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PHASE 2A > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Name 5 functions of the skin

A
  1. Barrier to infection
  2. Thermoregulation
  3. Protection against trauma
  4. Protection against UV
  5. Vitamin D synthesis
  6. Regulate H2O loss
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2
Q

What is the pH of normal skin?

A

5.5 = allows protease to remain on the skin

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3
Q

Describe skin pathophysiology

A

New cells in basal layer of epidermis vs mature corneocytes shed from surface of stratum corneum (desquamation)

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4
Q

How does desquamation work?

A

Involves degradation of extracellular corneodesmosomes under the action of protease enzymes

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5
Q

Name the 3 layers of skin

A
  1. Epidermis
  2. Dermis
  3. Subcutaneous tissue
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6
Q

What are the layers of the epidermis?

A
  1. Stratum corneum (outmost - layer of keratin)
  2. Stratum lucid
  3. Stratum granulosum
  4. Stratum spinous
  5. Stratum basale (dividing cells)
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7
Q

What is the stratum corneum made up of?

A

Corneodesmosomes = adhesion molecules keeping corneocytes together
Desmosomes

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8
Q

What does the dermis layer of skin contain?

A

Meissner’s corpuscle - light touch

Pacinian corpuscle = coarse touch and vibration

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9
Q

Name 4 cell types of the epidermis

A
  1. Keratinocytes = produce keratin as protective barrier
  2. Langerhans cells = present antigens and activate T cells
  3. Melanocytes = produce melanin (protect from UV)
  4. Merkel cells = contain specialised cells for sensation
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10
Q

Name 3 common causes of an itch WITH rash

A
  1. Urticaria
  2. Atopic eczema
  3. Psoriasis
  4. Scabies
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11
Q

Name 3 common causes of an itch WITHOUT a rash

A
  1. Renal failure
  2. Jaundice
  3. Iron deficiency
  4. Lymphoma
  5. Polycythaemia
  6. Pregnancy
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12
Q

What does an increase in corneodesmosomes lead to?

A

Thickening of skin = psoriasis

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13
Q

What does a decrease in corneodesmosomes lead to?

A

Thinning of skin = eczema

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14
Q

What is main cause of all skin cancer?

A

Sun exposure - UV light

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15
Q

Name 3 types of skin cancer

A
  1. Basal Cell Carcinoma (75%) = benign, grows slowly
  2. Squamous Cell Carcinoma (20%) = can metastasise, grows rapidly
  3. Melanoma (5%) = most malignant form of skin cancer
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16
Q

Give 4 risk factors for melanoma

A
  1. Sunlight exposure
  2. Red hair
  3. High density freckles
  4. Skin type 1
  5. Atypical moles
  6. Family history
  7. Immunosuppression
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17
Q

What is the presentation/ABCDE features of melanoma?

A 
Asymmetry of mole 
Border irregularity
Colour variation 
Diameter >6mm
Elevation/evolution
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18
Q

Name 4 type of melanoma

A
  1. Lentigo malignant melanoma
  2. Superficial Spreading malignant melanoma
  3. Nodule malignant melanoma
  4. Acral lentiginous malignant melanoma
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19
Q

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

A

Melanocytic nave –> dysplastic melanocytic nave –> in situ melanoma –> superficial spreading melanoma –> nodular melanoma

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20
Q

What is a lentigo malignant melanoma?

A

A patch of lentigo maligna - a slow growing macular area of pigmentation often on face in elderly
Develops a nodule signalling invasive malignancy

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21
Q

What is a Superficial Spreading malignant melanoma?

A

Large, flat, irregularly pigmented lesion

Grows laterally before vertical invasion

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22
Q

What is a Nodule malignant melanoma?

A

Rapidly growing pigmented nodule which bleeds or ulcerates (most aggressive)

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23
Q

What is a Acral lentiginous malignant melanoma?

A

Pigmented lesions on the palm, sole or under the nail

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24
Q

What is Hutchinson’s sign?

A

Pigmentation of nail and proximal nail fold

Important sign of subungual melanoma

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25
Q

Give 3 factors that can be used to determine the prognosis of melanoma

A
  1. Breslow’s thickness - the thinner (<1mm) the better
  2. Younger = better prognosis
  3. Female = better prognosis
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26
Q

What is the treatment for melanoma?

