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Year 4 SPM > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Steven Johnson syndrome

A

Mucocutaneous necrosis at 2 or > sites
Vague URTI sx start 2-3wks after drug, + 2 days before rash that affects <10% of body
- Painful erythematous macule evolving to form target lesions
- Severe mucosal ulceration of 2 or > surfaces e.g. conjunctiva, oral cavity, labia, urethra
- Necrosis distinguishes from erythema multiforme
- Skin may be limited or extensive involvement

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2
Q

Erythema multiforme

A

Hypersensitivity triggered mainly by HSV

  • Erythematous well-defined round lesions appear on extensor surfaces
  • Minimal mucosal involvement

No tx usually needed but can tx cause e.g. acyclovir

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3
Q

Toxic epidermal necrosis

A

Usually drug-induced

  • Flu like sx may precede skin involvement which affects >30% body surface
  • Extensive skin + mucosal necrosis accompanied by systemic toxicity
  • Widespread painful dusky erythema then necrosis of large sheets of epidermis
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4
Q

Rash seen in acute meningococcaemia

A

Non-blanching purpuric rash on trunk + extremities which may be preceded by a blanching maculopapular rash + can rapidly progress to ecchymoses, haemorrhage bullae + tissue necrosis

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5
Q

Erythroderma

A

Exfoliative dermatitis involving >90% of skin surface

  • Skin appears inflamed, oedematous + scaly
  • Systemically unwell

Tx underlying cause, emollients + wet wraps, topical steroids, treat 2 infection/fluid loss/ electrolyte imbalance/hypothermia/capillary leak syndrome

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6
Q

Causes of erythroderma

A

Previous skin disease
- Eczema
- Psoriasis
Drugs - sulphonamides, gold, sulfonylureas, penicillin, allopurinol

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7
Q

Dermatological emergencies

A
  • Erythema multiforme
  • Erythema nodosum
  • SJS
  • TEN
  • Meningococcal septicaemia
  • Eczema herpeticum
  • Necrotising fasciitis
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8
Q

Eczema herpeticum

A

Widespread eruption - serious complication of atopic eczema
Causes = HSV

Extensive crusted papule, blisters + erosions
Systemically unwell

Tx - acyclovir

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9
Q

Necrotising fasciitis

A

Rapidly spreading infection of the deep fascia with 2. tissue necrosis

Causes = group A haemolytic strep

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10
Q

Presentation of necrotising fasciitis

A 
Severe pain 
Erythematous, blistering + necrotic skin 
Systemically unwell 
Crepitus (subcut emphysema)
XR may show soft tissue gas
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11
Q

Cellulitis

A

Involves the deep subcutaneous tissues

  • Spreading bacterial infection of the skin
  • Strep pyogenes + staph aureus
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12
Q

Erysipelas

A

Acute superficial form of cellultis + involves the dermis + upper subcut tissue
- Distinguished from cellulitis by a well-defined, red raised border

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13
Q

Superficial fungal infections causes

A

3 main groups

  • Dermatophytes (tinea/ringworm)
  • Yeasts e.g. candidiasis
  • Moulds e.g. aspergillus
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14
Q

Tinea incognito

A

Inappropriate tx of tinea infection with topical or systemic corticosteroids - ill defined + less scaly + spreads more

  • Take skin scrapings, hair or nail clippings for correct diagnosis
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15
Q

What is BCC?

A

Slow growing, locally invasive malignant tumour of epidermal keratinocytes
- Most common malignant skin tumour

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16
Q

Appearance of BCC

A

Various morphological types - nodular (most common), superficial (plaque like), cystic, morphoeic (sclerosing), keratitis + pigmented

Nodular - small, skin-coloured papule or nodule with surface telangiectasia + a pearly rolled edge. Lesion may have a necrotic or ulcerated centre (rodent ulcer)

Most common over head + neck

17
Q

SCC

A

Locally invasive malignant tumour of epidermal keratinocytes which can metastasise

Keratotic (scaly, crusty) ill-defined nodule which may ulcerate

18
Q

What is malignant melanoma?

A

Invasive malignant tumour of epidermal melanocytes which has the potential to metastasise

More common on legs in W, trunk in M

19
Q

Causes of melanoma

A

UV exposure
Skin type I (always burns, never tans)
Hx of multiple moles/atypical moles
Fam hx/previous hx

20
Q

ABCDE symptoms

*major suspicious features

A 
Asymmetrical shape*
Border irregularity 
Colour irregularity*
Diameter >6mm
Evolution of lesion (e.g. change in size and/or shape)*
Symptoms e.g. bleeding, itching
21
Q

Types of melanoma

A
  • Superficial spreading (lower limbs in middle/young aged, related to intermittent high-intensity UV exposure)
  • Nodular melanoma (common on trunk in young/middle aged, related to intermittent high-intensity UV exposure)
  • Lentigo maligna melanoma - common on face, in elderly. Related to long-term cumulative UV exposure
  • Acral lentiginous (common on palms, soles + nail beds in elderly with no clear relation to UV exposure)
22
Q

Hidradenitis suppurativa

A

Chronic, painful, inflammatory skin disorder.
Characterized by development of inflammatory nodules, pustules, sinus tracts, and scars in intertriginous areas. Obstructs apocrine glands + prevents keratinocytes properly shedding

Suspect in pubertal or post-pubertal patients who have a diagnosis of recurrent furuncles or boils, especially in intertriginous areas.

Women > men
Adults under 40.

23
Q

Lichen planus

A

Unknown aetiology, probably immune mediated

itchy, papular rash on the palms, soles, genitalia and flexor surfaces of arms
Rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
Oral involvement in 50%: white-lace pattern on the buccal mucosa

24
Q

Seborrhoeic Dermatitis

A

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

Eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
otitis externa and blepharitis may develop

Tx:
- Scalp = 1st line = zinc prytithione (head + shoulders) and tar (neutragena t gel). 2nd line = ketaconazole

  • Face + body. 1st line = ketaconazole
25
Q

Pityriasis rosea

A

Presents with a salmon coloured solitary patch ‘herald patch’ which enlarges over a few days followed by generalised bilateral and symmetric macules with collarette scale. Pruritus is sometimes present. It self resolves within 6 – 8 week
- Christmas tree distribution

26
Q

Pathogenesis of vitiligo?

A

Autoimmune destruction of melanocytes

27
Q

Malignant melanoma - acral lentiginous

A

Arises in dark skinned individuals on their palms or soles. It is not linked to UVB induced DNA damage unlike the other types

28
Q

What condition is described as ‘stuck on’?

A

Seborrheic keratosis

29
Q

What is the best prognostic factor in melanoma?

A

Breslow thickness

30
Q

Leser-trelat sign

A

Sudden appearance of multiple seborrheic keratosis and is an indicator of a gastrointestinal tract carcinoma

31
Q

Pathology of pemphigus vulgaris

A

IgG antibody against desmoglein

Desmosomes are located in the stratum spinosum between keratinocytes. Antibodies against the desmoglein component result in painful flaccid bullae or blisters that rupture easily on both skin and oral mucosa. It is treated with corticosteroids.

32
Q

Lichen plans 6 ‘p’s

A

Pruritic, purple, polygonal, planar papules and plaques

It also often occurs with reticular white lines on the mucosal surfaces (Wickham striae). There is an association with hepatitis C.

Year 4 SPM (6 decks)

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