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Year 4 > dermatology > Flashcards

dermatology Flashcards

1
Q

def eczema

A

pattern of inflammation on the skin

inflamed, dry, occasionally scaly and vesicular skin rash

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2
Q

clinical features of eczema

A

acute eruption: erythema, vesicular/bullous lesions, exudates

secondary bacterial infection: above + golden crusting

chronicity of inflammation: increased scaling, xerosis (dryness), lichenification

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3
Q

pathophysiology of atopic eczema

A 
mutation of filaggrin gene 
breakdown of skin barrier function 
inflammatory cascade (Th2 cell)
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4
Q

endogenous type of eczema

A 
seborrhoea dermatitis 
varicose eczema 
discoid eczma 
atopic eczema 
pompholyx
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5
Q

exogenous types of eczema

A

irritant eczema
allergic eczema
photodermatitis

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6
Q

secondary changes in eczema

A

lichen simplex
asteatotic
pompholyx
infection

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7
Q

def pompholyx

A

relapsing-remitting vesicular eruption affecting palms and soles
associated with increased sweating

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8
Q

def eczema herpeticum

A

rare but severe disseminated infection with herpes simplex

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9
Q

presentation of eczema herpeticum

A 
fever 
grouped vesicles 
eroded, punched out lesions 
rapidly worsening, painful eczema 
usually on neck/face
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10
Q

diagnostic critetria for atopic eczema in children

A
  • child has itchy skin condition AND 3 of the following
    • visible flexural dermatitis (asian and black children may have it on extensor surfaces)
    • personal history of flexural dermititis
    • personal history of dry skin in th last 12/12
    • personal history of asthma or allergic rhinitis (or history of first degreee relative)
    • onset of signs and symptoms under the age of 2 y
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11
Q

treatment of atopic eczema

A
  • education (recognising flare ups)
  • emollient therapy (oitments and creams, soap substitutes)
  • topical steroids (for flare ups)
  • antibiotics for infection

step up from topical treatment:

  • phototherapy
  • azathioprine
  • ciclosporin
  • biologics
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12
Q

epidemiology of psoriasis

A
  • men and women are equally affected
  • presents in mid 20s typically
  • genetic component
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13
Q

triggers of psoriasis

A
  • medications (antimalarials, NSAIDs, beta blockers, lithium, terbinafine)
  • alcohol
  • psychological stress
  • infection
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14
Q

pathogenesis of psoriasis

A
  • epidermal hyperplasia (thickening and scaling): keratonocyte function dysregulated: increase in prod of keratonocytes and cell transit time in epidermis
  • angiogenesis: auspitz sign
  • T cell infiltration in skin
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15
Q

what is Auspitz sign

A

keratonocytes that are poorly adherent and easily scraped off revealing underlying dilated blood vessels

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16
Q

presentation of psoriasis

A
  • plaques on elbows, knees, scalp and trunk (may improved with sun, only midly itchy)
  • scaling
  • erythema
  • pustules (palmo-plantar pustulosis and deep seated yellowish sterile pustules)
  • Koebner’s phenomenon
  • nails: pitting, onycholysis, subungal hyperkeratosis, oil spots, beau’s lines, splinter haemorrhage
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17
Q

what is Koebner’s phenomenon

A

psoriasis in scares and areas of minor skin trauma

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18
Q

types of psoriasis

A
  • chronic stable plaque psoriasis
  • guttate psoriasis
  • flexural psoriasis
  • unstable psoriasis
  • pustular psoriaisis
  • psoriasis arthropathy
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19
Q

chronic stable plaque psoriasis features

A

persistent symmetrical plaques

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20
Q

gutatte psoriasis features

A
  • most seen in children
  • can be triggered by sore throat
  • small, numerous patches < 1 cm across
  • must refer to dermatology if covers > 50% of body surface area
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21
Q

flexural psoriasis features

A
  • affects genitalia and axillae

- erythematous, slightly shiny appearance

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22
Q

unstable psoriasis features

A
  • plaques lose clear cut edges, enlarged and join up

- erythrodermic psoriasis: erythema over 90% of body (+ if unwell, admit for treatment)

