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4th year medicine > dermatology > Flashcards

dermatology Flashcards

1
Q

therapeutic ladder

A 
irritant avoidance 
emollients
topical treatments
phototherapy 
systemic therapy eg immunosuppression
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2
Q

commonest bacteria found on face

A

staph. aureus

80% of people with acne have it on their skin

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3
Q

apple jelly appearance

A

cutaneous TB

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4
Q

herpes simplex -virus?

A

HSV 1

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5
Q

chicken pox -virus?

A

varicella zoster virus

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6
Q

one handed eczema

A

fungal infection

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7
Q

therapeutic acne

A
  • topicals
  • tetracycline abx
  • retinoid: isotretanoin (only prescribed in hospital)
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8
Q

acne excorrie

A

mild acne but excess picking

treat acne + treat psychological aspect

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9
Q

atrophic ice pick scarring

A

acne scarring

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10
Q

atopy triad

A

allergic rhinitis
athma
eczema

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11
Q

eczema - areas in different ages

A

onset in infancy on dace
childhood: elbow and knee flexures

adult: face trunk hands, flexures

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12
Q

widespread herpes simplex with eczema

A

eczema herpeticum

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13
Q

silvery scale plaques
well defined
scalp
extensor surfaces

A 
psoriasis 
two peaks of onset 
nail involvement 
scalp 
genital involvement
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14
Q

guttate psoriasis

A
  • small plaques

- can present after streptococcal throat infection

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15
Q

flexural psoriasis - areas

A

natal cleft
groin
axillae

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16
Q

pustules on hand and feet

doesn’t grow anything on swab

A

plantarpalmar pustulosis

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17
Q

psoriasis management

A

topical steroids
phototherapy
systemic: methotrexate

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18
Q

25yrs
1yr hx 3 lumps on lower leg
each lesion is firm, well-circumscribed and measures 3-4mm in diameter

best term to describe this lesion?

A

papule

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19
Q

nodule

A

solid elevated lesion developing within the skin >0.5cm

e.g. pyogenic granuloma

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20
Q

papule

A

circumscribed lesion in skin <0.5cm, solid

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21
Q

macule

A

entirely flat area within the skin

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22
Q

plaque

A

slightly elevated but superficial lesion of skin

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23
Q

38yrs

  • 4mth hx deeply pigmented lesion on left upper arm
  • fair skin and blue eyes
  • 1.5cm diameter asymmetrical shape and irregular edge
  • dermoscopy and surgical excision confirmed clinical diagnosis

diagnosis?

what feature is the best predictor of prognosis?

  • dermoscopy findings
  • eye colour
  • lesion depth
  • lesion diameter
  • skin type
A

malignant melanoma

lesion depth - Breslow thickness
- can only be identified histologically once lesion is excised

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24
Q

vesicle

A

raised clear fluid filled lesion >0.5cm

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25
Q

bulla

A

raised clear fluid filled lesion >0.5cm in reaction to insect bites

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26
Q

pustule

A

pus containing lesion <0.5cm

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27
Q

abscess

A

localised accumulation of pus in the dermis or subcutaneous tissue

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28
Q

wheal

A

transient raised lesion due to dermal oedema e.g. urticaria

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29
Q

boil

A

staphylococcal infection around or within a hair follicle

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30
Q

excoriation

A

loss of epidermis following trauma

e.g. excoriations in eczema

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31
Q

lichenification

A

well-defined roughening of skin with accentuation of skin markings. due to chronic rubbing

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32
Q

scales

A

psoriasis flakes of stratum corner. crust rough surface consisting of dried serum blood bacteria and cellular debris

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33
Q

port wine stain

A

Sturge weber syndrome
- congenital vascular anomalies

  1. port wine stain
  2. brain abnormality called a leptomeningeal angioma
  3. glaucoma
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34
Q

purpura

A

red or purple colour due to bleeding into skin or mucous membrane

this does not blanch on pressure

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35
Q

ulcer

A

loss of epidermis and dermis

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36
Q

fissure

A

en epidermal crack often due to excess dryness

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37
Q

erythema nodosum
pathology
causes

A

hypersensitivity response to various stimuli - inflammation of subcutaneous fat

  • drugs: penicillin, suphonamides
  • group A beta-haemolytic streptococcus
  • primary TB
  • pregnancy
  • sarcoidosis
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38
Q

erythema nodosum presentation

A
  • TENDER erythematous nodular lesions
  • resolve within 6 weeks
  • leave bruise-like discolouration as they resolve
  • resolve without atrophy or scarring - no treatment necessary
39
Q

