Dermatology Flashcards
What is the pathogenesis fo acne?
COMEDONES
What is the bacteria that causes inflammation in acne vulgaris?
Proprionbacterium acnes
What hormone increased acne?
Androgens
What is the treatment of acne vulgaris?
- Birth Control Pill
- Retinoids (Acutane)
- Benzoyl Peroxide
- Antibiotics
- Acid
- Photodynamic therapy
What are the causes of Childhood Acne (1-7 y/o)?
Red flag
- Precocious adrenarche
- Congenital adrenal hyperplasia
- Cushing syndrome
- Precocious puberty
- Gonadal /adrenal tumour
What is a common cause of Post-adolescent/adult acne?
PCOS
40 years old lady, few years history of central facial erythema, what’s your diagnosis?
Rosacea
Papules & Pustules, no comedones
What is the rarest, most severe form of rosacea?
Phymatous
5 years old, 3 months history of asymptomatic hair loss. What’s your diagnosis?
allopecia areata (non scarring, still have hair follicules)
What’s your diagnosis?
Tinea capititis
- Well-defined areas of broken hair
- Different lengths, all <1.5 cm
- Fronto-temporal or parieto-temporal
What is your diagnosis?
TRICHOTILLOMANIA
What is the treatment of Androgenetic alopecia?
5-alph reductase
- 6 years old girl
- Diffuse shedding over past month
- History : Appendectomy 3 months ago
- Diffuse non scarring hair loss
What’s your diagnosis?
TELOGEN EFFLUVIUM
What are the causes of telogen effluvium?
- Stress :any sever systemic disease, surgery, fever, psychological stress
- Endocrine: Hypo/hyperthyroidism…
- Nutrotional: Iron deficiency….
- Drug: Acitretin, Anticoagulant, Allopurinol…
What are the causes of scarring alopecia?
- Discoid Lupus
- Lichen planopilaris
- Frontal fibrosing alopecia
What’s your diagnosis?
Longitudinal melanonychia
What’s your diagnosis?
Distal subungual onychomycosis
2yo boy is brought in for the treatment of these asymptomatic lesions, what’s your diagnosis?
Molluscum contagiosum
What’s your diagnosis?
Pityriasis Versicolor
18 y/o very itchy rash after returning from a camping trip, what’s your diagnosis?
Scabies
5o years old male with painful facial lesions, what’s your diagnosis?
Herpes zoster
Macule (vitilgo)
What is this?
Patch (café au lat macule)
What is this?
Papule (MOLLUSCUM CONTAGIOSUM)
What is this?
Plaque (PSORIASIS)
What is this?
Nodule (BASAL CELL CARCINOMA)
What is this?
Tumour (BASAL CELL CARCINOMA)
What is this?
Vesicle (HERPES ZOSTER)
What is this?
Bulla (BULLOUS PEMPHIGOID)
What is this?
URTICARIA
What is this?
Cyst (EPIDERMOID CYST)
What is this?
Pustule (acne)
What is this?
Scale (Tinea pedis)
What is this?
Crust (IMPETIGO)
What is this?
Atrophy (STRIAE)
What is this?
Erosion (PEMPHIGUS VULGARIS: MORTEL ET URGENT)
What is this?
Ulcer (diabetic ulcer)
Redness and scaling of more than 90% of the skin, caused by dermatitis, psoriasis, drug reactions, cutaneous T cell lymphoma or idiopathic.
What’s your diagnosis?
Erythroderma, EMERGENCY –> biopsy, supportive and symptomatic treatment to relief pain and itching
- Pain out of proportion
- Skin is shiny and tense
- Does not respond to antibiotics
- Progresses at an alarming rate
- Characteristic gray–blue color within 36 hours of onset due to vessel thrombosis
- Thin, watery, malodorous fluid
- Sick and septic
What’s your diagnosis?
Necrotizing fasciitis EMERGENCY
Reaction to a drug 2-6 weeks later?
Dress syndrome EMERGENCY –> steroids for months
Pathogenesis of atopic dermatitis?
