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Phase 2a Medicine > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Describe the progression from melanocytic naevi (mole) to nodular melanoma

A

Melanocytic naevi -> dysplastic melanocytic naevi -> in situ melanoma -> superficial spreading melanoma -> nodular melanoma

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2
Q

What is the main cause of all skin cancer?

A

Sun exposure - UV light

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3
Q

What is the treatment for malignant melanoma?

A

Surgical excision.

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4
Q

Give 5 causes of generalised pruritus but no rash

A
  1. AGEING.
  2. Chronic renal failure.
  3. Cholestasis e.g. PBC.
  4. Iron deficiency.
  5. Lymphoma.
  6. Polycythaemia.
  7. Hypothyroid.
  8. Drugs
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5
Q

Give 3 causes of generalised pruritus with rash

A
  1. Urticaria.
  2. Atopic eczema.
  3. Psoriasis.
  4. Scabies.
  5. Lichen planus
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6
Q

What investigations might you do in someone with pruritus?

A
  1. FBC.
  2. Ferritin levels.
  3. U+E.
  4. LFT’s.
  5. TFT’s
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7
Q

What cytokines are commonly targeted in the treatment of pruritus?

A

IL-4 and IL-13.

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8
Q

Why do transdermal drugs need to be lipophilic?

A

They need to be lipophilic in order to get through the lipid rich stratum corneum

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9
Q

Give 2 essential properties of transdermal drugs.

A
  1. Lipophilic.

2. High affinity for their targets.

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10
Q

Give 3 advantages of transdermal drug delivery.

A
  1. Avoids first pass effect, hardly metabolised.
  2. No pain.
  3. Controlled dosing
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11
Q

What are emollients used for?

A

They hydrate the skin and reduce itching

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12
Q

In what diseases would the use of emollients be indicated?

A

Dry skin, eczema

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13
Q

What receptors do glucocorticoids target?

A

Cytoplasmic receptors.

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14
Q

How does hydrocortisone work?

A

Hydrocortisone targets cytoplasmic receptors. It leads to a reduction in pro-inflammatory cytokines and an increase in anti-inflammatories.

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15
Q

In what diseases would the use of hydrocortisone be indicated?

A

Eczema, contact dermatitis

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16
Q

Give 3 potential side effects of glucocorticoids.

A
  1. Skin thinning.
  2. Oral candidiasis.
  3. Acne.
  4. Striae.
  5. Bruising.
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17
Q

What receptors do vitamin A analogues target?

A

Nuclear retinoic acid receptors.

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18
Q

Name a vitamin D analogue

A

Calcipotriol

19
Q

How does calcipotriol work in the treatment of psoriasis?

A

Calcipotriol is a vitamin D analogue. It has anti-proliferative and anti-inflammatory effects.

20
Q

In what diseases would the use of calcipotriol be indicated?

A

Psoriasis.

21
Q

What receptors does tazarotene bind to?

A

Tazarotene is a Vitamin A analogue. It binds to nuclear retinoic acid receptors.

22
Q

How does tazarotene work in the treatment of acne and psoriasis?

A

Tazarotene is a Vitamin A analogue. It binds to nuclear retinoic acid receptors and modifies gene expression and inhibits cell proliferation.

23
Q

In what diseases would the use of tazarotene be indicated?

A

Psoriasis, acne

24
Q

Would you prescribe tazarotene to a pregnant lady?

A

NO! Tazarotene is highly teratogenic.

25
Q

What class of drug is tacrolimus?

A

Calcineurin inhibitor

26
Q

When might you prescribe someone tacrolimus?

A

Tacrolimus is often used as a second line treatment for eczema.

(1st line = glucocorticoids e.g. hydrocortisone).

27
Q

Name 3 drug induced dermatological reactions.

A
  1. Exanthematous reactions.
  2. Urticaria.
  3. Stephen Johnson syndrome.
28
Q

Give 5 signs of eczema.

A
  1. Superficial skin redness/inflammation.
  2. Oozing.
  3. Scaling.
  4. Pruritus.
  5. Flexors typically affected e.g. at elbows.
29
Q

Describe the aetiology of eczema.

A
  1. Genetic predisposition - loss of function mutations in filaggrin.
  2. Environmental triggers and irritants.
30
Q

Describe the treatment for eczema.

A
  1. Avoid irritants and allergens.
  2. Use emollients liberally and frequently.
  3. First line - hydrocortisone.
  4. Second line - tacrolimus.
  5. Third line - sedative anti-histamines.
31
Q

Briefly describe the pathophysiology of acne

A

Seborrhea (increased sebum production) -> narrowed follicle blocks sebum, comedo formation -> sebum stagnates and p.acne colonises -> inflammation of pilosebaceous unit.

32
Q

Describe the treatment for acne.

A

Treatment is important to avoid scarring and psychological distress:

  • Regular washing with acne soaps to remove grease.
  • Benzoyl peroxide and topical clindamycin.
  • 2nd line - topical retinoids e.g. tazarotene.
  • 3rd line - low dose oral antibiotics e.g. doxycycline.
  • Hormone treatment can also be used
33
Q

What is psoriasis?

A

A chronic hypo-proliferative disorder characterised by well demarcated silvery grey, scaly plaques over extensor surfaces such as elbows and knees and in the scalp.

34
Q

What environmental factors can cause psoriasis in a genetically susceptible individual?

A
  1. Group A streptococcal infection.
  2. Lithium.
  3. UV light.
  4. Alcohol.
  5. Stress.
35
Q

Describe the treatment for psoriasis.

A
  1. Emollients and reassurance.
  2. Vitamin D and A analogues e.g. calcipotriol and tazarotene.
  3. Phototherapy.
36
Q

What is necrotising fasciitis?

A

Deep spreading infection of all layers of the skin -> necrosis.

37
Q

Give 3 risk factors for necrotising fasciitis.

A
  1. IVDU.
  2. Diabetes mellitus.
  3. Homeless.
  4. Recent surgery.
38
Q

What bacteria can cause necrotising fasciitis?

A
  1. Type 1: aerobic and anaerobic.

2. Type 2: group A strep e.g. s.pyogenes.

39
Q

What is the treatment for necrotising fasciitis?

A
  1. Surgical debridement.

2. Aggressive IV benzylpenicillin and clindamycin.

40
Q

What is cellulitis?

A

Inflammation of the SC layer of the skin.

41
Q

What bacteria is the commonest causal organism of cellulitis?

A

S. pyogenes.

42
Q

Give 5 signs of cellulitis.

A
  1. Inflammation.
  2. Swelling.
  3. Redness.
  4. Warmth.
  5. Pain.
  6. Unilateral.
43
Q

What is the differential diagnosis in someone with the signs and symptoms of cellulitis?

A

DVT

44
Q

What is the treatment for cellulitis?

A

Penicillin and flucloxacillin.

Phase 2a Medicine (15 decks)

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