erythema multiforme
pathology
causes

A

limiting inflammatory condition

main cause: herpes simplex virus

  • infections
  • drugs: penicillin, sulphonamides
40
Q

erythema multiforme presentation

A
  • target lesions - initially seen on back of hands and feet then torso
  • upper limbs> lower limbs
  • ring rash - target/bullseye
  • cherry red central spot, then pale outer ring then pink outermost ring
  • pruritic mild
41
Q

pyogenic granuloma
pathology
causes

A 
relatively common benign skin lesion 
actually a haemangioma 
- trauma 
- pregnancy 
- women > men
42
Q

pyogenic granuloma presentation

A
  • common sites: head/neck, upper trunk, hands - presents at site of trauma
  • oral mucose - common in pregnancy
  • initially red spot progresses within days to weeks and becomes raised and spherical
  • can bleed a lot
43
Q

pyoderma gangrenosum

presentation

A
  • initially small red papule
  • later red necrotic ulcer
  • lower limbs
  • idiopathic 50%, IBD, rheumatoid
44
Q

pyoderma gangrenosum

causes

A
  • idiopathic 50%
  • IBD
  • rheumatoid
  • myeloproliferative disorders
  • connective tissue disorders
  • primary biliary cirrhosis
45
Q

pyoderma gangrenosum

management

A
  • first line - oral steroids

- immunosuppressive ciclosporin and infliximab in difficult cases

46
Q

angioedema and anaphylaxis - urticaria

pathology (types) and causes

A
  • urticaria is due to local increase in capillary permeability
  • inflammatory mediators released by mast cells
  • most are spontaneous or stress triggered, physical stimulus
  • acute urticaria <6wks
  • chronic urticaria >6wk
  • inducible urticaria: tight pyjamas
  • contact urticaria: transient swelling and redness e.g. latex allergy
47
Q

presentation of urticaria

A
  • swelling in superficial dermis - raised
  • itchy wheals 48hrs later they fade

chronic urticaria:
- joint pain
- fever
connective tissue disease more likely

48
Q

investigations for urticaria

A
  • bloods: FBC, CRP, complement IgG
  • autoimmune panel
  • no use for patch testing
  • check for tongue & laryngeal involvement
49
Q

management - urticaria

A
  • regular antihistamines
  • 1st line: CETIRIZINE 10mg TDS
  • fexofenadine
    +/= montelukast & ranitidine
  • prednisone for acute flare
  • anaphylaxis: adrenaline (0.5ml epipen) + corticosteroids + antihistamines
50
Q

eczema herpeticum

cause

A
  • serious complication of atopic eczema
  • HERPES SIMPLEX 1
  • can be facilitated by topical steroids
51
Q

eczema herpeticum

presentation

A
  • extensive crusted papule
  • blisters
  • erosions
  • fever
  • multiple monomorphic vesicles
52
Q

eczema herpeticum management

A
  • acyclovir PO or IV
  • abx for 2ndry bacterial infection
  • topical steroids if eczema gets bad
  • admission
53
Q

abx for infection of atopic eczema

A

erythromycin and clarithromycin

54
Q

allergic contact dermatitis

what type of reaction

A

type IV hypersensitivity

55
Q

allergic contact dermatitis presentation

A
  • localised in area of contact
  • hands - latex gloves
  • rubber, nickel, preservatives, cosmetics
56
Q

allergic contact dermatitis management

A
  • remove trigger and allergen
  • topical steroids: potent
  • antiseptic soak contains potassium permanganate if oozing
  • patch testing
  • emollients ++
57
Q

cellulitis
pathology
cause (two bacteria)

A
  • deep subcutaneous tissue
  • streptococcus pyogenes
  • staph aureus
58
Q

cellulitis presentation

A
  • erythema
  • swelling
  • lower legs
  • systemic upset
  • fever
  • pain
  • muscle upset
  • well demarcated
59
Q

cellulitis management

A
  • flucloxacillin
  • benzylpenicillin
  • linezolid
60
Q

erysipelas
pathology
cause

A
  • acute superficial form of cellulitis - superficial subcutaneous skin and the dermis
  • streptococcus
61
Q

erysipelas presentation

A
  • face common
  • rapid onset
  • pain
  • erythema
  • oedema
  • skin taught skin
  • fever and malaise/ rigors more common
62
Q

erysipelas management

A

IV penicillin

analgesia

63
Q

necrotising fasciitis
pathology
cause

A
  • rapidly spreading infection of deep fascia with secondary tissue necrosis
  • group A haemolytic streptococcus
64
Q

necrotising fasciitis

presentation

A
  • 50% in previously healthy
  • severe pain
  • erythematous
  • blistering and necrotic skin
  • systemically unwell with fever and tachycardia
  • crepitus
65
Q

necrotising fasciitis

investigations and management

A
  • x-ray - soft tissue
  • urgent referral for surgical debridement
  • IV piperacillin and tazosin
  • mortality 76%
66
Q

seborrheic keratosis
pathology and cause
risk factors

A

benign

  • basal cell papilloma. WART
  • proliferation of basal cell keratinocytes
  • need to rule out melanoma

risk factors:
- old age (80% >50yrs)

