temporary worsening of acne
  • Teratogenic - need to use 2 methods of contraception and not conceive for 5 weeks after stopping treatment
  • Increased triglycerides and cholesterol
  • Abnormal LFTs
  • Chelitis
  • Dry eyes
  • Dry nose and nosebleeds
  • Dry skin
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26
Q

Management options for acne scarring

A
  • Dermabrasion
  • Carbon dioxide laser resurfacing
  • Excision of small scars or cystic lesions
  • Punching out or grafting ice-pick scars
  • Fillers
  • Potent peels (alpha-hydroxy acids)
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27
Q

Management of urticaria

A
  • Non-sedative anti-histamines e.g. fexofenadine, cetirizine
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28
Q

4 autoimmune conditions associated with chronic symptoms urticaria

A
  • Thyroid disease
  • Vitiligo
  • Rheumatoid arthritis
  • Pernicious anaemia
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29
Q

Name 5 types of physical urticaria

A
  • Dermographism
  • Solar urticaria
  • Cold urticaria
  • Cholinergic urticaria
  • Aquagenic urticaria
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30
Q

Management of angioedema

A
  • C1-esterase inhibitors

- SC Icatibant (bradykinin B2 receptor antagonist)

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31
Q

Clinical features of anaphylaxis

A
  • Vasodilation
  • Hypotension
  • Bronchoconstriction
  • Circulatory collapse
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32
Q

Management of anaphylaxis

A
  • IM adrenaline
  • Oxygen
  • IV fluids
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33
Q

Most common inflammatory skin condition

A

Eczema

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34
Q

Two pathological processes in eczema

A

1) Abnormal/inappropriate immune system behaviour

2) Compromised skin barrier function

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35
Q

Cardinal pathological features of eczema

A
  • Intercellular epidermal oedema (spongiosis)
  • Lymphoid infiltrates in the dermis and epidermis
  • Acanthosis
  • Hyperkeratosis
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36
Q

Exacerbating factors for atopic eczema

A
  • Stress
  • Dry skin
  • Skin infection
  • Certain foods
  • Winter
  • Skin irritation
  • Hormones e.g. menstruation
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37
Q

Clinical features of atopic eczema

A
  • Itchy, scaly rash on face at 6-12 months old
  • Rash involves flexor surfaces
  • Excoriations
  • Skin weeps in flexures and feels rough and dry everywhere else
  • Soap and detergents worsen symptoms
  • Associated hay fever and asthma
  • Lichenification
  • Pityriasis alba
  • Dennie-Morgan folds
  • Increased peri-orbital pigmentation
  • Chellitis
  • Symptoms/signs of other atopic conditions e.g. sneezing, lacrimation, wheeze
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38
Q

Management of atopic eczema

A

1) Topical emollients
2) Topical antiseptics
3) Bandaging
4) Topical corticosteroids
5) Phototherapy - UVB or PUVA
6) Systemic immunosuppression

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39
Q

Biggest risk factor for contact irritant dermatitis

A

Atopic eczema

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40
Q

Differences between contact allergic dermatitis and contact irritant dermatitis

A

Contact irritant dermatitis has:

  • no period of sensitisation
  • dose dependent response
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41
Q

What type of hypersensitivity reaction is contact allergic dermatitis?

A

Type 4

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42
Q

Clinical features of contact allergic eczema

A
  • Eczema symptoms develop 24-96 hours after exposure to antigen
  • Erythema and induration
  • Weeping vesicles and blister formation
  • Itch
  • Acanthosis and hyperkeratosis in prolonged reactions
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43
Q

Investigation of choice for contact allergic dermatitis

A
  • Patch testing - suspected antigens applied to patient’s back then removed 24 hours later. Patient’s skin examined at 48-96 hours.
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44
Q

Clinical features of pemphigoid

A
  • Usually >60s
  • Itchy urticated lesions which precede blister formation by several months
  • Large, tense, robust fluid-filled blisters
  • Less mucosal involvement than pemphigus
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45
Q

