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Dermatology conditions Flashcards

1
Q

What is Basal cell carcinoma?

A

Common neoplasm, related to exposure of sunlight.

Can be locally aggressive, rarely metastasises

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2
Q

What causes basal cell carcinoma?

A

Repetitive and frequent exposure to UV radiation induces DNA damage in keratocytes.
Exponential increased of BCCS in relation to UV exposure

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3
Q

What are the risk factors of Basal cell carcinoma?

A 
Prolonged sun UV radiation exposure
Seen in Gorlin's syndrome
Most commonly head and neck
Increasing age
Male sex
Skin types I and II
Immunosuppression
Arsenic exposure
Previous BCC
Xeroderma pigmentoasum
Albinism
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4
Q

What is Gorlin-Goltz syndrome?

A 
A condition with multiple BCCs
Pitting of palms and soles
Jaw cysts
Spine and rib anomalies
Calcification of the falx cerebri
Cataracts
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5
Q

What are the symptoms of Basal cell carcinoma?

A

Slow, progressive skin lesion
Papules with associated telangiectasis
Pearly papules and/or plaques
Found on: Face, scalp, ears, trunks

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6
Q

What are the types of Basal Cell Carcinoma?

A 
Nodular (most common)
Superficial
Morphoeic
Pigmented
Basosquamous
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7
Q

What are the signs of nodular BCC?

A
  • Pearly nodule with rolled telangiectatic edge
  • Telangiectasis
  • Slowly enlarges
  • May have central ulcer
  • Micronodular and micirocystic types may infiltrate deeply
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8
Q

What are the signs of superficial BCC?

A
  • Multiple on trunk and shoulders
  • Erythematous well-demarcated plaques, larger than 20mm, central clearing and a thread-like border, rolled edge if stretched (may bleed or weep)
  • Slow growth, usually not aggressive, rarely invasive and very rarely metastasise
  • Confused with Bowen’s disease or inflammatory dermatosis
  • Particularly responsive to medical > surgical
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9
Q

What are the signs of Morphoeic BCC?

A
  • Sclerosing or infiltrative BCC
  • Found in mid-facial sites
  • More aggressive with poorly defiend borders
  • Characterised by thickened yellow plaques
  • Present late and become very large and require extensive plastic surgical reconstruction, may infiltrate nerves
  • Prone to recurrence after treatment
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10
Q

What are the signs of Pigmented BCC?

A
  • Brown, blue or greyish lesion
  • Nodular or superficial histology
  • Seem nore often in dark skinned people
  • May resemble malignant melanoma
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11
Q

What are the signs of basosquamous BCC?

A
  • Mixed BCC / SCC

- Potentially more aggressive than other forms

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12
Q

What are the investigations for BCC?

A

Biopsy rarely needed but can do biopsy if wanted

Diagnosis is mainly on clinical suspicion

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13
Q

What is a burns injury?

A

Burns are very common injuries, predominantly to the skin and superficial tissues, caused by heat from hot liquids, flames or contact with heated objects, electrical current or chemicals

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14
Q

What are the risk factors for burns injuries?

A

Young children
>60
Male sex

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15
Q

What does a first degree burn look like?

A

Red and painless

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16
Q

What does a second degree burn look like?

A

Wet + Painful burns

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17
Q

What does a third degree burn look like?

A

Dry + Insensate burns

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18
Q

What does a 4th degree burn look like?

A

Burns affecting subcutaneous tissue, tendon or bone

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19
Q

What is a sign of severe burn?

A

Clouded corneas

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20
Q

What investigations are done for burns injuries?

A

FBC (Low Hct, hypovolaemia, neutropenia, thrombocytopenia)
Metabolic panel (High level urea, glucose, creatinine, hyponatraemia, hypokalaemia)
Carboxyhaemoglobin (high in inhlaation injruy)
ABG (Metbaolic acidosis in inhalation injury)
Flourescein staining (Damaged epithelial cells in burns)
CT scan head and spine (Based on history or mode of injury)
Wound biopsy culture (if septic)
Wound histology (If septic)

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21
Q

What is Candidiasis?