A

Wide surgical excision

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27
Q

What is Glasgow’s 7 point checklist?

A 
Criteria for melanomas
Major criteria 
1. Change in size 
2. Change in shape 
3. Change in colour
Minor criteria 
4. Diameter >6mm 
5. Inflammation 
6. Oozing/bleeding
7. Mild itch/altered sensation
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28
Q

Define squamous cell carcinoma (SCC)

A

Locally invasive malignant tumour of the squamal keratinocytes

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29
Q

How do SCC present?

A

Keratotic, ill-defined nodules that ulcerate and grow rapidly

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30
Q

What is Bowen’s disease?

A

SCC in situ

Isolated scaly red plaques resembling psoriasis

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31
Q

What is keratoacanthoma?

A

Benign variant of SCC

Fasting growing and dome shaped

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32
Q

What are solar keratinises?

A

Erythematous silver-scaly papules with red base

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33
Q

What is the treatment for a SCC?

A

Surgical excision with a minimal margin of 5mm

Radiotherapy to affected nodes

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34
Q

Define Basal cell carcinoma (BCC)

A

Tumour of basal keratinocytes

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35
Q

How does a BCC present?

A

95% = non-pigmented
Shiny pearly nodules which may ulcerate
Bleeds following minor trauma and doesn’t heal

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36
Q

What is the treatment for a BCC?

A

Surgical excision

Alternative = radiotherapy, photodynamic therapy, cryotherapy

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37
Q

Define psoriasis

A

Chronic, inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration

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38
Q

When does psoriasis usually present?

A

2 peaks = 20s and 50s

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39
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
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40
Q

Describe the pathophysiology of psoriasis

A

T cell activation –> up-regulation of Th1 types of T cell cytokines –> increase uncontrolled hyper proliferation of keratinocytes in epidermis + increase in epidermal cell turnover rate

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41
Q

Name the different types of psoriasis

A
  1. Chronic plaque psoriasis
  2. Flexural psoriasis
  3. Guttate psoriasis
  4. Erythrodermic and pustular psoriasis
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42
Q

How does chronic plaque psoriasis present?

A

Salmon-pink silvery scaly lesions on extensor surfaces of limbs (knees, elbows) with scalp involvement

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43
Q

How does flexural psoriasis present?

A

Red glazed, non-scaly plaques in flexures (groin, axillae, submammary)

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44
Q

How does Guttate psoriasis present?

A

Raindrop psoriasis - explosive eruption of small plaques appear on trunk after strep infection
Mainly children and young adults affected

45
Q

How does erythrodermic and pustular psoriasis present?

A

Widespread intense inflammation of skin, with malaise, pyrexia and circulatory problems

46
Q

Name 4 associated symptoms of psoriasis

A
  1. Pitting of nail plate
  2. Onycholysis (separation of fingernail from nail bed)
  3. Discolouration of nails
  4. Subungual hyperkeratosis
  5. Psoriatic arthritis
47
Q

Describe the treatment of psoriasis

A
  1. Emollients and reassurance
  2. Vitamin D and A analogues (retinoids) - calcipotriol and tazarotene
  3. Topical corticosteroids - hydrocortisone, betamethasone
  4. Phototherapy
  5. Immunosuppression or biological agents - methotrexate, infliximab
48
Q

What are emollients used for?

A

Hydrate the skin and reduce itching

49
Q

How does hydrocortisone work?

A

Targets cytoplasmic receptors

Leads to reduction in pro-inflammatory cytokines and an increase in anti-inflammatories

50
Q

Give 3 potential side effects of corticosteroids

A
  1. Skin thinning
  2. Oral candidaisis
  3. Acne
  4. Striae
  5. Bruising
51
Q

How does calcipotriol work in the treatment of psoriasis?

A

Vitamin D analogue

Anti-proliferative and anti-inflammatory effects

52
Q

How does tazarotene work?

A

Vitamin A analogue

Modifies gene expression and inhibits cell proliferation

53
Q

Would you prescribe tazarotene to a pregnant lady?

A

No = highly teratogenic

54
Q

Why do transdermal drugs need to lipophilic?