Investigations and results in pemphigoid

A
  • Blister biopsy: eosinophil rich inflammatory infiltrate and sub-epidermal blisters
  • Immunofluorescence: IgG staining along basement membrane
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46
Q

Management of pemphigoid

A

1) Systemic corticosteroids +/- azathioprine
2) Other immunosuppressants
3) IV immunoglobulin, anti-CD20 antibodies or cyclophosphamide

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47
Q

Clinical features of pemphigus

A
  • Superficial blisters (may have burst or crusted)
  • Mucosal involvement - most patients have painful mouth erosions
  • Positive Nikolsky sign (if you rub normal skin a blister will appear)
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48
Q

Investigations and results in pemphigus

A
  • Biopsy: acantholysis

- Immunofluorescence: IgG intercellular staining

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49
Q

Management of pemphigus

A

1) High dose systemic corticosteroids
2) Azathioprine or mycophenolate
3) IV immunoglobulin, anti-CD20 antibodies or cyclophosphamide

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50
Q

Clinical features of dermatitis herpetiformis

A
  • Intense, burning itch
  • Small clusters of vesicles present on wrist, extensor surfaces of elbows and knees, sacrum and buttocks
  • NO mucosal involvement
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51
Q

Investigations and results in dermatitis herpetiformis

A
  • Biopsy: small polymorph abscess in the upper dermis
  • Immunofluorescence: granular deposition of IgA in the dermis papillary tips
  • TTG antibodies (80% of patients)
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52
Q

Management of dermatitis herpetiformis

A

1) Gluten free diet

2) Dapsone

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53
Q

Important side effects of dapsone

A
  • Haemolytic anaemia

- Agranulocytosis

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54
Q

Clinical features of erythema multiforme

A
  • <40s
  • Males more commonly affected
  • History of previous infection
  • TARGET LESIONS (red/ducky cyanotic middles with bright erythematous outer ring) - initially macular but may become papular. May be haemorrhage or blistering at the centre.
  • Rash most common on extremities e.g. hands, feet, face, elbows, knees
  • Mucosal involvement may occur
  • Fever and joint pain may occur
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55
Q

2 causes of erythema multiforme

A
  • HSV

- Mycoplasma

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56
Q

Management of erythema multiforme

A

1) Basic skin care with antiseptics
2) Topical steroids

  • IV fluids in those with severe mucosal involvement
  • Ophthalmology assessment in eye involvement
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57
Q

How long after starting a drug will TEN commence?

A

7-28 days

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58
Q

Main risk factor for TEN

A
  • Immunosuppression
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59
Q

Clinical features of TEN

A
  • Elderly patient
  • Sudden onset of diffuse erythema with sheets of skin undergoing necrosis
  • Excruciatingly painful
  • Mucosal involvement likely e.g. mouth, eyes, genitals
  • Wrinkling/blistering under sheets of skin
  • Nikolsky sign positive
  • Systemic features e.g. pyrexia, malaise, dysuria, sore eyes may precede rash
  • Often worse on the trunk
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60
Q

Definition of Steven-Johnson Syndrome

A

<10% of body area involvement (+ mucosal involvement)

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61
Q

Differentials for positive Nikolsky sign

A
  • Pemphigus
  • TEN
  • SSSS
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62
Q

Management of TEN

A
  • Stop relevant drugs ASAP
  • Monitor fluid balance
  • Adequate analgesia
  • Controlled pressure thermo-regulated bed and aluminium survival sheet
  • Ophthalmology assessment
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63
Q

Potential drug causes of TEN

A
  • Allopurinol
  • Carbamazepine
  • Sulphonamides
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64
Q

Clinical scoring system used to predict prognosis of TEN

A
  • SCORTEN
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65
Q

A SCORTEN score >? predicts death in 90% of cases

A

5

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66
Q

Main causes of death in TEN

A
  • Infection

- Hyper-catabolic state

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67
Q

Clinical features of SSSS

A
  • NO MUCOSAL INVOLVEMENT
  • Usually children <5 (or immunosuppressed adults/adults with renal failure)
  • Onset is a scarlet fever like rash around mouth and nappy area with peri-oral crusting and furrowing
  • Erythema first appears on face then generalises
  • Child is pyrexial but often systemically well
  • Intense pain
  • Over 48 hours, widespread blisters occur
  • May be Nikolsky sign positive
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68
Q

Investigations to consider in suspected SSSS?

