dermatology p124 Flashcards

Question

intertigo

Answer 1

Fungal infection due to chafing in moist body folds: * Under breasts * Armpits * Inner thighs Treat with topical antifungal cream: * Clotrimazole * Miconazole

Answer 2

Caused by *Pityrosporum orbiculare* * Usually a harmless commensal/ Also involved in ‘cradle cap’ Excessive growth causes the condition * Results in patchy skin pigmentation - Pale red or brownish Treat with topical or systemic antifungal * Topical ketoconazole (in wash or shampoo) * Systemic Itraconazole apply to the WHOLE body from the chin down including under the nails Treat ALL close contacts whether obviously infected or not

Answer 3

Infection with the ‘Scabies Mite’ \> *Sarcoptes scabiei* * From contact with an infected individual * (skin-to-skin) ➡ Occasionally from bedding * Usually 10-12 mites infect the host * 3 eggs a day for life of mite – up to 2 months Burrows appear on the skin * Folds between fingers & on wrists ITCH is often most troublesome feature * More severe at night * On trunk and limbs RASH appears on trunk and limbs * Tiny red intensely itchy bumps * May get secondary impetigo Rash and Itch are ALLERGY - can persist long after infestation gone Treatment * Chemical Insectisides (Scabicides) * Benzyl Benzoate * Permethrin * Malathion

Answer 4

Head/body/pubic types Transmitted through close contact with an infected individual * Shared items? - combs, bedding, brushes etc etc Head lice most commonly affect children ➡ Can spread to rest of family though! ➡ Look for ‘nits’ – eggs cemented to the hair near the scalp ➡ Need to go through hair with a ‘fine toothed comb’! NOT hygiene related Body lice treated by personal and clothing hygiene * Hot water washing and drying * Chemical Insecticides * Permethrin * Malathion * Phenothrin

Answer 5

atopic dermatitis contact dermatitis seborrhoeic dermatitis gravitational dermatitis

Answer 6

inflammatory skin condition

Answer 7

Often family history of hayfever, asthma and/or chronic dermatitis (general atopy) Defect in barrier function of the skin Begins in 3rd month life Spares perioral and paranasal region Gravitate towards the flexure regions of the skin Skin is itchy dry and flaky and occassionally weeps

Answer 8

i) Irritant CD * Reaction from chemical * Results in direct cellular injury * usually soaps and detergents ii) Allergic CD * Nickel is the most common offending metal * Latex is the next most common

Answer 9

Scalp and Eye lashes Appears as severe form of dandruff Beard Itch

Answer 10

Lower limbs Caused by poor venous return Management * Emollients * Oily and prevents drying of the irritated skin * apply after bathing to trap moisture * Corticosteroids * Remove the inflammation and allow skin to return to normal

Answer 11

Papulosquamous skin disorder - immune mediated * Often associated with Reiter’s, IBD, Pemphigus and Pemphigoid * May develop psoriatric arthritis Lithium Antimalarials, Beta-Blockers and Streptococcal infection can cause it Thick silvery scales covering an erythematous plaque and typically involving multiple body sites

Answer 12

* Hydrocortisone * Vitamin D3 analogue * Retinoids * Salicylic acid * Calcineurin inhibitors (Ciclosporin and Tacrolimus) \> PUVA (psoralen and ultraviolet A)

Answer 13

drugs to reduce cell turnover * methotrexate * ciclosporin * aitrein * infliximab * etanercept

Answer 14

pemphigoid pemphigus epidermolysis bullosa

Answer 15

Subepithelial immunologically mediated bullous disease 1) Bullous Pemphigoid * Tense blisters on normal skin or an erythematous base * Usually on flexor surfaces * Oral Lesions uncommon but can happen * Attacks Hemidesmosomal Major and Minor BMZ antigens * High levels of IgG and Eosinophils in the subepithelial * layer * Topical Corticosteroids best * Failing that ➡ Dapsone (If neutrophil predominant infiltrate) (Combo of Tetracycline and Nicotinamide) ➡ or immunesuppressants like Azathioprine 2) Mucous Membrane Pemphigoid * MMP is a subepithelial bullous disorder mainly of late middle age * Oral Lesions * Desquamative gingivitis * Erythematous/Erosive Lesions * Sometimes blood filled blisters * Chronic conjunctivitis * Systemic Prednisalone and Topical Hydrocortisone in a vacuum custom tray for the gingival lesions work well

