Dermatology ILOs Flashcards
What is the main cause of TEN and what differentiated this from SJS?
Drug induced
SJS: <10% skin detachment from body
TEN: >30% skin detachment
Give 2 risks and 2 symptoms of TEN
R: Female + HIV
S: Fever + Dysphagia
What 4 skin lesions may be seen in TEN/SJS
Macules
Diffuse erythema
Targetoid
Blisters
What 3 things may a FBC show in TEN?
Anaemia
Leukopenia
Neutropenia
Give 3 management options for TEN
Stop causative drug
Analgesia
Sterile bandages
Fluid balance
Give 2 complications of TEN
Sepsis
Death (30%)
Define erythema multiforme and give 2 causes
Hypersensitivity triggered by infections e.g. HSV or EBV presenting with skin eruption characterised by typical target lesion
EBV + Penicillin
Give 2 symptoms of erythema multiforme
Fever
Lesions on hands/feet/neck/face/trunk
Despite erythema multiforme being mainly self-limiting, name 2 treatments and 2 epidemiological points
Antihistamine + Mouthwash for oral pain
20-40y/o + male
Define acute urticaria and give 2 causes
Itchy wheals (hives) lasting <24 hours +/- angioedema Type 1 IgE response
Virus
Food allergy
What treatment can be given in acute urticaria and in which individuals does this condition commonly occur?
Antihistamine
Atopic individuals
Name 3 drugs which can cause a Lichenoid rash
ACEI
Diuretics
NSAIDs
Define erythroderma and give 2 causes
Widespread reddening of skin due to inflammatory skin disease
Drug induced e.g. ACEI
Atopic dermatitis
Give 3 symptoms of erythroderma
Redness and oedema
Fever
Itch
Name 3 things which blood tests may show in erythroderma
Anaemia
Eosinophilia
Raised IgE
Give 3 management options for erythroderma
Fluid balance
Emollient
Topical steroid
Give 2 complications of erythroderma
Fluid loss
Secondary infection
Define cellulitis and give 2 causative organisms
Bacterial infection of lower dermis and subcutaneous tissue
Haemophilus Influenza
Strep. Viridans
Give 3 symptoms of cellulitis
Warmth
Unilateral redness
Blistering
Give 2 risks and 2 complications of cellulitis
R: diabetes + pregnancy
C: NF + sepsis
Give 3 management options for cellulitis
ABX
Analgesia
Fluid balance
Define necrotising fasciitis
Infection of subcutaneous fascia, rapidly spreading over hours with a mix of anaerobes and aerobes
Give 3 symptoms of NF
Firstly painful, then PAINLESS
Systemically unwell
Skin breakdown with bullae
Give 3 investigations of NF
FBC (raised WCC, CRP, CK)
Blood culture
Deep tissue biopsy
Give 2 treatment options for NF
ABX in ITU
Debridement
What is Staphylococcus scalded skin syndrome?
Staph. Aureus producing exfoliative exotoxin = widespread bullae and exfoliation
Define impetigo and outline treatment
Staphylococcal infection of epidermis, ‘honey coloured’ crust
Tx: remove crust, give fluclox.
Define eczema
Inflammation of the skin, barrier defect + inherited abnormality in Filaggrin (protein which binds keratin fibres) considered cause
What is atopic eczema and how is it managed?
Increased IgE associated with asthma and allergic rhinitis
Tx: emollient, bandage, antihistamine, antibiotics
What is seborrhoeic dermatitis and give 1 treatment
Chronic, scaly inflammation on face, scalp, eyebrows and upper chest caused by overgrowth of Pityrosporum ovale yeast
Tx: Anti-yeast shampoo
What is eczema herpeticum?
Herpes simplex virus complicating eczema presenting as eczema that has suddenly become painful as opposed to itchy
Define psoriasis
Chronic relapsing scaling skin appearing at any age, anywhere on the body
caused by T-cell mediated AI disease
Outline the pathology of psoriasis
- Abnormal T-cell infiltration causes inflammatory cytokine, IL and TNF release = keratinocyte proliferation
Give 3 clinical features of psoriasis
- Redness (white in darker skin)
- Scaling
- centre of back/hairline
Give 3 treatment options for psoriasis
Topical creams
Phototherapy light Tx(to increase via. D and decrease turnover)
Immunosuppression
What are the 3 main types of skin cancer?