A
  • Superficial skin biopsy

- Culture swabs from throat and eyes

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69
Q

Management of SSSS

A
  • IV Flucloxacillin and Vancomycin
  • Supportive care
  • Barrier nursing
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70
Q

Causes/associations of leucocytoclastic vasculitis

A
  • Infection e.g. Hep A, B or C, streptococci or mycobacterium
  • Drugs e.g. beta blockers, penicillin, thiazide diuretics
  • Malignancy e.g. CLL, lymphoma, myeloma
  • Small vessel vasculitis
  • Systemic disease e.g. IBD, sarcoidosis, Behcet’s
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71
Q

Clinical features of leucocytoclastic vasculitis

A
  • Palpable purpura
  • Most commonly on the legs
  • Lesions can vary in size
  • Lesions may be blistered or pustular
72
Q

Management of leucocytoclastic vasculitis

A
  • Bed rest and leg elevation
  • Compression bandages
  • Systemic corticosteroids or dapsone
73
Q

Diseases associated with pyoderma gangrenosum

A
  • IBD
  • Rheumatoid arthritis
  • Ankylosing spondylitis
  • Myeloma
  • IgA gammopathy
  • Diabetes
  • Chronic active hepatitis
  • Primary biliary cirrhosis
74
Q

Clinical features of pyoderma gangrenosum

A
  • Lesion starts as a small red papule
  • Then becomes pustular and ulcerated with red/purple/blue edges
  • Lesion grows in size and becomes painful
  • Systemically unwell patient
  • Deep structures may be exposed
75
Q

Management of pyoderma gangrenosum

A
  • Systemic corticosteroids
76
Q

Triggers/causes of erythema nodosum

A
  • Drugs e.g. oral contraceptive, penicillin
  • Bacteria e.g. streptococci, myocobacterium
  • Sarcoidosis
  • Brucellosis
  • Malignancy e.g. lymphoma, leukaemia
  • IBD
  • Behcet’s syndrome
77
Q

Clinical features of erythema nodosum

A
  • Painful red, raised or indurated lesions (look like bruises) - no ulceration and epidermis intact
  • Most commonly seen in the lower legs
  • Most common in young adults
  • More common in females
  • May have associated malaise, pyrexia and arthralgia
78
Q

Management of erythema nodosum

A
  • NSAIDs
  • Bed rest and compression stockings
  • Systemic corticosteroids
79
Q

Clinical features of vitiligo

A
  • Symmetrical, sharply demarcated macular areas of depigmentation
  • Hair may lose pigment too
  • Most commonly affects the genitals, eyes, mouth and hands
  • Associated with autoimmune disease
80
Q

Management of vitiligo

A
  • Topical steroids
  • Topical calcineurin inhibitors
  • Phototherapy (PUVA or UVB)
  • Epidermal transplants
81
Q

Inheritance mode of albinism

A

Autosomal recessive

82
Q

Clinical features of albinism

A
  • Pale skin and hair
  • Loss of pigmentation of the iris and retina
  • Poor visual acuity
  • Nystagmus
  • Increased rates of skin cancer
83
Q

Management of albinism

A
  • Sun avoidance
  • Early treatment of skin cancer
  • Asssesment of visual acuity
84
Q

Clinical features of melasma/chloasma

A
  • Brown/grey patches on cheeks and forehead

- Most common during pregnancy

85
Q

Management of melasma/chloasma

A
  • Sunscreen
  • Azelaic acid
  • Topical retinoids
86
Q

Clinical features of rosacea

A
  • Erythema, telangiectasia and flushing with possible sensory symptoms
  • Oedema of the facial skin
  • Papules and pustules on the face
  • Ocular signs and symptoms e.g. blepharitis, keratitis, chalazia, scleritis, uveitis
  • Rhinophyma (tissue overgrowth of nose)
  • Most common on the nose and cheeks
  • More common in middle-aged adults
  • More common in those with pale skin and red hair
  • Tends to be worse in men
87
Q

