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5thyr > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Define macule and papule

A 
Macule = small, flat lesion <5mm
Papule = small, raised lesion <5mm
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2
Q

Define nodule and patch

A 
Patch = diffuse flat lesion >1cm
Nodule = discrete raised lesion >1cm
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3
Q

Define vesicle, bulla and pustule

A 
Vesicle = small fluid filled lesion <5mm 
Bulla = large fluid filled lesion 
Pustule = pus filled blister <5mm
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4
Q

What type of lesions is eczema?

Where are they found?

A

-Papules (small raised) and vesicles (small fluid filled)
on an erythematous base
-Commonly on flexor parts (extensor on babies)

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5
Q

What is the diagnostic criteria for atopic eczema?

A

Itchy skin condition plus 3 of the following:

  • History of itchiness in skin creases
  • History of atopic disease (personal or familial)
  • General dry skin
  • Visible flexural eczema
  • Onset in first 2 years of life
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6
Q

What genetic mutation is associated with atopic eczema?

A

Filaggrin

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7
Q

Where and how does discoid/nummular eczema present?

A
  • Coin shaped lesions

- Commonly at wrist

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8
Q

What type of hypersensitivity reaction is allergic contact dermatitis?

A

Type IV hypersensitivity - occurs after sensitisation and re-exposure to allergen

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9
Q

How can you distinguish between irritant and allergic contact dermatitis?

A

Irritant = fast onset of burning, stinging, soreness in exposed area and resolves quickly after removal of irritant

Allergic = delayed onset of redness, itch, scaling in exposed area and other areas. Takes longer to resolve.

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10
Q

Which type of contact dermatitis is more commonly associated with atopic eczema?

A

Irritant contact dermatitis

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11
Q

What is dyshidrotic eczema?

A

-formation of small blisters on extremities (F>M)

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12
Q

What is neurodermatitis

A

-constant itchyness, worse at night/relaxation>causes leathery skin

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13
Q

Eczema treatment:
1st line
2nd line
3rd line

A
  1. Topical emollients (500g/week-adults) when skin is moist
    - creams, lotions, ointments, soap substitutes
  2. Topical steroids - hydrocortisone (mildest) to dermovate (most potent)
  3. Phototherapy or immunosuppressants (oral pred)
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14
Q

What are some complications of eczema?

A

Lichenification in adults
Staphylococcal infection
Eczema herpeticum = rapidly worsening, painful, clustered blisters and punched out erosions

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15
Q

How would you treat an infection of eczema?

A

Flucloxacillin for 14 days (erythromycin if penicillin allergic)

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16
Q

How does seborrhoeic dermatitis present?

A

Erythematous SCALING rash over NASOLABIAL FOLDS, bridge of nose, eyebrows, ears and scalp (dandruff)

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17
Q

What medication can you give for seborrhoeic dermatitis?

A

Ketoconazole = topical antifungal (inflamitory reaction to yeast (Malassezia spp))

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18
Q

Pathophysiology of acne vulgaris?

A

Increased androgens→spots→colonisation by propionibacterium Acnes

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19
Q

What conditions can acne vulgaris be associated with?

What drugs can acne vulgaris be associated with?

A

Excess androgens e.g:

  • Polycystic ovarian syndrome
  • Cushing’s disease

Drugs

  • Steroid abuse
  • Lithium
  • Porgesterone (although COCP makes it better)
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20
Q

What type of lesions do you see in acne?

A

-comedones/papules (small raised)/pustules (pus filled raised)

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21
Q

What are the 2 forms of severe acne?

what are the difference in spots/other features?

A

Acne conglobata

  • cycts form
  • spots linked together under the skin

Acne fulimens

  • bleedy, crusty, ulcerated
  • SYSTEMIC FEATURES (fluctuating fever/joint pain/lose weight)

**immediate referral is indicated for both

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22
Q

What is the treatment of mild acne? (3 options)

What about in pregnancy?

