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Year 4 - Special Senses > Dermatology - Chronic Conditions > Flashcards

Dermatology - Chronic Conditions Flashcards

1
Q

Presentation of eczema.

A
  • itchy papules
  • dry, scaly patches
  • affects flexor aspects
  • lichenification
  • pitting of nails
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2
Q

Causes of eczema.

A
  • positive family history of atopy
  • genetic defect in skin barrier
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3
Q

Management of eczema.

General measures.

A
  • avoid known exacerbating agents
  • frequent emollients
  • bandages
  • soap substitutes
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4
Q

Management of eczema.

Topical therapies.

A

Topical steroids for active areas.

Topical immunomodulators (e.g. tacrolimus) for maintenance therapy (steroid-sparing).

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5
Q

Management of eczema.

Oral therapies.

A
  • antihistamines (symptomatic relief)
  • antibiotics (2° bacterial infection)
  • antivirals (eczema herpeticum)
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6
Q

Management of eczema.

Phototherapy and immunosuppressants.

A

Used in severe non-responsive cases.

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7
Q

Complications of eczema.

A
  • impetigo
  • molluscum contagiosum
  • viral warts
  • eczema herpeticum
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8
Q

What is eczema herpticum?

A

A severe skin infection in which eczema flares introduce breaks to the skin, by which HSV-1 can enter.

This results in a painful, blistering rash.

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9
Q

Management of eczema herpticum.

A

Emergency - admit to hospital for IV antivirals / antibiotics.

NB: do NOT use a steroid as this will make it worse.

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10
Q

Presentation of acne vulagris.

A

Inflammation of pilosebaceous follicle:
- open comedones
- closed comedones
- papules / pustules / nodules / cysts

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11
Q

Causes of acne vulagirs.

A
  • hormonal (androgens)
  • bacterial colonisation
  • abnormal follicular keratinization
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12
Q

Management of acne vulgaris.

A
  1. Topical benzoyl peroxide (reduce inflammation)
  2. Topical retinoids (slow production of sebum)
  3. Topical antibiotics (e.g. clindamycin)
  4. Oral antibiotics (e.g. lymecycline)
  5. oral contraceptive pill (female)
  6. Oral teinoids
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13
Q

Considerations of retinoid prescription.

A
  • strongly teratogenic (contraception required)
  • photosensitivity of skin to sunlight
  • suicidal ideation (screen for mental health issues)
  • Stevens-Johnson syndrome / TEN
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14
Q

Complications of acne vulgaris.

A
  • post-inflammatory hyperpigmentation
  • scarring
  • deformity
  • psychological and social effects
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15
Q

What is psoriasis?

A

A chronic inflammatory skin disease due to hyperproliferation of keratinocytes, and inflammatory cell infiltration.

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16
Q

Presentation of psoriasis.

A
  • well-dermacated scaly plaques
  • itching / burning / pain
  • extensor surfaces affected
  • nail changes
  • psoriatic arthropathy
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17
Q

Nail changes associated with psoriasis.

A
  • pitting
  • oncholysis
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18
Q

Köbner phenomenon.

A

The appearance of new skin lesions of a pre-existing dermatosis, upon areas of cutaneous injury in otherwise healthy skin.

Occurs in:
- psoriasis
- vitiligo
- lichen planus

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19
Q

Complications of psoriasis.

A
  • erythroderma
  • psychological and social effects
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20
Q

Management of psoriasis.

General measures.

A
  • avoid known precipitating factors
  • emollients to reduce scales
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21
Q

Management of psoriasis.

Topical therapies.

A

For localised and mild psoriasis:
- vitamin D analogues
- topical corticosteroids
- topical retinoids

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22
Q

Management of psoriasis.

Phototherapy.

A

For extensive disease.

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23
Q

Management of psoriasis.

Oral therapies.

A

Extensive or severe disease:
- methotrexate
- retinoids
- biologics

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24
Q

What is bullous pemphigoid?

