Dermatology - Extended 20-95 Flashcards
Lichen planus
24 - Shiny flat-topped plaques
Demographic: Affects about one in one hundred people worldwide
Mechanism: Autoimmune disorder, inflammatory cells attack protein in skin and mucosa = Hyperkeratotic skin disorder
Caused by: Stress, skin injury, herpes zoster, hepatitis C, drugs (gold)
Presentation: Papules and plaques that are shiny, flat-topped and firm on palpatition. Wickham striae (white lines) on plaques. 6P (Planar, purple, polygonal, pruritic, papules and plaques)
Localisation: Anywhere, but most often front of the wrists, lower back, and ankles. Inside your mouth, it may cause burning or soreness
Treatment:
Topical - Steroids (clobetasol), Calcineurin inhibitors, Retinoids
Systemic - Phototherapy, Prednison, Methotrexate
Onychomycosis
26 - Fungal infection of the nails
Mechanism: Follow an injury to the nail or inflammatorydisease of the nail
Caused by: Dermatophytes, yeasts (Candida albicans) or moulds
Presentation: Yellowing of side of nail. Nail lifts and crumbles. White patches and pits near top of nail plate. Yellow spots in lunula.
Treatment:
Topical - Antifungal, Laser, phototherapy
Systemic - Oral antifungal
Scabies
31
Demographic: Most common in children, young adults, and older persons
Mechanism: Direct skin-to-skin contact with someone else with scabies
Presentation: Itch arises 4–6 weeks after transmission of a mite. Burrows appear as 0.5–1.5 cm grey irregular tracks. Itch more severe at night, disturbing sleep. Erythematous papules on the trunk and limbs, often follicular (hypersensitivity reaction)
Localisation: Trunk and limbs, sparing the scalp
Treatment: Permethrin covering the entire body 8-10 hours. Washing of home furniture and bedsheets
Atopic dermatitis
32 Atopic eczema - Dry and flaky skin
Demographic: Genetic predisposition, Allergies (hay fever), Defect of proteins in epidermis (keratinocytes), Infections, Environmental factors. 80% of affected individuals develop it before the age of 6.
Mechanism: Cytokines cause barrier defects and inflammation that result in eczema. Filaggrin mediation (Causes increased permeability in epidermis, Unable to protect against pathogens, excess water loss)
Causes: 3 Major and 3 minor criteria.
- Major: Puritus, typical distribution, chronic or relapsing, family history
- Minor: widespread dry skin, hand and/or foot dermatitis, intolerance to wool or certain foods
Presentation: Generalised skin dryness, itch, and rash
Localisation: Small children -> Areas where they are crawling affected -> Extensor areas. Standing children - Flexor surfaces
Treatment:
Topical - Emollients, corticosteroids (triamcinolone), calcineurin inhibitors, phototheraphy
Systemic - Antihistamines, corticosteroids, immunosuppressives (methotrexate)
Stevens Johnson syndrome and toxic epidermal necrosysis
38 SJ syndrome -> TEN
Demographic: Anyone due to a drug reaction
Causes: beta-lactams (penicillins, cephalosporins), Paracetamol, NSAIDs
Presentation: Flu-like symptoms initially, Macules, diffused erythema, flaccid blisters → Blisters merge to form sheets of detached. +ve Nikolsky’s sign
- Skin detachment < 10% of body surface area = SJS
- Detachment between 10% and 30% of BSA = Overlap SJS/TEN
- Detachment > 30% of BSA = TEN
Localisation: Rash starting on the trunk and extending rapidly over hours to days onto the face and limbs (but rarely affecting the scalp, palms or soles
Treatment: Stopping of drugs, fluid replacement, pain relief, sterile handling
Erythema nodosum
39 Inflammation of the suncutaneous fat
Demographic: Affects everyone, but more commonly women
Caused by: Herpes, hepatitis, HIV
Presentation: Intial bilateral erythematous subcutaneous nodules for weeks, then fever and joint pain. Ankles can also swell. Initially bright to deep red, then spontaneously resolve within 2 months
Localisation: Anterior lower legs, knees and arms and rarely on the face and neck
Treatment: Pain managment (NSAIDs)
Systemic - Systemic corticosteroids, oral potassium iodide
Pityriasis rubra pilaris
45 - Reddish-orange coloured scaling patches with well-defined borders
Demographic: Inherited, Drugs (insulin) or vaccinations but unknown
Presentation: Red scaly rash on head and upper trunk → Multiple patches → reddish-orange lesions covering entire body. Palms and soles become thickened and yellow coloured. Nails become thickened and discoloured.
Localisation: May cover the entire body or just parts of the body such as the elbows and knees, palms and soles
Treatment:
Topical - Emollients !Topical corticosteroids are ineffective!
