dermatology Flashcards
polycythaemia features
Pruritus particularly after warm bath
‘Ruddy complexion’
Gout
Peptic ulcer disease
pemphigus vulgaris feartures
antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule
more common in the Ashkenazi Jewish population.
mucosal ulceration is common and often the presenting symptom. Oral involvement is seen in 50-70% of patients
skin blistering - flaccid, easily ruptured vesicles and bullae. Lesions are typically painful but not itchy. These may develop months after the initial mucosal symptoms. Nikolsky’s describes the spread of bullae following application of horizontal, tangential pressure to the skin
acantholysis on biopsy
acanthosis nigricans causes
Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin
Causes gastrointestinal cancer diabetes mellitus obesity polycystic ovarian syndrome acromegaly Cushing's disease hypothyroidism familial Prader-Willi syndrome drugs: oral contraceptive pill, nicotinic acid
hidradenitis suppurativa
multible abscesses in sweat gland areas
lichen planus Ps
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham’s striae over surface. Oral involvement common
hirsutism associated with
cushings
psoriasis exacerbating factors
The following factors may exacerbate psoriasis:
trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids
Streptococcal infection may trigger guttate psoriasis.
commonest keloid site
sternum
Pigmentation of nail bed affecting proximal nail fold
Acral lentiginous melanoma (Hutchinson’s sign)
lichen sclerosus mx
Lichen sclerosis is a dermatological condition that affects the vulva. The first line treatment is a strong topical steroid thus the answer is topical clobetasol propionate.
TEN drug causes
phenytoin sulphonamides allopurinol penicillins carbamazepine NSAIDs
seborrhoeic dermatitis fx
Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale). It is common, affecting around 2% of the general population
Features
eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop
erythroderma
Erythroderma is a term used when more than 95% of the skin is involved in a rash of any kind.
Causes of erythroderma eczema psoriasis drugs e.g. gold lymphomas, leukaemias idiopathic
Necrobiosis lipoidica diabeticorum fx
shiny, painless areas of yellow/red skin typically on the shin of diabetics
often associated with telangiectasia
impetigo tx
topical fusidic acid is first-line
topical retapamulin is used second-line if fusidic acid has been ineffective or is not tolerated
MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin (Bactroban) should, therefore, be used in this situation
Extensive disease
oral flucloxacillin
oral erythromycin if penicillin-allergic
children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
granuloma annulare
papular lesions that are often slightly hyperpigmented and depressed centrally
typically occur on the dorsal surfaces of the hands and feet, and on the extensor aspects of the arms and legs
PUVA therapy risk factor for
SCC
most accurate way of assessing burns
lund brower chart
lentigo maligna
Lentigo maligna is a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma.
pyoderma gangrenosum causes
idiopathic in 50% inflammatory bowel disease: ulcerative colitis, Crohn's rheumatoid arthritis, SLE myeloproliferative disorders lymphoma, myeloid leukaemias monoclonal gammopathy (IgA) primary biliary cirrhosis
pityriasis rosea
HHV 7
herald patch first
fungal nail
trichophyton rubrum
mx pyoderma gangernosum
the potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment
other immunosuppressive therapy, for example ciclosporin and infliximab, have a role in difficult cases
koebner phenomenon
psoriasis vitiligo warts lichen planus lichen sclerosus molluscum contagiosum
acne mx
topical retinoids
combination topical- retinoids, benzyl peroxide, abx
oral abx (cocp in females)
oral isotretinoin
pregnancy skin
Pemphigoid gestationis
pruritic blistering lesions
often develop in peri-umbilical region, later spreading to the trunk, back, buttocks and arms
usually presents 2nd or 3rd trimester and is rarely seen in the first pregnancy
oral corticosteroids are usually required
Polymorphic eruption of pregnancy
pruritic condition associated with last trimester
lesions often first appear in abdominal striae
management depends on severity: emollients, mild potency topical steroids and oral steroids may be used
acne organism
Propionibacterium acnes
ketoconazole s/e
hepatotoxicity, gynaecomastia
pyogenic granuloma
These present as friable overgrowths of granulation at sites of minor trauma. They may be ulcerated and bleeding on contact is common. They may be treated with curettage and cautery, formal excision may be used if there is diagnostic doubt.
actinic keratosis mx
prevention of further risk: e.g. sun avoidance, sun cream
fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
topical imiquimod: trials have shown good efficacy
cryotherapy
curettage and cautery
psoriasis mx
first-line: NICE recommend a potent corticosteroid applied once daily plus vitamin D analogue applied once daily (applied separately, one in the morning and the other in the evening) for up to 4 weeks as initial treatment
second-line: if no improvement after 8 weeks then offer a vitamin D analogue twice daily
third-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid applied twice daily for up to 4 weeks or a coal tar preparation applied once or twice daily
2ndary care- phototherapy, MTX, ustekinimab
ketatoacanthoma fx
Features - said to look like a volcano or crater
initially a smooth dome-shaped papule
rapidly grows to become a crater centrally-filled with keratin
MM types
Superficial
nodular (most aggressive)
lentigo
acral
Chondrodermatitis nodularis helicis
Chondrodermatitis nodularis helicis (CNH) is a common and benign condition characterised by the development of a painful nodule on the ear. It is thought to be caused by factors such as persistent pressure on the ear (e.g. secondary to sleep, headsets), trauma or cold. CNH is more common in men and with increasing age.
hyperhidrosis mx
aluminium chloride
isotretinoin s/e
contraception (e.g. Combined oral contraceptive pill and condoms)
dry skin, eyes and lips/mouth: the most common side-effect of isotretinoin
low mood*
raised triglycerides
hair thinning
nose bleeds (caused by dryness of the nasal mucosa)
intracranial hypertension: isotretinoin treatment should not be combined with tetracyclines for this reason
photosensitivity
acne rosacea mx
topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)
topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia
more severe disease is treated with systemic antibiotics e.g. Oxytetracycline
recommend daily application of a high-factor sunscreen
camouflage creams may help conceal redness
laser therapy may be appropriate for patients with prominent telangiectasia
patients with a rhinophyma should be referred to dermatology
pyogenic granuloma
Overgrowth of blood vessels.
Red nodules.
Usually follow trauma.
May mimic amelanotic melanoma.
erythrasma
Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum
Examination with Wood’s light reveals a coral-red fluorescence.
Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection
chondrodermatitis nodularis helicis vs actinic keratosis
chondrodermatitis is painful
lipoma 5cm ix
uss
types of burns
Superficial epidermal First degree Red and painful
Partial thickness (superficial dermal) Second degree Pale pink, painful, blistered
Partial thickness (deep dermal) Second degree Typically white but may have patches of non-blanching erythema. Reduced sensation
Full thickness Third degree White/brown/black in colour, no blisters, no pain
mx bcc eyelid
mohs micrographic surgery
curlings ulcers
complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa
embryological remnants and may be lined by hair and squamous epithelium
dermoid cyst
bowens disease
intra epithelial scc
pyogenic granuloma
most common sites are head/neck, upper trunk and hands. Lesions in the oral mucosa are common in pregnancy
initially small red/brown spot
rapidly progress within days to weeks forming raised, red/brown lesions which are often spherical in shape
the lesions may bleed profusely or ulcerate
mx hirsute
advise weight loss if overweight
cosmetic techniques such as waxing/bleaching - not available on the NHS
consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin). Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism
facial hirsutism: topical eflornithine - contraindicated in pregnancy and breast-feeding
