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Dermatology Flashcards

1
Q

What is actinic keratosis?

A

Pre-malignant sun damage

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2
Q

What does actinic keratosis look like?

A

Small, crusty, scaly lesions

May be pink, brown, red

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3
Q

How can you prevent actinic keratosis?

A

Avoid sun-exposure

Sun-cream

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4
Q

How do we treat actinic keratosis?

A

Fluorouracil cream (2-3 week course), often give hydrocortisone after for the redness
Topical diclofenac if mild
Cryotherapy
Cutterage and cautery

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5
Q

What does an erythema ab igne rash look like?

A

Reticulated, erythematous patches with hyperpigmentation and telangiectasia

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6
Q

What causes erythema ab igne?

A

Over-exposure to infrared radiation. If left untreated can lead to SCC

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7
Q

What is a keratoacanthoma?

A

A benign epithelial tumour

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8
Q

Features of a keratoacanthoma?

A

Common with advancing age
Initially a smooth dome-shaped papule
Rapidly grows to become a crater centrally filled with keratin

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9
Q

How do we treat keratoacanthomas?

A

They go away on their own after 3 months, but should be excised as they are difficult to clinically distinguish from SCC’s

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10
Q

What are fungal nail infections most commonly caused by?

A

Dermatophytes - mainly trichophyton rubrum (90%)

Yeasts - e.g. candida

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11
Q

How do you investigate nail infections?

A

Nail clippings

Scrapings of the nail

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12
Q

How do you treat fungal nail infections?

A

Don’t treat if asymptomatic or if patient does not care
Confirm via microbiology before starting treatment but:
Oral terbinafine or itraconazole first line for dermatophyte infections
Candida - topical antifungals such as amorolfine

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13
Q

How do we treat impetigo?

A

Topical fusidic acid (3x a day for 5 days) + good hygiene measures

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14
Q

What are the clinical features of impetigo?

A

Non-bullous - thin walled vesicles or pustules with a characteristic golden/brown crust
Bullous - flaccid fluid vesicles with blisters. Can still have yellow/brown crust

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15
Q

What causes impetigo?

A

Staph aureus for both bullous and non-bullous

Strep pyogens can also be a cause of non-bullous

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16
Q

How long before returning to work with impetigo?

A

48 hours following commencement of treatment

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17
Q

How to treat extensive impetigo disease?

A

Flucloxacillin

Oral erthromycin if pen-allergic

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18
Q

What are normal ankle-brachial pressure indexes?

A

0.90-1.2
<0.9 indicates arterial disease
>1.2 also indicates arterial disease
0.5-0.9 may be associated with intermittent claudication

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19
Q

How do we treat venous ulceration?

A 
Compression bandaging
Oral pentoxifylline (a peripheral dilator)
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20
Q

What is erythema nodosum?

A

Inflammation of subcutaneous fat, often over shins but can also be on forearms, thighs etc.

Characteristics:
Tender, erythematous, nodular lesions

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21
Q

What are causes of erythema nodosum?

A 
Infection - strep., TB, brucellosis
Systemic disease such as sarcoidosis, IBD, Behcet's
Malignancy/lymphoma
Drugs
Pregnancy
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22
Q

What is pyoderma gangrenosum associated with?

A 
IBD
Rheumatoid arthritis
Myeloproliferative disorders
Lymphoma/myeloid leukaemias
PBC
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23
Q

What are the features of pyoderma gangrenosum?

A

Initially small red papule
Later deep, red, necrotic ulcers with a violaceous (violet) border
Systemic features such as fever, myalgia
Typically on lower limbs

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24
Q

How do we treat pyoderma gangrenosum?