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23
Q

pustular psoriasis deatures

A

present either as

  • palmo-plantar pustulosis (red areas contain mix of new yellow pustules and older brown dried up pustules)
  • widespread pstular psoriasis (needs urgent hospital admission)
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24
Q

psoriatic arthropathy features

A
  • affects distal interphalangeals
  • symmetrical polyarthritiss
  • assymetrical oligoarthitis
  • arthritis mutilans
  • spondyloarthropathy
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25
Q

investigations for psoriasis

A
  • determine severity of disease and response to treatment
  • history
  • examination
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26
Q

treatment of sporiasis

A
  • education
  • emolients
  • topical steroids
  • vit D analogues
  • phototherapy (UVB or PUVA, 2-3 times a week for 10/52)
  • systemic (if failed phototherapy): ciclosporin, methotrexate, acitritin, fumaric acids, apremilast
  • biologics (for PASI and DLQI > 10): TNFi, IL12/IL13i, IL17i
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27
Q

what do you use to determine severity of disease in psoriasis

A
  • PASI (psoriasis area severity index): obj measure of disease severity
  • DLQI (dermatology of life index): impact of disease on patient’s life
  • PEST (psoriasis epidemiology screening tool: screen for psoriasis arthritis
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28
Q

complications of psoriasis

A

MI
T2DM
hyperlipidaemia
metabolic syndrome

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29
Q

acne vulgaris def

A

expansion and blockage of hair follicles and sebaceous gland and inflammation

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30
Q

aetiology of acne vulgaris

A
  • familial tendency
  • endogenous/exogenous androgenic hormones
  • acne bacteria
  • innate immune activation w/ inflam mediators
  • distention and occlusion of hair follicles
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31
Q

causes of flares in acne vulgaris

A
  • PCOS
  • drugs (steroids, hormones, anticonvulsants, epidermal growth factor receptor inhibitors)
  • application of occlusive cosmetics
  • high environmental humidity
  • diet high in dairy and glycaemic foods
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32
Q

acne vulgaris clinical features

A
  • open and closed uninflamed comedomes (blackheads and whiteheads)
  • inflammed papules and pustules
  • nodules and pseudocysts
  • post inflammatory erythematous or pigmented macules and scars
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33
Q

acne vulgaris pathophysiology

A
  • early comedome: accumulation of epithelial cells and keratin, plugginf
  • late comedone; accumulation of shed keratin and sebum
  • inflammatory papule/pustule: propionbacterium acnes proliferation and mild inflammation
  • nodule/cyst: marked inflammation, sscarring
  • androgens: hyperkeratinisation, increase sebocyte differentiation and production
34
Q

severity grading in acne vulgaris

A
  • mild acne: total lesion count < 30
  • moderare acne: lesions: 30-125
  • severe: > 125
35
Q

differentials of acne vulgaris

A

acne rosacea
acne congloblata
pyoderma faciale
acne exorciee

36
Q

treatment of acne vulgaris

A 
LIFESTYLE 
- avoid humidity 
low glycaemic, dairy and protein diets 
- stop smoking 
- avoid cosmetics and abraasive skin treatment 
- exposure to sunlight

MILD ACNE

  • topical antiacne agents
  • low dose COC
  • antiseptic or keratolytic washes (contains salicylic acid) ie benzyol peroxide
  • light/laser therapy

MODERATE ACNE:

  • as for mild +
  • tetracycline daily for 6m
  • antiandrogen therapy
  • isotretinoin (if failed response to topical retinoid and oral antibiotics for 3m)

SEVERE ACNE

  • referral to dermatologist
  • oral antibiotics
  • oral isotretinoin
37
Q

ACNE types of drugs that inhibit sebaceous gland function

A

anti androgens
oestrogens
isotretinion

38
Q

ACNE drugs that normalise pattern of follicular keratinisation

A

topical retinoids

39
Q

ACNE drugs with anti-inflammatory effects

A

anibiotics

corticosteroids

40
Q

ACNE drugs with antibacterial effects

A

antibiotics
benzyol peroxide
retinoids

41
Q

acne conglobata/fulminans

A
  • severe form of acne
  • more common in boys and in tropical climates
  • extensive, nodulocystic acne and abscess formation affecting trunk, face and limbs
42
Q

presentation of rosacea

A
  • facial flushing and persistent eryhtema (exacerbated by heat, excercise, hot or food/drinks, emotion, alcohol and sunlight)
  • telangiectasia (causing permanent facial eryjthema)
  • inflammatory papules
  • pustules
  • absence of comedomes
  • oedema
  • can be on cheek or nose
  • chronic (coarse in texture, rhinophyma)
  • associated symptoms: conjunctivitis, blepharitis, eyelid oedema
43
Q

treatment of rosacea

A

avoid exacerbators

topical treatment:

