dermatology (brief) Flashcards
what is erythroderma?
intense and usually widespread reddening of the skin due to inflammatory skin disease
- often precedes or is associated with exfoliation (skin peeling off in scales or layers), when it may also be known as exfoliative dermatitis (ED)
- most patients have underlying systemic +/or skin condition (eg eczema or psoriasis)
- Idiopathic erythroderma is sometimes called the ‘red man syndrome’
nb can also be side effect of drugs
what is toxic epidermal necrolysis?
on a spectrum with stevens-johnsons syndrome (TEN is more severe that SJS)
almost always as a allergic response to a drug
- more common in people with HIV
- flu-like prodrome
- red, necrosisng skin with detachment of epidermal layer
- also affects mucosal membranes
nb 20-30% mortality - most patients die of sepsis from secondary infection due to breaks in skin
stop offending treatment and supportive treatment
generalised pustular psoriasis:
- old name?
- possible triggers? 4
- presentation?
- treatment?
impetigo herpetiformis (nb no longer favoured as nothing to do with either HSV or impetigo)
- genetic defect
- sudden withdrawal of oral/IM steroids
- some drugs
- infection
- initially dry, red, tender skin
- > small pustules appear
- > pustules coalexce to form ‘lakes of pus’
- > these dry out to form smooth surface on which more pustules may then form
- get systemic symptoms indicative of inflammation
nb distinct/slightly different mechanism to psoriasis however 10% of people who get it also have psoriasis
- admission to hospital to stabilise fluid loss etc
- topical + oral steroids
- other drugs such as methotrexate
- Abx for superimposed infection
acanthosis nigricans:
- presentation?
- causes? 5
- treatment?
brown/black, poorly defined, velvety hyperpigmentation + thickening
- norm found in body folds, esp armpit + neck
- obesity
- over-production of hormones (eg cushings or hyperinsulinaemia)
- idiopathic
- hereditary
- underlying malignancy (most commonly a GI tumour)
nb underlying malignancy is rare, norm due to benign cause
- treat underlying cause
nicrobiosis lipoidica
- what is it/appearance?
- who’s most likely to get it?
- treatment?
a rare granulomatous skin condition that presents as red/brown patches on the front of shins
nb often painless but at risk of secondary infection
diabetics (though can occur in non-diabetics)
topical steroid cream is first line
(other treatments after that)
nb pathophysiology is not wel understood
Granuloma annulare
- looks like?
- caused by?
- mainly affects?
- prognosis?
a rash that often looks like a ring of small pink, purple or skin-coloured bumps
Lots of different types/appearances
A delayed hypersensitivity reaction
Children/young adults
Often goes away after a few weeks by itself, steroid cream may help
Nb can sometimes be associated w DM
Erythema nodosum
- what is it?
- how does it present?
- cause?
- treatment?
A type of inflammatory condition of subcutaneous fat
Red lumps appear on body (mainly on SHINS/legs)
Probably a hypersensitivity reaction (either to drugs or infections or other autoimmune conditions)
Treat underlying cause and wear tight bandages/compression stockings
SLE:
- what is it?
- type of antibodies present?
- 3 most common symptoms?
- 3 other common symptoms?
- organs commonly affected? 3
- non-pharm management? 2
Autoimmune condition affecting many parts of the body
Anti-nuclear antibodies
- joint pain
- skin rashes (esp butterfly rash)
- fatigue
Nb rashes on sunlight sensitive areas
- fever
- weight loss
- lymphadenopathy
- kidneys (inflammation -> CKD)
- brain (migraines, depression, anxiety)
- heart (pericarditis)
- lungs (pleuritis)
- stop smoking
- stay out of sun
Discoid lupus
- features?
- what percentage develop SLE?
- rash and thickening of skin on sun exposed skin (often butterfly rash)
- patches of baldness
- 5% will develop SLE
morphoea:
- what is it?
- AKA?
- cause?
- morphology?
- symptoms?
- treatment?
