Dermatology Flashcards
1
Q
Describe the six skin types
A
I - Always Burns, Never Tans
II - Always Burns, Sometimes Tans
III - Sometimes Burns, Always Tans
IV - Never Burns, Always Tans
V- Dark Brown, rarely burns, fast and easy tanning
VI- Black, Almost never burns
2
Q
Using the mnemonic SCAM - how would you describe an individual lesion?
A
Size (and shape)
Colour
Associated secondary change
Morphology (and margin)
3
Q
Using the mnemonic ABCD - how would you describe a pigmented lesion?
A
Asymmetry
(Irregular) Border
Colour (two or more)
Diameter (>6mm)
4
Q
Define: Lesion, Rash, Naevus, Comedone
A
Lesion - area of altered skin
Rash - an eruption
Naevus - Localised malformation of tissue, commonly pigmented
Comedone - blocked hair follicle/pore containing altered sebum/bacteria and cellular debris. Can be open (blackheads) or closed (whitehads)
5
Q
What is the Koebner Phenomenon in dermatological distribution?
A
Linear eruption
6
Q
Define the following Dermatological Configuration terms: Discrete, Confluent, Target, Annular, Discoid
A
Discrete - Separate Lesions
Confluent - Lesions merging together
Target - Concentric rings like a dartboard
Annular - Circle/Ring (like ringworm)
Discoid - Coin shaped
7
Q
Describe Erythema
A
Redness due to inflammation and vasodilation, that blanches under pressure
8
Q
Describe Purpura
A
Red/Purple discolouration due to bleeding into skin/mucous membrane that does not blanch with pressure
Can be Petichae (small pinpoint) or Ecchymoses (large bruise)
9
Q
What is the difference between Hypopigmentation and Depigmentation?
A
Hypopigmentation - areas of paler skin (eg Pityriasis Versicolor)
Depigmentation - White skin due to lack of melanin (eg Vitiligo)
10
Q
Define the morphological terms: Macule, Patch and Plaque
A
Macule - flat area of altered colour (freckles)
Patch - larger flat area of altered colour
Plaque - Palpable scaling raised lesion>0.5cm in diameter
11
Q
Define the morphological terms: Papule and Nodule
A
Papule - Solid raised lesion <0.5cm (eg Xanthomata)
Nodule - Solid raised lesion >0.5cm
12
Q
Define the morphological terms: Vesicle and Bullae
A
Vesicle - Raised clear fluid filled lesion <0.5cm
Bullae - Raised clear fluid filled lesion>0.5cm
13
Q
Define the morphological terms: Pustule and Abscess
A
Pustule - Pus containing lesion<0.5cm in diameter
Abscess - Localised accumulation of pus in dermis or subcut tissue
14
Q
Define the morphological terms: Wheal, Furuncle, Carbuncle
A
Wheal - Transient raised lesion due to dermal oedema
Furuncle - Staph infection in or around a hair follicle
Carbuncle - Staph infection around adjacent follicle
15
Q
Define: Excoriation, Lichenification and Scaling
A
Excoriation - loss of epidermis following trauma
Lichenification - well defined roughening of skin with accentuation of skin markings
Scaling - Flakes of Stratum Corneum
16
Q
Describe three different scar complications
A
Atrophic - thinning
Hypertrophic - Hyperproliferation within wound boundaries
Keloidal - Hyperproliferation beyond wound boundary
17
Q
Define Ulcer and Fissure
A
Ulcer - Loss of dermis and epidermis
Fissure - Epidermal crack due to excess dryness
18
Q
What is Hypertrichosis?
A
Non androgen dependent pattern of hair growth
19
Q
Define: Koilonychia, Oncholysis, Pitting
A
Koilonychia - Spoon depression of nail plate
Oncholysis - Separation of distail nail from nail bed (psoriasis, fungal nail function)
Pitting - Depression in nail plate (psoriasis, eczema)
20
Q
Describe the four different special cells of the skin
A
Keratinocytes (protective barrier)
Langerhans (immunological)
Melanocytes (protects cell nuclei from UV)
Merkel Cells (specialised nerve endings for sensation)
21
Q
Describe the four main layers of the epidermis
A
Stratum Corneum - Keratin
Stratum Granulosum
Stratum Spinosum - Prickle Cell
Stratum Basale - Actively dividing cells
22
Q
What is the ‘extra’ layer of the epidermis and where is it found?
