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Pass Medicine > Dermatology > Flashcards

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
Q

What is tinea pedis (athlete’s foot) caused by?

A

Fungi in the genus trichophyton

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26
Q

What are features of athlete’s foot?

A

Scaling, flaking and itching between the toes

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27
Q

How do we treat athlete’s foot?

A

Topical imidazole, undeconoate or terbinafine

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28
Q

What is vitiligo?

A

An autoimmune condition which results in the loss of melanocytes and subsequent depigmentation of the skin

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29
Q

What is vitiligo associated with?

A

Other autoimmune conditions, e.g. addison’s, type 1 DM, autoimmune thyroid disorders

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30
Q

How do we treat vitiligo?

A

Sunblock for affected areas of skin
Camouflage make-up
Topical corticosteroids may reverse changes if used early

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31
Q

What is molluscum contagiosum caused by?

A

Molluscum contagiosum virus

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32
Q

What are the features of molluscum contagiosum?

A

Pinkish/pearly white papules with a central umbilication

Lesions appear in clusters

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33
Q

What is the management for molluscum contagiosum?

A

Self-limiting (within 18 months)

They are contagious so avoid towel sharing etc.

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34
Q

What are the features of scabies?

A

Widespread pruritus
Linear burrows on the sides of fingers, interdigital webs and flexor aspects of wrists
In infants, face and scalp may be affected

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35
Q

What causes scabies?

A

Sarcoptes scabiei

36
Q

How is scabies spread?

A

Prolonged skin contact

37
Q

What type of hypersensitivity reaction do you get in scabies?

A

Type IV

38
Q

How do we manage scabies?

A

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
Q

What are the adverse effects of isotretinoin?

A 
Teratogenicity
Dry skin/eyes/mouth
Low mood
Raised triglycerides
Hair thinning
Nose bleeds
40
Q

What are the features of acne rosacea?

A

Typically affects nose, cheeks and forehead
Flushing
Telangiectasia
Later develops persistent erythema with papuples/pustules
Rhinophyma
Blepharitis sometimes

41
Q

How do we treat acne rosacea?

A

Topical metronidazole first line
Topical brimonide if flushiing but limited telangiectasia
Severe disease - systemic abx e.g. oxytetracycline

42
Q

In what condition do you get a rhinophyma?

A

Acne rosacea

43
Q

What are milia?

A

Small, benign, keratin-filled cysts typically found on the face

44
Q

Exacerbating factors of psoriasis?

A

Trauma
Alcohol
Drugs: beta blockers, lithium, NSAIDs, ACEi and infliximab
Steroid withdrawal

45
Q

How do we treat erythasma?

A

Erythromycin

46
Q

What is dermatitis herpetiformis?

A

An autoimmune blistering skin disorder associated with coeliac’s.
It is caused by IgA deposition in the dermis

47
Q

Features of dermatitis herpetiformis?

A

Itchy, vesicular lesions on extensor surfaces

48
Q

How to manage dermatitis herpetiformis?

A

Gluten-free diet

Dapsone

49
Q

What are the features of bullous pemphigoid?

A

Itchy, tense blisters typically around flexures

Mouth is usually spared

50
Q

What would you see on skin biopsy in bullous pemphigoid?

A

Immunofluorescence would show IgG and C3 at the dermoepidermal junction

51
Q

What is the management of bullous pemphigoid?

A

Refer to derm
Oral corticosteroids
Topical corticosteroids, immunosuppressants and abx

52
Q

What is acanthosis nigricans?

A

Describes symmetrical brown, velvety plaques

Often found in neck, axilla and groin

53
Q

What is pityriasis versicolor?

A

A superficial cutaneous fungal infection caused by Malassezia furfur

54
Q

Features of pityriasis versicolor?

A

Most commonly affects the trunk
Patches may be hypopigmented, pink or brown
Scaliness is common
Mild pruritus

55
Q

Treatment of pityriasis versicolor?

A

Topical antifungals (e.g. ketoconazole shampoo)

56
Q

What is lentigo maligna?

A

A type of melanoma in-situ (confined to the tissue of origin). It progresses slowly but may eventually cause lentigo maligna melanoma

57
Q

What is solar lentigo?