Answer 16

Autoantibodies attack surface antigens on keratinocytes Acantholysis occurs (loss of intercellular connections) \> Absent in Pemphigoid so is a useful diagnostic tool Forms subepithelial blisters like in Pemphigoid 1) Pemphigus Vulgaris * Most frequent form of pemphigus * Usually in 40’s-60’s * Correlation with Mediterranenan and Jewish ancestry * Association with HLA (Human Leukocyte Antigen) Allotypes * Begins with painful non healing ulcers in the mouth * Lesions progress to face scalp and upper torso * If left untreated will lead to death from metabolic consequences * Treated with Systemic Corticosteroids * ➡ Immunosuppresants like Methotrexate, Cylcophosphomide and Azathiorprine also used 2) Pemphigus Foliaceus * Superficial form of pemphigus afffecting skin and lacking mucosal involvement * blisters below the stratum corneum * only ab to Desmoglein 1 found in Pemphigus Foliaceus 3) Paraneoplastic Pemphigus * Severe mucosal involvement and various cutaneous lesions associated with mainly malignant neoplasms * Associated with CLL, Hodgkins and Non-Hodgkin’s Lymphoma, Waldenström’s Macroglobulinaemia * Characterised by its severe erosive lesions and ulcerations for the entirety of the oral cavity, tongue and lips, they are often very crusty too * Polymorphic cutaneous lesions usually affecting upper half of the body including arms * Lichenoid and Erythema Multiforme like lesions with transformations very common

Answer 17

\*genetic disorder\* where randomisation occurs in the coding for the skin * faults in the genes mean the basement membrane mean the epidermis and dermis seperate Very challenging disease for young families to deal with and extremely distressing Types * EB Simplex - usually confined to palms and soles * Junctional EB - very severe form in infants usually, can have severe oral implications * Dystrophic EB - Also known as butterfly child, due to the fragility of the skin in these patients * EB Acquisita \* - Is the autoimmune form of the disease that occurs in response to minor injury

Answer 18

inflammatory Mucocutaneous condition slight predominance in women Skin lesions are Violaceous polygonal flat topped papules and plaques T-Cell mediated autoimmune disease

Answer 19

usually occurs with genitals haivng concurrent lesions 4 main kinds * Reticular - White reticulated scale known as Wickham’s Striae * Papular - looks like white taste buds on oral mucosa * Erosive - Sore red pitted lesions with white reticular border * Erythematous - Ditto above but with less reticulation and shallower

Answer 20

* Amalgam restorations * Anti-diabetics, Antimalarials, Beta Blockers, NSAIDs * Hepatitis C virus infection

Answer 21

- Topical Corticosteroids for early oral lesions - Oral Corticosteroids for systemic presentation

Answer 22

scleroderma/systemic sclerosis raynaud's phenomenon dermatomyositis

Answer 23

- excess collagen deposition - connective tissue fibrosis - loss of elasticity - Local sclerosis - Anti-centromere antibody (ACA) - Systemic sclerosis - Anti-DNA topoisomerase (anti-Scl 70) - mainly women, slow progession - Raynaud’s phenomenon - Renal failure - GI malabsorption

Answer 24

- Limited mouth opening - poor access - limited tongue movement - plan treatment 10 years ahead! - compounded by sjogren’s - Dysphagia/Reflux Oesophagitis - CREST syndrome (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) - Cardiac and renal vasculitic disease - drug metabolism\* - Widening of PDL space - no tooth mobility at all

Answer 25

spasm of arteries cause episodes of reduced blood flow Typically the fingers, and less commonly the toes, are involved Rarely, the nose, ears, or lips are affected The episodes result in the affected part turning white and then blue Often, there is numbness or pain As blood flow returns, the area turns red and burns The episodes typically last minutes, but can last up to several hours Often associated with Scleroderma or Lupus

Answer 26

Inflammatory disorder with a skin rash and associated muscle weakness Often associated calcium deposits in the skin Often said to had an infective causation Muscle issues come from raises serum muscle enzymes The rash is purple with associated oedema

Answer 27

Acute inflammatory disorder, usually self limiting and recurrent * EM Major, EM minor and Stevens-Johnson Syndrome all sub manifestations of it Young adults 20-40 are the most commonly affected “Target Lesion” - i.e like a bullseye on a dart board is the classic cutaneous presentation Orally can vary from small ulcers to huge widespread erosive lesions Can lead to patients not being able to eat speak or even open their mouths