A
Stratum Lucidum - Paler compact keratin
In areas of ‘thick skin’ (eg soles of feet)
23
Q
Describe the composition of the Dermis
A
Made collagen/elastin/GAGs
Contains immune cells, nerves, lymphatics and blood supply
24
Q
What are the three main types of hair?
A
Lanugo - Fine long hair in foetus
Vellus - Fine short hair on body’s surface
Terminal - Coarse long hair on scalp/eyebrows/eyelashes
25
What are Sebaceous Glands?
Produce sebum via hair follicles
Lubricates and waterproofs skin
Stimulated by androgens
26
What are Sweat Glands? State the two types.
Innervated by sympathetic nervous system
Eccrine - Universally distributed in skin
Apocrine - located in axilla and genitalia etc and function from puberty onswards
27
Describe the pathophysiology of Urticaria
Mast cell releases mediators causing locally increased permeability of capillaries and venules
Involves only epidermis
can be acute or chronic
can be inducible (aquagenic, solar, cold induced)
28
How would you manage Urticaria?
Trigger avoidance - consider skin prick testing, skin biopsy, bloods and antibody testing
Try and avoid medication where possible
Antihistamines (6 weeks non-sedating such as loratidine)
Corticosteroids if severe
29
What is Angio-Oedema? How would you manage it?
Swelling of epidermis AND dermis
Stable and mild - no management
Stable and moderate - 6 weeks antihistamines
Progressing - IM hydrocortisone and chlorphenamine
30
Describe Hereditary Angio-Oedema and give two other causes of non allergic angio-oedema
Autosomal dominant deficiency of C1 esterase inhibitor (which normally aims to prevent reactviation of compliment system)
Causes recurrent swelling
Treated by C1 Esterase Inhibitor Concentrate (found in FFP)
Idiopathic (more likely if autoimmune), non-allergic drug reaction - eg to ACE
31
What is Anaphylaxis?
Bronchospasm, facial and laryngeal oedema
32
How would you manage Anaphylaxis?
1) A to E approach , lie down , elevate legs, remove triggers
2) Adrenaline (if in community - 500mcg 1:1000 IM, monitor response, if inadequate repeat, then continue to repeat every 5 minutes until resolution)
3) Consider nebulised salbutamol/mgso4 for wheeze
4) After resolution consider Hydrocortisone or chlorphenamine
33
What is Erythema Nodosum? Give 4 causes
Hypersensitivty reaction to a variety of stimuli causing inflammation of fat cells under skin
Strep Pyogenes, TB, Malignancy, IBD
34
How does Erythema Nodosum present?
Tender nodules usually on shins , after 2 weeks leave bruise like discolouration as they resolve
50% may experience arthralgia or morning stiffness
35
How do you manage Erythema Nodosum
Generally self limiting
Cool compresses and bed rest
NSAIDs
Treat underlying cause
36
Over 50% of Erythema Multiforme is caused by HSVI and HSVII, give a non infective cause
Drugs - Barbiturates, Penicillins, Sulfonamides, NSAIDs
37
Describe the presentation of Erythema Multiforme
Rash begins on extremities, symmetrically
Initially a dull red macule that develops a central papule/bullae to form a target lesion
38
How would you manage Erythema Multiforme?
Self Limiting
Analgesics and Steroid Creams
39
What is Steven Johnson's Syndrome?
A severe form of Erythema Multiforme, caused by hypersensitivity reaction normally to drugs such as Allopurinol/Carbemazepine/Penicillins
At least two mucosal sites involved
40
How might Steven Johnson Syndrome present?
May have a prodromal phase
Mucocutaneous Lesions (Erythema Multiforme)
May have other organ involvement (Dysuria, Conjunctivitis, Mouth Ulcers)
41
Describe four different managements for Steven Johnson Syndrome
Remove offending cause
Supportive
Immunomodulation (potentially pulsed steroids to avoid poor wound healing)
Plasmphoresis
42
What is SCORTEN?