A

1st line: (mild acne) TOPICAL TREATMENTS (1 then 2 of:)

  • Topical retinoids e.g. adapalene +/- benzoyl peroxide (burning>kills bacteria)
  • Topical antibiotic (1% clindamycin) AND benzoyl peroxide
  • Azelaic acid 20%.

PREGNACY

  • *retanoids are CONTRAINDICATED in PREGNANCY
  • *give topical erythromycin and benzoyl peroxide instead
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23
Q

Side effects of retinoids?

A

Teratogenic - don’t give in pregnancy
Photosensitivity
Dry skin

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24
Q

If topical treatments haven’t worked, what else can you prescribe for acne?

What about in pregnancy?

A

2nd line (moderate acne): ORAL ANTIBIOTICS 3 MONTHS

  • oral doxycycline/lymecycline
  • ALWAYS GIVE WITH topical retinoid (if not contraindicated) or benzoyl peroxide to reduce resistance

Can give COCP as an alternative to antibiotics

Pregnancy
**cant ive doxycycline (teratogenic)>give erythromycin

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25
Q

When would you consider a referral to dermatology for 3rd line acne treatment?

A
  • acne worsens on treatment
  • unable to tolerate side effects
  • they are starting to scar
  • if they have not responded to 2 different courses of antibiotics

Refer to derm for 3rd line treatment (isotretanoin)

26
Q

What are the side effects of doxycycline?

A
  • TERATOGENIC
  • teeth/nails discolouration
  • crazy dreams
27
Q

What is the 3rd line treatment for acne?

How does it work?

A 
3rd line (severe acne): ISOTRETANOIN 
-works by reducing sebum
28
Q

What are the side effects of isotretanoin?

A

Side effects

  • TETAROGENIC (need neg test and contraception 1 month after)
  • flakey dry lips and eyes (DRY EVERYWHERE)
  • hyperlipideamia
  • suicidal thought
29
Q

What is the pathophysiology behind psoriasis?

Most common type?

A
  • Hyperproliferation of keratinocytes
  • Inflammatory autoimmune T-cell mediated
  • Most common is chronic plaque psoriasis
30
Q

What is Auspitz’ sign?

A

Bleeding on scraping of a psoriatic lesion

31
Q

What is Kobner’s reaction? What conditions demonstrate this reaction?

A

Lesions arising following trauma to skin in otherwise health skin

  • Psoriasis
  • Lichen planus
  • Vitiligo
32
Q

What nail changes are seen in psoriasis?

A
  • Pitting - superficial depressions in nailbed
  • Onycholysis - separation of nail plate from nailbed
  • Subungual hyperkeratosis - thickening of nailbed
  • Oil drop discolouration

(50% will have nail changes)

33
Q

What antigens is psoriatic arthritis associated with?

A

HLA-B27 (also ankylosing spondylitis, IBD, reactive arthritis)
HLA-DR4 (also RA and type 1 diabetes)

34
Q

List the topical steroids in order of potency?

A

HEBDon bridge

  • Hydrocortisone (mild)
  • Eumovate (mod)
  • Betnovate (potent)
  • Dermavate (very potent)
35
Q

What topical treatment can be used in psoriasis?

A
  • Topical emollients
  • Topical Vitamine D anaglogues e.g. calipotriol (reduces keratinocyte proliferaiton)
  • Topical steroids (betnovate) used for flares
36
Q

Which psoraisis patients can be offered 2nd/3rd line therapy?

A

If extensive disease (>10% body affected)
2nd line: Phototherapy
3rd line: systemic therapy

37
Q

What systemic therapy is used in psoriasis?

A

First-line - Methotrexate
Second-line - Ciclosporin (1st line if rapid disease control in flares> need contraception)
Third-line -Acitretin

**Biologics if above hasn’t worked-mab

38
Q

What triggers a relapse of psoriasis?

A 
· Skin trauma (Koebner phenomenon)
· Infection - strep, HIV (GUTTATE)
· Drugs - BALI 
  - Beta-blockers 
  - Anti-malarials 
  - Lithium 
  - Indomethacin/NSAIDs 
· Withdrawal of steroids 
· Stress 
· Alcohol and smoking 
· Cold/dry weather
39
Q

What disease is oral lichen planus associated with?