Systemic - Methotrexate, PRP (Platelet rich plasma)
Dermatitis herpetiformis
51
Demographic: Linked to coeliac disease, 2:1 male-female ratio
Presentation: Blisters to appear in clusters, resembling herpes simplex. Symmetrical distribution. Lesions resolve to leave postinflammatory hypopigmentation and hyperpigmentation
Localisation: Scalp, shoulders, buttocks, elbows and knees
Treatment: Gluten-free diet, Dapsone, topical/systemic steroids, rituximab
Linear IgA bullous disease and acquired epidermolysis bullosa
52 - blistering disease
Demographic: Very rare, linked to Crohns disease
Mechanism: Linear deposition of immunoglobulin A (IgA) at the dermo-epidermal junction
Caused by: Genetics, Drugs (Vacomycin, captopril, lithium, penicillins)
Presentation: Vesicles and bullae, anywhere on the body (in small beads formation), secondary lesions crust due to scratching, pruritus
Localisation: Anywhere even mouth
Treatment:
Topical - Corticosteroids
Systemic - Tetracycline, erythromcyin, rituximab
Discoid lupus erythematosus
54 - Disk like plaques
Demographic: Around 20–40 people in every 100,000
Caused by: Genetic, sunlight, cigarette smoke, hormones
Presentation: Dry red patches → Red hyperpigmented plaques with scales. Follicular keratosis (plugged hair follicles)
Localisation: Nose, cheeks, ear lobe and concha
Treatment: Protection from sun, vitamin D, stop smoking
Topical - Corticosteroids, tacrolimus (calcineurin inhibitor)
Systemic - Corticosteroids, methotrexate, retinoids
Systemic lupus erythematosus
55 - circulating autoantibodies
Demographic: Smokers, rare
Mechanism: Affects several organs (such as skin, joints and kidneys) and blood tests reveal circulating autoantibodies.
Caused by: Genetic, sunlight, EBV, Hormones, Cigarette smoke
Presentation: Nail fold capillaries, Raynaud phenomenon, Urticaria, Diffuse hair thinning, butterfly rash, diffuse hair loss
Localisation: Everywhere
Treatment: Stop smoking, sunscreen
Topical - Corticosteroids, Tacrolimus (calcineurin inhibitor)
Systemic - Corticosteroids, methotrexate, rituximab
Subacute cutaneous lupus erythematosus
56 - circulating autoantibodies
Demographic:
Mechanism:
Caused by: Caused by: Genetic, sunlight, EBV, Hormones, Cigarette smoke
Presentation: Flat, scaly patches resembling psoriasis, resolve with minimal scaring
Localisation: Trunk, back and arms, spares face and hands
Treatment:
Topical - Corticosteroids
Systemic - Methotrexate, Corticosteroids (prednisone)
Systemic sclerosis
58 Thickening of skin
Demographic: Rare, 5 times more common in females than males
Mechanism: Autoimmune
Caused by: Genetics, Injury and exposure to vinyl, drugs, fumes, chloride
Presentation: Skin fibrosis, thickening and tightening of the skin of the fingers and toes. Raynaud phenomenon
Localisation: Hands and feet
Treatment: Stop smoking
Topical - tacrolimus, corticosteroids, phototherapy
Systemic - Methotrexate, corticosteroids, rituximab, iV immunoglobulin
Pyoderma gangrenosum
63 - Enlarging ulcer
Demographic: Over 50
Mechanism: Autoinflammatory disease
50% caused by: Crohn disease, Rheumatoid arthritis
Presentation: At site of injury, small pustule → Blood-blister → Painful ulcer that enlarge (heal with scaring)
Localisation: Site of injury
Treatment:
Topical - Steroids, tacrolimus, doxycycline
Systemic - Oral prednisone, cyclosporine, methotrexate
Acne vulgaris
65 -
Demographic: Mainly adolescents
Presentation: Superficial open (blackheads) or closed (white heads) comedones -> dead skin and oils (papules, pustules). Deep lesions → Nodules
Localisation: Face, neck, chest and back
Treatment:
Mild → Adapalene (retinoid), Vitamin A (retinoid) or sunlight
Moderate → Tetracyclines (doxycycline)
Severe → Oral Isotretinoin (retinoid)
Acne rosacea
66 - Old peoples face rash
Demographic: 30-60 years old, fair skinned, blue eyes often
Mechanism: Skin damage due to UV
Caused by: Facial creams with topical steroids, antimicrobials
Presentation: Red face, red papules and pustules on nose, forehead and cheeks, dry flaku facial skin. Sensitive skin
Localisation: Face
Treatment: Avoid oil based creams, no topical steroids, protect from sun
Topical - Metronidazole creams
Systemic - Oral isotretinoin
Raynaud’s phenomenon
72 - Cold fingers
Demographic: Starts under 25 years of age, 5x in women than in men
Mechanism: Reduction in the blood supply to the fingers, toes, or nipple in response to cold
Caused by: Cold weather, psychological upset
Presentation: Fingers turn numb and white. Rewarming blue → Bright red + swelling due to increased blood flow
Localisation: Fingers, toes, or nipple
Treatment: Stop smoking, insulation, avoid triggers