Management options for rosacea

A
  • General skin care - avoid irritants, soaps, UVR and many cosmetics
  • Avoid precipitants e.g. alcohol, spicy food
  • Topical brimonidine tartrate (improves erythema)
  • Topical antibiotics e.g. metronidazole
  • Topical azelaic acid
  • Topical ivermectin
  • Systemic antibiotics e.g. metronidazole, tetracyclines
  • Systemic isoretinoin
  • Surgical treatment of rhinophyma e.g. dermabrasion, surgical shaving
88
Q

Medication ontra-indicated in rosacea

A
  • Corticosteroids
89
Q

Clinical features of premolar dermatitis

A
  • Most common in young women
  • Papules, pustules and erythema around the mouth
  • Usually precipitated by topical corticosteroids or steroids inhalers
90
Q

Management of premolar dermatitis

A
  • Gradual reduction of topical corticosteroids

- Systemic tetracyclines

91
Q

Clinical features of seborrhoeic dermatitis

A
  • Erythematous and scaly condition in sebum rich areas e.g. face, nasolabial folds, forehead, upper chest and back
  • Most commonly seen in young and middle-aged adults
92
Q

Management of seborrhoeic dermatitis

A
  • Topical ketoconazole

- Topical steroids (may be added to speed up resolution)

93
Q

Two causes of scarring alopecia

A
  • Lichen planus

- SLE

94
Q

Clinical features of lichen planus

A
  • Intensely itchy rash
  • Presence of violaceous polygonal flat-topped plaques
  • Typically involves the wrists, forearms, lower legs or feet
  • Frequent oral/mucosal involvement with a white mesh like pattern
  • Can cause scarring alopecia
  • Can affect the nails - causes thinning, longitudinal ridging and a widespread pattern (tracyonychia)
  • More common in middle aged
95
Q

Chronic lichen planus of the mucosa is associated with ???

A

Squamous cell carcinoma

96
Q

Diagnostic investigation in lichen planus

A
  • Wickham’s striae (lace-like pattern) on dermatoscope
97
Q

Management options for lichen planus

A
  • Potent topical corticosteroids
  • Sedative antihistamines
  • Topical calcineurin inhibitors
  • Short term systemic corticosteroids
98
Q

Clinical features of lichen slerosus

A
  • Atrophic wrinkled skin (‘cigarette paper’ skin)
  • Typically affects skin, mucosa and genitals
  • White patches of skin
  • May lead to blisters, bleeding and scarring
99
Q

Lichen sclerosus of the genitals is associated with an increased risk of ???

A

Squamous cell carcinoma

100
Q

Management of lichen sclerosus

A

Topical steroids

101
Q

Clinical features of pityriasis rosea

A
  • Typically follows a viral infection
  • Development of a Herald patch followed by smaller lesions 7-10 days later
  • Typically affects the trunk in ‘Christmas’ tree distribution
102
Q

Clinical features of ichthyosis vulgaris

A
  • Diffuse polygonal scaling
  • Sparing of the flexures
  • Keratosis pilaris
  • Hyperlinear palms
  • May be associated with atopic dermatitis
103
Q

Acquired ichthyosis may be a sign of ???