A

A blistering skin disorder affecting the elderly.

Autoantibodies against antigens between the epidermis and dermis, causing a sub-epidermal split in the skin.

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25
Q

Presentation of bullous pemphigoid.

A
  • tense, fluid-filled blisters
  • erythematous skin
  • itching
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26
Q

Management of bullous pemphigoid.

A

General measures - wound dressings, monitor for signs of infection.

Topical steroids.

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27
Q

What is pemphigus vulgaris?

A

A blistering skin disorder affecting the middle aged.

Autoantibodies against antigens within teh epidermis cause an intra-epidermal split in the skin.

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28
Q

Presentation of pemphigus vulgaris.

A
  • painful lesions
  • mucosal involvement
  • flaccid, easily ruptured blisters
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29
Q

Management of pemphigus vulgaris.

A

General measures - wound dressings, monitor for signs of infection, oral hygiene.

Oral therapies - high dose steroids and immunosuppressive agents (e.g. methotrexate).

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30
Q

What is vitiligo?

A

An autoimmune disorder, whereby autoantibodies cause destruction of melanocytes.

This results in hypopigmentation of the skin.

31
Q

Presentation of vitiligo.

A
  • presentation at any age
  • symmetrical depigmentation
  • Köbner phenomenon
32
Q

Management of vitiligo.

A
  • minimise skin injury (Köbner phenomenon)
  • topical treatments (e.g. steroids, calcineurin inhibitors)
  • phototherapy
  • oral immunosuppressants (e.g. methotrexate)
33
Q

What is melasma?

A

Overproduction of melanin by melanocytes.

34
Q

Triggers of melasma.

A

Genetic predisposition plus:
- sun exposure
- hormonal changes
- contraceptive pills

35
Q

Presentation of melasma.

A

Symmetrical:
- brown macules
- irregular borders

36
Q

Management of melasma.

A
  • lifelong sun protection
  • discontinuation of hormonal contraceptive pills
  • cosmetic camouflage
  • vitamin C
37
Q

What is lichen lpanus?

A

A chronic inflammatory condition affecting the skin and mucosal surfaces.

Result of autoimmune destruction of keratinocytes.

38
Q

Risk factors for lichen planus.

A
  • genetic predisposition
  • physical / emotional stress
  • ## contact allergy
39
Q

Symptoms of cutaneous lichen planus.

A
  • itching
  • papules
  • clusters
  • common on wrist, lower back and ankles
40
Q

Symptoms of oral lichen planus.

A
  • painless white streaks
  • painful erosions and ulcers
  • diffuse redness of gums
  • inflammation of gums
41
Q

Complications of lichen planus.

A
  • progression to SCC
42
Q

How is lichen planus diagnosed?

A

Clinical diagnosis - skin biopsy to confirm the diagnosis and look for cancer.

43
Q

General management of lichen planus.

A
  • avoid soaps
  • use emollients regularly
  • sedating antihistamines for nocturnal itch
44
Q

Medical management of lichen planus.

A
  • topical corticosteroids
  • topical retinoids
45
Q

What is rosacea?

A

A chronic inflammatory skin condition, predominantly affecting the convexities of the centrofacial region.

46
Q

Risk factors for rosacea.

A
  • genetics
  • smoking
  • alcohol
  • emotional stress
47
Q

Diagnostic clinical features of rosacea.

A

Phymatous changes - facial skin thickening.

Persistent erythema.

48
Q

Symptoms of rosacea.

A
  • flushing / transient erythema
  • telangiectasia
  • ocular manifestations
  • burning sensation
  • stinging sensation
  • oedema
49
Q

What is pityriasis rosea?

A

A generalised, self-limiting rash that has an unknown cause.

May be caused by HHV-6 or HHV-7.

50
Q

Presentation of pityriasis rosea.

A

Herald patch

Other symptoms:
- generalised itch
- low grade pyrexia
- headache
- lethargy

51
Q

Disease course - pityriasis rosea.

