Dermatology conditions Flashcards
Eczema
Chronic, itchy, inflammatory skin condition that affects people of all ages, although presents more frequently in childhood
Eczema clinical features
Presence of an itch
Generalised dryness
Affects flexures of the limbs (back of knees, inner elbows)
Thickened (lichenified) skin from repeated scratching
Family/personal history of atopy
Eczema severity
Mild - areas of dry skin & infrequent itching
Moderate - areas of dry skin, frequent itchy & redness
Severe - widespread areas of dry skin, incessant itching & redness
Infected - eczema is weeping, crusted or there are pustules with fever or malaise
Eczema mx
Importance of skin care measures & avoidance of triggers
Mild eczema
- Emollients
- Mild potency topical corticosteroids
Moderate eczema
- Emollients
- Moderate potency topical corticosteroids
- Topical calcineurin inhibitors (tacrolimus or pimecrolimus)
- Bandages
Severe eczema
- Emollients
- Potent topical corticosteroids
- Topical calcineurin inhibitors (tacrolimus or pimecrolimus)
- Bandages
- Phototherapy
- Oral corticosteroids
Eczema referral
Uncertain diagnosis
Not controlled with current treatment
Recurrent secondary infection
High risk of complications
Eczema complications
Infection - eczema herpeticum, superficial fungal infections
Psychosocial problems
Acne vulgaris
Chronic inflammatory skin condition affecting mainly the face, back and chest
Characterised by blockage and inflammation of the pilosebaceous unit (hair follicle, hair shaft & sebaceous gland)
Non-inflamed lesions = comedones, inflammatory acne lesions = papules & pustules
Acne fulminans
Sudden severe inflammatory reaction that precipitates deep ulcerations & erosions, sometimes with systemic effects (fever, arthralgia & myalgia)
Acne vulgaris clinical features
Comedones - blackheads or whiteheads
Inflammatory lesions - papules, pustules, nodules or cysts
Scarring
Pigmentation
Seborrhoea (increased sebum production)
Acne vulgaris mx advice
Avoid over-cleaning the skin
Use a non-alkaline synthetic detergent cleansing product BD on acne-prone skin
Avoid oil-based products & remove make-up at the end of the day
Persistent picking or scratching of lesions can increase the risk of scarring
Treatments may irritate the skin, especially at the start of treatment
Mild to moderate acne mx
12 week course of one of the following first-line options:
- fixed combination of topical adapalene with topical benzoyl peroxide
- fixed combination of topical tretinoin with topical clindamycin
- fixed combination of topical benzoyl peroxide with topical clindamycin
Moderate to severe acne mx
12 week course of one of the following first-line options:
- fixed combination of topical adapalene with topical benzoyl peroxide to be applied once daily
- fixed combination of topical tretinoin with topical clindamycin to be applied once daily
- fixed combination of topical benzoyl peroxide with topical adapalene to be applied once daily, with oral lymecycline/doxycycline
- topical azelaic acid applied twice daily, with either oral lymecycline/doxycycline
COCPs in combination with topical agents can be considered as an alternative to systemic antibiotics (eg. Dianette)
Acne vulgaris referral
Urgently refer people with acne fulminans on the same day to the on-call hospital dermatology team
Mild to moderate acne that have no responded to two completed courses of treatment
Moderate to severe acne that has not responded to previous treatment that includes an oral antibiotic
Acne with scarring
Acne with persistent pigmentary changes
Acne vulgaris complications
Skin changes - scarring, hyperpigmentation, depigmentation
Psychosocial effects
Psoriasis
Systemic, immune-mediated, inflammatory skin disease with typically has a chronic relapsing-remitting course & may have nail and joint involvement
Psoriasis types
Chronic plaque psoriasis - most common form
Localised pustular psoriasis
Flexural psoriasis
Guttate psoriasis
Erythrodermic psoriasis - potentially life threatening medical emergency
Generalised pustular psoriasis
Nail psoriasis
Psoriasis clinical features
Extensor surfaces (elbows & knees), trunk, flexures, sacral & natal cleft, scalp & behind the ears & umbilicus
Size & shape of lesions - large plaques, usually a clear delineation between normal & affected skin
Silvery scale
Auspitz sign - pinpoint bleeding when adherent psoriatic scales are scraped away
Involvement of other areas - joint tenderness, nail changes
Psoriasis mx
Lifestyle advice - weight loss, smoking cessation & alcohol reduction
Management of associated stress, distress, anxiety and/or depression
Topical preparations - emollients, corticosteroids, vitamin D analogues, coal tar & short-contract dithranol
Specialist treatments - topical calcineurin inhibitors, phototherapy, systemic/biologic therapy
Psoriasis referral
Uncertain diagnosis
Psoriasis is extensive - > 10% of body surface affected
Resistant to topical drug treatments in primary care/treatments are not tolerated
Severe nail disease
Actinic keratosis
Precancerous scaly spot found on sun-damaged skin
May be considered an early form of cutaneous SCC
Actinic keratosis risk factors
Fair skin with a history of sunburn
History of long hours spent outdoors for work or recreation
Defective immune system
Actinic keratosis pathophysiology
Result of abnormal skin cell development due to DNA damage by short wavelength UVB
More likely to appear if the immune function is poor, due to ageing, recent sun exposure, predisposing disease or certain drugs
Actinic keratosis clinical features
Flat or thickened papule or plaque
White or yellow, scaly, warty or horny surface
Skin coloured, red or pigmented
Tender or asymptomatic
Site - sun-exposed areas
Actinic keratosis diagnosis
Clinical
Dermoscopy
Occasionally, biopsy → exclude SCC or if treatment fails
Actinic keratosis mx
Prevention of further risk - sun avoidance, sun cream
Fluorouracil cream - 2-3 week course
Topical diclofenac for mild cases
Removal by cryotherapy, curettage & cautery or excision
Actinic keratosis complications
Increased risk of developing cutaneous SCC
- patient > 10 actinic keratoses is thought to be about 10 to 15%
Bowen’s disease (intraepidermal SCC)
Malignant SCC cells are confined to the epidermis
Bowen’s disease risk factors
Sun exposure
Arsenic ingestion
Ionising radiation
HPV infection
Immune suppression due to disease (CLL) or medicines (eg. azathioprine, ciclosporin)
Bowen’s disease aetiology
Ultraviolet radiation - damages the skin cell nucleic acids, resulting in a mutant clone of the gene, p53 → uncontrolled growth of the skin cells
HPV
Bowen’s disease clinical features
Irregular scaly plaques
Often orange-red colour but may also be brown
Most often on sun-exposed sites of the ears, face, hands & lower legs
Bowen’s disease diagnosis
Recognised clinically
Dermatoscopy
Diagnosis may be confirmed by biopsy → histology reveals full thickness dysplasia of the epidermis
Bowen’s disease mx
Observation - may not to be necessary to remove all lesions, particularly in elderly patients
Topical fluorouracil
Cryotherapy
Excision
Photodynamic therapy
Bowen’s disease complications
Invasive SCC
Other skin cancers - BCC and melanoma