67
Q

seborrheic keratosis

management

A

reassure - most don’t need treatment

  • aldara cream
  • cryotherapy
  • curettage
68
Q

seborrheic keratosis

presentation

A
  • asymmetry
  • border - notched
  • colour - multiple <2
  • usually brown
  • matt rough surface
  • catch on clothes
  • may bleed
69
Q

dermatofibroma

presentation

A 
benign 
very common
- firm elevated dermal nodule 
- smooth 
- central white scar 
- 5-10mm diameter 
- red/brown 
- young adults 
- arms and legs (mostly legs) 
- hx of trauma 
- lesions have histiocytes blood vessles and fibrotic changes
70
Q

dermatofibroma

management

A
  • effudex OD for 4 wks topical
71
Q

actinic keratosis

presentation

A
  • benign sun-spots
  • red pink brown
  • scaly and rough
  • flat or raised sore and itchy
72
Q

actinic keratosis

management

A
  • efudex (5% fluorouracil)
  • cryotherapy
  • curettage under LA
  • monitor growth - risk of SCC
73
Q

lipoma

A

benign tumours of fat

  • soft masses in subcutaneous tissue
  • often multiple lesions
  • painful
  • don’t normally need treatment - harmless
  • can be cut out
74
Q

vascular tumours

A

benign

  • cherry angioma - small red papular vascular lesions
  • strawberry naevus in newborns
  • pyogenic granuloma
  • rapidly developing 2-3wks
  • red or weepy crusted nodule
  • can bleed a lot
  • trauma induced + pregnancy
  • young adults & children
75
Q

rosacea presentation and exacerbating factors

A
  • chronic disorder of pilosebaceous units
  • flushing - first symptom
  • no comedones
  • vascular telangiectasia common
  • papulopustular + erythema
  • rhinopehyma - red wart like growths on nose
  • nose, cheeks, forehead

sunlight can exacerbate
worse with ALCOHOL

76
Q

ocular rosacea

A
  • dry eyes
  • irritation
  • redness
  • crusting
  • itching
  • burning
  • recurrent infections
77
Q

rosacea management

A

mild:

  • topical metronidazole (papules, no pustules or plaques)
  • topical brimonidine gel (flushing no telangectasia)

severe disease:

  • oxytetracycline abx
  • daily suncream
  • laser - prominent telangiectasia
  • rhinophyma needs referral

occular rosacea mx:
- doxycycline abx

78
Q

psoriasis

pathology, types

A

chronic inflammatory condition due to hyper proliferation of keratinocytes and inflammatory cell infiltration

types:

  • chronic plaque psoriasis - most common - on extensors, sacrum and scalp
  • seborrheic
  • flexural (body folds)
  • pustular psoriasis: palms ans soles
79
Q

psoriasis precipitating factors

A
  • trauma - koebner phenomenon
  • infection
  • drugs: beta blockers, lithium, NSAIDs, ACEi, infliximab
  • stress
  • alcohol
80
Q

acute psoriasis

A

acute pustular:

  • immediate management
  • pustules on erythematous and tender skin

guttate:
- 2ndry to streptococcal infection/sore throat
- raindrop lesions, trunks and limbs
- more common in children and teens

erythrodemic:
- burned looking skin
- peeling like sheets

81
Q

psoriasis presentation

A
  • well demarcated
  • erythematous scaly plaques
  • extensors, scalp, sacrum,
  • itchy or painful
    auspitz sign: scratch and removal of scales –> bleeding)
  • 50% nail changes - onycholysis
  • nail pitting
  • 5% –> psoriatic arthritis: DIP, rheumatoid like, psoriatic spondylosis

clinical diagnosis

82
Q

psoriasis management

A

lifestyle:

