Dermatology I Flashcards
Define a macule
Localised area of colour or textural change in skin
Define a papule
Small solid elevation of skin <5mm in diameter
Define a nodule
Similar to papule but larder than 5mm.
What might nail abnormalities be associated with
- Skin diseases eg lichen plants or psoriasis
- Systemic diseases - anaemia, CT diseases, endocrine tings, and fuck tonnes of other things
What is finger clubbing associated with
- Inflammatory bowel disease (Crohn’s)
- Malabsorption
- Liver cirrhosis
- Cyanotic congenital heart disease
- Atrioventricular malformation
- Endocarditis
- Graves’ disease
- Lung cancer
- TB
etc
What is finger clubbing
Distorted angle of the nail bed
What is nail pitting associated with
- Psoriasis
- Lichen plans
- Reiter’s syndrome
- Incontinentia pigmenti
- Alopecia areata
What is Koilonychia associated with
- May be normal in infants
- Iron deficiency anaemia
- Haemochromatosis
- Raynaud’s phenomenon
- Systemic lupus erythematosus
- Trauma
What is Koilonychia
Spoon nails that are soft and look scooped out
What are Beau’s lines associated with
- Any severe illness disrupting nail growth
- Raynaud’s phenomenon
- Pemphigus vulgaris
- Trauma
What are splinter haemorrhages in nails associated with
- Trauma
- Infective endocarditis
- Systemic lupus erythematosus
- Rheumatoid disease
- Peptic ulceration
- Malignancy
- Oral contraceptive therapy
- Pregnancy
- Psoriasis
What is Herpetic whitlow
- Swelling, reddening and tenderness of the skin of infected finger
- Due to cutaneous herpes simplex virus infection
- Associated pyrexia and lymphadenopathy
- Initially vesicles form that may burst and coalesce
- Associated pain often seems large relative to apparent clinical features
What is Paronychia
- Localised superficial irritation of epidermis bordering nails
- May be due to infection, chemical irritation or excessive contact with moisture
What are the causes of acute and chronic paronychia
Acute - usually due to staphylococcus aureus
Chronic - several different micro-organisms, mix of yeasts and bacteria
Name some malignant skin tumours
- Basal cell carcinoma (BCC)
- Squamous cell carcinoma (SCC)
- Malignant melanoma
- Cutaneous Lymphoma
What are the predisposing factors of BCC/SCC
- UV radiation
- Skin type I or II (freckles)
- Ionising radiation
- Burn/vaccination scars
- Immunosuppression
- Arsenic
Describe the skin types of the fitzpatrick scale
6 types
Gets more and more towards black skin and the higher the number the less easily it burns and tans
What the some more predisposing factors specifically for BCC
- M>F
- > 40 years old
- Outdoor occupation
- Immunosuppression
- Solar elastosis
- Sites of trauma on the face
- Naevus sebaceus
- Gorlins syndrome
What type of cancer is BCC
Locally invasive cancer of epidermal basaloid cells
Describe the presentation of BCC
- Spontaneous ulcer that fails to heal
- Non-healing asymptomatic lump or sore spot that grows slowly
- May bleed with crust formation that may separate during sleep to leave blood on pillow
- Nodular BCCs
- Superficial BCCs
Describe Nodular BCCs
Most common and mainly affects head and neck - typically a pearly papule with a rolled edge, telangectasia and central depression +/- ulceration
Describe Superficial BCCs
Slowly growing scaly pink patch or plaque, may mimic eczema or psoriasis
Describe the prognosis of BCCs
- Slow growing and non-aggressive
- Only rarely metastasise
Describe the presentation of SCCs
- Malignant tumour of keratinocytes
- Usually arises in areas of damaged skin eg in association with ‘actinic keratosis’
- Typically occurs in people aged >55
- More common in males
- May metastasise
Describe the appearance of SCCs
Found in sun exposed sites - face, neck, forearm, hand
Starts with an area of ‘actinic keratosis’ as a small papule that ulcerates and crusts