A

An infection caused by candida. Common commensal on skin, pharynx or Vagina. Invasion implies when the fungus is in normally sterile tissues.

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22
Q

What causes candidiasis?

A

Caused by 15 different candida species

Candida albicans is the most common cause

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23
Q

What are the main types of candidiasis?

A 
Oral 
Oesophageal (AIDS defining condition)
Candidial vulvovaginitis
Candidal skin infections
Invasive candidal infections
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24
Q

What are the Risk factors for candidiasis?

A 
Broad-spectrum antibiotics
Immunocompromised
Central venous lines
Cushing's disease
Diabetes mellitus
GI tract surgery
Poor oral hygiene
Pregnancy and pill
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25
What are the signs and symptoms of Oral candidiasis?
Oral thrush | - Curd-like white patches in mouth, removed easily revealing an underlying red base. More common in neonates.
26
What are the signs and symptoms of oesophageal candidiasis?
Dysphagia Pain on swallowing food or fluids AIDS-defining illness
27
What are the signs and symptoms of candidal skin infections?
Soreness and itching Skin appearance can be variable Red, moist skin area with ragged, peeling edge and possibly papules and pustules
28
What are the signs of vaginal thrush?
White curd discharge | Vulva and vagina may be red, fissured and sore
29
What are the signs of invasive candidiasis?
Fever and chills | Can spread to cause fungemia, endocardiits, endophthalmost, osteomyelitis and CNS infections
30
What are the investigations for candidiasis?
Therapeutic trials of antifungal (fluconazole) Skin scraping/oral swabbing/endoscopy Culture on Sabouraud's medium Blood cultures
31
What is cellulitis and Erysipelas?
Commonly seen as manifestations of the same condition and the terms are often used interchangeably. They are acute, painful and potentially serious infections of the skin and SC tissues.
32
What is the most common cause of cellulitis and Erysipelas?
Streptococcus spp. Staphylococcus spp. Caused by a wide range of aerobic and anaerobic bacteria
33
What is cellulitis?
Infection of dermis and subcutaneous tissue and has poorly demarcated borders
34
What is Erysipelas?
``` Superficial cellulitis (Dermis and Upper SC tissues) Sharply demarcated borders ```
35
What causes cellulitis?
Most infections that affect skin due to streptococci, although other organisms may be responsible if integrity is compromised Gram negative organisms, anaerobes or fungi may cause cellulitis Cellulitis around surgical wounds, less than 24hrs postoperatively may result from group A beta-haemolytic streptococci or clostridium perfringens (Producing gas/crepitus)
36
What is Erysipelas?
Most are group A streptococci | Strep. Pneumoniae, Klebsiella pneumoniae, haemophilus influenzae tybe B, yersinia enterocolitica adn moraxella spp.
37
What are the risk factors for Cellulitis and Erysipelas?
``` Previous erysipelas or cellulitis Venous insufficiency Elderly age Alcoholism IV drug use Lymphoedema Overweight/obesity Athlete's foot/skin abrasions Inflammatory dermatoses Insect bites Pregnancy ```
38
What are the symptoms of Erysipelas?
Painful, shiny light-red swelling of clearly defined area of skin Cause blisters and swelling of nearby lymph nodes Fever and malaise
39
What are the symptoms of cellulitis?
Reddened skin less clearly defined, often is dark-red/purple Produces pus History of cut, scratch or injury Periorbital cellulitis - painful swollen red skin around the eye Orbital cellulitis - Painful or limited eye movements, visual impairment
40
What are the signs of Cellulitis and Erysipelas?
Lesions (Erythema, oedema, warm, tender distinct margins, pyrexia (suggest systemic spread)) Periorbital (swollen eyelids and conjunctival infection) Orbital cellulitis (Proptosis, Impaired visual acuity and eye movements, test for RAPD, visual acuity and colour vision)
41
What are the investigations for Cellulitis and Erysipelas?