  • water based emolients
  • metronidazole gel/cream
  • ivermectin 1% cream
  • azelaic acid
  • tacrolimus cream

Systemic treatments:

  • tetracycline antibiotics
  • low dose isotretinoin
44
Q

differentials of rosacea

A
  • acne (wider distribution, improvement with sunlight)
  • seborrhoeic eczema (no pustules, eczematous changes present, scalp flaking)
  • SLE (light sensitivity, erythema, scarring, no pustules)
  • perioral dermatitis (pustules and erythema around chin, precipitated by potent topical steroids and premenstrual exacerbation)
45
Q

def actinic keratoses

A

pre cancerous area of thick, scaly or crusty skin

46
Q

presentation of actinic keratoses

A
  • on face, dorsal hands, distal limbs, bald scalp (exposed skin)
  • Hx of working outdoors or high intensity UV
  • rough areas of skin to raised keratotic lesion
  • irregular edge < 1cm
47
Q

management of actinic keratoses

A
  • removal
  • liquid nitrogen
  • topical treatment: (5FU cream, diclofenac, ingenol mebutate gel)
  • photodynamic therapy
  • observation
48
Q

risks of actinic keratoses

A
  • further actinic keratoses

- increase risk of SCC, BCC and melanoma

49
Q

what is the most common skin cancer

A

basal cell carcinoma

50
Q

risk facrtors for BCC

A
  • age
  • fair skin
  • high intensity UV exposure
  • radiation
  • immunosuppression
  • previous Hx of BCC or other skin cancers
  • Gorlin’s syndrome
51
Q

presentation of BCC

A
  • usually on sun exposed area
  • lesion starts as small papule and slowly grows
  • colour: clear to deeply pigmented
  • spontaneous bleeding or ulceration
  • rolled edges
52
Q

complications of BCC

A
  • reccurent BCC

- metastasis (rare)

53
Q

types of BCC

A
  • nodular lesions
  • superficial lesions
  • pigmented lesions
  • pigmented lesions
  • morphoeic or sclerosis lesions
54
Q

management of BCC

A
  • excision (Mohs surgery)
  • grapting
  • curettage and cautery
  • radiotherapy
  • cryotherapy
  • imiquimif 5%
55
Q

bad prognosis of BCC

A
  • lesions involving eyelid margins, ear and lips
  • perineural invasion on histology
  • recurrent lesion
  • lesions in immunosupressed patients
56
Q

def SCC

A

dysplastic proliferaton of abnormal keratinocytes

57
Q

risk factors for SCC

A
  • increasing age
  • fair skin
  • smoking
  • high intensity UV exposure
  • radiation
  • immunosuppression (HPV or renal transplant)
  • previous hx of SCC
  • xeroderma pigmentosum
  • will dvlp in any chronic wound or scar
58
Q

pathophysiology of SCC

A
  • de novo
  • pre existing skin lesion (actinic keratoses or bowens disease)
  • gene mutation (BCL2, RAS, p53)
  • alterations in intracellular signal transduction pathways
59
Q

investigations for BCC

A

biopsy

60
Q

presentation of SCC

A
  • high risk sites: lip, ear, hands/feet, genitalia
  • rapidly growing nodular lesions
  • painful
  • markerdly keratotic
  • surface changes (crusting, ulceration, formation of a cutaneous horn, may be verucuous)
61
Q

managament of SCC

A

prophylaxis:

  • education
  • UV protection

with lesion:

  • surgival excision + grafting
  • radiotherapy
62
Q

SCC worse prognosis if

A
  • immunosupression
  • lesions on lips or ear
  • tumours > 2cm in size
  • invasion > 4mm
  • perineural invasion
  • poorly differentiated
63
Q