What predisposing factors are there for SCC specifically
- F>M
- Old age
- Erythema ab igne
- Chronic granulomas/ulcers
- Tar
- Albinism
- Xeroderma pigmentosa
What are malignant melanomas
Malignant tumour of melanocytes that usually arise in the epidermis
How do malignant melanomas affect men and women differently
- F>M, 2:1
- Females most commonly in lower legs
- Males most commonly in the back
What are some of the risk factors for malignant melanomas
- UV radiation
- Skin type I or II
Pre-existing melanocytes lesions: - Multiple banal naevi
- Dysplastic/atypical naevi
- Congenital naevi
- Previous malignant melanoma
- Family history of multiple/atypical naevi or melanomas
What are some diagnostic features of malignant melanomas
the following changes in a naevus or pigmented lesion may suggest diagnosis of malignant melanoma:
- Size: recent increase
- Shape: irregular outline
- Colour: variation
- Erythema: at edge
- Crusting, oozing or bleeding
- Itch: common
What are the characteristics of psoriasis and what is psoriasis
- Chronic, non-infectious, relapsing inflammatory condition
- Increased numbers of cycling epidermal cells
- Well demarcated, red, scaly patches of skin topped by silvery scales
- Pitting or onycholysis of nails
What are some of the presentation patterns of psoriasis
- Plaque
- Guttate
- Flexural
- Localised forms
- Generalised pustular
- Nail involvement
- Erythroderma
What are some precipitating factors of psoriasis
- Koebner phenomenon - following trauma
- Infection - streptococcal sore throat leading to guttate psoriasis
- Drugs - beta blockers, lithium, antimalarials
- Stress
- Sunlight but in 90% improves it
- Alcohol
What are the characeristic presentations of plaque-like psoriasis
- Well-defined, disc shaped plaques
- Involving elbows, knees, scalp hair margin or sacrum
- Plaques usually red and covered by white scales
- If detached leave bleeding points
- Sometimes pruritic (itchy)
What is psoriatic arthropathy
Arthritis you can get if you have psoriasis e.g. distal, rheumatoid, mutilans arthritis or ankylosis spondylitis
What are the main treatment options of psoriasis
- Corticosteroids
- Methotrexate
- Ciclosporin
What are the dental aspects of psoriasis
- Drug-induced gingival hyperplasia
- Drug-induced oral ulceration
- Destructive TMJ disease
- (Suspected association with geographic tongue)
What is eczema characterised by
A pattern of non-infective inflammatory cutaneous response characterised by:
- Spongiosis (epidermal oedema) in acute stage
- Lichenification (thickening of prickle cell layer and hyperkeratosis) in chronic stage
AY BAWS CAN I HABE DE NOTE PLZ
basically there are a shit ton of endogenous ways that you can get eczema like atomically and other shit idk
How common is atopic eczema
12-15% of infants affected
Patients with atopy have an inherited tendency to develop what conditions?
- Eczema
- Asthma
- Hay fever
- Urticaria
- Dermographism
Associated with high serum IgE levels
What are some exogenous routes that a patient can develop eczema
- Contact irritant
- Contact allergic
- Infective
What are the typical presentations of seborrhoeic dermatitis
- Face, scalp and neck frequently involved
- Red and scaly rash - may be exudation and crusting if severe
Who is particularly susceptible to seborrhoeic dermatitis
Immunosuppressed patients
What is seborrhoeic dermatitis associated with
Yeast - pityrosporum ovale
What is a common treatment method for seborrhoeic dermatitis
Responds to topical combination antifungals with a weak corticosteroid
What are some treatment routes/options for eczema
- Identify aetiology
- Treat secondary infection
- Emollients and soap substitutes
- Topical corticosteroids
- Immunosuppressants
What are the dental aspects of eczema
- Association with atopy
- Perioral dermatitis
- Exfoliative cheilitis
- Oral allergy syndrome