``` Blood culture (pathogen growth) FBC (Leucocytosis) Discharge sample and send for MC&S Aspiration CT scan MRI (if NF suspected) ```
42
What is the management for cellulitis and Erysipelas?
General (Rest, elevation of limbs and analgesia) Prescribe analgesia (paracetamol/ibuproden) Flucloxacillin 500mg 4x/day, sometimes penicillin V for cellulitis Erythromycin 50mg 4x daily if penicillin allergic, Clarithromycin if intolerant Clindamycin (second line) Co-amoxiclav if facial involvement NSAIDs and CORTICOSTEROIDS
43
What are the complications of Cellulitis and Erysipelas?
Sepsis | Chronic oedema in affected extremity
44
What is Eczema?
Inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course. Affects all age groups, commonly misdiagnosed before 5 and affects 10-20% of children
45
What causes Eczema?
Cells of stratum corneum form a barrier between cells that are lipids and proteins Defects in barrier leads to eczema Many patients have a gene mutation in filagrin gene
46
What are the risk factors/causes for exogenous eczema?
Irritants Contact Atopic Eczema herpeticum
47
What are risk factors/causes for endogenous eczema?
``` Atopic Seborrheic Pompholyx Varicose Lichen simplex Discoid ```
48
What are the risk factors for eczema?
``` Age <5 years Family history of eczema Allergic rhinitis Asthma Antihelminthic treatment in utero Active and passive exposure to smoke ```
49
What are the symptoms of Eczema?
``` Itching Heat Tenderness Redness Weeping Crusting Ask about occupational exposure to irritants Ask about personal/gmaily history of atopy Loss of pigment ```
50
What are the signs of eczema?
``` Acute: - Poorly demarcated erythematous oedematous dry scaling patches - Papules - Vesicles with exudation and crusting - Excoriation marks Chronic: - Thickened epidermis - Skin Lichenification - Fissures - Change in pigmentation ```
51
Where does atopic eczema act?
Mainly faces and flexure surfaces
52
Where does seborrhoeic eczema act?
Yellow, greasy scales on erythematous plaques. | Found on eyebrows, scalp and presternal area
53
Where does pompholyx eczema act?
Vesiculobullous eruptions on palms and soles
54
Where does Discoid eczema act?
Coin shaped | On legs and trunk
55
Where does asteatotic eczema act?
Dry, crazy pairing patern
56
What investigations are done for eczema?
Clinical diagnosis Allergy testing IgE levels (elevated) Skin biopsy
57
What is Erythema multiforme?
Acute hypersensitivity reaction of the skin and mucous membranes. Stevens-Johnson syndrome is a severe, rare form with bullous lesions and necrotic ulcers
58
What causes erythema multiforme?
Skin-directed immune reaction which occurs following exposure to a trigger in predisposed individuals
59
What changes occur in erythema multiforme?
Degeneration of basal epidermal cells Development of vesicles between cells in the basement membrane Lymphocytic infiltrate around the blood vessels and at the dermo-epidermal junction
60
What can cause erythema multiforme?
Drugs (sulphonamides, NSAIDs, anti-convulsants, allopurinol) Infections (HSV, EBV, adenovirus, chlamydia) Inflammatory conditions (RA, SLE, Sarcoidosis, UC) Malignancy (Lymphomas, leukaemia, myeloma) Radiotherapy 50% are Idiopathic
61
What are the symptoms of Erythema multiformer?
Non-specific prodromal symptoms of URTI Sudden itching/burning/painful skin lesions Few to hundreds of red papules (spots) which begin over back of feet and hands and spread upwards to the trunk Over time papules evolve to plaques and then to typically targe shaped lesions Skin lesions fade leaving pigmentation Steven-Johnsons' syndrome (fever and mucosal involvement too)
62
What are the signs of Erythema multiforme?
Classic target lesions with a rim of erythema surrounding paler area Vesicles / Bullae Urticarial plaques Lesions are symmetrical and distributed over arms and legs
63
What are the characteristic signs of Steven-Johnsons' syndrome?
Affecting >2 mucous membranes (e.g. conjunctiva, cornea, lips, mouth, genitalia) Systemic symptoms (e.g. sore throat, cough, fever, headache, myalgia, arthralgia, diarrhoea/vomiting) Shock (hypotension and tachycardia)