Predicts mortality for Steven Johnson Syndrome
Score greater than 3 requires ITU
43
What is Erythroderma? Give four causes.
Exfoliative dermatitis involving atleast 95% skin's surface
Previous skin disease, Lymphoma, Drugs (Penicillin, Allopurinol), Idiopathic
44
How might Erythroderma present?
Skin appears inflamed, oedematous and scaly
Pt feels systemically unwell with malaise and lymphadenopathy
45
How would you manage Erythroderma? Give 3 complications.
Emollients and wet wraps to maintain skin's moisture
Topical steroids
Hypothermia, Secondafry Infection, High Output Heart Failure
46
What is Eczema Herpeticum?
Rare and serious skin infection caused by Herpes Simlex Virus
Many possible complications so treated as an emergency
47
How does Eczema Herpeticum present? How would you manage it?
Systemically unwell with extensive crusted papules/blisters/erosions
Antivirals (Acyclovir)
48
What is Necrotising Fasciitis?
Rapidly progressing infection of the deep fascia causing necrosis of subcutaneous tissue
Normally caused by Group A Strep, or a mixture of aerobic and anaerobic
49
How does Necrotising Fasciitis present?
Severe pain, Erythema, Tachycardia, Crepitus (Subcutaneous Emphysema)
50
How would you manage Necrotising Fasciitis?
Extensive Surgical Debridement
IV Antibiotics
51
Define Cellulitis
Spreading bacterial infection of the skin involving the deep subcutaneous tissue and dermis
52
What is the difference between Cellulitis and Erysipelas?
Erysipelas is a more superficial form
Erysipelas has more sharply demarcated borders than Cellulitis
53
Give 5 risk factors for Cellulitis/Erysipelas
IVDU
Elderly
Venous Insuffiency
Lymphoedema
Alcoholism
54
Erysipelas is mainly caused by Strep Pyrogenes, name the causative organisms of Cellulitis.
Staph Aureus
Post Op - Strep Pyogenes, Closdtrodium Perfringes (crepitus)
55
How would you manage Cellulitis/Erysipelas?
Rest, Elevation and Analgesia
Uncomplicated - Flucloxacillin 500mg QTS
Facial Involvement - Co _ Amoxiclav
56
What is Staphylococcal Scalded Syndrome?
Scald appearance seen in infancy and early childhood
Caused by epidermolytic strain of toxigenic STaph Aureus
57
How might Staphylococcal Scalded Syndrome present?
Scald appearance followed by large bullae
Painful lesions
Lesions on buttocks/hands/feet/face (perioral crusting)
58
How would you manage Staphylococcal Scalded Syndrome?
Flucloxacillin (or Vancomycin for MRSA)
Analgesia
Petroleum Jelly
59
Describe Tinea Corporis and Tinea Cruris
Corporis - Fungal infection of Trunk/Limbs, ittchy circular lesions with raised edges
Cruris - same as corporis but in groin and natal cleft
60
Describe Tinea Manuum and Tinea Pedis
Tinea Manuum - Fungal infection of hands
Tinea Pedis - Athlete's Foot
Scaling and fissuring dryness
61
Describe Tinea Capitus and Tinea Unguium
Capitis - Scalp Ringworm (patches of broken hair, scaling and infammation)
Unguium - Fungal infection of the nail causing yellowed discoloration/thickened/crumbly nail
62
What is Tinea Incognito?
Due to inappropriate treatment of fungal infection with steroid creams
Ill defined and less scaly
63
What is Ptyriasis/ Tinea Versicolor?
Cutaneous infection with the yeast Malassezia Furfur
Causes scaly brown patches on upper trunk that fail to tan on sun exposure
64
State the two non melanoma skin cancers
Basal Cell Carcinoma
Squamous Cell Carcinoma
65
Give 3 risk factors of skin cancer
Age
UV exposure
Type I skin
66
Describe the presentation of nodular BCC (TURP)
T- Telangiectasia
U- Ulceration
R- Rolled Edges
P- Pearly
67
What is Squamous Cell Carcinoma?