A

Hepatitis C

40
Q

What is the management of eczema herpeticum?

A

Oral acyclovir
Oral flucloxacillin (to cover secondary bacterial infection)
Stop topical steroids

***children should be admitted for IV aciclovir

41
Q

What phototherapy is used to treat psoriasis?

A

1st line: Narrowband UVB phototherapy

2nd line:. Psoralen + UVA (PUVA)

42
Q

Side effects of ciclosporin

A

5 H’s

  • Hypertrophy of gums
  • Hypertrichosis
  • Hypertension
  • Hyperkalaemia
  • Hyperglycaemia (diabetes)

Requires monitoring of U&Es, BP and fasting glucose

43
Q

Describe a classic BCC

A
  • Waxy
  • Rolled edges
  • Central depression
44
Q

What are the types of BCC?

What do they look like?

A

Nodular
-shiney round edge/central depression/rolled edges

Superficial
-red scaley plaques

Morphic

  • blend in more (ill defined edges)
  • waxy
  • more aggressive
45
Q

Treatment of BCCs?

A
  • Mohs micrographic surgery (good healing)

- Radiotherapy if surgery not appropriate

46
Q

BCC vs SCC (appearance/growth)

A

BCC

  • WAXY
  • slow growing
  • locally invasive, less likely to metastasise

SCC

  • SCALEY/CRUSTY (keratotic)
  • more likely to metastasise
  • common post liver transplant (immunocompromised)
47
Q

What are the main precursors to SCC?

A
  • Actinic keratoses (aka solar keratosis) - 10% progress to SCC
  • Bowen’s disease
  • P53 supressor gene mutation
48
Q

Treatment of SCC?

A

Surgery with 4mm boarder

49
Q

How do you treat actinic keratoses?

A

Topical 5 fluorouracil (5FU)

50
Q

What is a slow growing patch of brown skin (often resembles a freckle on face)?

A

Lentigo maligna (in situ melanoma)

  • irregularly shaped brown macule that grows slowly
  • can progress to lentigo maligna melanoma
51
Q

What is a melanoma?

Where do you most often get them?

A

Cancer: problem with epidermal melanocytes
Women: legs Men: trunk

52
Q

What is the most common type of melanoma?

A

Superficial spreading melanoma is most common

grows laterally→less likely to metastasise unlike nodular→grows downwards

53
Q

What is the name of melanoma on the sole of foot?

What is unique about these?

A

Acral melanoma

  • sole of foot/nail bed
  • ONLY ONE NOT EFFECTED BY UV LIGHT
54
Q

What is the management of melanomas?

A
  • Biopsy and determine breslows thickness
  • Wide local excision
  • May need lymphadenectomy (mets to LN are common)
  • Chemotherapy if metastatic
55
Q

What is a Kaposi sarcoma? (how does it look)

A

Soft tissue tumour presents with purple cutaneous nodules

56
Q

Who does kaposi sarcoma tend to affect?

Whats the treatment?

A

Those with HIV (or other forms of immunosuppression)

Treatment:

  • Give HIV treatment (combination of antivirals)
  • Reducing transplant medication

Chemo or interferon if not worked

57
Q

What is the management of keloid scars?

A
  • Silicone dressings

- If failed>steroid injections

58
Q

What is a ganglion?

A

A ganglion cyst is a fluid-filled swelling that usually develops near a joint or tendon

Usually back of wrist
3x more women

59
Q

How long do ganglions last for?

What is the management?

A

-Usually self limiting: Several months then usually disappear

  • If pain or loss of movement:
    a) aspiration
    b) excision
60
Q

What is a cherry hemangioma?

A

Campbell de Morgan spot

Benign proliferation of mature capillaries

61
Q

Treatment of common warts?

A

Self limiting, however treat if painful/cosmetic/patient request

  • Cryotherapy every 2 weeks until gone (max 6)
  • Topical salicylic acid for 12 weeks

*not for face>refer to derm

5thyr (18 decks)

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