64
What are the investigations for Erythema multiforme?
Usually unneeded Bloods (Leucocytosis, Eosinophils, ESR/CRP) Imaging (exclude sarcoidosis and atypical pneumonia) Skin biopsy (if doubted)
65
What is Erythema nodosum?
Panniculitis (Inflammation of SC fat tissue) presenting as red or violet SC nodules on B/L shins
66
What causes Erytma nodosum?
Delayed hypersensitivity reaction to antigens associated with various infectious agents, drugs, diseases, pregnancy and BCG vaccinations
67
What infections cause Erythema nodosum?
``` Bacterial e.g. streptococcus Viral e.g. EBV Fungal e.g. Histoplasmosis Mycobacterium e.g. TB, leprosy Yersinia ```
68
What diseases cause Erythema nodosum?
``` Sarcoidosis IBD Behcet's disease Leukaemia Hodgkin's disease ```
69
What drugs cause erythema nodosum?
Sulphonamides Penicillin Oral contraceptive pills Dapsone
70
What are the symptoms of Erythema nodosum?
``` Tender red or violet raised nodules B/L on both shins Occasionally on thighs or forearms Fatigue Fever Anorexia Weight loss Arthralgia Symptoms of underlying cause ```
71
What are the signs of Erythema nodosum?
Crops of red/violet dome-shaped nodules usually present on both shins Occasionally appear on thighs and forearms Nodules are tender to palpation Low-grade pyrexia Joints may be tender and painful on movement Signs of underlying cause
72
What are the investigations for Erythema nodosum?
``` Anti-streptolysin-O titres FBC CRP/ESR U&Es Serum ACE (Raised in sarcoidosis) Throat swabs and cultures Mantoux/head skin test for TB CXR: B/L hilar lymphadenopathy indicates sarcoidosis and unilateral indicates TB ```
73
What is Herpes?
A disease resulting from HSV1/HSV2 infection It can manifest in many ways (Genital, Gingivostomatitis, Herpetic whitlow, Herpes gladiatorum, eczema herpeticum, herpes meningitis, HSV keratitis, Recurrent HSV)
74
What is gingivostomatitis?
Ulcers filled with yellow sough around mouth
75
What is herpetic whitlow?
Infection of the virus in abrasions near fingernail/nailbed
76
What is Herpes gladitorium?
Vesicles wherever HSV is ground into the skin by force
77
What is HSV Keratitis?
Corneal dendritic ulcers
78
What causes Herpes?
Transmitted via close contact with an individual who is shedding the virus. After primary infection, virus becomes dormant Reactivation occurs in response to physical and emotional stresses or immunosuppression Virus causes cytolysis of infected epithelial cells leading to vesicle formation
79
What are the symptoms of HSV1 infection?
``` Possible symptoms of primary: - Pharyngitis - Gingivostomatitis - Herpetic whitlow Possible symptoms of reactivation: - Prodrome of perioral tingling and burning - Vesicles appear - Heal within 8-10 days ```
80
What are the symptoms of HSV2 infection?
- Painful blisters and rash in the genital, perigenital and anal area - Dysuria - Fever - Malaise
81
Which virus causes herpetic encephalitis?
HSV1
82
What are the symptoms of HSV keratoconjunctivitis?
Watering eyes | Photophobia
83
What are the signs of HSV1 infections?
``` Presents as herpetic labialis (cold sores) Tender cervical lymphadenopathy Erythematous, oedematous pharynx Oral ulcers filled with yellow slough Herpetic whitlow Signs of encephalitis ```
84
What are the signs of HSV2 infections?
HSV2 is nearly always sexually transmitted and causes genital herpes - genital or anal blisters - Maculopapular rash - Vesicles - Ulcers - All found on external genitalia, anal margin and upper thighs - inguinal lymphadenopathy, pyrexia HSV keratoconjunctivitis - Dendritic ulcer on the iris
85
What are the investigations for Herpes?
Clinical diagnosis | Vesicle fluid can be sampled and sent for electron microscopy, PCR
86
What is a lipoma?
Slow-growing, benign adipose tumours that are most often found on SC tissues.
87
What causes a lipoma?
``` Benign tumours of adipocytes Occur wherever fat can expand i.e. not scalp or palm Conditions associated with lipomas: - Familial multiple lipomatosis - Gardner's syndrome - Decrum's disease - Madelung's disease Liposarcoma - rare malignant tumour of adipose tissue ```