Locally invasive malignant tumour of keratinocytes with the ability to metastasise
68
Name 3 pre malignant conditions that are a risk factor for SCC?
Actinic Keratoses (ie sun spots)
Bowens Disease
Leukoplakia
69
How do Squamous Cell Carcinomas present?
Keratotic
Ill defined
Potentially ulcerating
70
Describe four managements of Skin Cancer
Surgical Excision
Radiotherapy
Cryotherapy/Cautery
Mohs Micrographic Surgery
71
What is Mohs Micrographic Surgery
Borders progressively excised until free of tumour microscopically
Good for cosmetically sensitive areas
72
What is a Malignant Melanoma?
Invasive malignant tumour of epidermal melanocytes with the ability to metastasise
73
Describe the four types of Malignant Melanoma
Superficial Spreading - common on lower limbs
Nodular Melanoma - Common on trunk
Lentigo Maligna Melanoma - common on face in elderly due to long term cumulative exposure
Acral Lentigous Melanoma - Palms, soles and nail beds
74
What is the Breslow Thickness?
The risk of recurrence of Malignant Melanoma
The thicker the melanoma the higher the risk
75
Describe the presentation of Atopic Eczema
Usually develops in childhood and resolves during adulthood
Itchy erythematous dry scaly patches normally on flexor aspects (but can be on face and extensor aspects in infants
76
Give 5 other dermatological features of atopic eczema
Excoriation
Lichenification
Nail pitting
Hypo/Hyperpigmentation
Chronic lesions - dry and scaly (erythematous or grey/brown)
77
Name two conservative managements of Eczema
Avoid triggers (such as wool/synthetic fibres and extremes of temperature)
Frequent emollients
78
Give 3 pharmacological managements for Eczema
Topical Therapies - topical steroids (for flares) or topical immunomodulators (tacrolimus)
Oral therapies - antihistamines
Immunosupressants for severe non responsive cases
79
State three secondary viral infectons of Eczema
Molluscum Contagiosum
Viral Warts
Eczema Herpeticum
80
What is Acne Vulgaris?
Inflammatory disease of pilosebaceous follicles
Due to androgens there is increased sebum production which subsequently causes them to become blocked
81
What is Propionibacterium Acne?
Bacterial colonisation and inflammation of sebaceous glands
82
Acne Vulgaris can be non inflammatory or inflammatory . Describe the appearance of both
Non Inflammatory - Open and closed comedones
Inflammatory - Papules/postules/nodules/cysts
83
Describe three topical therapies for Acne Vulgaris
Benzoyl Peroxide - reduces sebum production and growth of P.Acnes (may cause burning sensation)
Topical Abx - Clindamycin/Tetracycline (normally combined with another therapy)
Topical Retinoids - Tretinoin, anti inflammatory (contraindicated in pregnancy)
84
How long do systemic treatments for Acne take to work?
3-4 months
85
Describe three oral treatments for Acne
Lymecycline/Doxycycline (erythro if preg)
Anti-Androgens - COCP
Oral Isotretinoin (VERY TOXIC)
86
What is Psoriasis?
Chronic Inflammatory skin disease due to hyperproliferation of keratinocytes and inflammatory cell infiltration
87
Describe the pathophysiology of Psoriasis
Injury/infection increases pro-inflammatory markers such as IL6 and TNF
APC activated which then activate TH1 and TH17
Abnormal keratinocyte differentiation (decreasing keratinocyte transit time)
88
State four subtypes of Psoriasis
Chronic Plaque (most common)
Guttate (raindrop lesions, post strep)
Seborrhoeic (scalp and behind ears, blepharitis)
Pustular (plantar, palmar)
89
How does Psoriasis present? Describe two extra-epidermal manifestations.
Well demarcated erythematous scaly plaques, common on extensor surfaces and scalp
Nail changes (pitting,oncholysis) and Psoriatic Arthropathy
90
What is Auspitz Sign?
Scratch and gentle scale removal causes capillary bleeding in Psoriasis
91
Describe two oral and two topical therapies for Psoriasis
Topical - Vitamin D Analogues (Calcipitriol), Topical Steroids
Oral - Methotrexate, Retnoids
92
Name a complication of Psoriasis
Erythroderma
93
What determines blister fragility?
