Dermatology Flashcards
1
Q
What is eczema herpeticum
A
HSV infection of eczematous skin
2
Q
Who typically presents with eczema herpeticum
A
children and infants
3
Q
What are the possible complications of eczema herpeticum
A
- blindness
- organ failure
- death
4
Q
What is a differential for eczema herpeticum
A
impetigo
5
Q
What is erythroderma
A
and inflammatory skin condition which causes red, hot painful skin covering 90% of the body
6
Q
What type of patient is more likely to get eryhroderma
A
those with inflammatory skin disease eg psoriasis
7
Q
How should erythroderma be managed
A
cool, wet dressings and emollients
8
Q
What is erythema multiforme
A
a type 4 hypersensitivity reaction, usually to infection, that typically affects the palms and soles and has targetoid lesions
9
Q
describe the signs you look for in erythema multiforme
A
targetoid lesions on the palms and soles, and sometimes haemorrhagic crusting on the lips
10
Q
What usually causes erythema multiforme?
A
infection (>70% HSV)
11
Q
What is the treatment for erythema multiforme?
A
- treat underlying cause
- give rehydration
- analgesics
12
Q
What is the difference between Stevens-Johnson syndrome and Toxic epidermal necrolysis
A
TEN is the more severe form and covers >30% of the body
13
Q
What % of the skin should be affected for a diagnosis of SJS
A
> 10%
14
Q
What is SJS
A
A type 4 hypersensitivity reaction covering >10% of the body in macules, blisters or sheets of desquamation
15
Q
Describe the changes that occur to the skin in SJS and TEN
A
macules form, then become blisters, then sheets of desquamation
16
Q
What is Nikolsky’s sign? Is it positive or negative for SJS/TEN
A
Gentle rubbing of the skin causes desquamation
Positive in SJS/TEN
17
Q
What causes SJS/TEN?
A
Change in medication
18
Q
What is the management of SJS/TEN
A
Stop meds, monitor fluids, analgesics
19
Q
What type of bacteria is most likely to cause skin infections?
A
gram positive (staph, group A strep)
20
Q
What is impetigo?
A
A skin infection that causes bullae and honey-coloured crust
21
Q
what usually causes impetigo?
A
staph aureus
22
Q
What treatment should be given for impetigo?
A
hydrogen peroxide cream or topical antibiotic
23
Q
What is staphylococcal scalded skin syndrome?
A
generalised form of impetigo causing a widespread, erythematous rash
24
Q
what bacteria usually causes staphylococcal scalded skin syndrome?
A
staph aureus
25
What is erysipelas?
infection of the upper layer of the dermis and lymphatics
26
What does erysipelas look like?
erythematous lesion with clear demarcation
27
What is cellulitis?
infection of the deep dermis and subcut tissue
28
What does cellulitis look like?
Fast-spreading erythematous lesion with indistinct margins
29
what is the visual difference between cellulitis and erysipelas
erysipelas has clear demarcation of the lesion whereas cellulitis has indistinct borders
30
What should be given to treat cellulitis or erysipelas
anitbiotics
31
What is a skin abscess?
A walled-off infection with a collection of pus
32
What is atopic dermatitis?
eczema
33
What is eczema
a pruritic rash on flexor surfaces and exposed skin (eg face) caused by type I hypersensitivity reaction
34
Where would areas of eczema be found?
```
flexor surfaces (eg backs of knees, insides of elbows)
exposed skin (eg face and hands)
```
35
What is the treatment for eczema
emollients and moisturisers
| - topical corticosteroids can be used in acute flare ups
36
why are topical corticosteroids not suitable for long term use in eczema
they will cause skin atrophy
37
What are the three most common types of leg ulcers?