88
What is Decrum's disease?
A disease causing multiple scattered lipomas which may be painful, typically in post-menopausal women
89
What are the signs and symptoms of Lipomas?
``` Most are asymptomatic Compression of nerves can cause pain Soft or firm nodule Smooth normal surface Skin coloured Most are <5cm diameter Mobile Soft/doughy feel Hint of fluctuance ```
90
What are the investigations for lipoma?
Usually clinical | US/MRI/CT if any doubt
91
What is a melanoma?
Malignancy arising from neoplastic transformation of melanocytes, the pigment forming skin cells. The leading cause of death from skin disease.
92
What are the types of melanoma?
Lentigo maligna melanoma Superficial melanoma Nodular melanoma Acral lentiginous melanoma
93
What are Lentigo maligna melanoma?
Patch of lentigo maligna develops a papule or nodule signalling invasive tumours
94
What is superficial melanoma?
Large, flat, irregularly pigmented lesion which grows laterally before vertical invasion develops
95
What is nodular melanoma?
Most aggressive type | Rapidly growing pigmented nodule which bleeds or ulcerates. Rarely amelanotic and mimic pyogenic granuloma
96
what is acral lentiginous melanoma?
Pigmented lesions on palm, sole or under the nail, usually presents late, most common in non-white people
97
How do melanomas mestastasise and where to?
Via blood and lymphatics | Metastasis to: Lymph nodes, liver, lung, bone and brain
98
What causes a melanoma?
Arises from melanocytes Inheritance of sun-sensitive skin and specific melanoma-related genes Mainly CDKN2A, encoding p16 and p14ARF, affecting p53 and retinoblastoma cycle
99
What are the risk factors for melanoma?
Family history of melanoma Personal history of melanoma Personal history of skin cancer (including actinic damage) History of atypical naevi (6mm or larger with irregular pigmentation) Fitzpatrick skin type I or II (Light-coloured skin) Red or blonde hair High freckle density Sun exposure Sun bed use Light eye colour Increased number of benign-appearing melanocyte naevi Large congenital naevi Immunosuppression Xeroderma pigmentosum
100
What are the symptoms of a melanoma?
``` Change in size, shape or colour of pigmented skin lesion Redness Bleeding Crusting Ulceration ```
101
What are the signs of a melanoma?
``` ABCDE(F) A - Asymmetry B - Border irregularity C - Colour variation D - Diameter >6 mm E - Elevation F - Fast evolving ```
102
What are the investigations for melanoma?
``` Excisional biopsy Dermoscopy Lymphoscintigraphy Sentinal lymph node biopsy Staging Bloods CDKN2A genetic test ```
103
What is Molluscum contagiosum?
Common skin infection caused by a pox virus that affects children and adults/ Transmission is usually by direct skin contact
104
What causes molluscum contagiosum?
Viral skin infection caused by molluscum contagiosum virus (MCV) It is a type of pox virus
105
What are the risk factors for molluscum contagiosum?
Mainly in children Immunocompromised (HIV) Atopic eczema
106
What are the symptoms of molluscum contagiosum?
Incubation period (2-8 weeks) Usually asymptomatic May be tenderness, pruritus and eczema around the lesion Lesions last for around 8 months
107
What investigations are done for molluscum contagiosum?
Clinical diagnosis | Dermatoscopy may be useful if any doubt
108
What is a pressure sore?
Damage to skin, usually over a bony prominence, as a result of pressure
109
What causes a pressure sore?
Constant pressure limits blood flow to the skin leading to tissue damage Occurs as a result of pressure, friction and shear
110
What are the Risk Factors for Pressure sores?
Immobility Obesity Alzheimer's disease Diabetes
111
What are the signs and symptoms of pressure sores?
Most commonly at the sacrum and heel Pressure sores staged 1-4 Very tender May become infected leading to fevers, erythema and foul smell
112
What are the investigations for pressure sores?
Clinical diagnosis | Waterlow score to predict risk
113
What is Psoriasis?
