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Internal Medicine Subspecialties > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Factors influencing changes in skin colour

A
  1. Genetic
  2. Hormonal
  3. Inflammatory
  4. Autoimmune
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2
Q

Changes in skin colour may be considered as:

A

a. Congenital vs Acquired

b. Localized vs Generalized

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3
Q

Congenital causes of hypopigmentation include:

A

a. Albinism

b. Tuberous sclerosis

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4
Q

What is Albinism?

A

Autosomal recessive disorder of tyrosinase metabolism resulting in hypopigmentation

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5
Q

What are the different types of Albinism?

A

a. Ocular albinism: visual system affected (iris, retina)

b. Oculocutaneous albinism: skin, hair and eyes affected

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6
Q

What syndrome can Albinism be associated with?

A

Chediak Higashi syndrome

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7
Q

What features are seen in Chediak Higashi syndrome?

A

a. Hypopigmentation
b. Recurrent infections
c. Mild coagulation defects
d. Neurologic problems

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8
Q

What can be found on Physical Examination in a person with Albinism?

A

a. Hypopigmentation of skin, hair, eyes
b. Eyes: Nystagmus, strabismus, iris translucency, decr visual acuity, photophobia, amblyopia
c. Skin photosensitivity

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9
Q

What is the pathophys of Albinism

A

Disorder of tyrosinase metabolism–> partial or complete failure of melanin production from the melanocytes in the skin and/or the eyes–> hypopigmentation

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10
Q

What skin cancers can be seen with Albinism?

A

a. Actinic keratoses
b. Squamous cell carcinomas
c. Melanoma

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11
Q

Diagnosis of Albinism?

A

a. Skin Biopsy (test for melanin)

b. Genetic testing

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12
Q

How is Albinism managed?

A

a. Photoprotection (sunglasses, sunscreen)
b. Skin surveillance for malignancies
c. Ophthalmic care

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13
Q

What is Piebaldism?

A

a. Rare autosomal dominant condition
b. Characterized by a patch of white hair in the front (forelock)
c. Associated with patches of depigmented skin usually on the forehead
d. One of the cutaneous signs of Waardenburg syndrome

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14
Q

Management of Piebaldism?

A

a. Photoprotection
b. Skin surveillance
c. Camouflage with cosmetic cover creams

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15
Q

What is Tuberous sclerosis?

A

Autosomal dominant disorder that causes non-cancerous tumours to grow in various organs of the body

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16
Q

What genes are affected in Tuberous sclerosis?

A

TSC1 or TSC2 (codes for Hamartin and Tuberin respectively)

Both genes function as tumour suppressors

17
Q

What are the skin manifestations in Tuberous sclerosis?

A
  1. Adenoma sebaceum
  2. Ashleaf spots (3 or more)
  3. Shagreen patches
18
Q

What are Ashleaf spots?

A

Hypopigmented macules on the trunk and extremities associated with Tuberous sclerosis. This is apparent in infancy

19
Q

What is a Shagreen patch?

A

This is a flesh-coloured plaque of skin in the lumbosacral region with an orange peel consistency. This is associated with Tuberous sclerosis and develops in childhood or early adolescence

20
Q

What is adenoma sebaceum?

A

Reddish nodules in a butterfly pattern around the nose & cheeks; (facial angiofibroma)

21
Q

Which benign tumours are associated with Tuberous sclerosis?

A
  1. Brain tumours (Giant cell astrocytoma which is most commonly subependymal)
  2. Cardiac rhabdomyosarcoma
  3. Renal cysts or renal angiomyolipoma
  4. Subungual fibromas
22
Q

(True/False) Tuberous sclerosis is associated with infantile spasms or seizures?

A

True.

The greater number of brain tumours, the more severe the seizures

23
Q

(True/False) Tuberous sclerosis is associated with intellectual disability?

A

True. This is due to brain lesions

24
Q

Mx of Tuberous Sclerosis?

A
  1. Antiepileptics
  2. Removal of angiofibromas (Laser therapy)
  3. Tumours (Surgery/Chemo)
25
Q

What are Acquired causes of Hypopigmentation?

A

Vitiligo & Hypopituitarism

26
Q

What is Vitilgo?

A

A common skin condition in which a patchy loss of epidermal melanocytes results in depigmentation. Thought to be due to autoimmune destruction of melanocytes

27
Q

Localized Causes of Hypopigmentation:

A
  1. Post-inflammatory (Eczema, Psoriasis, Cutaneous Lupus)
  2. Infections e.g. Leprosy, Pityriasis versicolor
  3. Drugs e.g. topical steroids
28
Q

Congenital Causes of Hyperpigmentation

A
  1. Neurofibromatosis

2. Peutz-Jeghers Syndrome

29
Q

Acquired Causes of Hyperpigmentation

A
  1. Endocrine Dx (Addison’s Dx, Cushing’s Syndrome, Ectopic ACTH, Chronic Renal Failure, Oestrogens)
  2. Haemochromatosis
  3. Vitamin B Deficiency
  4. Infections (Pityriasis Versicolor)
  5. Post-inflammatory (Acne, eczema, lichen planus, Cutaneous lupus)
  6. Acanthosis Nigricans
30
Q

What is Acanthosis Nigricans?

A

A velvety thickening of hyperpigmentation of the skin. Usually seen in the axillae and other intertriginous folds

31
Q

Aetiology of Acanthosis Nigricans

A

Hereditary, Endocrine Dx, Obesity, Drugs, Malignancies (adenocarcinomas of GI or GU tracts, lymphomas)

32
Q

What is a Spitz Naevus?

A

Acquired pigmented, fleshy pink papule in children

33
Q

What is a Halo naevus?

A

Melanocytic Naevus surrounded by a halo of depigmentation. the whole naevus fades with time

34
Q

What is a Naevus?

A

A benign neoplasm of the skin that is congenital or acquired

35
Q

What is a Blue Naevus?

A

A collection of deeply pigmented melanocytes situated deep in the dermis causing a deep blue colour

36
Q

What are the different types of Acquired melanocytic naevus?

A
  1. Junctional nevi (flat macules, melanocytes proliferate along the dermo-epidermal border)
  2. Compound nevi (cells at the dermo-epidermal jxn and in the dermis producing a raised brown lesion
  3. Intradermal nevi (no cells at the dermo-epidermal jxn; deeper cells char of neural tissue
37
Q

What is a Becker’s Naevus?

A

An area of increased pigmentation often assoc with increase in hair growth

38
Q

What is a dysplastic Naevus?

A

Nevus with malignant potential typically seen on the trunk

39
Q

Complications of Steroid Use? (‘CUSHINGOID’)

A 
Cataracts
Ulcers
Skin thinning, bruising, Striae
Hyperglycemia, HTN, Hirsutism
Infections
Necrosis of the femoral head
Glucose elevation
Osteoporosis, obesity
Immunosuppression
Depression, DM

Internal Medicine Subspecialties (5 decks)

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