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ΩΩ 2a Bateman - Systems Based > Dermatology > Flashcards

Dermatology Flashcards

1
Q

WHAT IS ECZEMA?

A

Papules and vesicles on an erythematous base.

ITCHY!!!

Reaction pattern to stimuli

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2
Q

What are the two type of eczema?

What is the exogenous one precipitated by?

A
  1. Endogenous (atopic)
  2. Exogenous (contact dermatitis)

Contact dermatitis is a type of eczema precipitated by an exogenous agent e.g. chemicals, sweat, abrasives

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3
Q

What is filaggrin?

A

Skin barrier protein

If damaged increases the risk of eczema

Genetic predisopsition

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4
Q

What is the treatment of eczema?

A
  1. Emollients
  2. Topical steroids
    • Mild - hydrocortisone
    • Moderate - Betamethasone
    • Potent - Fluticasone
    • Very potent - Clobetasol
  3. UV radiation
  4. Immunosuppressants:
    • e.g. ciclosporin, antihistamines and azathioprine
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5
Q

WHAT IS ACNE?

A

Inflammatory disease of the pilosebaceous follicles

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6
Q

What is the pathology of acne?

A
  1. Increased sebum production (hormonal in adolescents)
  2. Abnormal follicular keratinization
  3. Pilosebaceous duct obstruction
  4. Bacterial colonisation with Propionibacterium acne
  5. Inflammation

P. acnes

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7
Q

What is the presentation of acne?

A
  1. Blackheads and whiteheads (open and closed comedomes)
  2. Inflammatory lesions
  3. Papules
  4. Nodules
  5. Cysts
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8
Q

What is the management of acne?

A
  1. Mild
    • Topical therapies e.g. benzylperoxide and topical antibiotics and topical retinoids
    • Topical adapalene with benzyl peroxide
  2. Moderate
    • Oral therapies
    • e.g. oral antibiotics - erythromycin, doxycycline
    • anti-androgens in females (COCP or cyproteroneacetate)
  3. Severe
    • Oral retinoids
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9
Q

WHAT IS PSORIASIS?

A

Chronic, inflammatory skin disease due to hyper-proliferation of Keratinocytes + inflammatory cell infiltration

Well demarcated erythematous plaques topped with silvery scales

NOT ITCHY

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10
Q

Where can psoriasis be seen?

A

Extensor surfaces

Associated nail changes: pitting, onycholysis

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11
Q

What are the precipitating (flare up) factors for psoriasis?

A
  1. Trauma
  2. Drugs
    • Lithium
    • Beta blockers
  3. Stress
  4. Smoking
  5. Alcohol
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12
Q

What is the treatment for psoriasis?

A

Mild

  1. Regular emollients may help to reduce scale loss and reduce pruritus
  2. First-line: NICE recommend:
    - Potent corticosteroid applied once daily plus vitamin D analogue applied once daily, for up to 4 weeks as initial treatment
  3. Second-line: if no improvement after 8 weeks then offer:
    - A vitamin D analogue twice daily
  4. Third-line: if no improvement after 8-12 weeks then offer either:
    - A potent corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily

NEED TO WAIT 4 WEEKS IN BETWEEN EACH STEROID COURSE

Moderate
Phototherapy

Severe
Oral methotrexate
Retinoids
Ciclosporin
Infliximab

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13
Q

What is Koebner phenomenon?

A

The Koebner phenomenon describes skin lesions that appear at the site of injury. It is seen in:

  1. psoriasis
  2. vitiligo
  3. warts
  4. lichen planus
  5. lichen sclerosus
  6. molluscum contagiosum
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14
Q

WHAT ARE THE FEATURES OF A BCC?

What is it a tumour of?

Does it metastasise?

A
  1. Slow growing
  2. Locally invasive
  3. Tumour of the epidermal keratinocytes
  4. Rarely metastasises but locally destructive
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15
Q

What are the risk factors for a BCC?

A
  1. UV exposure
  2. Skin type 1 (burns rather than tans)
  3. Aging
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16
Q

What is the presentation of a BCC?

A
  1. many types of BCC are described. The most common type is nodular BCC, which is described here
  2. sun-exposed sites, especially the head and neck account for the majority of lesions
  3. initially a pearly, flesh-coloured papule with telangiectasia
  4. may later ulcerate leaving a central ‘crater’
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17
Q

What is the treatment of a BCC?

A

Surgically excise

Radiotherapy if surgery is not appropriate

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18
Q

What are the complications of a BCC?

A

Local tissue destruction

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19
Q

WHAT IS A SCC?

A

Locally invasive malignant tumour of keratinocytes

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20
Q

What are the risk factors for a SCC?

