Dermatology Flashcards
structure of the skin
epidermis - stratum corneum (sheds) (outer layer), Langerhans cells
dermis - collagen, elastin, nerve endings and hair follicles, gives flexibility and strength
subcutaneous tissue aka fat, insulation and protection
psoriasis - explain diagnosis and management
complications too
hyperproliferation of epidermis
can spread anywhere
1. lifestyle modifications to reduce exacerbation risk:
- smoking cessation
- drinking
- weight loss if overweight
2. topical agents - may take few weeks to work and sudden stop could lead to relapse of symptoms
psoriatic arthritis
pt can present with athropathy - same treatment as osteoarthritis - NSAIDS,DMARDS
history
systematic approach
1. site of onset -
2. Duration - onset, previous episodes, change
3 .distribution - flexors/extensors? sun-exposed sites? asymmetrical/symmetrical? mucous membranes?
4. Symptoms - itching/soreness?
5. Exacerbating/relieving factors
6. Response to treatment
7. PMH, FH inc atopy, drugH , social, travel and maybe sexual history, Psychological impact
examination
- remove makeup/creams and fully exposed
- examine hair, scalp, nails, mucous membranes
- comment on morphology - appearance of lesions (areas of friction/pressure/sweaty patches/size/colour)
- Palpate - tenderness, warmth, thickness, blanching, bleeds, scaling
- examine other systems if appropriate e.g lymphs, joints
basal cell carcinoma - explain diagnosis and management
diagnosis - symptoms slowly enlarging, irregular shaped/borders. inappropriate growth/proliferation of one of the layer of skin. Usually occurs on (face, arms, neck, scalp) over exposed to sunlight and increased age means cells lose ability to replicate properly
management - routine referral - rarely spreads to other body parts so usually not life threatening
Contact dermatitis
- presentation
- explain diagnosis
- management
- rash due to skin reaction from contact with a substance. inflamed - red, itchy, can blister and local rash
- patch testing helps identify cause
a) avoid irritant, cool compress, avoid scratching, cut nails (prevent infection),
b) - moisturisers/emollients (if mild) - must not smoke, use naked flames as creams in contact with clothes you are flammable.
- consider topical corticosteroids (e.g. hydrocortisone) 3. antibiotics if infected
(antihistamines- reduce need to itch (break itch-scratch cycle))
granulomas
?
keloid scar
pathological scar, overproduction of scar tissue
more common in afro-Caribbean skin type 5/6
impetigo
around corners of mouth, yellow crust
shingles
can occur more than once, vesicular rash
tick bites
targetoid appearance
lyme disease
slapped cheek syndrome
symptoms - >38c, runny nose, sore throat, headache
- few days later, lighter-coloured rash may appear on the chest, arms and legs. skin raised and can be itchy. fade in 2 wks
- cheek rash fade in 2 days
viral - parovirus B19, no longer once this typical rash appeared can return to school after informing skl
- self care (don’t need GP) - drink fluids, simple analgesia, rest, moisturiser on itchy rash, go to pharmacist about itchy rash for antihistamines
safety net
- careful in pregnant, weak immune system, blood disorders
- severe anaemia signs - very pale skin, shortness of breath, extreme tiredness, fainting
Acne vulgaris
P - explain diagnosis/causes
chronic inflammatory condition affecting face, back and chest
P - spots, oily skin sometimes painful to touch
1. inflamed lesions inc. papules pustules, nodules
2. non - inflamed lesions - comedomes
causes -
- hormones level changes during puberty - they increase sebum production, thicken inner lining of hair follicles blocking them, inc P.acne bacteria proliferation
- increased keratinocyte production - clogging pores
- bacterial proliferation in sebaceous gland
Acne vulgaris
M
- advise - skin care 2x daily washing gentle soap (avoid over cleaning - dry and irritate), avoid popping, remove makeup well and wear less
- Single topical treatment- retinoid creams - adapalene ( X pregnancy), antibiotics clindamycin w benzoyl peroxide
- Systemic oral antibiotics - 3/12 w tetracycline e.g doxycycline/lymecycline
Rosacea
presentation
risk F
M
chronic inflam condition
chin, cheeks, nose and forehead
recurrent episodes of flushing, erythema, papules and pustules
RF - smoking, hot/cold environment, spicy food/drinks, alcohol, stress
M - non-oily emollients, alpha adrenergic creams and oral Abx
Squamous cell carcinoma
P
RF
P - varying - firm, red nodule, can be scaly, can necrotise and become ulcer, bleeding
RF - excessive UV light exposure esp if susceptible to it, history of skin cancer/malignancies, immunodeficient/genetic conditions
SCC
M
referral if
M - depends on size
small - minor surgery - curettage and electrodessication (scooping to remove tissue)
large - excision/radiotherapy
metastasised - chemo and targeted drug therapy
R
- non-healing keratinising/crusted tumours >1cm
- immunosuppressed pts
- expansion over 8wks
- indurated skin on palpation ( loss of elasticity/pliability)
melanoma P rf M referral
Asymmetrical Borders irregular Colour - multiple Diameter >6mm Evolving
RF
having many moles
FH
UV - inc history sunburn
M - surgery to remove
if spread beyond the skin then surgery to remove affected lymph node, chem/radio etc
referral - depends on 7 point checklist - diff criteria if major 2pts/minor 1pt lesion features
how to safety net solitary lesions
reassurance - cancer risk low w current symptoms
features to look out for - changes in colour, shape or growth, bleeding/oozing, non-healing in 2mths
fungal skin
P
feet - toes/soles - itching, burning sensation
groin/upper inner thighs - itchy red rash, worse on
(aka tinea cruris) exercise, can spread a
scalp - localised bald patches - hair would regrow after
treatment unlike alopecia
skin - red, scaly, cracked, blistered
fungal skin
RF
poor personal hygiene, sweat heavily
low socioeconomic status - warm/wet
overcrowding - frequent human contact
fungal skin
M
self -care advice: loose-fitting clothing, wash and don’t scratch affected area, don’t share towels
- topical antifungal in mild for adults - terbinafine cream
- if marked inflammation - topical corticosteroid on addition - hydrocortisone cream
- oral antifungal if severe/extensive - terbinafine again
Fungal nail - different types
Subungual hyperkeratosis: accumulation of skin cells between nail and nail bed. scaling under the distal nail; the nail is discoloured, opaque, and thickened.
Paronychia: inflammation (pain, red, pus) of the folds of skin around the nail. Candida infection is likely
Endonyx - infection of the nail plate with white discolouration, in the absence of onycholysis (painless detachment of nail from bed) and subungual hyperkeratosis.
fungal nail - P
general
unilateral, abnormal, discoloured,
superficially white - small white patches
begins distally and then to nail bed - so nail lifts up
white/yellow streaks on nails.
