Dermatology - Lumps and Bumps Flashcards
Psoriasis, eczema, contact dermatitis
Indications
Differential diagnosis may be difficult
Red patches, swelling, itchy and painful
Main differences between psoriasis and eczema
Psoriasis - scaly, affects nail and scalp, adults, arthritis
Eczema - face and hands,. no scaling, only children, no arthritis
Psoriatic arthritis is associated with
HLA association - what is this
ulcerative colitis
HLA - human leukocyte antigens - self antigens displaced by MHCs
AUTOIMMUNE
Psoriasis tx
Aims and methods
Reduce keratinocyte proliferation
Coal tar
Retinoids
Vit D
Immune suppression
Steroids
Methotrexate
TNF blocker
Eczema tx
Identify triggers Emollient cream Topical steroids Antihistamines for itchiness Antibiotics if infected
Oral manifestations of skin disease
Lichen planus
Herpes
Blistering conditions
Lichen planus
Describe
Location
Histological appearance
Auto immune
Itchy papular rash
Flexor surfaces, mouth and genitalia
Band like T cell infiltrate
Saw-shaped rête ridges
Herpes infections
Post herpetic
Herpes simplex
Chicken pox
Herpes Zoster (shingles)
Recurrent herpes labialis
Ocular keratitis
Myalgia due to infection
Examination of lumps - criteria
Site Size Shape Mobility Consistency Surface Covering mucosa Pulsatile
Site of lesion criteria
Where
Neck
Face scalp or nose
Size, shape
Two dimensions unless round
Mobile or fixed
Moved freely
Fixed to skin, bone and muscle
Consistency/surface texture
Consistency - hard, firm, soft rubbery, fluctuant
Surface - irregular, smooth craggy
Covering skin/mucosa
Normal, ulcerated, colour, erythema, blanches
Other featres
Compressible, thrill, pulsatile,
Gorlin’s
Multiple odontogenic keratocysts of the jaw
Common skin lumps/pigmented lesions
Epidermal cysts Basal cell carcinoma Squamous cell carcinoma - rolled edge Vascular malformations Seborrheic warts Benign pigmented naevi Melanoma
Seborrheic warts
More in elderly Basal cell papilloma May be multiple Well defined Raised edge Warty pigmented
Epidermal cysts
AKA sebaceous cyst Fixed Punctum - small distinct point History of discharge May become infected
BCC
Distribution
Characteristics
Common in elderly
Scalp, face and neck in 80% of patients
Light genetic predisposition in people with Gorlin Goltz
Pearlescent
Well defined Rarely metastasises Slow growing Pearly edge May crust then appear to regress
SCC
Non-melanoma skin cancer Elderly due to sun exposure Face head and arms Variable growth May metastasise
Melanoma
Young patients
Sun exposure
Found on trunk and limbs
Usually metastasises
Kerastoacanthoma
large necrosed centre due to accelerated growth of tissue peripherally
Skin lesion occurring in sun damaged skin
Malignant melanoma
Indications
Deep melanoma is worse
Asymmetric, irregular border, off colour, larger diameter
Treatment of BCC
Surgery
Radiotherapy
Imiquimod - immune stimulation
Treatment of SCC
Surgery 1-3mm margin around lesion - primary and then to deal with lymph node metastasis
Radiotherapy
Psoriasis - phenomenon?
Koebner - raised bumps on superficial wounds
Eczema aetiology? HLA?
What causes it then
Type I
Type IV
No HLA association
Caused by IgE
Atopic eczema
Allergic contact dermatitis