A
  1. Excessive exposure to sunlight / psoralen UVA therapy
  2. Actinic keratoses and Bowen’s disease
  3. Immunosuppression e.g. following renal transplant, HIV
  4. Smoking
  5. Long-standing leg ulcers (Marjolin’s ulcer)
  6. Genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism
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21
Q

What is the presentation of a SCC?

A

Scaly and crusty, ill-defined edges, may ulcerate

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22
Q

What is the management of a SCC?

A
  1. Surgical excision with 4mm margins if lesion <20mm in diameter.
  2. If tumour >20mm then margins should be 6mm.
  3. Mohs micrographic surgery may be used in high-risk patients and in cosmetically important sites.
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23
Q

WHAT IS A MELENOMA?

A

Invasive tumour of melanocytes

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24
Q

What are the risk factors for a melenoma

A
  1. UV exposure
  2. Skin type 1
  3. Atypical moles
  4. Multiple moles
  5. Family history
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25
Q

What is the presentation of a melenoma?

A
  1. A – asymmetrical shape
  2. B – boarder irregularity
  3. C – colour irregularity
  4. D- diameter >5cm
  5. E – evolution/change of lesion

SYMPTOMS e.g. bleeding, itching

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26
Q

What is the treatment of a melanoma?

A

Excision biopsy

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27
Q

WHAT ARE THE RISK FACTORS FOR ARTERIAL SKIN ULCERS?

A
  1. Arterial disease (atherosclerosis)
  2. Smoking
  3. Cholesterol
  4. DM
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28
Q

How does a arterial ulcer present?

What does the ulcer look like?

A
  1. Pain, worse when legs elevated
  2. Cold skin
  3. Absent peripheral pulses
  4. Shiny pale skin
  5. Loss of hair

Ulcer

  1. Small
  2. Sharply defined
  3. Necrotic base
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29
Q

What are the investigations of an arterial ulcer?

A
  1. ABPI < 0.8 suggests arterial insufficiency
  2. Doppler studies
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30
Q

What is the treatment of a arterial ulcer?

A
  1. Symptomatic treatment - rest and warmth
  2. Vascular reconstruction or angioplasty
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31
Q

WHAT ARE THE RISK FACTORS FOR VENOUS ULCERS?

A
  1. Varicose veins
  2. DVT
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32
Q

How does a venous ulcer present?

What does the ulcer look like?

A
  1. Pain (minimal)
  2. Warm skin
  3. Normal peripheral pulses, leg oedema, haemosiderin, lipodermatoosclerosis
  4. Large, shallow, irregular, exudative
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33
Q

What are the investigations of a venous ulcer?

A

ABPI normal (>0.8 – 1)

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34
Q

What is the management of a venous ulcer?

A
  1. Compression bandaging
  2. Oral pentoxifylline, a peripheral vasodilator
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35
Q

WHAT CONDITIONS ARE NEUROLOGICAL ULCERS FOUND?

A

DM

Neurological disease

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36
Q

What are the symptoms of neurological ulcers?

What does the ulcer look like?

A

Often painless

Found at pressure sites (e.g. heel or toes)

Warm skin and normal peripheral pulses

Associated peripheral neuropathy

Variable size, maybe surrounded by callus

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37
Q

What is the treatment for neurological ulcers?

A
  1. Appropriate foot wear
  2. Control DM
  3. Podiatary
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38
Q

WHAT IS CELLULITIS?

A

Bacterial infection of the deep subcutaneous tissue

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39
Q

What are the causes of cellulitis?

A

S. pyogenes, S. aureus

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40
Q

What are the risk factors for cellulitis?

A
  1. Immunosuppression
  2. Wounds
  3. Leg ulcers
  4. Trauma
  5. Athletes foot
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41
Q

What is the presentation of cellulitis?

A
  1. Commonly occurs on the shins
  2. Erythema, pain, swelling
  3. There may be some associated systemic upset such as fever
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42
Q

What is the treatment of cellulitis?

A
  1. Fluclox or benpen - FIRST LINE
  2. Clarithromycin if allergic
  3. Erythromycin if pregnant
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43
Q

WHAT IS NECROTISING FASCITIS?

A

Bacterial infection of the deep fascia + tissue necrosis

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44
Q

What are the causes of NF?

A

Type 1 - pseudomonas, haemolytic staph

Type 2 - Group A haemolytic strep

Type 3 - gram negative

Type 4 - fungal infection

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45
Q

What are the risk factors for necrotising fasciitis?

A
  1. Skin factors: recent trauma, burns or soft tissue infection
  2. Diabebtes Mellitus
  3. IVDU
  4. Immunosuppresion
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46
Q

What are the clinical features of necrotising fasciitis?