Depends on the level of split within the skin
More fragile - intraepidermal
Less fragile - subepidermal
94
What is Bullous Pemphigoid?
Immunobullous blistering (subepidermal) condition usually affecting the elderly
95
How will Bullous Pemphigoid present?
Tense fluid filled blisters on an erythematous base, often itchy
Normally affects trunk or limbs
96
How do you manage Bullous Pemphigoid?
Topical steroids for local disease
Oral therapies for widespread (steroids, tetracycline)
97
What is Pemphigus Vulgaris?
Immunobullous blistering (intraepidermal) condition usually affecting the middle aged
98
How will Pemphigus Vulgaris present?
Flaccid and easily ruptured blisters, often painful and affecting mucosal areas
99
How would you manage Pemphigus Vulgaris?
High dose steroids
Immunosupressants
100
Scabies is an itchy rash caused by a parasitic mite, give four risk factors.
Overcrowding
Poverty
Homelessness
Poor Hygiene
101
How does Scabies present?
Signs and symptoms don't develop for 3-4 weeks
Widespread itching (worse at night and when warm)
Papular/Vesicular lesions at burrow sites
102
How do you investigate Scabies?
Usually just clinical
Ink Burrow Test - Ink rubbed over burrow and wiped with an alcohol wipe, ink should track the burrow sites
103
Describe four management points for Scabies
All close contacts should be treated on the same day to avoid reinfestation
Topical Parasiticidal Cream (Permethrin) applied head to toe once a week
Wash clothes/towels/bedding
Antihistamines for itching
104
How does Senile Purpura present?
Elderly population with sun damaged skin
Extensor surfaces of hands and forearms
105
Describe the presentation of a Venous Ulcer (including common sites)
Large shallow and irregular usually in malleolar area
Exudative and granulating base
Pain on standing
106
How would you manage a Venous Ulcer?
Compression bandaging
107
Describe the presentation of an Arterial Ulcer (including common sites)
Small and sharply defined with a deep necrotic base
Abent peripheral pulses, shiny skin and loss of hair
Pain at night/elevation of leg
108
How would you manage an Arterial Ulcer?
Vascular Reconstruction
109
What is ABPI? What do values indicate?
Ankle Brachial Pressure Index, compares peripheral blood flow
Normal is 1-1.4
If less than 0.8 it is suggestive of arterial insufficiency
110
Describe the presentation of a Neuropathic Ulcer (including common sites)
Often painless, variable in size and shape
Granulating base
Often in pressure sites (heels, soles, toes)
Can be Neuroischaemic
111
How would you manage a Neuropathic Ulcer?
Wound debridement
Regular repositioning
Good nutrition
Appropriate footwear
112
What is a Dermatofibroma?
Benign mass, often mistaken for a more serious pathology, following on from insect bites such as mosquitos
113
State the two layers of the dermis
Papillary
Reticular
114
Describe the relevance of a skin lesion (suspected malignancy) itching and bleeding respectively
Itching - Perineural Invasion
Bleeding - Ulcerative component
115
When would you do a punch lesion of a suspicious lesion?
If it was in a cosmetically sensitive area
116
Name 5 subtypes of BCC
Nodular
Superficial (can appear like dermatitis)
Morphoeic
Pigmented
Basosquamous
117
Apart from pre-malignant conditions, give three risk factors specific for SCC
Viral Infections
Chronic Wounds
Psoriasis Treatment
118
What is Bowen's Disease?
In- Situ SCC disease (pre-malignant condition)
Erythematous plaques and sharp borders
119
Name four types of SCC
Ulcerative
Verrucous
Marjdins (arising from chronic wounds)
Subungal (underneath nail bed)
120
What is Gorlin Syndrome?
Autosomal Dominant condition increasing risk of BCCs. Presents as Multiple BCCs
121
What is Rosacea?
Chronic relapsing disease of facial skin characterised by flushing episodes, persistent erythema, telangiectasia, papules and pustules
122
What is a common presentation of Rosacea in men?