A

Oral steroids first line

Other immunosuppressive therapy - e.g. ciclosporin

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25
What is tinea pedis (athlete's foot) caused by?
Fungi in the genus trichophyton
26
What are features of athlete's foot?
Scaling, flaking and itching between the toes
27
How do we treat athlete's foot?
Topical imidazole, undeconoate or terbinafine
28
What is vitiligo?
An autoimmune condition which results in the loss of melanocytes and subsequent depigmentation of the skin
29
What is vitiligo associated with?
Other autoimmune conditions, e.g. addison's, type 1 DM, autoimmune thyroid disorders
30
How do we treat vitiligo?
Sunblock for affected areas of skin Camouflage make-up Topical corticosteroids may reverse changes if used early
31
What is molluscum contagiosum caused by?
Molluscum contagiosum virus
32
What are the features of molluscum contagiosum?
Pinkish/pearly white papules with a central umbilication | Lesions appear in clusters
33
What is the management for molluscum contagiosum?
Self-limiting (within 18 months) | They are contagious so avoid towel sharing etc.
34
What are the features of scabies?
Widespread pruritus Linear burrows on the sides of fingers, interdigital webs and flexor aspects of wrists In infants, face and scalp may be affected
35
What causes scabies?
Sarcoptes scabiei
36
How is scabies spread?
Prolonged skin contact
37
What type of hypersensitivity reaction do you get in scabies?
Type IV
38
How do we manage scabies?
Permethrin 5% Malathion 0.5% 2nd line Treat everyone in household at the same time regardless of symptoms Launder/iron/tumble dry all clothing/bedding/towels on first day of treatment
39
What are the adverse effects of isotretinoin?
``` Teratogenicity Dry skin/eyes/mouth Low mood Raised triglycerides Hair thinning Nose bleeds ```
40
What are the features of acne rosacea?
Typically affects nose, cheeks and forehead Flushing Telangiectasia Later develops persistent erythema with papuples/pustules Rhinophyma Blepharitis sometimes
41
How do we treat acne rosacea?
Topical metronidazole first line Topical brimonide if flushiing but limited telangiectasia Severe disease - systemic abx e.g. oxytetracycline
42
In what condition do you get a rhinophyma?
Acne rosacea
43
What are milia?
Small, benign, keratin-filled cysts typically found on the face
44
Exacerbating factors of psoriasis?
Trauma Alcohol Drugs: beta blockers, lithium, NSAIDs, ACEi and infliximab Steroid withdrawal
45
How do we treat erythasma?
Erythromycin
46
What is dermatitis herpetiformis?
An autoimmune blistering skin disorder associated with coeliac's. It is caused by IgA deposition in the dermis
47
Features of dermatitis herpetiformis?
Itchy, vesicular lesions on extensor surfaces
48
How to manage dermatitis herpetiformis?
Gluten-free diet | Dapsone
49
What are the features of bullous pemphigoid?
Itchy, tense blisters typically around flexures | Mouth is usually spared
50
What would you see on skin biopsy in bullous pemphigoid?
Immunofluorescence would show IgG and C3 at the dermoepidermal junction
51
What is the management of bullous pemphigoid?
Refer to derm Oral corticosteroids Topical corticosteroids, immunosuppressants and abx
52
What is acanthosis nigricans?
Describes symmetrical brown, velvety plaques | Often found in neck, axilla and groin
53
What is pityriasis versicolor?
A superficial cutaneous fungal infection caused by Malassezia furfur
54
Features of pityriasis versicolor?
Most commonly affects the trunk Patches may be hypopigmented, pink or brown Scaliness is common Mild pruritus
55
Treatment of pityriasis versicolor?
Topical antifungals (e.g. ketoconazole shampoo)
56
What is lentigo maligna?
A type of melanoma in-situ (confined to the tissue of origin). It progresses slowly but may eventually cause lentigo maligna melanoma
57
What is solar lentigo?
A harmless patch of darkened skin - | Due to sun exposure (UV) causing proliferation of melanocytes and accumulation of melanin within the cells
58