A

Underlying malignancy e.g. lymphoma

104
Q

Clinical features of impetigo

A
  • More common in children under 6
  • Most commonly around the nose and mouth
  • Begins with small vesicles which rupture followed by pus-filled blisters, with honey/golden crust
  • May have associated leucocytosis and lymphadenopathy
105
Q

Diagnostic investigation for impetigo

A
  • Sampling of blister contents or skin swab
106
Q

Management of impetigo

A
  • Removal of crusts with wet dressings and cleaning of wounds
  • Use personal towels and face cloths
  • Topical mupirocin or fusidic acid +/- chlorhexidine
  • Systemic antibiotics e.g. Flucloxacillin or cephalosporin
107
Q

Common causes of folliculitis

A
  • Staph
  • Candida
  • HSV
  • Gram-negative folliculitis
108
Q

Triggers/risk factors for folliculitis

A
  • Excess sweating
  • Obesity
  • Diabetes
  • Topical or systemic corticosteroids
  • Oily skin care preparations
109
Q

Management of folliculitis

A

Normally not required. Can use:

  • Topical antiseptics
  • Topical fusidic acid or mupirocin
  • Systemic antibiotics (if systemically unwell)
110
Q

Clinical features of cellulitis

A
  • Elderly patients
  • Unilateral area of erythema of the lower leg, with oedema, pain and local warmth
  • Systemically unwell: pyrexia, malaise, leucocytosis
  • May be associated painful ascending lymphangitis
111
Q

Management of cellulitis

A
  • IV/oral Flucloxacillin +/- Benzylpenicillin
112
Q

Diagnostic test for dermatophyte infection

A
  • Skin scraping
113
Q

Management of dermatophyte infection

A
  • Topical miconazole/ketoconazole or terbinafine

- Oral terbinafine in scalp or nail dermatophyte infection)

114
Q

Clinical features of pityriasis versicolor

A
  • Most commonly seen in young people
  • Most commonly noticed after a summer holiday
  • Dull red/light brown scaly plaques on upper chest and back
  • Slightly scaly
115
Q

Diagnostic test for pityriasis versicolor

A
  • Examination of scale with a drop of potassium hydroxide
116
Q

Management of pityriasis versicolor

A
  • Topical ketoconazole
117
Q

Clinical features of molluscum contagious

A
  • Most common in children
  • Lesions/papules/nodules with a shiny white centre and central umbilication
  • Often accompanied with eczema
118
Q

What should you suspect in an adult with molluscum contagious

A

Immunosuppression

119
Q

Clinical features of herpes simplex reactivation

A
  • Tingling around lips
  • Papule formation on lip
  • Clustering or grouping of blistered lesions
120
Q

Management of herpes simplex reactivation

A
  • Topical acyclovir from earliest onset of symptoms
121
Q

Diagnostic test for eczema herpeticum

A
  • Rapid fluorescence or PCR of skin scrapings
122
Q

Clinical features of eczema herpeticum

A
  • Hundreds of punched out lesions
  • Background of eczema
  • Systemically unwell
123
Q

Management of eczema herpeticum

A
  • Systemic antivirals e.g. Acyclovir
124
Q

Clinical features of chickenpox

A
  • Spread by droplets, incubation period of 3 weeks
  • Most commonly affects children
  • Lesions begin as red merciless before forming small blisters then crust
  • Lesions occur in crops
  • Lesions are very itchy
125
Q

When would you be concerned about a varicella zoster infection?

A
  • Adults who are immunocompromised or not previously exposed to the virus - can produce a severe illness with pyrexia, malaria and pneumonia
  • Pregnant women - can cause foetal abnormalities, spontaneous miscarriage or pre-term birth
126
Q

Clinical features of singles

A
  • Dermatomal pattern of vesicles on a red base which pustules, crust and may scar
  • Vesicles preceded by dermatomal pain
127
Q

What can exposure to a patient with shingles lead someone to develop?