* venous ulcers
* arterial ulcers
* neuropathic ulcers
38
What type of leg ulcer is common in diabetes
arterial/neuropathic
39
What other types of leg ulcers apart from venous, arterial, and neuropathic ulcers, might you get
* pyoderma gangrenosum
* infectious cause (eg syphillus)
* malignant cause
40
What causes venous ulcers
venous valve incompetence causes blood stasis which increased blood pressure in the veins, leading to compression and ischaemia which causes tissue death
41
What kind of ulcers might you see in venous ulcers? where?
shallow, mildly painful ulcers
| found in the gaiter area
42
What is the gaiter area? what type of leg ulcers are commonly found there?
the area on the leg above the medial maleolus
| venous leg ulcers
43
What other findings might you find on inspection of the leg in venous ulceration
* varicose veins
* oedema
* brown discoloured skin
44
What are some risk factors for venous ulceration
* old age
* female
* pregnant
* obese
45
What treatment is used for venous ulceration
* compression bandages
* elevation
* possibly surgery
46
What causes arterial leg ulcers
peripheral vascular disease causes ischaemia in the leg which causes tissue death, resulting in ulceration. Usually ulcers result from small wounds that don't heal
47
What other signs might point towards arterial ulceration?
* cold limb
| * pulseless
48
Where are arterial ulcers commonly found?
On bony prominences eg the heel or the toe
49
What is treatment for arterial ulcers
Surgical revasculisation
50
What is neuropathic ulcer?
peripheral neuropathy causing loss of sensation which may result in ulcers on pressure points (eg the sole of the feet) going unnoticed and presenting late
51
What is the main cause of neuropathic ulcer>
diabetes mellitus
52
Describe what the ulcers usually look like in neuropathic ulcer
What is a distinctive characteristic
They are "punched out" and painless
53
What is pyoderma gangrenosum
an inflammatory and ulcerating skin condition usually caused by an underlying condition eg inflammatory bowel disease/arthritis
It is a diagnosis of exclusion
54
What is psoriasis
an inflammatory condition of the skin which causes itchy or painful plaque formation with 'silvery scales' on extensor surfaces and around scalp and trunk
55
Where are classic locations for psoriatic plaques?
* scalp
* trunk
* buttocks
* extensor surfaces (eg elbows)
56
What is koebner's phenomenon?
psoriatic plaque at sign of trauma
57
What is Auspitz's sign?
removal of the top of a psoriatic scale will reveal pinpoint bleeding
58
What signs might be noticed on the hands in psoriasis?
* plaques
* joint swelling
* nail pitting
59
What other condition can occur with psoriasis
psoriatic arthritis
60
What is first line treatment for psoriasis?
emollients and topical corticosteroids
61
What is second- and third- line treatment for psoriasis
* systemic biologics
* systemic non-biologics
* phototherapy
62
What systemic non- biologics can be given for psoriasis
* methotrexate
* cyclosporine
* Acitretin
63
What systemic biologics can be given
TNFa-inhibitors:
* adalimumab
* etanercept
* infliximab
anti-interleukin agents
* brodalumab
64
What is found on exam of acne vulgaris?
* erythematous papules, pustules, cysts and nodules commonly on the trunk and face, sometimes with scarring
65
What happens to the skin in acne vulgaris?
* plug formation of dead keratinocytes
* sebum overproduction
* bacterial colonisation
66
What is a whitehead
a closed comedone
67
What is a blackhead
an open comedone
68
What factors can worsen acne?
* androgen (eg puberty)
| * products that block pores
69
How do androgens worsen acne
Increase sebum production
70
What conditions are associated with acne vulgaris
* PCOS
* cushing's
* congenital adrenal hyperplasia
71
How is acne treated?
* topical retinoids
* topical antibiotics
* oral antibiotics
* isotretinoin
72
What age of patient is most common for acne rosacea
adults
73
What might be found on exam in rosacea?