A

Symptoms

  1. Severe pain out of proportion
  2. Fever
  3. Necrotic skin
  4. Systemically unwell

Signs

  1. Soft tissue gas seen on Xray
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47
Q

What is the treatment of necrotising fasciitis?

A
  1. Surgical debridement
  2. IV Abx - benzylpenicillin, flucloxacillin
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48
Q

WHAT IS A LIPOMA?

A

Common, benign tumour of adipocytes

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49
Q

What are the features of a lipoma?

A
  1. Smooth
  2. Mobile
  3. Painless
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50
Q

What are the investigations for a lipoma?

A
  1. Ultrasound if mass is >5cm
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51
Q

What factors make a liposarcoma more suggestive than a lipoma?

A
  1. Size >5cm
  2. Increasing size
  3. Pain
  4. Deep anatomical location
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52
Q

WHAT IS ERYTHEMA NODOSUM?

A

Inflammation of subcutaneous fat

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53
Q

What are the symptoms of erythema nodosum?

A
  1. Typically causes tender, erythematous, nodular lesions
  2. Usually occurs over shins, may also occur elsewhere (e.g. forearms, thighs)
  3. Usually resolves within 6 weeks
  4. Lesions heal without scarring
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54
Q

What are the causes of erythema nodosum?

A
  1. Infection
    • streptococci
    • tuberculosis
    • brucellosis
  2. Systemic disease
    • sarcoidosis
    • inflammatory bowel disease
    • Behcet’s
  3. Malignancy/lymphoma
  4. Drugs
    • penicillins
    • sulphonamides
    • combined oral contraceptive pill
  5. Pregnancy
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55
Q

What is an important test you need when you suspect eryhtema nodosum?

A
  1. Chest x-ray
    • Exclude sarcoidosis and TB
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56
Q

WHAT IS STRAWBERRY NAEVI?

A

Strawberry naevi (capillary haemangioma) are usually not present at birth but may develop rapidly in the first month of life.

They appear as erythematous, raised and multilobed tumours.

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57
Q

What is the treatment of strawberry naevi?

A
  1. Normally nothing and will disappear in the first few months of life
  2. If treatment is required (e.g. Visual field obstruction) then propranolol is increasingly replacing systemic steroids as the treatment of choice.
  3. Topical beta-blockers such as timolol are also sometimes used.
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58
Q

WHAT IS POLYMORPHIC ERUPTION OF PREGNANCY?

A
  1. It usually presents within the first pregnancy.
  2. It appears as an itchy, bumpy rash that starts in the stretch marks of the abdomen in the last 3 months of pregnancy then clears with delivery.
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59
Q

What is spared in polymorphic eruption of pregnancy?

A

Periumbilical region

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60
Q

WHAT IS SHINGLES?

A
  1. Shingles (herpes zoster infection) is an acute, unilateral, painful blistering rash caused by reactivation of the varicella-zoster virus (VZV).
  2. Following primary infection with VZV (chickenpox), the virus lies dormant in the dorsal root or cranial nerve ganglia.
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61
Q

What are the risk factors for shingles?

A
  1. Increasing age
  2. HIV: strong risk factor, 15 times more common
  3. Other immunosuppressive conditions (e.g. steroids, chemotherapy)
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62
Q

What are the features of shingles?

A
  1. Prodromal period
    • burning pain over the affected dermatome for 2-3 days
    • pain may be severe and interfere with sleep
    • around 20% of patients will experience fever, headache, lethargy
  2. Rash
    • initially erythematous, macular rash over the affected dermatome
    • quickly becomes vesicular
    • characteristically is well demarcated by the dermatome and does not cross the midline. However, some ‘bleeding’ into adjacent areas may be seen
63
Q

What is the management for shingles?

A
  1. Remind patients they are potentially infectious
  2. may need to avoid pregnant women and the immunosuppressed
  3. Should be advised that they are infectious until the vesicles have crusted over, usually 5-7 days following onset
  4. Covering lesions reduces the risk
  5. Analgesia
    • Paracetamol and NSAIDs are first-line
    • If not responding then use of neuropathic agents (e.g. amitriptyline) can be considered
    • Oral corticosteroids may be considered in the first 2 weeks in immunocompetent adults with localized shingles if the pain is severe and not responding to the above treatments
  6. Antivirals
    • NICE Clinical Knowledge Summaries makes recommendations on when to use antivirals
    • In practice, they recommend antivirals within 72 hours for the majority of patients, unless the patient is < 50 years and has a ‘mild’ truncal rash associated with mild pain and no underlying risk factors
    • One of the benefits of prescribing antivirals is a reduced incidence of post-herpetic neuralgia, particularly in older people
    • Aciclovir, famciclovir, or valaciclovir are recommended
64
Q

What are the complications of shingles?