- Lack of filaggrin protein and other proteins, oil and moisture
- Hyperreaction of TH2
- Pruritus
- Redness
- Texture
- Typical morphology and distribution: depends on the age: starts on the extensors and on the face (baby) and ends on the flexors (adults)
- Chronic or chronically-relapsing
- Personal or family history
- Increased sensitivity to irritants and environmental stimuli
- Increased rates of infections
- Associated with atopic features (allergy, asthma, allergic rhinitis)
What’s your diagnosis?
Atopic dermatitis
Investigation rules of a skin lump/bump?
ABCDE Rule
- Asymmetry (color or bordr)
- Border (irregular)
- Colour (more than 2)
- Diameter (> 6mm)
- Evolution (wks-months)
EFG Rule (nodular or amelanotic subtypes)
- Elevated
- Firm
- Growing
What is the most important prognosis factor of skin lump/bump?
depth/thickness
Types of Non-melanoma skin cancer (NMSC)?
- Basal cell carcinoma
- Squamous cell carcinoma
What is a Papulosquamous lesion?
Consists of papules = elevated primary skin lesions < 1.0 cm AND scale = surface change/laminated masses of keratin from stratum corneum
What is the treatment of psoriasis?
- General measures: emollients for moisturizing + avoid trauma
- Topicals: steroids, vitamin D, calcineurin inh.
- Systemics: PO meds, biologics
What are the types of Lichen planus?
- Drug-induced: onset = few mths to > 1 yr (ACE-I, diuretics, anti-malarials, NSAIDs, β-blockers)
- Classic type: multiple P’s = purple, pruritic, polygonal, planar (flat) + papules/plaques
- Oral: multiple variants; most common = white lacy reticulated (buccal mucosa, tongue)
- Genital: most common = white lacy reticulated; erosive = risk of SCC
- Nail: often isolated finding including nail thinning, longitudinal ridging + fissuring, oncholysis
- Scalp: scarring alopecia + red perifollicular papules that are scaly when active
What is the treatment of Lichen planus?
- General measures: emollients for moisturizing, avoid trauma, stop meds if drug induced
- Depends on: extent, location, variant, pt charact, nail disease, prior Rx + presence of Hep C
- Topics: steroids, calcineurin inhibitors, retinoids ; systemics Þ retinoids, immunosupp. meds
What is Pityriasis rosea?
Red patches common among teens + young adults
- Occurs often in spring + fall, some clustering in close contacts ; maybe linked with viral activat.
- Trauma is NOT assoc.; syphilis looks like PR + can be mistaken so WEAR GLOVES during PE!!
Pityriasis rosea treatment?
General measures = stop meds if drug-induced + emollients for moisturizing + topical steroids
What are the growth phases of the hair?
- Anagen: matrix cells grow, divide and become keratinized to form the growing hair
- Catagen: matrix proliferating cells abruptly cease proliferating so that hair bulb involutes and regresses
- Telogen: hair falls (100 days)
What is Tinea Capitis?
- Infection of the scalp by fungi
- Diagnosis: Scraping, KOH, Culture
- Treatment is oral antifungal; and topical therapy to reduce infectivity
What is Trichotillomania?
- Habitual, compulsive plucking of hair
- A well-defined area of hair loss with shortened, broken-off hairs of different lengths (frontoptemporal or parietotemporal)
- Treatment: stop + psychiatric evaluation
What is Androgenetic alopecia?
De la calvitie
What are the causes of Telogen effluvium Alopecia?
- Stress: any sever systemic disease, surgery, fever, psychological stress
- Endocrine: Hypo/hyperthyroidism…
- Nutrotional: Iron deficiency….
- Drug: Acitretin, Anticoagulant, Allopurinol…
Treatement of acne?
What is Onychomadesis?
Complete separation of the nail plate from the bed, full but temporary arrest of growth of nail matrix, caused by trauma, dermatoligic disease (eczema), fever, viral illness, hand-foot-mouth disease
What causes Nail pitting?
holes in the plate because of matrix problem
What usually causes Acute Paronychia?
staph aureus
What usually causes Chronic paronychia?
Non purulent, glistening erythema with nail dystrophy, candida and irritation caused by saliva
What is Melanonychia?
- brown or black pigmented band along the length of nail, nail matrix nevus or lentigo, MAY BE subungual melanoma
What is Racial melanonychia?
Nail problem with darker skin phototypes, benign
What is Onychomycosis?