How do we treat lentigo maligna?
Refer to dermatology (probably for surgery)
59
What is seborrhoeic dermatitis?
Chronic dermatitis thought to be an inflammatory reaction to a normal skin inhabitant called malassezia furfur (a fungus)
60
Features of seborrhoeic dermatitis?
Eczematous lesions on sebum-rich areas: scalp (dandruff), periorbital, auricular and nasolabial folds Otitis externa/blepharitis can occur
61
How do we manage seborrhoeic dermatitis?
Topical antifungal - ketoconazole | Head + shoulders shampoo for scalp (first line)
62
What is guttate psoriasis caused by?
It is often preceded by an URTI (usually strep throat)
63
How do we manage guttate psoriasis?
Usually resolves spontaneously within 2-3 months There is no firm evidence to support abx use Can use topical agents as per psoriasis (topical steroids, vit D, dithranol and tar preparations)
64
What are the features of guttate psoriasis?
'Tear drop' scaly papules on the trunk and limbs
65
How can you differentiate between guttate psoriasis and pityriasis rosea?
Pityriasis rosea: - Less likely to have recent URTI - 'Herald patch' (lone patch of redness) for 1-2 weeks before widespread symptoms
66
What is erythema multiforme?
It is a hypersensitivity reaction which is most commonly triggered by infections
67
What are the features of erythema multiforme?
Target lesions Initially seen on the back of the hands/feet before spreading to the torso Upper limbs are more commonly affected than lower limbs Pruritus is occasionally seen and is usually mild
68
What are the causes of erythema multiforme?
Herpes simplex virus (most common) Idiopathic Mycoplasma, streptococcus Drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, OCP, nevirapiine
69
What is erythema multiforme major?
The most severe form, associated with mucosal involvement
70
How do we treat erythema multiforme?
``` Symptomatically Oral antihistamines Analgesics Local skin care Topical steroids can be considered ```
71
What is a pyogenic granuloma?
A relatively common benign skin lesion
72
What are the factors associated with pyogenic granuloma?
Trauma Pregnancy More common in women/young adults
73
What are the features of pyogenic granuloma?
``` Head/neck/upper trunk/hands Oral mucosa common in pregnancy Initially a small red/brown spot Rapidly progresses to form a raised red/brown lesion often spherical in shape Lesion can bleed/ulcerate ```
74
How do we treat pyogenic granuloma?
If associated with pregnancy, often resolve spontaneously post-partum Removal via curettage, cauterisation, cryotherapy/excision
75
Which anti-fungal causes gynecomastia?
Ketoconazole
76
What is acanthosis nigricans associated with?
``` GI Cancer DM Obesity PCOS Acromegaly Cushing's Hypothyroidism Prader-willi OCP ```
77
What is a sebaceous cyst?
A term which emcompasses both epidermoid and pilar cysts
78
Features of a sebaceous cyst?
Typically contains a punctum and are often located on the scalp
79
What is hereditary haemorrhagic telangiectasia?
An autosomal domiinant condition characterised by multiple telangiectasia over the skin and mucous membranes
80
Diagnostic criteria of hereditary haemorrhagic telangiectasia?
Epistaxis (spontaneous/recurrent nosebleeds) Telangiectases (lips, oral cavity, fingers and nose) Visceral lesions FHx
81
What is Bowen's disease?
Bowen's disease is a type of intraepidermal SCC
82
Features of Bowen's disease?
Red, scaly patches | Often occur on sun-exposed areas (e.g. lower limbs)
83
How do we treat Bowen's disease?
Topical 5-fluorouracil or imiquimod Cryotherapy Excision
84
How can you treat telangiectasia in acne rosacea?
Laser therapy
85
What type of hypersensitivity reaction is contact dermatitis?
Type IV
86
What are the features of lichen planus?
Itchy, papular, polygonal rash | 'White lines' (Wickham's striae)
87
How to treat lichen planus?
Topical steroids Benzydamine mouthwash/spray for oral lichen planus If extensive, oral steroids/immunosuppression

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