A
  1. Post-herpetic neuralgia
    • The most common complications
    • More common in older patients
    • Affects between 5%-30% of patients depending on age
    • Most commonly resolves with 6 months but may last longer
  2. Herpes zoster ophthalmicus (shingles affecting affecting the ocular division of the trigeminal nerve) is associated with a variety of ocular complications
  3. Herpes zoster oticus (Ramsay Hunt syndrome): may result in ear lesions and facial paralysis
65
Q

WHAT IS HIRSUTISM AND HYPERTRICHOSIS?

A

Hirsutism is often used to describe androgen-dependent hair growth in women, with hypertrichosis being used for androgen-independent hair growth

66
Q

What are the causes of Hirsutism and hypertrichosis?

A
  1. Polycystic ovarian syndrome is the most common causes of hirsutism.

Other causes include:

  1. Cushing’s syndrome
  2. congenital adrenal hyperplasia
  3. androgen therapy
  4. obesity: thought to be due to insulin resistance
  5. adrenal tumour
  6. androgen secreting ovarian tumour
  7. drugs: phenytoin, corticosteroids
67
Q

What is the management for Hirsutism and hypertrichosis?

A
  1. Advise weight loss if overweight
  2. Cosmetic techniques such as waxing/bleaching - not available on the NHS
  3. Consider using combined oral contraceptive pills such as co-cyprindiol (Dianette) or ethinylestradiol and drospirenone (Yasmin).
    • Co-cyprindiol should not be used long-term due to the increased risk of venous thromboembolism
  4. Facial hirsutism
    • Topical eflornithine - contraindicated in pregnancy and breast-feeding
68
Q

WHAT IS LICHEN SCLEROSIS?

A

Lichen sclerosus was previously termed lichen sclerosus et atrophicus. It is an inflammatory condition that usually affects the genitalia and is more common in elderly females. Lichen sclerosus leads to atrophy of the epidermis with white plaques forming

69
Q

What are the features of lichen sclerosis?

A
  1. White patches that may scar
  2. Itch is prominent
  3. May result in pain during intercourse or urination
70
Q

What are the investigations for lichen sclerosis?

A
  1. The diagnosis is usually made on clinical grounds but a biopsy may be performed if atypical features are present
71
Q

What is the management of lichen sclerosis?

A
  1. Topical steroids and emollients
72
Q

What is an association with lichen sclerosis?

A
  1. Increased risk of vulval cancer
73
Q

What is the difference between lichen sclerosis and lichen planus?

A

Lichen planus is typically raised purple-red discoloured areas, however, rather than white plaques

74
Q

WAT ARE THE FEATURES OF LICHEN PLANUS?

A
  1. itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
  2. rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
  3. Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
  4. oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
  5. nails: thinning of nail plate, longitudinal ridging
75
Q

What is the treatment of lichen planus?

A
  1. potent topical steroids are the mainstay of treatment
  2. benzydamine mouthwash or spray is recommended for oral lichen planus
  3. extensive lichen planus may require oral steroids or immunosuppression
76
Q

WHAT IS A DERMATOFIBROMA?

A
  1. Dermatofibromas (also known as histiocytomas) are common benign fibrous skin lesions.
  2. They are caused by the abnormal growth of dermal dendritic histiocyte cells, often following a precipitating injury.
  3. Common areas include the arms and legs.
77
Q

What are the features of a dermatofibroma?

A
  1. Solitary firm papule or nodule, typically on a limb
  2. Typically around 5-10mm in size
  3. Overlying skin dimples on pinching the lesion
78
Q

What is a test for a dermatofibroma?

A

Solitary firm papule/nodule that dimples on pinching → dermatofibroma

79
Q

WHAT IS PYODERMA GANGRENOSUM?

A

Pyoderma gangrenosum is a rare, non-infectious, inflammatory disorder. It is an uncommon cause of very painful skin ulceration. It may affect any part of the skin, but the lower legs are the most common site.

80
Q

What is the pathophysiology of pyoderma gangrenosum?

A
  1. pyoderma gangrenosum is classified as a neutrophilic dermatosis
  2. neutrophilic dermatoses are skin conditions characterised by dense infiltration of neutrophils in the affected tissue and this is often seen on biopsy
81
Q

What are the causes of pyoderma gangrenosum?

A
  1. diopathic in 50%
  2. inflammatory bowel disease in 10-15%
    • ulcerative colitis
    • Crohn’s
  3. rheumatological
    • rheumatoid arthritis
    • SLE
  4. haematological
    • myeloproliferative disorders
    • lymphoma
    • myeloid leukaemias
    • monoclonal gammopathy (IgA)
  5. granulomatosis with polyangiitis
  6. primary biliary cirrhosis
82
Q

What are the features of pyoderma gangrensoum?

