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dermatology Flashcards

1
Q

Describing a rash

A

DCM!
D = distribution - skin folds/flexural
C = configuration (grouping) - linear, annular (ring), discoid (coin like), cluster
M = Morphology - cyst/fissue/macule/papule/polyp/pustule/nodule

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2
Q

define macule

A

flat (non-palpable) are of altered colour <0.5cm eg freckle

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3
Q

define patch

A

Flat area of altered colour >0.5cm e.g. port-wine stain

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4
Q

define papule

A

Solid raised lesion <0.5cm e.g. xanthomata

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5
Q

define nodule

A

Solid raised lesion >0.5cm with deeper component e.g. granuloma

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6
Q

define plaque

A

Flat, palpable, raised scaling lesion, well circumscribed e.g. psoriasis

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7
Q

define vesicle

A

Raised, clear, fluid filled lesion <0.5cm e.g. HSV

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8
Q

define bulla

A

Raised, clear, fluid filled lesion >0.5cm

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9
Q

define pustule

A

Pus containing lesion <0.5cm e.g. acne

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10
Q

define abscess

A

Localised accumulation of pus in dermis or subcutaneous e.g. periungual

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11
Q

define wheal

A

Transient, raised lesion due to dermal oedema e.g. urticaria

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12
Q

define boil

A

Staphylococcus infection around or within hair follice

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13
Q

define secondary excoriation

A

Loss of epidermis following trauma e.g. eczema

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14
Q

define lichenification

A

Well-defined roughening of skin with attenuation of skin markings

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15
Q

define scale

A

flakes of stratum corneum e.g. psoriasis (silver scaling)

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16
Q

define crust

A

Rough surface of dried blood, serum or bacteria e.g. burst blister

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17
Q

define scar

A

New fibrous tissue occurring post wound healing, may be atrophic (thinning), hypertrophic (hyperproliferation within boundary), or keloidal (beyond boundary)

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18
Q

define ulcer

A

Loss of epidermis and dermis

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19
Q

define fissure

A

Epidermal crack due to excess dryness, e.g. eczema

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20
Q

define striae

A

Linear areas, purple, pink, or white e.g. steroids

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21
Q

layers of skin

A

top to bottom:
1 - epidermis
2 - dermis
3 - subcutaneous layer

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22
Q

function of normal skin

A 
Protection against environment
Temperature regulation
Sensation
Vitamin D synthesis
Immunosurveillance
Stop fluid loss
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23
Q

epidermis 4 main cell types

A
  1. Keratinocytes - produce keratin (protective layer)
  2. Langerhans’ cells - present antigens and activate T-lymphocytes
  3. Melanocytes - produce melanin - pigment and protects nuclei
    from UV radiation induced DNA damage
  4. Merkel cells - Special nerve endings for sensation
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24
Q

what do the 4 layers of the epidermis represent

A

the different stages in maturation of the keratinocytes

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25
Q

4 layers of epidermis

A

brown slugs grab cocks - excuse my french tehe - bottom to top
1. Stratum basale (basal) - actively dividing cells
2. Stratum spinosum (prickle) - differentiating cells
3. Stratum granulosum (granular) - cells lose nuclei, contain granules of keratohyaline, secrete lipid to extracellular space
3a – Stratum lucidum - paler compact keratin - only at thick skin (sole)
5. Stratum corneum (horny) - layer of keratin

26
Q

what does the dermis consist of?

A

Dermis made up of collagen (mainly), elastin and glycoaminoglycans (GAG) - synthesised by fibroblasts.
Also contains immune cells, nerve cells, skin appendages, lymphatic/blood vessels

27
Q

problems with epidermis and dermis

A

epidermis - Increased turnover (psoriasis), changes in surface/loss (scales, crust), changes in pigmentation

dermis - Changes in contour (papules, nodules), disorders of appendages (hair/acne), lymphatic and bv problems (erythema - vasodilation, purpura - capillary leak)

28
Q

Hair-
types?
structure?