A

In order to get through the lipid rich stratum corneum

55
Q

Give 2 essential properties of transdermal drugs

A
  1. Lipophilic

2. High affinity for their targets

56
Q

Give 2 advantages of transdermal drug delivery

A
  1. Avoids first pass effect, hardly metabolised
  2. No pain
  3. Controlled dosing
57
Q

Describe the pathophysiology of atopic eczema

A

Abnormal epithelial barrier function - allows antigenic and irritant agents to penetrate and reach immune cells
Initial activation of Th2 type CD4 cells drive inflammatory process (increase in IgE production)

58
Q

Name 3 exacerbating factors of atopic eczema

A
  1. Strong detergents and chemicals
  2. House dust mites
  3. Animal fur
  4. Diet
59
Q

How does eczema present?

A

Itchy, erythematous scaly patches in flexures (elbows, ankles, knees)
Increased dryness of skin
Hypo or hyper pigmentation
Risk of secondary infection due to broken skin

60
Q

What are 2 signs of chronic eczema?

A
  1. Excoriations (stretch marks)

2. Skin thickening (lichenification)

61
Q

What happens to the serum IgE in eczema?

A

In 80% = raised

62
Q

How do you diagnose eczema?

A

Must have itchy skin condition in past 6 months + 3 or more of

  1. History of involvement of skin creases
  2. Personal history of asthma or hay fever
  3. History of generally dry skin
  4. Childhood onset
63
Q

Describe the aetiology of eczema

A
  1. Genetic predisposition - loss of function mutation in filaggrin
  2. Environmental triggers and irritants
64
Q

Describe the treatment for eczema

A
  1. Avoid irritants and allergens
  2. Use emollients
  3. Hydrocortisone (1st line) or stronger steroids
  4. Tacrolimus (2nd line) - topical immunomodulators
  5. Antibiotics for secondary infections
65
Q

Briefly describe the natural history of eczema

A

Sub-clinical skin barrier defect –> sub-clnicial inflammation –> AD phase 1 (non-atopic) –> AD phase 2 (true atopic, extrinsic), high IgE

66
Q

Define allergic dermatitis

A

Sensitisation of T lymphocytes over a period of time - itching and dermatitis results upon re-exposure to the antigen

67
Q

Give 3 causes of contact dermatitis

A
  1. Detergents
  2. Soaps
  3. Oils
  4. Solvents
  5. Type 4 hypersensitivity reaction
68
Q

How does contact dermatitis present?

A

Rash with Clear demarcation/odd-shaped area

69
Q

How can you diagnose contact/allergic dermatitis?

A

Patch testing = identify the allergen

70
Q

How can you treat contact dermatitis?

A

Remove cause
Steroids
Anti-pruritic agents

71
Q

Where does seborrhoeic dermatitis usually effect?

A

Scalp and face - thickened, scaly skin

72
Q

What can trigger seborrhoeic dermatitis?

A

Yeast infection

73
Q

What is the treatment for seborrhoeic dermatitis?

A
  1. Antifungal treatment

2. Keratolytic agents to reduce thickening

74
Q

What is cellulitis?

A

Bacterial infection of the deep subcutaneous tissue of the skin

75
Q

Give 4 risk factors for cellulitis

A
  1. Lymphoedema
  2. Site of entry - leg ulcer, trauma, tinea pedis
  3. Venous insufficiency
  4. Leg oedema
  5. Obesity
76
Q

Name 3 causes of cellulitis

A
  1. Strep pyogenes (most common)
  2. Staph aureus
  3. Community acquired MRSA
77
Q

Give 4 signs of cellulitis

A
  1. Erythema, with poorly marked margins
  2. Inflammation
  3. Swelling
  4. Warmth
  5. Tenderness
  6. Low grade fever
78
Q

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

A

DVT

79
Q

What is the treatment for cellulitis?

A

Phenoxymethylpenicillin and flucloxacillin (erythromycin if allergic to penicillin)

80
Q

What is necrotising fasciitis?

A

Rapidly progressive infection of deep fascia resulting in necrosis of subcutaneous tissue

81
Q

Give 3 risk factors for necrotising fasciitis

A
  1. IVDU
  2. DM
  3. Homeless
  4. Recent surgery
82
Q

What bacteria can cause necrotising fasciitis?