Rhinophyma - enlarged nose
123
What is the first line management for Rosacea?
Topical Metronidazole
124
How does Lichen Planus present?
Affects flexor surfaces of wrists/forearms/legs
Intensely itchy 2-5mm red/violet shiny topped pamphlet (Wickham Striae)
Mucous Membranes - White raises trabecular lesions
125
How is Lichen Planus managed?
Topical Steroids if required
126
What is Toxic Epidermal Necrolysis?
Similar to Steven Johnson Syndrome
Normally drug induced
Full thickness epidermal necrosis with superior dermal detachment
127
Name 6 management options for BCC
Surgical excision (with 4mm border)
Moh's micrographic surgery
Radiotherapy
Cryotherapy/Cautery
Photodynamic therapy
Topical Imiquimod
128
Give three risk factors for Malignant Melanoma
UV exposure
Type 1 Skin
Dysplastic Naevus Syndrome
129
Name three prognostic factors for Malignant Melanoma
Breslow Thickness
Ulceration
Mitoses
130
Describe the step up management for Eczema
Mild - Liberal emollient and Hydrocortisone cream
Moderate - Liberal emollient and Betamethasone/Clobetasone (consider antihistamines)
Severe - Same as moderate plus oral steroids
131
How does Acne present in darker skin?
Hyperpigmented
Less Erythematous
132
When can you refer patients to Dermatology for consideration of commencing Isotretinoin in Acne?
If the patient has tried two different antibiotics for three months each
133
Name three long term effects of Acne
Scarring
Pigmentation issues
Psychological effects
134
Describe the NICE step up management for Chronic Plaque Psoriasis
Emollients
1) Potent Steroid and Calcipitriol for four weeks
2) If no improvement after 8 weeks then Calcipitriol BD
3) If no improvement after 8-12 weeks then potent steroid BD for up to 4 weeks or coal tar preparation
135
What are the secondary care management options for Chronic Plaque Psoriasis?
Phototherapy (three times a week, can cause skin ageing/SCC)
Systemic therapies such as Methotrexate or Cyclosporin
136
How is Psoriasis of the Scalp managed?
Potent topical steroids once daily for four weeks
If unresponsive try a different formula, or try physically removing scales first
137
How is Face/Flexural/Genital Psoriasis managed?
Mild to Moderate potency steroid for maximum two weeks
138
What is Vitiligo?
Acquired depigmenting disorder where there is complete loss of melanocytes (thought to be autoimmune)
139
How does Vitiligo present?
At any age
Single or multiple patches of depigmentation (often symmetrical)
Exhibits Koebner phenomenon
140
Describe the management options for Vitiligo
Minimise skin injury (could trigger a new patch)
Topical Steroids and Tacrolimus
UVB Phototherapy
Oral Immunosupressants
141
What is Melasma?
Acquired chronic skin disorder where there is increased skin pigmentation
Caused by genetic predisposition + trigger (eg COCP, Pregnancy, Sun exposure)
142
How does Melasma present?
Brown macules with irregular borders
Symmetrical
Normally forehead, upper lip and cheeks
143
How is Melasma managed?
Lifelong sun protection
Cosmetic camouflage
Topical Hydroquinone/Vitamin C
144
What is Lichen Planus?
Pruritic Papular Eruption most likely T cell mediated in origin
Associated with Trauma/Hep B/Hep C/PBC
145
How does Lichen Planus present?
Acute, affecting flexor surfaces
Intensely itchy 2-5mm red shiny topped papule with white streaks (Wickham's Striae)
May get blisters
146
How does Lichen Planus present on hands and feet?
Firm and yellow papules
147
How does Lichen Planus present on mucous membranes?
White slightly raised lesions with trabecular appearance (can be asymptomatic or painful)
148
How is Lichen Planus managed?
May not require - may self resolve in 1y
Moderately potent steroids and sedating antihistamines
Topical steroids for oral lichen planus
If resistant - immunosupression
149
What is the main complication of Lichen Planus?
Oral SCC
150
What is Seborrhoeic Dermatitis?
