Dermatology Conditions A Flashcards
Acne - Description
inflammation of pilosebaceous follicles
Acne - Risk Factors (5)
1) 12-24 years old
2) family history
3) iatrogenic (e.g. androgens, corticosteroids, lithium)
4) endocrine disorders (e.g. polycystic ovary syndrome, precocious puberty)
5) diet
Acne - Pathophysiology (10)
1) hypercornification
2) narrowing of hair follicle
3) increased androgen sensitivity of hair follicle
4) increased sebum production
5) sebum traps in hair follicle
6) Propionibactrium acne colonies anaerobic hair follicle
7) P. acne breaks down sebum lipids into free fatty acids
8) free fatty acids cause inflammation
9) neutrophil attraction
10) pus formation
Acne - Signs (5)
1) face, chest, upper back
2) closed comedone papules (whiteheads)
3) open comedone papules (blackheads)
4) pustules
5) tender skin lesions
Acne - Complications (2)
1) scarring
2) dyspigmentation
Acne - Investigations (0/2)
consider
1) skin swab MS+C
2) hormonal tests (female)
Acne - Management (3/4/0)
conservative 1) avoid overwashing 2) don’t pick 3) healthy diet medical 1) TOP retinoid (mild) 2) TOP benzoyl peroxide (moderate) 3) PO retinoid (severe) 4) antiandrogens (e.g. combined oral contraceptive) (female hormone related)
Eczema - Description
inflammation of skin due to thinning stratum corneum, characterised by dry pruritic skin
Eczema - Risk Factors (4)
1) <5 years old
2) family history
3) hayfever
4) asthma
Eczema - Types (2)
1) atopic dermatitis (endogenous)
2) contact dermatitis (exogenous)
Eczema - Triggers (4)
1) infection
2) detergents
3) pets
4) stress
Eczema - Symptoms (1)
1) pruritus
Eczema - Signs (6)
1) esp. face, neck , flexure surfaces
2) xerosis
3) erythema
4) scaling
5) papules
6) vesicles
Eczema - Investigations (0/3)
consider
1) allergy testing
2) serum IgE (high, 80%)
3) skin biopsy
Eczema - Diagnosis (Atopic Dermatitis) (6)
1) clinical diagnosis
2) high serum IgG
3) pruritus past 6 months
+ 3 of:
1) history of flexure surface involvement
2) history of xerosis
3) childhood onset
4) asthma or hayfever
Eczema - Management (3/3/1)
conservative 1) avoid triggers 2) emollients (moisturiser, e.g. E45) 3) bath soap substitutes medical 1) TOP corticosteroid (1st) 2) TOP calcineurin inhibitor (e.g. tacrolimus) (2nd) 3) antihistamines surgery 1) UV light therapy
Psoriasis - Description
chronic inflammation of skin due to hyperproliferation of keratinocytes characterised by scaly erythematous plaques
Psoriasis - Risk Factors (7)
1) genetic
2) infection (group A Streptococci)
3) local trauma (Koebner phenomenon)
4) stress
5) smoking
6) alcohol (esp. beer)
7) light skin
Psoriasis - Pathophysiology (3)
1) T cell activation upregulates proinflammatory Th1 cytokines (e.g. growth factors)
2) increased epidermal cell turnover
3) uncontrolled hyperproliferation of keratinocytes
Psoriasis - Symptoms (2)
1) pruritus
2) skin discomfort
Psoriasis - Signs (4)
1) scalp, elbows, knees, lower back
2) circumscribed salmon-silver scaly erythematous plaques
3) nail pitting
4) onycholysis
Psoriasis - Complications (4)
1) psoriatic arthritis
2) cardiovascular disease (e.g. MI)
3) lymphoma
4) depression
Psoriasis - Investigations (0/1)
consider
1) skin biopsy
Psoriasis - Management (2/4/1)
conservative 1) avoid triggers 2) emollients (moisturiser, e.g. E45) medical 1) TOP corticosteroids (mild) 2) TOP vitamin D analogue (mild) 3) methotrexate (moderate—>severe) 4) anti-TNF biological agents (refractory, severe) surgery 1) UV light therapy (moderate)
Basal Cell Carcinoma - Description
malignant proliferation of basal epidermal keratinocytes
Basal Cell Carcinoma - Risk Factors (3)
1) older age
2) UV exposure
3) skin type 1 (burns, doesn’t tan)
Basal Cell Carcinoma - Signs (Nodular*) (5)
1) sun exposed areas (esp. head, neck)
2) pearly papule
3) rolled edges
4) associated telangiectasia
5) may ulcerate (rodent ulcers)
Basal Cell Carcinoma - Signs (Superficial) (3)
1) trunk, shoulder
2) scaly erythematous plaque
3) raised smooth edge
Basal Cell Carcinoma - Investigations (1/0)
initial
1) skin biopsy*
Basal Cell Carcinoma - Management (0/0/2)
surgery
1) cryotherapy (superficial)
2) wide border excision (+ histology to ensure clear tumour margin)
Squamous Cell Carcinoma - Description
malignant proliferation of squamous epidermal keratinocytes
Squamous Cell Carcinoma - Risk Factors (6)
1) older age
2) UV exposure
3) skin type 1 (burns, doesn’t tan)
4) premalignant skin conditions
5) immunocompromised
6) male
Squamous Cell Carcinoma - Signs (4)
1) sun exposed areas
2) scaly, crusty nodule
3) ill defined edges
4) may ulcerate
Squamous Cell Carcinoma - Complications (1)
1) metastasis
Squamous Cell Carcinoma - Investigations (2/2)
initial 1) skin biopsy 2) lymph node examination (metastasis) consider 1) body CT (metastasis) 2) sentinel lymph node biopsy (metastasis)
Squamous Cell Carcinoma - Management (0/1/1)
medical
1) radiotherapy (non-resectable)
surgery
1) wide border excision (+ histology to ensure clear tumour border margins)
Melanoma - Decsription
malignant proliferation of epidermal melanocytes
Melanoma - Risk Factors (8)
1) UV exposure
2) skin type 1 (burns, doesn’t tan)
3) red/blonde hair
4) freckles
5) atypical moles
6) multiple moles
7) immunocompromised
8) alcohol
Melanoma - Symptoms (2)
1) pruritus
2) bleeding
Melanoma - Signs (2)
1) back, chest (male)
2) lower legs (female)
Melanoma - Diagnosis (ABCDE)
A) asymmetrical B) border irregularity C) colour irregularity (very dark —> black) D) diameter >6mm E) evolution of lesion
Melanoma - Complications (1)
1) metastasis (esp. lung, liver, brain)
Melanoma - Investigations (2/2)
initial 1) dermatoscopy (prior to biopsy) 2) skin biopsy consider 1) body CT (metastasis) 2) sentinel lymph node biopsy (metastasis)
Melanoma - Management (0/2/2)
medical 1) chemotherapy (iplimunab) (metastatic) 2) radiotherapy (non-resectable) surgery 1) wide border excision (+ histology to ensure clear tumour margins) 2) lymph node excision (metastatic)