NICE weighted 7 point checklist of pigmented lesion

A

Major features (scoring 2 points each):

  • change in size
  • irregular shape
  • irregular colour

Minor features (scoring 1 point each):

  • > 7 mm diameter
  • inflammation
  • oozinf
  • change in sensation

2WW referral if > 3

64
Q

worrying features of pigmented lesion: ABCDE approach

A 
Assymetry (Can be first sign of melanoma)
Border (irregular, blurred)
Colour (More than 3 colours)
Diameter (>6mm)
Evolution (Sudden onset/change)
65
Q

def melanocytic naevus

A

mole

66
Q

types of naevi, location and appearance

A
  • junctional: mel present in dermo-epidermal junction. Brown colour and flat
  • intradermal: mel found in dermis. skin coloured and raised
  • compound: mel found in dermo-epidermal junction and within dermis. Brown and raised
67
Q

risk factors for melanoma

A
  • age
  • fair, freckled skin, burns easily
  • large nb of moles
  • atypical moles
  • personal/FH of melanoma
  • UV radiation
  • immunocompromised
  • inflam conditions (IBD)
  • obesity
68
Q

pathophysiology of melanoma

A

50% arise from pre-existing moles

50% de novo

69
Q

what is development of melanocyte into melanoma

A 
melanocyte 
benign mole 
atypical mole 
melanoma in situ 
radical growth phase melanoma 
vertical growth phase melanoma
70
Q

types of melanoma

A
  • superfical spreading melanoma
  • nodular melanomas
  • lentigo maligna melanomas
  • acral lentigious melanoma
71
Q

presentation of melanoma

A
  • existing/new mole changing rapidly over periods of weeks to months
  • colour: brown, blacks, grays and red
  • diametre: > 7mm or ‘ugly duckling’
  • if mole inflammed or reddish edge, bleeding, oozing or crusting, starts feeling itch/pain
  • regression: pale around mole
72
Q

management of melanoma

A
  • excision of lesion with narrow margin of normal skin (do not need bipsy, must be done same day/Week)
  • BRAF inhibitors (if BRAF V600 mutation and stage 3-4)
73
Q

likely places of metastasis of melanoma

A 
nodal
lung/pleura
brain 
liver 
bone
74
Q

prognosis of melanoma

A
  • related to depth of invasion (Breslow thickness: distance in mm from granular layer in epidermis to deepest level of invasion in dermis)
  • nodular melanoma worse prognosis
75
Q

indications for 2WW for moles

A
  • a new mole growing quickly in a patient
  • a long standing mole which is changing in shape and colour
  • a mole which has >3 colours and lost its symmetry
  • any new nodule which is growing, and is pigmented or vascular in appearance
  • new pigmented line in a nail
  • something growing under a nail, especially if there is vascular tissue or pigment
76
Q

causes of widespread itch

A

neuro:

  • peripheral neuropathy
  • post herpatic neuropathy
  • MS

psychogenic:

  • parasitophobia
  • OCD
  • depression/anxiety

metabolic:
- hyperthyroidism
- CKD (secondary hyperparathyroidism, uraemic pruritis)
- diabtes

GI:
- cholestasis

Malignancy:

  • Hodgkin’s pruritis
  • myeloid and lymphatic leukaemia
  • solic malignant tumours (paraneoplastic manifestations)

haematological:

  • Polycythaemia rubra vera
  • myeloid dysplasia

infection:
- HIV
Hep C

drugs

77
Q

skin markers of internal malignancy

A
  • acanthosis nigricans: gastric adenoma
  • figurate erythema: bronchilal/oesophageal/breast carcinoma
  • pruritis: lymphoma
  • dermatomyositis: lung/breast/ovarian/testicular carcinomas
  • acquired ichthyosis: Hodgkin’s disease, sarcoma, lymphoma
78
Q

def seborrhoeic keratoses

A

benign epidermal skin lesion in older people

79
Q

features of seborrhoeic keratoses

A
  • large variation in colour from flesh to light brown/black
  • have a stuck on appearance
  • keratotic plugs on surface
80
Q

managemen,t of seborrhoeic keratoses

A
  • reassurance about benign nature

- option for removal

Year 4 (13 decks)

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