A

A harmless patch of darkened skin -

Due to sun exposure (UV) causing proliferation of melanocytes and accumulation of melanin within the cells

58
Q

How do we treat lentigo maligna?

A

Refer to dermatology (probably for surgery)

59
Q

What is seborrhoeic dermatitis?

A

Chronic dermatitis thought to be an inflammatory reaction to a normal skin inhabitant called malassezia furfur (a fungus)

60
Q

Features of seborrhoeic dermatitis?

A

Eczematous lesions on sebum-rich areas: scalp (dandruff), periorbital, auricular and nasolabial folds
Otitis externa/blepharitis can occur

61
Q

How do we manage seborrhoeic dermatitis?

A

Topical antifungal - ketoconazole

Head + shoulders shampoo for scalp (first line)

62
Q

What is guttate psoriasis caused by?

A

It is often preceded by an URTI (usually strep throat)

63
Q

How do we manage guttate psoriasis?

A

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
Q

What are the features of guttate psoriasis?

A

‘Tear drop’ scaly papules on the trunk and limbs

65
Q

How can you differentiate between guttate psoriasis and pityriasis rosea?

A

Pityriasis rosea:

  • Less likely to have recent URTI
  • ‘Herald patch’ (lone patch of redness) for 1-2 weeks before widespread symptoms
66
Q

What is erythema multiforme?

A

It is a hypersensitivity reaction which is most commonly triggered by infections

67
Q

What are the features of erythema multiforme?

A

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
Q

What are the causes of erythema multiforme?

A

Herpes simplex virus (most common)
Idiopathic
Mycoplasma, streptococcus
Drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, OCP, nevirapiine

69
Q

What is erythema multiforme major?

A

The most severe form, associated with mucosal involvement

70
Q

How do we treat erythema multiforme?

A 
Symptomatically
Oral antihistamines
Analgesics
Local skin care
Topical steroids can be considered
71
Q

What is a pyogenic granuloma?

A

A relatively common benign skin lesion

72
Q

What are the factors associated with pyogenic granuloma?

A

Trauma
Pregnancy
More common in women/young adults

73
Q

What are the features of pyogenic granuloma?

A 
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
Q

How do we treat pyogenic granuloma?

A

If associated with pregnancy, often resolve spontaneously post-partum
Removal via curettage, cauterisation, cryotherapy/excision

75
Q

Which anti-fungal causes gynecomastia?

A

Ketoconazole

76
Q

What is acanthosis nigricans associated with?

A 
GI Cancer
DM
Obesity
PCOS
Acromegaly
Cushing's
Hypothyroidism
Prader-willi
OCP
77
Q

What is a sebaceous cyst?

A

A term which emcompasses both epidermoid and pilar cysts

78
Q

Features of a sebaceous cyst?

A

Typically contains a punctum and are often located on the scalp

79
Q

What is hereditary haemorrhagic telangiectasia?

A

An autosomal domiinant condition characterised by multiple telangiectasia over the skin and mucous membranes

80
Q

Diagnostic criteria of hereditary haemorrhagic telangiectasia?

A

Epistaxis (spontaneous/recurrent nosebleeds)
Telangiectases (lips, oral cavity, fingers and nose)
Visceral lesions
FHx

81
Q

What is Bowen’s disease?

A

Bowen’s disease is a type of intraepidermal SCC

82
Q

Features of Bowen’s disease?

A

Red, scaly patches

Often occur on sun-exposed areas (e.g. lower limbs)

83
Q

How do we treat Bowen’s disease?

A

Topical 5-fluorouracil or imiquimod
Cryotherapy
Excision

84
Q

How can you treat telangiectasia in acne rosacea?

A

Laser therapy

85
Q

What type of hypersensitivity reaction is contact dermatitis?

A

Type IV

86
Q

What are the features of lichen planus?

A

Itchy, papular, polygonal rash

‘White lines’ (Wickham’s striae)

87
Q

How to treat lichen planus?

A

Topical steroids
Benzydamine mouthwash/spray for oral lichen planus
If extensive, oral steroids/immunosuppression

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