A
  1. location
    • typically on the lower limb
    • soften at the site of a minor injury as in this patient’s case and this is known as pathergy
  2. initially features:
    • usually starts quite suddenly
    • small pustule, red bump or blood-blister
  3. later features:
    • the skin then breaks down resulting in an ulcer which is often painful
    • the edge of the ulcer is often described as purple, violaceous and undermined.
    • the ulcer itself may be deep and necrotic
  4. may be accompanied by systemic symptoms
    • fever
    • myalgia
83
Q

What is used for the diagnosis of pyoderma gangrenosum?

A
  1. often made by the characteristic appearance, associations with other diseases, the presence of pathergy, histology results and when other diseases have been ruled out
  2. histology is not specific and can vary depending on the time and site of the specimen but may be helpful in ruling out other causes of an ulcer.
84
Q

What is the management for pyoderma gangrenosum?

A
  1. the potential for rapid progression is high in most patients and most doctors advocate oral steroids as first-line treatment
  2. other immunosuppressive therapy, for example, ciclosporin and infliximab, have a role in difficult cases
  3. any surgery should be postponed until the disease process is controlled on immunosuppression to risk worsening of the disease (pathergy)
85
Q

WHAT IS ERYTHEMA MULTIFORME?

A

Erythema multiforme is a hypersensitivity reaction that is most commonly triggered by infections. It may be divided into minor and major forms.

86
Q

What are the features of erythema multiforme?

A
  1. Target lesions
  2. Initially seen on the back of the hands / feet before spreading to the torso
  3. Upper limbs are more commonly affected than the lower limbs
  4. Pruritus is occasionally seen and is usually mild
87
Q

WHAT IS GUTTATE PSORIASIS?

A

Guttate psoriasis is more common in children and adolescents. It may be precipitated by a streptococcal infection 2-4 weeks prior to the lesions appearing.

88
Q

What are the features of guttate psoriasis?

A
  1. Tear drop papules on the trunk and limbs
  2. Gutta is Latin for drop
  3. pink, scaly patches or plques of psoriasis
  4. tends to be acute onset over days
89
Q

WHAT IS ACANTHOSIS NIGRICANS?

A

Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin.

90
Q

What are the causes of acanthosis nigricans?

A
  1. type 2 diabetes mellitus
  2. gastrointestinal cancer
  3. obesity
  4. polycystic ovarian syndrome
  5. acromegaly
  6. Cushing’s disease
  7. hypothyroidism
  8. familial
  9. Prader-Willi syndrome
  10. drugs
    • combined oral contraceptive pill
    • nicotinic acid
91
Q

What is the pathophysiology of acanthosis nigricans?

A

insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)

92
Q

WHAT ARE PYOGENIC GRANULOMAS?

A
  1. Overgrowth of blood vessels.
  2. Red nodules.
  3. Usually follow trauma.
  4. May mimic amelanotic melanoma
  5. Bleed easily
93
Q

WHAT ARE KERATOACONATHOMA?

A
  1. Keratoacanthomas may reach a considerable size prior to sloughing off and scarring
  2. Rapid growing
94
Q

WHAT IS ACTINIC KERATOSES?

A

Actinic, or solar, keratoses (AK) is a common premalignant skin lesion that develops as a consequence of chronic sun exposure

95
Q

What are the features of actinic keratoses?

A
  1. small, crusty or scaly, lesions
  2. may be pink, red, brown or the same colour as the skin
  3. typically on sun-exposed areas e.g. temples of head
  4. multiple lesions may be present
96
Q

What is the management for actinic keratosis?

A
  1. prevention of further risk: e.g. sun avoidance, sun cream
  2. fluorouracil cream: typically a 2 to 3 week course. The skin will become red and inflamed - sometimes topical hydrocortisone is given following fluorouracil to help settle the inflammation
  3. topical diclofenac: may be used for mild AKs. Moderate efficacy but much fewer side-effects
  4. topical imiquimod: trials have shown good efficacy
  5. cryotherapy
  6. curettage and cautery
97
Q

WHAT ARE SEBORRHOEIC KERATOSES?

A

Seborrhoeic keratoses are benign epidermal skin lesions seen in older people

98
Q

What are the features of seborrhoeic keratoses?

A
  1. large variation in colour from flesh to light-brown to black
  2. have a ‘stuck-on’ appearance
  3. keratotic plugs may be seen on the surface
99
Q

WHAT IS 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 (formerly known as Pityrosporum ovale).

100
Q

What are the features of seborrhoeic dermatitis?