Common benign scaling skin rash, commonly affecting areas rich in sebaceous glands (face/scalp/chest)
151
Describe the pathophysiology of Seborrhoeic Dermatitis
Inflammatory reaction to Malassezia Yeast
More common in Parkinson's and HIV
Associated Pityriasis Captis (Dandruff)
152
How does Seborrhoeic Dermatitis present on the scalp?
Associated fine scaling
Dry pink patches with bran like scale
153
How does Seborrhoeic Dermatitis present on the face?
Inflamed, greasy with fine scaling
Commonly affecting nasolabial folds, bridge of nose, blepharitis
154
How does Seborrhoeic Dermatitis present on the chest?
Papules and greasy scales
155
How is Seborrhoeic Dermatitis of the scalp managed?
Remove thick crusts or scales with Olive Oil
Ketaconazole shampoo atleast twice a week for a month
156
How is Seborrhoeic Dermatitis of the face/chest managed?
Ketoconazole cream daily for 2-4 weeks
Intermittent Hydrocortisone/Tacrolimus
157
What is Rosacea?
Chronic relapsing disease of facial skin, characterised by facial flushing with persistent erythema/telangiectasia/papules/pustules
158
Describe the pathophysiology of Rosacea
Chronic acneiform disorder of pilosebaceous glands with increased capillary reactivity to heat
159
How does Rosacea present?
Intermittent flushing progressing to constant (triggered by changes in temp/alcohol/caffiene/spice)
Skin isn't greasy/may be dry
160
Describe the non medical management of Rosacea
Reassurance
Avoiding precipitating factors
Daily sun screen
Cosmetic camouflage
161
Describe the medical management of Rosacea
Avoid topical steroids
Flushing - Brimonidine (topical alpha agonists)
Mild - Ivermectin
Mod/Severe - Add Doxycycline
Telangiectasia - laser therapy
Rhinophyma - requires surgery
162
What is Rhinophyma?
Large nose occurring almost exclusively in men secondary to Rosacea
163
Tuberous Sclerosis is the systemic formation of Hamartomas. Describe four dermatological manifestations
Ash Leaf Macules (areas of depigmentation on the trunk)
Facial Angiofibroma (small red nodule)
Shagreen Patches (orange peel patches over sacrum and back)
Skin tags
164
Neurofibromatosis is an Autosomal Dominant disorder. Name four dermatological manifestations
Cafe au Lait spots
Axillary/Inguinal Freckles
Hypopigmented macules
Benign Cherry angiomas
165
Name three skin disorders of Pregnancy
Atopic Eruption of Pregnancy
Polymorphic Eruption of Pregnancy
Pemphigoid Gestationis
166
What is Atopic Eruption of Preganancy?
Very common
Eczematous itchy white rash
Doesn't require any specific treatment
167
What is Polymorphic Eruption of Pregnancy?
Pruritic condition associated with last trimester
Lesions often appearing in abdominal striae
Can give emollients/topical steroids/oral steroids depending on severity
Piriton for the itch
168
What is Pemphigoid Gestationis?
Pruritic blistering lesions often starting in periumbilical region and spreading
Rarely seen in first pregnancy or first trimester
Normally requires oral steroids
169
Actinic Keratoses are thickened scaly growths caused by sunlight. Describe the pathophysiology
Characteristic UV mutations
Atypical pleomorphic keratinocytes in basal layer
Confined to epidermis
Can progress to Bowens or SCC
170
How does Actinic Keratoses present?
Sun exposed areas
Small rough spots that can enlarge to become red and scaly
171
How is Actinic Keratoses diagnosed?
With a Dermatoscope
Grade 1 - slightly palpable
Grade 2 - moderately thick
Grade 3 - very thick, hyperkeratotic
Field Damage - multiple AKs on a background of erythema and sun damage
172
Emollients and Sun Protection should be used in Actinic Keratoses. What other management options are there?
Topical 5FU
Diclofenac Gel
Imiquimod
Ablative
173
Bowen's Disease is SCC in situ. Give four risk factors
Sun damage
Radiation
Arsenic
HPV
174
How does Bowen's disease present?
-Slow growing, erythematous hyperkeratotic patch/plaque with an irregular border
-Size related to duration
-Asymptomatic but may bleed
175
How can Bowen's disease be managed?