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma
What can a basal cell carcinoma look like?
- Shiny rolled edges
- Ulcerated centre
- Broken vessels
Give 3 treatments of basal cell carcinoma
Surgical excision with 3-4mm margin
Curettage and cautery
Cryotherapy
Define squamous cell carcinoma and give 2 treatments
From keratinocytes in normal skin or chronically inflamed skin e.g. surgical scar
Tx:
- Surgical excision with 4mm margin
- Curettage and cautery
Define Lentigo melanoma
Precursor to melanoma usually on the face on sun damaged skin
Define acral melanoma
Usually presents late and has a poorer prognosis and although rare is slightly more common in darker skin types
Give 3 treatment options for melanoma
Surgical excision with margins depending on Breslow score
Immunotherapy e.g. ipilimumab
MEK (immune checkpoint) inhibitor e.g. trametinib
Outline the parameters of the Breslow score for skin cancer removal
- I = <1mm
- II = 1-2mm
- III = 2-4mm
- IV = >4mm
Define acne vulgaris and give 3 clinical features
- Papules
- Pustules
- Open and closed comedones
Caused by keratin and sebum blocking sebaceous glands
What bacteria is commonly implicated in acne?
Propionibacteria
Give 3 treatments of acne
Reduce plugging: topical treatments e.g. retinoid
Reduce bacteria: topical/oral antibiotics
Reduce sebum production: hormones e.g. anti-androgen like OCP
What is oral isotretinoin (Roacutane)?
An oral retinoid treatment for severe acne vulgaris which is a concentrated form of vitamin A
Name 3 skin conditions associated with diabetes
Necrobiosis lipidica
Diabetic dermopathy
Granuloma annulare
What thyroid pathology can cause dry skin?
Hypothyroidism
Which skin condition of reddened concentric bands on the skin is associated with lung cancer?
Erythema Gyratum Repens
What is acanthosis nigricans?
Smooth, velvet-like hyperkeratotic plaques in groin, neck and axillae
What is erythema nodosum and name 2 conditions with which it is associated
Streptococcal infection
- Sarcoidosis
- IBD
Define leg ulcers and give 2 causes
Full thickness skin loss on leg or foot due to any cause, acute or chronic (>4 weeks)
Pressure + Injury
Give 3 symptoms of leg ulcers
Below knee, mostly inner ankles
Surrounded by mottled brown or black skin
Painless unless infected
Give 3 treatment options for leg ulcers
Elevate and compress
Surgery
US guided sclerotherapy
Name 2 groups of people who may get leg ulcers
Diabetics
Chronic venous insufficiency
Define rosacea and give 3 symptoms
Chronic rash involving central face, starting often between 30-60 y/o
Frequent flushing or blushing
Red papules and pustles
Dry, flaky face
Give 3 triggers of Rosacea
Alcohol
Sun
Spicy food
Give 3 treatments for Rosacea
Reduce triggers
ABX e.g. doxycycline
Topical e.g. Metronidazole gel
Define chronic urticaria
Daily or episodic wheals or angioedema present for 6 weeks or more e.g. dermographism
What is the cause of chronic urticaria?
Chemical mediators from mast cells and basophils including histamine and cytokines
What is bullous pemphigoid and name one treatment?
Blisters between epidermis and dermis, IgG binds to BM causing blistering. Tx: steroids
What is bullous pemphigus?
IgG binds to desmosomes with mucosal involvement common
What is dermatitis herpetiformis?
IgA antibodies due to intolerance of gliadin fraction of gluten (associated with coeliac)
Define alopecia areata and give the cause
One or more round bald patches appear suddenly on the scalp caused by AI disorder when T-cells surround the hair follicle
Give 3 treatments for alopecia
Topical e.g. potent or ultrapotent topical steroids
Intralesional cortisone injections
Systemic corticosteroids
Define cutaneous vasculitis
Group of disorders where blood vessels become inflamed in the skin (capillaries, small vessels, medium vessels and large vessels (e.g. giant cell arteritis)
Give 2 causes of cutaneous vasculitis
Bacterial infection
Indirect injury by autoantibodies
Give 2 symptoms of cutaneous vasculitis
Petechiae
Purpura
Give 2 indications for surgery in cellulitis
Sepsis syndrome
Signs of NF