Chronic inflammatory skin disease characterised by erythematous, circumscribed, scaly papules and plaques. It can cause itching, irritation, burning and stinging
114
What causes psoriasis?
Unknown cause Made up of genes, infections, immunology and drugs Immune response defined by T cells in dermis, initiating release of cytokines
115
What are the risk factors for Psoriasis?
``` Genetic Infection Local trauma Stress Smoking Light skin Beer intake ```
116
What are the types of Psoriasis?
Guttate Palmoplantar Generalised pustular
117
What is Guttate psoriasis?
Affects teens and those in early 20s Triggered by streptococcal sore throat Small pink and scaly lesions
118
What is Palmoplantar psoriasis?
Psoriasis on hands and feet | Smoking, middle-aged women, AI thyroid disease, pustules on hands and feet
119
What is generalised pustular psoriasis?
Hypoparathyroidism
120
What are the symptoms of psoriasis?
Commonly: Scalp, Elbows, Knees, Buttocks, Genital area, foot soles itching and occasionally tender skin Pinpoint bleeding with removing scales (Auspitz phenomenin) Skin lesions may develop at sites of trauma/scars (Koebner phenomenin)
121
What are the signs of psoriasis?
Discoid/nummular psoriasis (symmetrical, well-demarcated erythematous plaques with silvery scales over extensor surfaces) Flexural psoriasis (Less scaly plaques in axilla, groins, perianal and genital skin) Guttate psoriasis (small drop-like lesions over trunk and limbs) Palmoplantar psoriasis - pustules distributed over limbs and torso - Nail signs (Pitting, onycholysis, subungual hyperkeratosis) - Joint signs (asymmetrical oligoarthritis, symmetrical polyarthritis, Distal interphalangeal joint, arthritis mutilans, psoriatic spondylitis)
122
What investigations are done for psoriasis?
Most do not need investigations - Guttate psoriasis - anti-streptolysin-O titre, throat swab - Flexural psoriasis - Skin swabs to exclude candidiasis Nail clipping analysis for onychomycosis Joint involvement analysed by checking for rheumatoid factor Skin biopsy
123
What are sebacious cysts?
Either epidermoid or pilar cysts - epithelium lined, keratinous, debris-filled cysts Both contain keratin, not sebum and do not originate from sebaceous glands
124
What is the difference between epidermoid and pilar cysts?
Epidermoid - Epidermis | Pilar - Hair follicles
125
What causes sebaceous cysts?
Occlusion of the pilosebaceous gland Can be caused by traumatic insertion of epidermal elements into the dermis Embryonic remnants
126
What are the risk factors for sebaceous cysts?
Gardner's syndrome = Autosomal dominant characterised by multiple polyps in the colon and in extra-colonic sites
127
What are the symptoms of sebaceous cysts?
Non-tender slow-growing skin swelling There are often multiple Common on hair-bearing regions of the body May become red, hot and tender if superimposed infection or inflammation Infection is quite common - dischare cheesy foul-smelling pus
128
What are the signs of sebaceous cysts?
Firm, round, mobile SC nodules Characteristic overlying central punctum Foul pus (granular and creamy) exits through punctum
129
What are the investigations for sebaceous cysts?
None needed | Skin biopsy or FNA may be used to rule out other differentials
130
What is a squamous cell carcinoma?
Proliferation of atypical, transformed keratinocytes in the skin with malignant behaviour. Ranges from in situ tumours (Bowen's disease) to invasive and metastatic disease
131
What causes Squamous cell carcinoma?
Excess sun light exposure
132
What are the risk factors for squamous cell carcinoma?
``` UV radiation exposure Immunosuppression Fair skin Hereditary skin conditions Older age Male sex Ionising radiation Carcinogens Actinic keratosis Previous skin cancer HPV Tobacco smoking Thiazide diuretic and cardiac drugs Keratoconthomas Tattoos ```
133
What are the symptoms for Squamous cell carcinoma?
``` Skin lesion Ulcerated Recurrent bleeding Non-healing Bone pain Plaques ```
134
What are the signs of squamous cell carcinoma?
Variable appearance - may be ulcerated, hyperkeratotic (with keratin horn), crusted or scaly, non-healing Sun-exposed areas Palpate for local lymphadenopathy Hepatomegaly