A

3 types-

  1. lanugo - fine,
  2. vellus - body,
  3. terminal - coarse i.e. scalp, eyelash)

structure -
made of modified keratin, divided into shaft (keratinised tube) and bulb (actively dividing cells and melanocytes)

29
Q

Nails

A

Made of nail plate (hard keratin) arising from matrix at posterior nail fold and rests on nail bed (contains capillaries)
Pathology: matrix (pits + ridges), bed (splinter haemorrhages), plate (thickened + discoloured)

30
Q

therapies
medical
physical
FTU

A 
MEDICAL
 - topical or systemic 
Deliver Rx to affected area and reduces SE side effects.
Suitable at local + less severe. 
Active constituent transported to skin by base.
FORMS
Lotion - liquid
Cream (oil in water)
Gel (polymers in liquid)
Ointment (oil with little water)
Paste (powder in ointment)

PHYSICAL
cryotherapy, phototherapy, photodynamic therapy, laser/surgery

FTU - finger tip unit - crease to top = 0.5g

31
Q 
emollients
indications
directions
SE
examples
A

indications
Rehydrate skin, re-establish surface lipid layer. Use at dry, scaling conditions as soap substitute

directions
In direction of hair liberally

SE
Irritant - rash

eg
Aqueous cream, emulsifying ointment, liquid paraffin (all 500g/tub)
Diprobase (cream)
Double base (gel)
Dermol (antibacterial)
32
Q

topical/oral corticosteroids
least -> most potent
when used

A
  1. Hydrocortisone (YOU BET DERM)
  2. Clobetasone butyrate (Eumovate)
  3. Betamethasone valerate (Betnovate)
  4. Clobetasol propionate (Dermovate)

Come in 30g tubes (enough to cover whole body once)

Anti-inflammatory, anti-proliferative
allergic/immune conditions, blistering, inflammatory skin conditions, connective tissue disease, vasculitis

33
Q

topic steroid SE

A

Skin atrophy, telangiectasia, striae, exacerbation skin conditions
acne, perioral dermatitis

34
Q

topical abx examples +SE

A

Fusidic acid, mupirocin, neomycin

Local (irritation, allergy)
Systemic: GI upset, rash, anaphylaxis, candidiasis, ABX associated infections

35
Q

oral retinoids
examples
indications
SE

A

Isotretinoin, acitretin

indications:
Acne, psoriasis, disorders of keratinisation

SE
Mucocutaneous reactions: dry skin, lips, eyes
Disordered liver function (LFT)
Hypercholesterolaemia (Blood test)
Myalgia, arthralgia, depression
Teratogenicity (effective contraception one month before, during and after isotretinoin, 2 years after acitretin)

36
Q

ciclosporin + tacrolimus
what are they
SE

A

Calcineurin inhibitors

SE - HTN and renal dysfunction
monitor BP and Ur + Cr

37
Q

azathioprine
what is it
how does it work
SE

A

Pro-drug for mercaptopurine

Inhibits enzymes required for DNA synthesis of T and B cells

SE:
Hepatotoxicity and myelotoxicity

38
Q 
contact dermatitis 
pres
types
ix
mgmt
A

pres
History of contact with irritants and occupational history
Localised burning, stinging, itching, blistering, redness, swelling at area of contact

types
Irritant - direct toxicity without prior sensitisation
Allergic - delayed hypersensitivity (history of atopy)

ix
Patch testing may identify agent

mgmt
Irritant: emollients/topical corticosteroids + irritant avoidance (gloves)
Allergic: topical corticosteroids + allergen avoidance (±topical calcineurin… as AD)

39
Q

seborrhoeic dermatitis
pres
mgmt

A

pres
Pruritic, erythematous, scaly patches on scalp, nasolabial fold,
anterior chest
Infant - cradle cap (resolves by 12 months)
Adult - Flares with stress. Uninflamed scalp form is dandruff
or pityriasis capitis (fungus pityrosporum ovale)

mgmt
Infants - emollients and topical corticosteroids
Adults (scalp only) - topical shampoo (salicylic acid - keratolytic, coal tar, antifungal - ketoconazole) or topical corticosteroids
Adults (non-scalp) - topical corticosteroids ± topical antifungals (ketoconazole)
Lasting over 3 months - oral antifungal (ketoconazole)