A
  1. eczematous lesions on the sebum-rich areas: scalp (may cause dandruff), periorbital, auricular and nasolabial folds
  2. otitis externa and blepharitis may develop
101
Q

WHEN ARE IV FLUIDS NEEDED FOR BURNS?

A

2nd degree and above

102
Q

What are the different degrees of burns?

A
103
Q

WHAT IS ERYTHEMA AB IGNE?

A
  1. Erythema ab igne is a skin disorder caused by over exposure to infrared radiation.
  2. Characteristic features include reticulated, erythematous patches with hyperpigmentation and telangiectasia.
  3. A typical history would be an elderly women who always sits next to an open fire.
104
Q

What does erythema ab igne look like?

A
105
Q

WHAT ARE FUNGAL NAIL INFECTIONS?

A
  1. Onychomycosis is fungal infection of the nails. This may be caused by
  2. dermatophytes - mainly Trichophyton rubrum, accounts for 90% of cases
  3. yeasts - such as Candida
  4. non-dermatophyte moulds
106
Q

What ar ethe features of fungal nail infections?

A
  1. ‘unsightly’ nails are a common reason for presentation
  2. thickened, rough, opaque nails are the most common finding
107
Q

What are the investigations for fungal nail infections?

A
  1. nail clippings
  2. scrapings of the affected nail
  3. the false-negative rate for cultures are around 30%, so repeat samples may need to be sent if the clinical suspicion is high
108
Q

What is the treatment of fungal nail infections?

A
  1. Do not need to be treated if it is asymptomatic and the patient is not bothered by the appearance
  2. Diagnosis should be confirmed by microbiology before starting treatment
  3. Dermatophyte infection:
    • Oral terbinafine is currently recommended first-line with oral itraconazole as an alternative
    • 6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be treated for 3 - 6 months
    • treatment is successful in around 50-80% of people
  4. Candida infection:
    • Mild disease should be treated with topical antifungals (e.g. Amorolfine) whilst more severe infections should be treated with oral itraconazole for a period of 12 weeks
  5. If topical topical treatment is given treatment should be continued for 6 months for fingernails and 9-12 months for toenails
109
Q

WHAT IS ROSACEA?

A

Rosacea (sometimes referred to as acne rosacea) is a chronic skin disease of unknown aetiology.

110
Q

What are the features of rosacea?

A
  1. typically affects nose, cheeks and forehead
  2. flushing is often first symptom
  3. telangiectasia are common
  4. later develops into persistent erythema with papules and pustules
  5. rhinophyma
  6. ocular involvement: blepharitis
  7. sunlight may exacerbate symptoms/
111
Q

What is the management of rosacea?

A
  1. Topical metronidazole may be used for mild symptoms (i.e. Limited number of papules and pustules, no plaques)
  2. Topical brimonidine gel may be considered for patients with predominant flushing but limited telangiectasia
  3. More severe disease is treated with systemic antibiotics e.g. Oxytetracycline
  4. recommend daily application of a high-factor sunscreen
  5. camouflage creams may help conceal redness
  6. laser therapy may be appropriate for patients with prominent telangiectasia
  7. patients with a rhinophyma should be referred to dermatology
112
Q

WHAT IS PITYRIASIS VERSICOLOR?

A

Pityriasis versicolor, also called tinea versicolor, is a superficial cutaneous fungal infection caused by Malassezia furfur (formerly termed Pityrosporum ovale)

113
Q

What are the features of pityriasis versicolor?

A
  1. most commonly affects trunk
  2. patches may be hypopigmented, pink or brown (hence versicolor). May be more noticeable following a suntan
  3. scale is common
  4. mild pruritus
114
Q

What is the management for pityriasis versicolor?

A
  1. Topical antifungal. NICE Clinical Knowledge Summaries advise ketoconazole shampoo as this is more cost effective for large areas
  2. If failure to respond to topical treatment then consider alternative diagnoses (e.g. send scrapings to confirm the diagnosis) + oral itraconazole
115
Q

WHAT IS IMPETIGO?

A

Impetigo is a superficial bacterial skin infection usually caused by either Staphylcoccus aureus or Streptococcus pyogenes. It can be a primary infection or a complication of an existing skin condition such as eczema (in this case), scabies or insect bites. Impetigo is common in children, particularly during warm weather.

116
Q

What are the features of impetigo?

A
  1. ‘Golden’, crusted skin lesions typically found around the mouth
  2. Very contagious
117
Q

What is the management of impetigo?