Topical 5FU
Cryotherapy
Photodynamic therapy
Surgical excision
3% untreated will progress to invasive SCC
176
What is a Keratocanthoma?
Rapidly growing squamoproliferative lesions that look like well differentiated SCCs
Grow rapidly over few weeks to months, and then spontaneously resolve over 4-6m
177
How to Keratocanthomas present?
Solitary round firm skin coloured/red papules progressing to domes
May have central ulceration or Keratin plug
178
How are Keratocanthomas investigated?
Excisional biopsy under 2ww as can't distinguish from SCC
179
How can Keloid Scars be managed?
Intralesional Steroids
Pressure/Occlusive dressings
Surgical removal is a risk as it may be bigger than before
180
What is the purpose of Emollients? Name a possible SE
Rehydrates skin and re-establishes surface lipid layer
Can be used as a soap substitute
May have irritant/allergic reaction
181
Describe steroids in terms of potency
Mild - Hydrocortisone
Moderate - Clobetasone (Eumovate)
Potent - Betamethasone (Betnovate)
Very Potent - Clobetasol Proprionate (Dermovate)
182
Name three local and three systemic side effects of steroids
Local - Skin Atrophy, Telangiectasia, Striae
Systemic - Cushings, Hypertension, Immunosupression
183
Name three side effects of Aciclovir
GI upset
Raised LFTs
Reversible neruological reactions
184
Name one sedating and one non sedating antihistamine
Non Sedative - Loratidine
Sedative - Chlorpheniramine
185
Name a topical antiseptic
Chlorhexidine
186
Name four SE of Oral Retinoids
Dry Skin/Lips/Eyes
Disordered LFTs
Hypercholesterolaemia
Depression
187
Describe two local and two systemic effects of Biologic therapies
Local - Redness, Swelling
Systemic - Allergy, Flu like
188
Describe the step up management for Eczema
Mild - Emollients and Hydrocortisone
Moderate - Emollients, Betamethasone/Clobetasone, consider antihistamines or topical tacrolimus
Severe - moderate plus consideration of oral steroids or phototherapy
189
How would you manage Tinea Capitus
If signs of a Kerion - refer to Dermatology
Oral Terbinafine and Ketoconazole Shampoo
189
How would you manage Tinea Corporis?
If mild, Topical Terbinafine/Clotrimazole (if inflammatory can add in Hydrocortisone)
If moderate to severe use Oral Terbinafine
190
How would you manage Tinea Pedis medically?
Mild - Topical Terbinafine +/- Steroids
Mod to Severe - Oral Terbinafine
191
What general management advice should you give someone with Tinea Pedis?
-Keep feet dry
-Well fitting footwear and clean cotton socks
-Dispose of any shoes that may contain fungal spores
- Wear socks/footwear in public areas such as pools
192
How is Tinea Unguium managed?
Only if Symptomatic (difficulty walking)/Cosmetically distressed/Immunocompromised
If 1 or 2 nails affected - Topical Amorolfine for up to a year
More than 2 nails affected then Oral Terbinafine (Dermatophytes) or Itraconzaole (Yeasts)
193
What general management advice should you give patients with Tinea Unguium?
Keep nails short
Don’t share nail clippers with other members of the family
Dispose of any shoes which may contain fungal spores
194
How are topical steroids measured?
Finger Tip Units
1 finger tip unit = 0.5 grams = covers twice that of a flat adult hand
195
How is Isotretinoin monitored?
Serum LFTs and Lipids before starting, after one month of treatment, and then every three months thereafter
196
Why can you not combine Isotretinoin and Doxycycline?
Will cause Idiopathic Intracranial Hypertension
197
What is the Eron Classification?
For cellulitis
I - not systemically unwell and no comorbidities
II - systemically unwell OR systemically well with comorbidities
III - Severely systemically unwell or profound comorbidities
IV - sepsis or necrotising fasciitis
198
What is the relationship between melanoma and vitamin D?
High levels of circulating vitamin D are associated with reduced progression of melanoma, therefore these levels should be optimal when commencing treatment