135
What are the investigations of squamous cell carcinoma?
Skin biopsy - staging CT body scan / MRI scan / PET scan - lymphadenopathy and/or visceral nodules suggests mets FBC with differential (Normal except with bone marrow mets) LFT and CXR (Normal without mets)
136
What is Urticaria?
Itchy, red, blotchy rash resulting from swelling of the superficial part of the skin Angioedema occurs when the deep tissues, lower dermis and SC tissues are involved and become swollen Angio-oedema occurs in association with urticaria in about 40% of cases (AKA hives)
137
What causes urticaria?
Caused by activation of mast cells in the skin, resulting in the release of histamines The cytokine release leads to capillary leakage, causing swelling of the skin and vasodilatation > erythematous appearance
138
What are the triggers for acute urticaria?
Allergies Viral infections Skin contact with chemicals Physical stimuli
139
What are the triggers for chronic urticaria?
Chronic spontaneous urticaria - medication, stress, infections Autoimmune
140
What are the signs and symptoms of Urticaria?
Central, itchy white papule or plaque surrounded by erythematous flare Blanching, oedematous, non-painful, pruritic Lesions vary in size and shape May be associated with swelling of soft tissues of eyelids, lips and tongue Individual lesions are transient Stridor Time scales - Acute - quickly but recover over 48 hours - Chronic - rash for > 6 weeks
141
What are the investigations for Urticaria?
Usually clinical | Tests may be required for chronic urticaria (e.g. FBC, ESR/CRP, patch testing, IgE tests) depending on history
142
What is Varicella Zoster?
Primary infection is varicella (Chicken pox) | Reactivates causing zoster (shingles)
143
What causes Varicella zoster?
Primary infection with human alpha herpes virus, varicella zoster, in a non-immnue host Virus Takes a lifelong latency in cranial nerves and dorsal root ganglia
144
What are the risk factors for varicella zoster?
Age 1-9 years Exposure to varicella Unimmunised status Occupational exposure
145
What are the symptoms of Varicella?
Prodromal malaise Mild pyrexia Sudden appearances of intensely itchy spreading rash affecting face and trunk Vesicles weep and crust over Contagious from 48hrs before rash until after they have all crusted over
146
What are the symptoms of zoster?
May occur after period of stress Tingling/hyperaesthesia in a dermatome Painful skin lesions Recovery 10-14 days
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What are the signs of varicella?
Maculopapular rash Area of weeping and crusting Skin excoriation (from scrathing) Mild pyrexia
148
What are the signs of zoster?
Vesicular maculopapular rash Dermatomal distribution Skin excoriation
149
What is the management of varicella zoster?
Minimalise scratching Avoid pregnant people and anyone immunocompromised Analgesia and antipyretics for symptoms Antivirals
150
What is the antiviral treatment for varicella zoster?
Some need IV aciclovir or oral aciclovir
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Which people would need IV aciclovir?
- High- risk patients who are immunocompromised - Sytemic disease - Patients on high-dose steroids - New lesions after 8 days
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Which people need Oral aciclovir?
Chronic medical condition Over 12 years old Secondary case in a household Pregnant patient
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What are the complications for varicella?
``` Secondary infection Scarring Pneominits and ataxia Purpura fulminans DIX Pneumonia Encephalitis Congenital varicella syndrome ```
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What are the complications for zoster?
Postherpetic neuralgia Zoster ophthalmicus (rash in ophthalmic division of the trigeminal nerve) Ramsay-Hunt syndrome (zoster of the ear and facial nerve - vesicles behind pinna of ear or in the ear canal) Sacral zoster Motor zoster

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