40
Q

types of cancer

A

melanoma - 10%
non -melanoma:
1. BCC - 70% - hair follicle, mets rare, low recurrance
2. SCC - 20% - keratinocytes, premalignant = actinic keratosis, in-situ - bowen’s, METS common, high recurrance

41
Q

approach to describing pigmented lesion

A 
ABCDE
Asymmetry
Border
Colour
Diameter
EVOLUTION!
42
Q

breslows thickness and clarkes level

A

assessing MM

Breslow’s thickness = depth of invasion, measured on histology
Thin = 1mm
Intermediate = 1-4mm
Thick = 4mm
Clark’s level = less accurate measure of tumour thickness

43
Q 
bullous pemphigoid
what is it
causes
pres
ix
mgmt
A

what is it
A chronic blistering (sub-epidermal) skin disorder normally affecting the elderly

Caused by autoantibodies against hemidesmosal antigens in epidermis and dermis = sub-epidermal split in skin

pres
Tense fluid filled blisters on erythematous base
Often itchy and presents on trunk and limbs.
Symmetrical and favour flexures
Preceded by nonspecific itchy rash

ix
Skin biopsy for histopathology
Sub-epidermal blister with dermal inflammatory cell infiltrate rich in eosinophils

mgmt
General measures:
Wound dressing, monitor for infection signs
Topical therapies (for localised):
- Corticosteroids
- Tacrolimus
Oral therapies (for widespread lesions):
1. Steroids - prednisolone (short term) + sedating antihistamines - hydroxyzine
2. Nicotinamide (B3) + oral tetracycline
3. Immunosuppressives (azathioprine, methotrexate, ciclosporin)

44
Q

pemphigus vulgaris
what is it
mgmt

A

Autoimmune blistering skin disorder affecting the middle aged
Autoantibodies against antigens in epidermis causing intra-epidermal split in skin (shallower)
Flaccid easily ruptured blisters forming erosions and crusts (painful)
Affects mucosal areas

Management
General measures - wound dressing, monitor for infection, oral care
Oral therapies - high dose oral steroids, immunosuppressants (methotrexate, azathioprine, cyclophosphamide, mycophenolate mofetil)

45
Q 
impetigo
who
pres
cause
mgmt
A

Common in children
Golden crust or vesicles/bullae in bullous impetigo

S.aureus
Susceptible post trauma/skin breaks e.g. eczema
Highly contagious

Treat with antibiotics
Topical fusidic acid
Intranasal mupirocin
Oral flucloxacillin

46
Q

herpes simplex
types
mgmt

A

Type 1 = oral herpes - oral ulcer with vermillion border or vesicles
Type 2 = genital herpes

Treat with aciclovir - oral ± topical

47
Q 
warts
aka
def
cause
mgmt
A

aka
Verrucae vulgaris

def
Elevated, round, hyperkeratotic skin papules with rough grey or brown surface

cause
HPV (6-11)

mgmt
Cryotherapy, silver nitrate, debridement and salicylic acid

48
Q

molluscum contagiosum
cause
pres
mgmt

A

Viral - affects 20% children

Acquired through skin to skin contact, sexually in adults

Pearly, smooth papule with a central umbilication commonly distributed at face and groin

Manage children expectantly. Avoid sharing towels/clothing
Adult STD: curettage, cryotherapy

49
Q 
scabies
causes
pres
dx
mgmt
A

Caused by infection with mites, transmission via skin to skin contact. Often seen in overcrowded living conditions