A

Type 1 = aerobic and anaerobic bacteria

Type 2 = Group A beta-haemolytic strep (strep pyogenes)

83
Q

Give 4 signs of necrotising fasciitis

A
  1. Intense pain that is out of proportion to the skin findings of initial site of infection
  2. Spreading erythema and pain
  3. Crepitus
  4. Fever
  5. Multi-organ failure –> death
84
Q

What is the treatment for necrotising fasciitis?

A

Surgical debridement +/- amputation
Type 1 = broad spec Abx with inclusion of metronidazole
Type 2 = benzylpenicillin and clindamycin

85
Q

Briefly describe the pathophysiology of acne

A

Seborrhea (increased sebum production) –> narrowed follicle (due to hypercornification) blocks sebum –> sebum stagnates and p. acne colonises –> irritation, inflammation and attraction of neutrophils

86
Q

Describe the signs of acne

A
  1. Open comedones (blackheads)
  2. Closed comedones (whiteheads)
  3. Papules and pustules
  4. Hyperpigmentation
  5. Scarring
87
Q

Describe the treatment for acne

A

Regular washing with acne soap to remove grease
Benzoyl peroxide (keratolytic) and clindamycin
Topical retinoids - tazarotene
Low dose Abx - doxycycline or minocycline
Hormonal treatment - co-cyprindiol

88
Q

Give 3 signs of rosacea

A
  1. Flushing
  2. Erythema
  3. Papules and pustules
89
Q

How does Rosacea differ for acne?

A

Rosacea = no comedones and tends to affect older people

90
Q

Define ulcer

A

Abnormal breaks in an epithelial surface

91
Q

Define venous ulceration

A

Loss of skin below the knee on the leg or foot that takes more than 2 weeks to heal

92
Q

Give 3 causes of venous ulceration

A

Sustained venous Hypertension in superficial veins due to:

  • Incompetent valves
  • Previous DVT
  • Atherosclerosis
  • Vasculitis - SLE, RA
93
Q

Describe the pathophysiology of a venous ulcer

A

Increased pressure –> extravasation of fibrinogen through capillary wall –> perivascular fibrin deposition –> poor oxygenation of surrounding skin

94
Q

How does a venous ulcer present?

A 
Sloping, gradual edges
Large, shallow, irregular and exudative ulcer 
Oedema of lower leg 
Venous eczema 
Varicose veins 
Lipodermaosclerosis
95
Q

What investigations would you do on a patient you suspect to have a venous ulcer?

A

Doppler US - to exclude artery disease

96
Q

What is the treatment for venous ulceration?

A

High compression bandaging and leg elevation

97
Q

What is an arterial ulcer?

A

Punched out, painful ulcer higher up on the leg or on the feet

98
Q

What are 3 risk factors for an arterial ulcer?

A
  1. Claudication
  2. Hypertension
  3. Angina
  4. Smoking
99
Q

What are the signs of an arterial ulcer?

A
  1. Cold and pale leg
  2. Loss of leg hair
    3 Absent peripheral pulses
100
Q

How would you confirm an arterial ulcer?

A

Doppler US

101
Q

What is the treatment for an arterial ulcer?

A

Clean and cover
Analgesia
Vascular reconstruction if needed
NO compression bandaging

102
Q

How do neuropathic ulcers usually present?

A

Painless

Seen over pressure areas of feet or heel due to repeated trauma

103
Q

What diseases are associate with neuropathic ulcers?

A
  1. DM

2. Neurological disease

104
Q

How do you treat neuropathic ulcers?

A

Keep clean and remove pressure/trauma

Correctly fitting shoes

105
Q

What is the most common cutaneous vasculitis?

A

Leucocytoclastic vasculitis/angitis

= symmetrical palpable purpura

106
Q

Give 3 causes of Leucocytoclastic vasculitis

A
  1. Idiopathic
  2. Drugs
  3. Infection
  4. Inflammatory disease
  5. Malignant disease
107
Q

How do you confirm cutaneous vasculitis?

A

Skin biopsy

108
Q

What is the treatment for cutaneous vasculitis?

A

Analgesia
Support stockings
Dapsone (Abx) or prednisone

109
Q

Name 3 other types of ulcer

A
  1. Infective - TB, syphilis
  2. Traumatic
  3. Malignant
  4. Lymphoedema
  5. Pyoderma gangranosum
  6. Drug induced

PHASE 2A (16 decks)

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