Dermatology Flashcards
List signs and symptoms of basal cell carcinoma
- Ulcer with raised rolled edge
- Telangiectasia (blood vessels)
- Nodule on the skin (pearly or waxy)
Describe diagnosis of basal cell carcinoma
- Visually
- Confirmation with excision biopsy
Define basal cell carcinoma
- A malignant neoplasm and the most common type of skin cancer.
- Rarely metastasises
Describe epidemiology of basal cell carcinoma
- 75000 diagnosed a year UK
- Full time GP diagnoses one person per year
List risks for basal cell carcinoma
- Exposure to UV
- Older age
- Male
- Radiation exposure
- Over 50
- History of skin cancer
- Fair skin
- Chronic infections and skin inflammation
- Immunosuppression
List risk factors for squamous cell carcinoma
- Over exposure to sunlight
- Outdoor occupation
- Fair skin
- Immunosuppression
- Smoking
- Age
- Skin trauma (chronic inflammation eg. ulcers)
- Asbestos, arsenic
- More common in men
Describe epidemiology of squamous cell carcinoma
- 25000 diagnosed each year
- Full time GP diagnoses someone every 1-2 years
- 2nd most common skin cancer
Describe signs and symptoms of squamous cell carcinoma
- Raised lesion of the skin
- Flat reddish or brownish patches in the skin, often with a rough, scaly, or crusted surface
- Hyper keratotic, ulcerated, rolled edges, non-healing
- Presence of pearls = good prognosis as it indicated the tumour is well differentiated
Describe diagnosis of squamous cell carcinoma
- Can be diagnosed visually
- Confirm with excision biopsy
Define squamous cell carcinoma
- A skin cancer in the squamous cells of the middle and outer layers of the skin, affecting keratinocytes
- Usually not life threatening though can be aggressive
Define melanoma
Tumour of melanocytes. Malignant skin cancer, rapidly metastasises
Describe epidemiology of melanoma
- 13000 each year in UK
- Full time GP diagnoses one every 3-5 years
List risk factors for melanoma
- UVB and artificial light
- Repeated sunburn
- Moles
- Genetic (cdk inhibitor 2a tumour supressor gene mutation)
- Pale skin
- Radiotherapy
- Immunosuppression
- Increased age
- Previous diagnosis of skin cancer
List signs and symptoms of melanoma
ABCDE (asymmetry, border, colour, diameter over 6mm, evolving)
- Asymmetrical
- Blurred, irregular border with jagged edges
- Multiple shades (eg. brown and black)
- More than 6mm wide
- Evolving
- In women, commonly in lower legs. In men, commonly on head, neck, chest and back.
- More worrying if thick and over 6mm
Describe investigations of melanoma
- Dermoscopy - looking for irregularity in colour, borders, blue-white veil, broad network, irregular vascularity
- Biopsy to identify thickness (melanoma invasion)
Define psoriasis
- A condition where there is inflammation of the skin, and signs of psoriasis are red spots or patches which characteristically become scaly - autoimmune
- It tends to come and go throughout the patients’ lifespan, and the severity of the condition can vary from patient to patient.
Describe aetiology of psoriasis
- Patients make skin cells more quickly than normal leading to inflammation (epidermal cells of the malphigan layer of the skin)
- Thought the be autoimmune, genetic and environmental.
- Palmoplantar is associated with smoking
List types of psoriasis
- Plaque most common (75-90%)
- Pustular
- Guttate
- Flexural
- Erythodermic
List signs and symptoms of plaque psoriasis
- Patches of various sizes of red skin with white scales
- Bleed when scales are removed (auspitz sign)
- Can be very thick, particularly in scalp
List signs and symptoms of pustular psoriasis
- Small fluid filled pustules, can be localised or generalised
- Generalised is a medical emergency as it can be fatal. Here, you have widespread erythema and non-follicular pustules which can coalesce.
- The patient often has fever, malaise, a raised heart rate and is systemically unwell.
List signs and symptoms of guttate psoriasis
- Body covered with multiple teardrop-like psoriatic patches
- Follows bacterial throat infection
List signs and symptoms of flexural psoriasis
- Red and shiny
- Affects groin, axillae, inframammary folds
List signs and symptoms of erythodermic psoriasis
- Presents with widespread painful red skin – severe psoriasis with more than 90% of the body affected.