Pruritus, erythematous papules, linear burrows in interdigital web space

dx
Confirmed by microscopic visualisation of mites, eggs, faeces in skin scrapings

mgmt
Treat the whole family + wash clothes >60 degrees
Topical permethrin (5%) + antihistamines: apply from neck down and wash after 8 hours

50
Q

ulcer
def
what do you check?
most common

A

Abnormal breaks in the epithelial surface

Need to check 3 things in all ulcers

  1. Site
  2. Edge
  3. Base

Most common ulcers are venous (80%), then arterial (20%)

51
Q

pathophys of venous ulcers

A

Chronic venous insufficiency (affects 7% of population)
Incompetent valves in veins of lower leg
Blood squeezed into superficial veins rather than to heart -> dilation (varicosities) and raised pressure
Raised pressure -> oedema, venous eczema and extravasation of fibrinogen
Extravascular fibrin deposition
Poor oxygenation of surrounding skin + ulceration

52
Q 
venous ulcer
site
appearance
ix
mgmt
A

Medial/lateral malleolus. Between knee and ankle

appearance
Large
Shallow/sloping edge
Painless/mild pain (relieve by elevation)
Irregular border
Moist granulating base

ix
ABPI using Doppler for pulses - to exclude arterial
Measure SA
Swabs for microbiology - if signs cellulitis
Biopsy if atypical appearance or fail to heal in 12 weeks

mgmt
Graduated compression + leg elevation (exclude art and neuro!)
Maximise pressure at ankle/gaiter and decrease as higher.
Debridement and cleaning - debride slough
Dressing - Occlusive hydrocolloidal - allows epthelial migration and influx of leukocytes and moisture
ABX if cellulitis suspected

53
Q 
arterial ulcers 
causes
suspect if 
site 
appearance
ix
mgmt
A

causes
atherosclerosis
tissue hypoxia

suspect if
CV RFs
6 ps

site
more distal
dorsum of foot or toes

appearance
Painful, initially irregular edge (may become more clear), grey granulating base, no bleeding on debridement, punched out, cold shiny surrounding skin

ix
ABPI: BP cuff on lower calf above ankle. Doppler probe on dorsalis pedis. Divide systolic at ankle by arm (highest) -> <0.9 implies peripheral arterial disease

mgmt
vascular surgeon problem lol

54
Q

neuropathic ulcers
site
appearance
mgmt

A

Under callouses or over pressure points (plantar aspect of 1st and 5th metatarsophalangeal joint

Punched out + deep sinus
Surrounded by chronic inflammatory tissue
Probing and debridement leads to brisk bleeding
Painless
Sloughy/necrotic base

mgmt
Seek cause of neuropathy (often diabetes)
Diabetic foot management (socks/shoes/pressure/clean/check sensation)

55
Q

mgmt of urticaria, angioedema, + anaphylaxis

A

Acute urticaria ± angioedema with airway involvement
->IM adrenaline (1 in 1000) + airway protection + IV antihistamines (chlorphenamine/dipenhydramine = 2nd generation) + IV corticosteroids (hydrocortisone) + trigger identification + avoidance

Acute urticaria ± angioedema without airway involvement
2nd gen antihistamine, H1 receptor antagonist - (e.g. loratadine, non sedating) + systemic corticosteroid (prednisolone) + trigger avoidance

Chronic urticaria
Loratadine

anaphylaxis
adult - 0.5mg 1:1000 adrenaline, 200mg hydrocortisone, chlorphenamine 10mg
6-12 - 0.3mg, 100mg, 5mg
<6 - 0.15mg, 50mg, 2.5mg

56
Q 
rosacea
def
pres
triggers
mgmt
A 
def
Common chronic skin condition affecting convexities of face + forehead

pres
Flushing, dilated telangiectasia (facial), facial erythema, inflammatory papules
Prominent sebaceous glands - fibrosis and rhinophyma
Ocular - blepharitis

triggers
Climate (sunshine), chemical/ingested agents (alcohol), stress, hot baths/drinks

mgmt
Topical antibiotic/anti-inflammatory ± oral antibiotic
- Metronidazole/azelaic acid (top)
- Doxycycline/tetracycline (oral)