A

Rash resolves without treatment within 3 months.

It can leave discolouration of the skin where the lesions were, but this will resolve within a few months.

52
Q

Management of pityriasis rosea.

A

No treatment for rash - resolves spontaneously.

Patient education and reassurance is all that is required - it is not contagious.

Emollients, topical steroids or sedating antihistamines can be used to treat itching.

53
Q

Indications of emollients.

A

Rehydrate skin and re-establish the surface lipid layer.

Useful for dry, scaling conditions and as soap substitutes.

54
Q

Side effects of emollients.

A

Reactions may be irritant or allergic (e.g. due to preservatives or perfumes in creams).

55
Q

Examples of topical steroids:

a) mildly potent

b) moderately potent

c) potent

d) very potent

A

a) hydrocortisone

b) clobetasone (Eumovate)

c) betamethasone (Betnovate)

d) Clobetasol (Dermovate)

56
Q

Indications of topical steroids.

A

Anti-inflammatory and anti-proliferative effects.

Useful for allergic and immune reactions, inflammatory skin conditions, blistering disorders, connective tissue diseases and vasculitis.

57
Q

Side effects of topical corticosteroids.

A
  • skin atrophy
  • telangiectasia
  • striae
  • skin infections
  • acne
  • perioral dermatitis
  • allergic contact dermatitis
58
Q

Side effects of oral corticosteroids.

A
  • Cushing’s syndrome
  • immunosuppression
  • hypertension
  • diabetes
  • osteoporosis
  • cataracts
  • psychosis
  • peptic ulceration
59
Q

Indications of aciclovir.

A

Viral infections due to herpes simplex or herpes zoster virus.

60
Q

Side effects of oral aciclovir.

A
  • GI upset
  • raised liver enzymes
  • neurological reactions (reversible)
  • haematological disorders
61
Q

Examples of antihistamines:

a) nonsedative

b) sedative

A

a) cetirizine, loratadine

b) chlorpheniramine; hydroxyzine

62
Q

Indications of oral anithistamines.

A

Block histamine receptors to produce an anti-pruritic effect.

Useful for type 1 hypersensitivity reactions and eczema.

63
Q

Side effects of antihistamines.

A

Antimuscarinic effects:
- dry mouth
- blurred vision
- urinary retention
- constipation

Sedative antihistamines can cause sedation - caution driving and working with heavy machinery.

64
Q

Examples of oral retinoids.

A
  • isotretinoin
  • acitretin
65
Q

Indications of oral retinoids.

A

Used last line for:
- acne vulgaris
- psoriasis
- disorders of keratinisation

66
Q

Side effects of oral retinoids.

A
  • dry skin, lips and eyes
  • disordered liver function
  • hypercholesterolaemia
  • hypertrigylceridaemia
  • myalgia / arthralgia
  • depression / suicidal ideation
  • teratogenic
67
Q

Contraception considerations for

a) isotretinoin

b) acitretin

A

Both are teratogenic therefore double contraception used.

a) 1 month before, during, and 1 month after isotretinoin

b) 1 month before, during, and 2 years after acitretin

68
Q

Examples of biological therapy.

A
  • infliximab
  • etanercept
  • interluekins
69
Q

Indications of biological therapy.

A

Usually last line in psoriasis and atopic dermatitis.

70
Q

Local side effects of biological therapy.

A

Delivered via injection:
- redness
- swelling
- bruising

71
Q

Systemic side effects of biological therapy.

A
  • allergic reactions
  • antibody formation
  • flu-like symptoms
  • hepatitis
  • demyelinating disease
  • heart failure
  • rare reports of lymphoma
72
Q

Patient education for emollients.

A
  • apply liberally and regularly.
73
Q

Patient education for topical corticosteroids.

A
  • apply thinly and only for short-term use (1-2 weeks)
  • apply only hydrocortisone to face, neck and flexures
  • fingertip unit

Year 4 - Special Senses (17 decks)

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