A

Chickenpox (if they have not had it before)

128
Q

Management of shingles

A
  • Aciclovir to shorten symptoms duration (IV in immunocompromised patients)
  • Vaccination in older adults
129
Q

Clinical features of scabies

A
  • Transmitted via close physical contact, causes reaction ~3 weeks after infestation
  • Intense itch which is worse at night and widespread excoriation
  • Burrows seen on palms, soles and in finger webs
  • Nodules seen around nipples and genitalia
130
Q

Diagnostic tests for scabies

A
  • Full body examination

- Fine needly pushed along burrow and examined under microscope

131
Q

Clinical features of head lice

A
  • Itchy eruption on scalp and nape of neck

- Mites and nits seen on hair

132
Q

Management of scabies

A
  • Permethrin or malathion applied after a warm bath, left on overnight and repeated 7 days later (treat affected individual and all close contacts)
  • Hot cycle wash of clothing and bedding
133
Q

Management of head lice

A
  • Topical malathion or permethrin repeated 7 days later
134
Q

Management of body lice

A

Disinfect clothes with hot washes and ironing

135
Q

Clinical features of polymorphic eruption of pregnancy

A
  • Itchy red papules late in the 3rd trimester or just after delivery
  • Lesions located preferentially within the striae
  • Sparing of the umbilical region
  • Rash spreads from abdomen to other parts of the trunk and limbs
  • Most common in first pregnancy and rarely recurs
136
Q

Management of PEP

A
  • Topical corticosteroids and antihistamines
137
Q

Clinical features of pemphigoid gestationis

A
  • Appearance similar to pemphigoid
  • Does not favour the striae
  • No umbilical sparing
  • Occurs earlier in final trimester or before
  • Likely to recur and be more severe in future pregnancies (if father is the same)
138
Q

Investigations used to diagnose pemphigoid gestationis

A
  • Pathology (eosinophils and sub-epidermal blisters)

- Immunofluorescence (positive C3 and IgG along basement membrane)

139
Q

Management of pemphigoid gestationis

A
  • Topical corticosteroids and sedative antihistamines
140
Q

Inheritance mode of neurofibromatosis

A

Autosomal dominant

141
Q

Clinical features of neurofibromatosis

A
  • Cafe au lait spots
  • Axillary freckling
  • Neurofibromas
  • Flexiform large sub-cutanrous neurofibromas
  • Lisch nodules
  • CNS tumours
142
Q

Clinical features of tuberous sclerosis

A
  • Ash-leaf macules
  • Shagreen patches
  • Angiofibromas
  • Periungal fibromas
  • Seizures and cognitive impairment
143
Q

Inheritance mode of tuberous sclerosis

A

Autosomal dominant

144
Q

Potential causes of acanthosis nigricans

A
  • Underlying malignancy
  • Obesity
  • Type 2 diabetes
145
Q

What would you be worried about in a patient with acanthosis nigricans?

A
  • Underlying malignancy
146
Q

Clinical features of acanthosis nigricans

A
  • Brown hyper-keratotic velvety/warty areas in axilla, neck and groin
  • Multiple superimposed skin tags
147
Q

What would you be worried about in a patient with dermatomyositis?

A

Underlying malignancy

148
Q

Clinical features of dermatomyositis

A
  • More common in women
  • Proximal muscle weakness
  • Heliotrope rash around the eyes
  • Erythematous rash in a photosensitive distribution
  • Gottron’s papules (Violaceous lichenoid rash along dorsal surface of hands and fingers)
  • Painful cuticles and prominent nail fold capillaries
149
Q

Investigations in dermatomyositis

A
  • Skin biopsy

- Raised serum creatinine kinase

150
Q

Management of dermatomyositis

A
  • High dose prednisolone
151
Q

Inheritance mode of HHT

A

Autosomal dominant

152
Q

Clinical features of HHT

A
  • Small flat red spots on the lips, oral and nasal mucosa, skin (particularly the hands) and GI tract
  • Frequently presents with nosebleeds or GI bleeds
  • May lead to anaemia
153
Q

Risk factors for BCC

A
  • UV radiation exposure
  • Sun sensitive skin
  • Age
  • Immunosuppression (especially those who have undergone organ transplant)
  • Gorlin’s syndrome (rare inherited syndrome which presents with large numbers of BCCs at a young age)
154
Q

Commonest skin cancer

A

BCC

155
Q

Clinical features of a nodular BCC

A
  • Translucent quality
  • ‘Pearly’ translucent papules
  • Papules surrounded by an ulcerated crater
  • Telangiectasia
  • Most common on the middle 1/3rd of the face (and other sun exposed sites e.g. scalp, back, legs, arms)
  • Usually <1cm diameter
  • Appear over months/years (slow-growing)
  • Well defined tumour margins
156
Q

Why do BCCs need treatment, despite not being able to metastasise?

