Face, Scalp and Neck Flashcards by Sasha Murdoch

What is acne

a common condition that affects nearly all adolescents and has an equal sex incidence

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How does acne arise

chronic inflammation and blockage of the pilosebaceous units with an increased production of sum and colonisation of the ducts

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What are the clinical features of acne

comedones
papules 
pustules
cysts 
scars

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Where on the body does acne arise

face
shoulders
back
upper chest

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What can acne be confused with

rosacea

folliculitis

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What are some first line treatments for acne

Benzoyl peroxide cream or gel
Isotretinoin
Antibiotics (clindamycin) for moderate to sever acne
Topical agents: azalea acid and adapalene

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What is the first line systemic antibiotic for acne

tetracycline 500mg BD for 4 months

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When should a patient with acne be referred to a dermatologist

Non-response to topical or antibiotic therapy

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What is Rosacea

A chronic inflammatory facial dermatosis characterised by erythema and pustules

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At what age is rosacea commonest

middle age

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What is the earliest symptom of rosacea

Flushing

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What can exacerbate rosacea

sunlight and topical steroids

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What is the main difference between acne and rosacea

rosacea lacks the comedones of acne and occurs in an older age group

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What is the first line treatment for rosacea

Topical metronidazole gel or cream

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What is seborrhoeic dermatitis

a chronic inflammatory eruption of the face and scalp seen in adults

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How does seborrhoeic dermatitis arise

yeast pityrosporum ovale that colonises the scalp induces an inflammatory response in some people that manifests as a dermatitis

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Where on the body does seborrhoeic dermatitis usually occur

sides of the nose
forehead
eyebrow
eyelashes 
moustache area

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What is the treatment for seborrhoeic dermatitis

steroid or antimicrobial cream

medicated shampoo if on the scalp

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What is polymorphic light eruption (PLE) characterised by

itchy papules, plaques and sometimes vesicles in light exposed areas

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What sex is affected more commonly by PLE

women (2x more)

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What drugs can cause photosensitivity

ACE inhibitors 
NSAIDs
phenothiazines 
ciprofloxacin 
tetracyclines
thiazides

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What is impetigo

a common superficial skin infection due either to staph or strep or both

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What are the clinical features of impetigo

Thin walled-easily ruptured vesicles, often on the face which leaves areas of yellow0crusted exudates
Bullous form, with blisters 1-2cm in diameter

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What can impetigo be confused with

herpes simplex or a fungal infection

How is impetigo treated

removal of crusts with saline soaks application of topical antibiotic (mupirocin or fusidic acid) Systemic: oral flucloxacillin for widespread infection

What can strep progenies impetigo result in

glomerulonephritis

What is erysipelas

An acute infection of the dermis by Strep progenies

What are the clinical features of erysipelas

Fever, malaise | well-demarcated erythema, oedema and tenderness usually affecting the face, over leg

What is the treatment for erysipelas

In patient treatment! | systemic penicillin

When should erysipelas be referred

it is a medical emergency so urgently!

What is herpes simplex

A very common, acute self-limiting vesicular eruption due to infection with Herpesvirus hominid

How is herpes simplex spread

direct contact

What are the clinical features of herpes simplex

acute vulvovaginitis penile or perianal lesions Small blisters usually on lips, face or genitals are recurrent lesions Crusts form within 24-48 hours and fade after 1 week

What is the treatment for herpes simplex

may not need any topical acyclovir cream reduces the length of the attack oral acyclovir may be needed for more severe attacks IV acyclovir for immunosuppressed

What is androgenetic alopecia

age related and genetically determined condition with loss of hair

What are the clinical features of androgenetic alopecia

Hair loss from the temples and vertex of the scale | women- more diffuse age -related hair loss

What is the treatment for androgenetic alopecia

Most none is required, but if indicated, topical minoxidil | Iron supplementation can be beneficial if serum ferritin is low

What is alopecia areata (AA)

An autoimmune condition

What are the clinical features of AA

Circumscribed loss of scalp, beard or eyebrow hair | Characteristic exclamation mark hairs

What is hirsutism

A male pattern growth of terminal hair in female | PCOS is a fairly common cause

What are the clinical features of hirsutism

Male pattern facial hair and pubic hair growth that is no longer flat-topped but extends up to the umbilicus

What is an epidermal cyst

keratin filled cyst derived from the epidermis | usually seen on the scalp, face or trunk

What are the clinical features of an epidermal cyst

firm, skin coloured, mobile and normally 1-3cm in diameter

What is the curative treatment for an epidermal cyst

excision

What is actinic keratosis

single or multiple discrete scaly hyperkeratotic rough-surfaced areas usually less than 1cm in diameter

What does photo damaged skin show on histology

connective tissue damage

What are the clinical features of actinic keratoses

on sun-exposed sites and those with far skin

What can actinic keratoses progress into

squamous cell carcinoma

What can sometimes develop into actinic keratoses

a cutaneous horn

What is the treatment for actinic keratosis

cryosurgery

Describe the appearance of photo damaged skin

coarse wrinkled telangiectatic irregularly pigmented and prone to benign and malignant neoplasms

What is the commonest form of skin cancer

Basal cell carcinoma

What do basal cell carcinomas arise from

basal keratinocytes of the epidermis

Where are common sites for basal cell carcinomas

around the nose inner cants of the eyelids temple

What is the treatment for most basal cell carcinomas

complete excision with an adequate margin of normal tissue

What are squamous cell carcinomas derived from

keratinocytes

What are the clinical features of a squamous cell carcinoma

may start within an actinic keratosis as a small papule that may progress to ulcerate and form a crust Develops as a dome shaped nodule

How might squamous cells be treated in the elderly

radiotherapy

Do all squamous cell carcinomas metastasise

No - hardly any do