Fungal infection of nail unit, look at interdigital space
What are the 2 main players of urticaria?
- Mast cell: primary effector cell of urticaria
- Histamine released from the mast cells is the most probable mediator
What are the 2 Immunologic pathogenesis mechanisms of urticaria?
- IgE mediated (Type I hypersensitivity): no allergic reaction to the first exposure Þ antibody Þ reaction SECOND exposure
- Complement mediated:
- Infections: viral infection (+++), potentially in bacterial and parasitic infections
- Auto-immune/systemic disease: thyroid, collagen vascular
What are the Non-immunologic pathogenesis of urticaria?
- Chemical histamine liberators: opiates, polymyxin, thiamine in cheese, egg white, muscle relaxant, narcotics
- Physical agents: cold, heat, sunlight
What drug is important to avoid when you have an urticaria crisis?
Aspirin, NSAID
What are the possible treatment of urticaria?
- Identification and elimination or reduction of its cause
- Symptomatic relief if not able to detect or avoid cause
- Block the effect of already released histamine
- Block the release of histamine (anti-histamine type 1 and 2)
- Block mediator other than histamine (mast cell stabilizer such as Ketotifen, Leukotrine antagonists, Omalizumab)
- Modulate inflammatory, cellular and immunological component of urticaria
What is Angioedema?
- Well-demarcated non-pitting edema that occurs deeper in the dermis and subcutaneous tissue, specially in area of loose connective tissue such as the face, eyelids or mucous membrane involving the lips and tongue
- Often caused by the same pathological factors involved in urticarial
- Not itchy but painful, last 72 hours
Factors that contribute to acne?
- ↑ Sebum production
- Follicular Hyperkeratinization
- Proprionibacterium acnes
- Inflammatory response
Types of acne?
- Acne vulgaris (Adolescent acne)
- Adult acne (post- Adolescent)
- Infantile and neonatal acne
- Acne excoriée (jeunes filles, rose)
- Acne conglobate & acne fulminans (systemic manifestations)
Types of Acneiform eruptions?
- Drug-induced acne
- Occupational acne & acne cosmetica
- Acne mechanica
What distinguishes rosacea from acne?
comedones
What are the rosacea subtypes?
- Erythematotelangiectatic
- Papulopustular
- Phymatous
- Ocular
What is Hidradenitis SUPPURATIVA?
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease characterized by persistent or recurrent flares of inflamed painful nodules, sinuses and scars in the axilla, groin, or both.
Macule (vitilgo)
What is the triad of drug hypersensitivity syndrome?
- Fever
- Exanthametous eruption
- Internal organ involvement
What are the possible causes of hair loss?
TOP HAT
Telogen effluvium, Tinea capitis
Out of Fe or Zn
Physical: trichotillomania
Hormonal: hypothyroidism, androgenic
Autoimmune: SLE, Alopecia areata
Toxins: chemotherapy, metals, anticoagulants, SSRIs, vitamin A
What are the possible causes of pruritis?
SCRATCHEDD
Scabies
Cholestasis
Renal
Autoimmune
Tumours
Crazies (psychiatric)
Hematology (polycythemia, lymphoma)
Endocrine (thyroid, parathyroid)
Drugs
Dry skin
What is your diagnosis?
Psoriasis post trauma: Koebner Phenomenon
What are the types of Papulosquamous disorders?
- Psoriasis
- Lichen planus
- Pityriasis rosea
- Parapsoriasis
- Pityriasis rubra pilaris
If you have a patient with angioedema WITHOUT urticaria, what’s your diagnosis?
ACE inhibitors reaction
What are the different drugs that have been associated with SJS/TEN?
SATAN
Sulfa antibiotics, sulfasalazine
Allopurinol - #1
Tetracyclines
Anticonvulsants (carbamazepine, lamotrigine, phenobarbital, phenytoin)
NSAIDS
What is the difference between Exanthematous Drug Eruption, DRESS and SJS/TEN?
They are all drug reactions BUT
Exanthematous Drug Eruption:
- 7-11 days
- Just generalized skin erythema
SJS:
- 1-3 weeks
- Skin peels off
DRESS:
- 3 weeks
- Organ involvement
- No skin peeling