* erythematous face
* blushing
* telangiectasis
* papules and pustules
74
What non-skin findings might be found in rosacea
ocular involvement
* conjunctivitis
* telangiectasis on eyelids
75
How common is ocular involvement in acne rosacea
>50%
76
What might exacerbate rosacea
* spicy foods
* alcohol
* heat
* sun exposure
77
Give a differential for acne rosacea
lupus erythematosus
78
What lifestyle advice can be given for rosacea
* avoid spicy food/ alcohol
| * use sunblock and avoid sun exposure
79
What treatment can be given for rosacea
* topical brimodine (an alpha-adrenergic agonist)
80
What are small blisters called
vesicles
81
what are large blisters called
bullae
82
give some examples of generalised blistering skin disorders that do not cause systemic symptoms
* pemphigoid
* bullous impetigo
* dermatitis herpetiformis
83
What is pemphigoid
And autoimmune blistering skin reaction
84
give some examples of generalised blistering skin disorders that do cause systemic symptoms
* disseminated herpes zoster (chickenpox)
* SJS + TEN
* scalded skin syndrome
* paraneoplastic pemphigoid
85
Give some examples of localised blistering skin disorders
* contact dermatitis
* erythema multiforme
* herpes zoster
* friction blisters
* HSV
86
What is urticaria also known as
hives
87
What duration is acute uritcaria
<6 weeks
88
Describe urticaria in appearance
red, raised, itchy rash
89
What duration is chronic urticaria
>6 weeks
90
What are the types of chronic urticaria
* spontaneous urticaria
* autoimmune urticaria
* inducible urticaria
91
describe inducible urticaria
rash can be induced by physical stimuli
92
What treatment can be given for acute urticaria
antihistamine or topical corticosteroids
93
What usually causes acute urticaria?
allergic reaction
94
What are the three main types of skin cancer?
* squamous cell carcinoma
* basal cell carcinoma
* melanoma
95
What cells cause basal cell carcinoma
cells in the stratum basale
96
Describe the appearance of basal cell carcinoma
Typically a pearly nodule with a raised, red, edge
| Can be plaque-like, may be shiny, may not be raised
97
What is the treatment for basal cell carcinoma
excision
98
What is squamous cell carcinoma
cancer of the squamous cells of the epidermis
99
Describe the appearance of squamous cell carcinoma
A hard, scaly dome like lesion that is often eroded at the centre
100
How is squamous cell carcinoma easily differentiated from a wart
typically larger and may be painful
101
What is the precursor to squamous cell carcinoma called
actinic keratosis
102
What is the name for squamous cell carcinoma in situ
Bowen's disease
103
What is the treatment for squamous cell carcinoma
excision
104
What should you look for in examination of a mole?
```
Asymmetry
Borders
Colours
Diameter
Evolution/enlargement
```
105
What about a mole's borders would concern you on examination?
Irregular borders
106
What colouration of a mole would concern you?
multiple colours
107
What is alopecia areata?
A chronic autoimmune non-scarring hair loss disorder
108
What does presentation in alopecia areata look like?
discreet circular patches of hairloss without pain or itchiniess
109
What other non-hair signs might be found in alopecia areata
nail bedd pitting
110
What conditions are associated with alopecia areata
other autoimmune conditions
111
What might happen to the disorder in alopecia areata?
hair may grow back or may proceed to alopecia totalis
112
what is erythema nodosum
painful erythematous nodular lesions on the anterior shins
113
What might cause erythema nodosum
* sarcoidosis
* drugs
* bacterial infection
114
What is erythema marginatum?
pink coalescent rings which come and go on the trunk
115
what is erythema marginatum associated with
rheumatic fever
116
What is erythema chronicum migrans also described as
bulls eye mark
117
what is erythema chronicum migrans a sign of?
Lyme disease
118
what are common associated with vitiligo?
organ specific autoimmune conditions
119
What is pyoderma gangrenosum
nodule or pustule ulceration
120
what is pyroderma gangrenosum associated with
* UC + crohn's
| * RA
121
What skin manifestations might you find in crohn's disease
* perianal/vulval ulcers
* pyoderma gangrenosum
* erythema nodosum
122
What skin manifestation might you see of coeliac's
dermatitis herpetiformis
| a very itchy erythematous rash
123
Describe pretibial myxoedema
red oedematous discolouration of the shin
124
What condition causes pretibial myxoedema
hyperparathyroidism
125
what is acanthosis nigricans
pigmented rough skin in axillae or groin
126
what is acanthosis nigricans associated with
stomach cancer
127
what might cause cutaneous vasculitis?
* drugs
* serum sickness
* infection
128
What might patients present with in cutaneous vasculitis
* purpura
* petechiae
* urticaria
* shallow ulcers
* nodules