- It is a serious condition and is potentially life threatening
List factors that exacerbate psoriasis
- Bacterial (streptococcal) and fungal infection may precipitate psoriasis.
- Lithium, beta-blockers, anti-malarials, ACE inhibitors and withdrawal of steroids may also cause a flare-up.
- Psoriasis may appear in the site of a recent skin injury.
- Ultraviolet light is usually beneficial except in cases of photosensitive psoriasis.
- Additionally, hormonal changes can affect psoriasis as well – female patients may find it is worse during puberty and menopause, and improves during pregnancy.
- Stress, smoking alcohol
Describe epidemiology of psoriasis
- Around 1–3% of the world’s population has psoriasis
- About 1.3–2.2% of the UK population is estimated to have psoriasis
- A UK retrospective cohort study found the incidence rate of adult psoriasis to be 28 per 10,000 person-years
= Onset may occur at any age, but there are two peaks in incidence — between 20–30 years of age and 50–60 years of age - Guttate psoriasis is more common in people under 30 years of age
- Men and women are typically equally affected however localized pustular psoriasis is more common in women
- Most common in white people
Describe investigations of psoriasis
- Clinical diagnosis
- Ask about symptoms
- Associated conditions
- Perception of severity
- Stress, anxiety, depression
- Family history
- Examine for systemic illness, and classify type by distribution, number of lesions, size and shape of lesions, colour, surface features, involvement of other arms
- Document total body percentage
- Skin patch testing, IgE, skin biopsy
List the general symptoms of psoriasis
- Itch, irritation, burining, pain, bleeding and scaling
- Systenic illness - fever, malaise, weight loss
- Onycholysis, pitting, sublingual hyperkeratosis
- Psoriatic arthritis causes symmetrical polyarthritis
Define eczema including subtypes
- Atopic eczema is a chronic, itchy, inflammatory skin condition that affects people of all ages, although it presents most frequently in childhood. Type 1/4 hypersensitivity
- Contact caused by contact with a particular substance, type 4
- Discoid skin is itchy, swollen and cracked in circular or oval patches, more common in elderly
- Dyshidrotic is where tiny blisters develop on the fingers, palms of hands and soles of feet
- Herpeticum is a viral infection in people with eczema affecting large areas of skin, caused by HSV1
- Seborrheic eczema is a common skin condition causing redness, scaly patches and dandruff most commonly affecting the scalp
Define actinic keratoses
- Discrete, dry, rough, adherent scaly lesions that can be single or multiple and occur in sun exposed areas.
- Increases risk of squamous cell carcinoma
List types of melanoma
- Solar lentigo (brown fixed patches on sun exposed areas) can form lentigo maligna (often on face or back)
- Nodular melanoma (tend to be more invasive, domed shape with rapid growth)
- Superficial spreading (most common)
- Amelanotic
- Acral (affecting the nail)
Describe bowens disease
- Scaly keratosis, benign and eventually develops into SCC.
- Red scaly patch on skin
List signs and symptoms of eczema
- Bilateral
- Erythematous
- Red
- Face, scalp and flexures often effected in children, and creases, chest and neck in adults
- If chronic, lichenification
- Pruritis
- In eczema herpiceticum large patches of eczema with heretic type blisters, painful with fevers and lethargy
Describe epidemiology of eczema
- Affects approximately 20-30% of children in developed countries. Incidence is highest in developed countries in urbanised areas
- Prevalence is increasing
- Most cases present before the age of 5
Describe aetiology of eczema
- History of atopy (70% of cases)
- Asthma
- Hay fever
- Allergic rhinitis
- Family history – genetic component (filaggrin gene mutation)
- Breast feeding – breast feeding a child as the sole nutrition in the first 3 months of life decreases risk in those with a family history of atopy
List common triggers for eczema
- Soaps, detergents, shower gels, bubble baths, washing-up liquids
- Skin infections – particularly staphylococcus aureus
- Extremes of temperature
- Abrasive or synthetic fabrics (e.g. wool, nylon)
- Dietary factors (more common in children)
- Inhaled allergens
- House dust mites
- Pollen
- Pet dander
- Mould
- Stress
- Hormonal changes in women (pregnancy, with menstrual cycle)