A
  1. Limited, localised disease
  2. NICE Clinical Knowledge Summaries now recommend hydrogen peroxide 1% cream for ‘people who are not systemically unwell or at a high risk of complications’
    • the change was announced in 2020 by NICE and Public Health England and seems aimed at cutting antibiotic resistance
    • the evidence base shows it is just as effective at treating non‑bullous impetigo as a topical antibiotic
  3. topical antibiotic creams:
    • topical fusidic acid
    • topical mupirocin should be used if fusidic acid resistance is suspected
    • MRSA is not susceptible to either fusidic acid or retapamulin. Topical mupirocin should, therefore, be used in this situation
  4. Extensive disease
    • oral flucloxacillin
    • oral erythromycin if penicillin-allergic
  5. School exclusion
    • children should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
118
Q

WHAT IS TINEA?

A
  1. Tinea is a term given to dermatophyte fungal infections. Three main types of infection are described depending on what part of the body is infected
  2. tinea capitis - scalp
  3. tinea corporis - trunk, legs or arms
  4. tinea pedis - feet
119
Q

What is the treatment of the different tineas?

A
  1. Tinea capitis (scalp ringworm)
    • Topical ketoconazole shampoo should be given for the first two weeks to reduce transmission
  2. Tinea corporis (ringworm)
    • May be treated with oral fluconazole
  3. Tinea pedis
    • Topical imidazole, undecenoate or terbinafine
120
Q

WHAT IS SCABIES?

A
  1. Scabies is caused by the mite Sarcoptes scabiei and is spread by prolonged skin contact. It typically affects children and young adults.
  2. The scabies mite burrows into the skin, laying its eggs in the stratum corneum. The intense pruritus associated with scabies is due to a delayed-type IV hypersensitivityreaction to mites/eggs which occurs about 30 days after the initial infection.
121
Q

What are the features of scabies?

A
  1. widespread pruritus
  2. linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist
  3. in infants, the face and scalp may also be affected
  4. secondary features are seen due to scratching: excoriation, infection
122
Q

What is the management of scabies?

A
  1. Permethrin 5% is first-line
  2. Malathion 0.5% is second-line
  3. give appropriate guidance on use (see below)
  4. pruritus persists for up to 4-6 weeks post eradication
  5. TWO DOSES ARE REQUIRED 1 WEEK APART
123
Q

What is the further advice on treatment for scabies?

A
  1. avoid close physical contact with others until treatment is complete
  2. all household and close physical contacts should be treated at the same time, even if asymptomatic
  3. launder, iron or tumble dry clothing, bedding, towels, etc., on the first day of treatment to kill off mites.
124
Q

WHAT IS NECROBIOSIS LIPOIDICA DIABETICORUM?

A
  1. shiny, painless areas of yellow/red skin typically on the shin of diabetics
  2. often associated with telangiectasia
125
Q

WHAT IS PITYRIASIS ROSEA?

A
  1. Pityriasis rosea describes an acute, self-limiting rash which tends to affect young adults.
  2. The aetiology is not fully understood but is thought that herpes hominis virus 7 (HHV-7) may play a role.
126
Q

What are the features of pityriasis rosea?

A
  1. in the majority of patients there is no prodrome, but a minority may give a history of a recent viral infection
  2. herald patch (usually on trunk)
  3. followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance
127
Q

What is the management of pityriasis rosea?

A
  1. self-limiting - usually disappears after 6-12 weeks
128
Q

WHAT IS ERYTHRASMA?

A

Erythrasma is a generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum

129
Q

What is the treatment for erythrasma?

A
  1. Topical miconazole or antibacterial are usually effective.
  2. Oral erythromycin may be used for more extensive infection
130
Q

WHAT IS TOXIC EPIDERMAL NECROLYSIS?

A
  1. Toxic epidermal necrolysis (TEN) is a potentially life-threatening skin disorder that is most commonly seen secondary to a drug reaction.
  2. In this condition, the skin develops a scalded appearance over an extensive area.
  3. Some authors consider TEN to be the severe end of a spectrum of skin disorders which includes erythema multiforme and Stevens-Johnson syndrome,
131
Q

What are the features of toxic epidermal necrolysis?

A
  1. systemically unwell e.g. pyrexia, tachycardic
  2. positive Nikolsky’s sign: the epidermis separates with mild lateral pressure
132
Q

What drugs induce toxic epidermal necrolysis?

A
  1. phenytoin
  2. sulphonamides
  3. allopurinol
  4. penicillins
  5. carbamazepine
  6. NSAIDs
133
Q

What is the management of toxic epidermal necrolysis?

A
  1. stop precipitating factor
  2. supportive care
  3. often in an intensive care unit
  4. volume loss and electrolyte derangement are potential complications
  5. intravenous immunoglobulin has been shown to be effective and is now commonly used first-line
  6. other treatment options include: immunosuppressive agents (ciclosporin and cyclophosphamide), plasmapheresis
134
Q

WHAT IS ERYSIPELAS?