A

They can invade locally and destroy nearby structures

157
Q

Risk factors for SCC

A
  • Age
  • Male sex (2:1)
  • UVR exposure (more so than other cancers), including PUVA
  • Immunosuppression (especially patients who have had organ transplants)
158
Q

Main cancer risk in immunosuppressed patients

A

Squamous cell carcinoma

159
Q

Clinical features of an SCC

A
  • Ulcerated keratinising nodule – may focus around a keratin plug to give a ‘volcano’ appearance
  • Vary in size (0.5-4cm)
  • Surrounding skin may show features of UV radiation damage e.g. dermal atrophy, increased variation of pigmentation and increased skin vasculature
  • Only present on sites of cumulative UV exposure e.g. heads of bald men, tops of ears, face and back of hands
160
Q

Management of SCC

A
  • Surgical excision with 4-6mm normal tissue margin

- Surgical excision + radiotherapy for high risk tumours

161
Q

Risk factors for melanoma

A
  • UV radiation exposure
  • Sun sensitive skin
  • Middle-age
  • Female sex
  • Family history (10% of cases) – Affected individuals have larger number of atypical naevi
  • PUVA therapy – increases risk
  • Immunosuppression (lower risk than SCC)
162
Q

Clinical features of superficial spreading melanoma

A
  • Flat/almost flat lesions in which cells appear to have spread laterally from one point
  • Normally resemble normal melanotic naevi
163
Q

Clinical features of lentigo maligna melanoma

A
  • On continually sun-exposed skin e.g. face, back of hands

- Present over many years with a slow increase in area and gradual darkening in colour

164
Q

Clinical feature of aural melanoma

A
  • Present on palms or soles
165
Q

Most common sites for melanoma to present

A
  • Trunk or legs
166
Q

Most important prognostic indicator for a melanoma without metastatic spread at diagnosis

A

Breslow thickness

167
Q

Management of malignant melanoma

A
  • Surgical excision with 2mm margin followed by further excision based on Breslow thickness on histopathology
168
Q

Clinical features of actinic keratoses

A
  • Erythema
  • Scale which feels rough on palpation
  • Size varies from 1mm to >1cm in diameter
  • Frequently multiple lesions
169
Q

Management options for actinic keratoses

A
  • Topical NSAIDs e.g. diclofenac
  • Cryotherapy
  • Curette and cautery
  • Topical chemotherapy agents
170
Q

Clinical features of keratocanthoma

A
  • Morphologically similar to an SCC
  • Lesion grows very quickly over 6-8 weeks then involute and disappear without any treatment
  • Tend to scar on healing
171
Q

Management of keratocanthoma

A

Surgical excision

172
Q

Clinical features of seborrheic keratoses

A
  • ‘Stuck on’ appearance
  • Warty/irregular surface with an irregular edge
  • Variable pigmentation
  • Often appear greasy
  • Most common on the trunk but can also occur on the face or limbs
  • May itch or bleed
  • Start to appear in 30-40s
  • More common in Caucasians
  • Some have ‘comedo like’ openings or white milia like (pseudocyst) structures
173
Q

Clinical features of solar lentigines

A
  • Almost flat brown marks
  • Common on the back of hands, forearms and face
  • Surrounding skin may show features of sun damage
  • Very common after middle age in sun sensitive patients
174
Q

Clinical features of Campbell de Morgan Spots

A
  • Collapse and shrink in volume on pressure
175
Q

Clinical features of Pyogenic granulomas

A
  • Caused by trauma
  • Common on the hands and around the mouth
  • Bleed after minimal trauma
176
Q

Management of pyogenic granulomas

A
  • Surgical excision or curette

Year 5 (9 decks)

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