- patches of inflammation + fibrosis of the skin due to increased collagen deposition
- aka local scleroderma
- autoimmune (certain HLA types)
- often triggered by something external (insect bites, repeated friction, extreme exercise)
nb lots of subtypes
- inflam phase (pink/purple/bruise-like areas)
- sclerosis (skin is hard/thick/pale)
- dyspigmentation + atrophy (often hyper pigmentation, atrophy to deeper tissues can occur)
- itch +/or pain
- hair loss (if on scalp etc)
- pain/tingling + mild weakness
nb can get symptoms from deeper skin involvement too
autoimmune
- steroid creams
- phototherapy
- systemic drugs like methotrexate, steroids etc
lichen sclerosis:
- what is it?
- areas of body affected?
- who’s most at risk?
- morphology?
- symptoms?
- complications?
- treatment?
chronic (autoimmune) skin condition
- genital areas
- perianal areas
nb can rarely affect other areas too
- women
- over 50 (often post-menopausal)
- PMH or FH of autoimmune
in women: affects labia minor +/- majora
in men: often affects glans of penis
- bruises, blood blister + ulcers appear from scratching/minimal friction
- urine can sting + irritate
- painful sex
- discomfort or bleeding on bowel movement
increased risk of vulval, penile or anal cancer
- emollients
- avoid friction to area
- topical steroids
can use systemic if not responding
surgery if cancerous
Systemic scleroderma
- what is it?
- who most at risk?
- signs and symptoms?
- types of treatment?
Autoimmune condition attacking connective tissue
Women 30-50
- raynauds phenomenon
- thick skin over hands, feet + face
- heartburn
- problems swallowing (dysphagia)
- weight loss
- fatigue
- joint pain/stiffness
Problems conceiving/repeated miscarriages
- medication to improve circulation
- medicines that reduce the activity of the immune system and slow the progression of the condition
- steroid medication to relieve joint and muscle problems
- moisturising affected areas of skin to help keep it supple and relieve itchiness
- various medicines to control other symptoms (such as pain, heartburn and high blood pressure)
dermatomyositis:
- what is it?
- who does it affect?
- symptoms?
- tests?
- treatment?
inflammation of voluntary muscles in association with a rash
- rare acquired inflammatory muscle disease
- women (2:1)
- most common 50-70 ages
- symptomless, itchy or burning rash
- affects sun-exposed areas
- rash almost always occurs before onset of muscle weakness
- get proximal muscle weakness and other variations of rash
- ANA and histology of rash (looks similar to SLE)
- testing for cancers
25% of people have an underlying malignancy (norm ovarian, breast or lung)
- immune suppressants (steroids, cytotoxic, biologics)
- treat cancer (if relevant)
vitiligo:
- what is it?
- risk factors? 5
- signs/symptoms?
- tests?
- treatment?
acquired depigmenting of skin, autoimmune reaction to melanocytes
- can be particularly cosmetically disabling, esp in people with dark skin
- South Indian ethnicities
- average onset 15-30 years
- FH of vitiligo
- PMH or FH of autoimmune conditions
- PMH of haematological conditions/cancers
nb male + female affected equally
hypo pigmentation well defined areas:
- sun-exposed areas
- body folds
- sites of injury
- genitalia + nipples
nb can mimic hypopigmented malignant melanoma…
extension of vitiligo over a few months then skin regiments then may relapse
- clinical diagnosis (see better under UV light)
- screen for other autoimmune conditions
- avoid sunlight (use high SPF suncream)
- use camouflage makeup
- use topical steroids
- maybe some new biologics??
cutaneous vasculitis:
- what is it?
- what can it be a sign of?
- what does it look like?
- treatment?
large group of disorders which involve inflamed blood vessels in the skin (varying sizes eg capiliritis, medium vessel vasculitis etc)
- in a minority of cases can be a sign of underlying systemic vasculitis
most are idiopathic and self-limiting
depends of size of vessel involved but:
- purpura
- petechiae
- etc
steroids and DMARDS (depending on severity)
