Dermatology Flashcards
What is Eczema?
Itchy, dry inflammatory condition of the skin.
What are some different types of eczema?
Atopic - genetic barrier dysfunction Seborrheoic - face/scalp and scale associated. Discoid - annular/circular patches Pomphylx - vesicles affecting palms and soles. Varicose - oedema/venous insufficiency. Contact allergic dermatitis Contact irritant dermatitis Photoaggravated.
What are some features of Atopic Eczema?
Commonest type in children
Overactive immune response to environmental stimuli.
Abnormality in filaggrin expression resulting in loss of skin barrier function.
Typically starts on face/neck in infancy and then flexural pattern predominates in older children.
What is the function of filaggrin?
Bind the keratin filaments together and plays a role in producing a natural moisturising factor.
What can cause flares in childhood eczema?
Infections/viral illness Environment - central heating, cold air. Pets Teething Stress Idiopathic
What are some features of Seborrheoic Dermatitis?
Mainly scalp and face affected
Often babies under 3 months but usually resolves by 1yr.
Associated with proliferation of various species if the skin commensal Malassezia in its yeast form.
What is the treatment for Seborrheoic dermatitis?
Emollients
Anti-fungal creams/shampoos
Mild topica steroids
What are the features of Discoid eczema?
Scattered annular/circular patches of itchy eczema.
Can occur as part of atopic eczema or in isolation.
What are the features of Pomphylx Eczema?
Hand and foot eczema
Characterised by vesicles
Can be intensely itchy.
What is allergic eczema?
Skin becomes sensitised to an allergen.
Type IV hypersensitivity reaction occurs so patch testing is helpful.
What is irritant eczema?
Repeated contact with an irritant usually water and soaps, citrus, tomatoes, chemical irritants.
What investigations would you carry out for immediate reaction allergic eczema?
Blood test for specific IgE antibodies (RAST)
Skin prick testing
Commonest allergens are milk, soy, peanuts and eggs.
What are some treatments for Eczema?
Emollients Topical steroids Calcineurin inhibitors e.g protopic - steroid sparing topical agents. UVB light therapy Immunosuppressive medication
What are some different types of topical steroid?
Dermovate - very potent
Betnovate - potent
Eumovate - moderate
Hydrocortisone - mild
What is the correct way to use steroids?
Once daily for 1-2weeks
If improvement then use alternate day for a few more days.
If there are stubborn areas can use twice weekly on them.
If eczema starts to flare go back to daily applications.
Finger tip worth amount of topical steroid.
What is Impetigo?
Common acute superficial bacterial skin infection.
Pustules and honey coloured crusted erosions.
Staph Aureus is causative agent.
What is the treatment for impetigo?
Topical antibacterial - Fucidin
Oral Antibiotic - Flucloxacillin.
What is Molluscum Contagiosum?
Common benign self-limiting infection. Caused by the Molluscipox virus. 2week - 6month incubation period. Transmission to close direct contact. Pearly papules with an umbilicate centre. Cam take up to 2year s to clear.
What are some treatment options for Molluscum contagiosum?
Nothing
5% potassium Hydroxide
What are viral warts?
Common non-cancerous growths of the skin caused by infection with human papilloma virus.
Often skin coloured or present as verrucas on foot.
Transmitted by direct skin contact.
What are the treatment options for viral warts?
Topical treatments - salicylic acid and paring
Crytherapy
90% resolve in 24 months.
What are viral exanthems?
Reaction to a toxin produced by an organism, damage to the skin by an organism or an immune response.
Associated with viral illnesses.
Fever malaise and headache often alongside.
Chicken pox, measles, rubella, roseola and erythema infectious are all examples.
What is Chicken pox?
Highly contagious disease caused by primary infection with varicella-zoster virus.
1 infection is thought to confer lifelong immunity.
Red papules progressing to vesicles that often start on trunk.
Itchy and associated with viral symptoms.
Incubation period 10-21 days
Contagious 1-2 days before rash appears.
Self-limiting
What is parvovirus?
Erythema infectiosum is causative viral disease.
Incubation period 7-10days
Erythematous rash on cheeks initially and then a lace work rash on trunk and limbs.
Can take 6 weeks to fade
Mild self limiting illness.
Virus targets red cells in bone marrow.
Risk to pregnant women.
What is Hand Foot and Mouth disease?
Enterovirus infection usually coxsackie virus A16.
Blisters appear on hands, feet and in mouth, alongside viral symptoms.
Epidemics late summer and autumn months.
Self-limiting, supportive treatment.
What is Eczema Coxsackium?
Associated viral symptoms with a history of eczema.
Flared sites in previous areas of eczema.
Self-limiting.
What is eczema Herpeticum?
Unwell child with a history of eczema. Monomorphic punched out lesions Need to withhold steroids for 24hrs. Treat with aciclovir - oral/IV Ophthalmology review if near eye.
What is Orofacial Granulomatosis?
Lip swelling and fissuring Oral mucosal lesions - ulcers, tags, cobblestone appearance. Caused by Crohn's disease. Check faecal calprotectin if GI symptoms Consider patch testing Benzoate and cinnamate free diet.
What are the clinical features of Erythema Nodosum?
Painful erythematous subcutaneous nodules
Mainly over shins
Slow resolution like a bruise
6-8weeks
What are the causes of erythema nodosum?
Infections - streptococcus, upper resp tract Inflammatory bowel disease Sarcoidosis Drugs - OCP, Sulphonamides, penicillin Mycobacterial infections Idiopathic
What is Dermatitis Herpetiformis?
Rare but persistent immunobullous disease that has been linked to Coeliac disease.
Itchy blisters can appear in clusters and often symmetry
Scalp, shoulders, buttocks, elbows and knees are common sites.
What os the treatment for dermatitis herpetiformis?
Emollients
Gluten free diet
Topical steroids
Dapsone
What is urticaria?
Wheals and hives associated with angioedema.
Areas of rash can last from few mins to 24hrs.
Acute <6 weeks
Chronic >6weeks
What are some causes of Urticaria?
Viral infection Bacterial infection Food or drug allergy NSAIDs, Opiates Vaccinations Idiopathic
What is the treatment for urticaria?
Consider possible triggers Antihistamines - 3x daily e.g. Ranitidine Montelukast Omalizumab Ciclosporin