  • avoid sun
  • reduce alcohol
  • reduce BMI

chronic plaque psoriasis:
- 1st line: POTENT TOPICAL STEROID + VIT D OD

  • if no improvement after 8 wks: vit D BD alone
  • if vit D not effective after 8-12 wks:
    • -> coal tar OD
    • -> potent topical steroid BD
  • if no effect:
    • -> calcipotriol + betamethasone OD 4wks
  • phototherapy:
  • ->UVB: plaque, guttate
  • ->PUVA (psoralen): palmoplantar pustulosis
  • systemic therapy:
  • -> methotrexate
  • -> ciclosporin (rapid/short term treatment, in conception, for palmoplantar pustulosis)
  • biologics
    e. g adalimumab, etanercept
83
Q

side effects of steroids

A
  • skin atrophy
  • striae
  • rebound symptoms
  • flexures, scalp, face: 1-2 wks/month at a time
  • no more than 8 wks at one site at a time
  • very potent steroids not >4ks at a time
  • NICE recommends 4 week breaks
84
Q

vitamin D - what does it do and when to avoid

A

calcitriol

reduces scale and thickness of plaques

avoid in pregnancy

85
Q

acne vulgaris

causes
precipitating factors

A

an inflammatory disease of the pilosebaceous follicle
80% are teenagers 13-18

causes:

  • inflammation
  • bacterial colonisation with propionibacterium acnes (anaerobic rod resilient to penicillin)
  • abnormal follicular keratinisation
  • increased sebum production

precipitating factors

  • PCOS
  • trauma-Koebner phenomenon
  • infection
  • durgs - ciclosporin, lithium, tamoxifen
  • stress
  • alcohol
86
Q

acne
clinical features
mild, moderate and severe

A 
mild:
- non-inflammatory lesions
- open and closed comedones 
- papules <5mm
sparse lesions

moderate:
- pustules and papules

severe:

  • nodular acne
  • cystic
  • pitting
  • pin-roll scarring, ice pick scars, hypertrophic
  • unusual sites e.g. trunk, back
  • keloid scarring
  • lots of lesions >100
87
Q

acne management - mild moderate, severe

A

mild:

  • single topical exfoliants: tea tree oil
  • keratolytics: benzyl-peroxide, salicylic acid
  • topical retinoids: adapalene
  • topical abx: clindamycin

moderate:
combination: topical retinoid + oral abx (lymecycline 3months at least/ erythromycin)
2nd line: anti-androgens COCP (dianette, Yasmin)

severe acne:
- oral retinoids (roaccutane, isotretanoin)
laser and dermavate for keloid scarring

88
Q

side effects of roaccutane

A
  • DEPRESSIVE
  • DRY skin (lips)
  • TERATOGENIC (two contraceptives needed and wait at least 6wks before conceiving)
  • hypertrigleridaemia (LFTs before, durine and once after)
  • can only prescribe one month at a time
  • avoid alcohol
  • hair thinning
  • nose bleeds
89
Q

eczema causes, aggravating factors

A

papules and vesicles on an erythematous base

atopic eczema usually develops by early childhood and resolves in teenagers

causes:

  • FHx atopy: allergic rhinitis, eczema, asthma
  • genetic - filaggrin gene mutations

aggravating factors:

  • allergens pollens
  • pets
  • chemicals and food
  • sweating, heat
  • infection
90
Q

types of eczema

A

discoid:
- well defined patches often infected with staph

pompholyx: itchy small vesicles

Id reaction: reaction to inflammation/ infection on skin - reaction occurs away from site

asteatotic eczema: dried up riverbed pattern

varicose eczema:

  • varicose veins
  • scaly itchy dry
  • lipdermatosclerosis - red and painful leg. hx cellulitis
  • champagne bottle legs - oedema proximal
91
Q

varicose eczema risk factors

A

obesity
pregnant
DVT
immobility

92
Q

complications of eczema

A
  • bacterial infection
  • viral infection - mollusc contagiosum: pearly papules with central umbilication
  • viral warts and ECZEMA HERPETICUM –> IV ACYCLOVIR
93
Q

management of eczema

A
  • avoid triggers
  • frequent emollients: dermabase
  • bandages
  • soap substitutes

topical:
- steroids for flare ups
- immunomodulators e.g. tacrolimus

oral:

  • antihistamines
  • abx: flucloxacillin for 2ndry bacterial infection
  • acyclovir for 2ndry herpes infection
  • phototherapy
  • immunosuppressants: oral prednisone, azathioprine, ciclosporin
94
Q

eczema clinical features

A
  • itchy
  • erythematous dry scale
  • chronic scratching
  • excoriations
  • vesicular weepy
  • infancy: face
    children: elbow & knee flexures
    adults: face, trunk, hands

4th year medicine (8 decks)

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