57
Q 
seborrhoeic keratosis
def
pres
location
assoc
mgmt
A

Common, multiple, benign lesions affecting over 50s (80-100%)

pres
STUCK-ON lesions, well-circumscribed plaques or papules, may be warty appearance, grey-brown-black, painless

loc
Torso or head

assoc
UV sun damage, white

Milia-like cysts and comedone-like openings

mgmt
Itchy - steroids (topical)
Flat - cryotherapy
Raised - curettage or cautery

58
Q 
lichen planus
what is it
location
pres
mgmt
A

A self-limiting inflammatory disease affecting skin (+genitals), nails, hair and mucous membranes. Most common in middle aged women. Associated with intense pruritus (80%) and scarring alopecia

Characteristic eruption:
Itchy, shiny, flat-topped violaceous papules and plaques

Location:
Extremities

Visible at mucosa/cutaneous lesions
Wickham’s striae (overlying lacy white network) and oral erosions

mgmt
Cutaneous
-> Topical corticosteroid (clobetasol) + antihistamine (e.g. chlorphenamine)
Oral
-> Topical corticosteroid ± oral corticosteroid
Genital
-> Topical corticosteroid/calcineurin inhibitor

59
Q

ddx of itch

A

Renal pruritus (chronic renal failure) - Urea mediated
Cholestatic pruritus = Bile salt mediated
Haematological pruritus (polycythaemia vera)- increased number basophils and mast cells in skin
Endocrine pruritus - hyper (kinin) /hypothyroidism (xerosis), DM
Malignant pruritus:
1. Hodgkin lymphoma - bradykinin mediated
2. Carcinoid syndrome - serotonin mediated

60
Q

vasculitic skin changes

A

Vasculitis commonly affects the skin and the kidneys: therefore do a urine dip
Think of cutaneous vasculitis when on renal/cardiovascular
Small vessels: purpura, petechiae, ulcers
Medium vessels: nodules and livedo reticularis

61
Q 
alopecia areata
what is it
assoc
types
pres
ddx
mgmt
prog
A

Autoimmune disease: inflammatory cells (T-lymphocytes) target hair follicles - preventing growth

Common disorder - affects 2% of population. Strong association HLA (class 2). May be family Hx of AI disease

Small round patch of hair loss which may regrow spontaneously.
Patchy hair-loss. In non-scarring follicular markings/orifices are retained -> consider reversible. Exclamation mark hairs (narrower near skin). Positive hair pull test (>5 hairs)

Types:
Patchy alopecia areata
Alopecia totalis (scalp)
Alopecia universalis - all body hair

ddx
Scarring alopecia. Lack of follicular markings + inflammation, scale and erythema. On biopsy = lymphocyte or neutrophil infiltrate

mgmt
Limited= topical corticosteroid + cosmetic camouflage and support or intralesional corticosteroid
Extensive = topical immunotherapy + cosmetic camouflage + support

prog
Relapses. In 2 years most will have spontaneous regrowth

62
Q 
androgenic alopecia
aka
what is it
inheritance
pattern
mgmt
ix
A

Genetically determined patterned progressive hair loss from scalp.

Dominantly inherited with variable penetrance therefore family Hx relevant.

Men (onset 20-25):
Progressive shortening of anagen phase with increased telogen phase.
Androgen (DHT) mediated follicular miniaturisation -> fine, short, non-pig vellus hair
Testosterone to DHT by 5-alpha-reductase
Pattern: receding frontal hairline, thinning in temporal areas progressing to crown
Rx = topical minoxidil ± oral finasteride (not for women) ± cosmetic aids (minoxidil = 3/6 months see some growth)

Women (onset menopause, assoc PCOS):
Diffuse thinning on crown but preservation of frontal hair line

Ix:
Hair pull (<3 hairs - areata), TFT (hyperthyroidism), dermatoscopy (follicular miniaturisation)

finals (17 decks)

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