A

Erysipelas is localised skin infection caused by Streptococcus pyogenes. In simple terms, it is a more superficial, limited version of cellulitis.

The treatment of choice is flucloxacillin.

135
Q

WHAT IS ECZEMA HERPETICUM?

A
  1. Eczema herpeticum describes a severe primary infection of the skin by herpes simplex virus 1 or 2.
  2. It is more commonly seen in children with atopic eczema and often presents as a rapidly progressing painful rash.
136
Q

What are the features of eczema herpeticum?

A
  1. On examination, monomorphic punched-out erosions (circular, depressed, ulcerated lesions) usually 1–3 mm in diameter are typically seen.
  2. As it is potentially life-threatening children should be admitted for IV aciclovir.
137
Q

WHAT IS BULLOUS PEMPHIGOID?

A

Bullous pemphigoid is an autoimmune condition causing sub-epidermal blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230.

138
Q

What are the features of bullous pemphigoid?

A
  1. itchy, tense blisters typically around flexures
  2. the blisters usually heal without scarring
  3. there is usually no mucosal involvement (i.e. the mouth is spared)*
139
Q

What is the treatment for bullous pemphigoid?

A
  1. High-dose steroids
140
Q

WHAT ARE KELOID SCARS?

A
  1. Keloid scars are tumour-like lesions that arise from the connective tissue of a scar and extend beyond the dimensions of the original wound
  2. Commonly on sternum
141
Q

WHAT IS VITILIGO?

A

Vitiligo is an autoimmune condition which results in the loss of melanocytes and consequent depigmentation of the skin. It is thought to affect around 1% of the population and symptoms typically develop by the age of 20-30 years.

142
Q

What are the features of vitiligo?

A
  1. well-demarcated patches of depigmented skin
  2. the peripheries tend to be most affected
  3. trauma may precipitate new lesions (Koebner phenomenon)
143
Q

What are the associated conditions with vililigo?

A
  1. type 1 diabetes mellitus
  2. Addison’s disease
  3. autoimmune thyroid disorders
  4. pernicious anaemia
  5. alopecia areata
144
Q

What is the management of vitiligo?

A
  1. sunblock for affected areas of skin
  2. camouflage make-up
  3. topical corticosteroids may reverse the changes if applied early
  4. there may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients
145
Q

WHAT IS A SALMON PATCH?

A

Salmon patches are a kind of vascular birthmark which can be seen in around half of newborn babies they are also known as stork marks or stork bites. They are pink and blotchy, and commonly found on the forehead, eyelids and nape of the neck. They usually fade over a few months, though marks on the neck may persist.

146
Q

WHAT IS A PORT WINE STAIN?

A
  1. Port wine stains are vascular birthmarks that tend to be unilateral. They are deep red or purple in colour.
  2. Unlike other vascular birthmarks such as salmon patches and strawberry haemangiomas, they do not spontaneously resolve, and in fact often darken and become raised over time.
  3. Treatment is with cosmetic camouflage or laser therapy (multiple sessions are required).
147
Q

WHAT IS MOLLUSCUM CONTAGIOSUM?

A
  1. Molluscum contagiosum is a common skin infection caused by molluscum contagiosum virus (MCV), a member of the Poxviridae family.
  2. Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels.
  3. The majority of cases occur in children (often in children with atopic eczema), with the maximum incidence in preschool children aged 1-4 years.
148
Q

WHAT ARE CHERRY HAEMANGIOMA?

A

Cherry haemangiomas (Campbell de Morgan spots) are benign skin lesions which contain an abnormal proliferation of capillaries. They are more common with advancing age and affect men and women equally.

149
Q

What are the features of cherry haemangioma?

A
  1. erythematous, papular lesions
  2. typically 1-3 mm in size
  3. non-blanching
  4. not found on the mucous membranes
150
Q

WHAT IS BOWEN’S DISEASE?

A
  1. Bowen’s disease is a type of precancerous dermatosis that is a precursor to squamous cell carcinoma.
  2. It is more common in elderly patients.
  3. There is around a 5-10% chance of developing invasive skin cancer if left untreated.
151
Q

More Bowen’s disease?

A
152
Q

WHAT IS POMPHOLYX ECZEMA MADE WORSE BY?

A

Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures

153
Q

WHAT ARE THE FEATURES OF ATOPIC DERMATITS?

A
  1. Atopic dermatitis often presents early on in childhood, with an atopic background.
  2. Atopic dermatitis affects the flexural areas, and in children can be found on the scalp and on the face.
  3. Often the genital area is spared as nappies allow the skin to retain moisture.

ΩΩ 2a Bateman - Systems Based (11 decks)

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